Running head: COLCHICINE FOR GOUT TREATMENT 1

Colchicine for Gout Treatment

Christopher C. Manaois

HCIN 552

Dr. Johnathan Mack

December 12, 2019

COLCHICINE FOR GOUT TREATMENT 2

Abstract

Elevated uric acid levels in the blood cause gout. The uric acid levels are often from consuming

foods rich in purines. Typically, gout can be treated by modifying one’s lifestyle, along with

medications, to lower urate levels and for pain and inflammation relief. Colchicine is one of the

medications that physicians can prescribe to help with the patient’s symptoms. However, this

medication does have contraindications that can be harmful or deadly. A clinical decision support

system (CDSS) rule informing and alerting the provider before prescribing the medication can

possibly avoid medical malpractice lawsuits against the provider and the healthcare institution.

Most importantly, quality of care and patient safety will be upheld with the employment of a

CDSS rule.
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Colchicine for Gout Treatment

Patient safety is important and prescribing the correct medication is essential. The goal of

this paper is to make sure safe and competent Colchicine prescription for onset of acute gout or

gout attack. As soon as the diagnosis of gout is made, this clinical decision support will alert the

provider of contraindications—as recommended by the American College of Physician—based

on the pertinent information gathered from the patient (Quaseem, Harris, & Forciea, 2016).

Some medication interactions can be dangerous, even fatal, for patients if not detected and

addressed accordingly. Following the alert, the provider can either modify or sign the order with

more consideration and confidence. This CDSS will potentially enable the provider to avoid the

occurrences of medical prescription error relating to Colchicine interaction with some drugs.

Background

Gout is a disease that is associated with increased uric acid levels in the blood by means

of food consumption (Choi, Mount, & Reginato, 2005). Body tissues and certain foods like red

meat, beans, or beer contain purines (Choi, Mount, & Reginato, 2005). When these purines are

broken down, uric acid is produced (Choi, Mount, & Reginato, 2005). The body normally

eliminates uric acid, but if it is unable to, crystals build up in joint areas like the toes, knees,

ankles, elbows, and fingers (Choi, Mount, & Reginato, 2005). Symptoms include obvious

inflammation and excruciating pain on the joint site. 

Gout has different stages. Asymptomatic hyperuricemia is the initial stage, when the uric

acid concentration is high and present no symptoms. During this stage, crystals are starting to

form in the joints. Acute gout or gout attacks occur when there is a sudden spike of uric acid

levels from events like a night of eating or eating. The symptoms intensify in eight to twelve

hours and go away in 10 days. Interval gout is the stage in between gout attacks where there are
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no symptoms, but the gout is not gone. Lastly, chronic gout is when an individual maintains high

levels of uric acid for several years. During this stage, attacks come often and at times do not go

away (Quaseem, Harris, & Forciea, 2016). 

To diagnose if patients suffer gout, providers order laboratory tests to measure uric acid

levels in the blood, assess the pain site and severity, and examine the affected site by x-ray,

ultrasound, computerized tomography (CT) scan, or magnetic resonance imaging (MRI; Arthritis

Foundation, n.d.). Treating gout essentially requires lifestyle changes in limiting the

consumption of food and drinks containing purines. Providers may also prescribe medications to

treat gout. Allopurinol and Febuxostat are medications that aid in lowering urate levels,

Probenecid is a medication to treat chronic gout, and medications such as nonsteroidal anti-

inflammatory drugs (NSAIDs), glucocorticosteroids, or Colchicine are used to treat pain

symptoms (Gout Education Society, n.d.).

Details

The United States Food and Drug Administration (FDA, 2019) stated there are at least

100,0000 reported cases of errors linked to medical prescription. Errors may result in a lawsuit

where providers and the institution will take toll. For medications used to treat gout, Colchicine

is known to cause Colchicine toxicity when not correctly prescribed with Cytochrome P450 3A4

(CYP3A4) and P-glycoprotein inhibitors (Davis, Wason, & DiGiacinto, 2013). Fatal Colchicine

toxicity usually occurs in 24 to 72 hours and is associated with multiorgan failure (Sadiq,

Robinson, & Terrell, 2019).

The CDSS will launch an alert when providers prescribe Colchicine to the patient. Figure

A1 shows the placement of the CDSS within a provider’s workflow. The alert will point out to

the provider that CYP3A4 and P-glycoprotein inhibitors are contraindicated drugs, as shown in
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Figure A2. Through this alert, the provider can reassess the patient’s information to verify they

are not taking any of these medications. If Colchicine treatment is necessary, the provider can

modify the prescription to a safe dosage.

Summary and Conclusion

Gout is a disease that can be treated and prevented through lifestyle changes and

medications. Physicians may prescribe Colchicine to treat pain symptoms. Colchicine, however,

may have dangerous to fatal reactions with other medications like CYP3A4 and P-

glycoprotein inhibitors. Providers must be extra careful to check if these medications were

prescribed. There are always elements of human error, and this CDSS rule will provide an

opportunity for providers to double check their order and potentially prevent errors. The CDSS

will launch as the provider prescribes Colchicine to the patient. An alert will appear on the

screen emphasizing the contraindications with CYP3A4 and P-glycoprotein inhibitors. The

provider will then decide if cancelling or modifying the prescription will work best and be safest.

With this CDSS, the provider and healthcare institution may avoid medical malpractice lawsuits.

Most importantly, the safety and lives of each patient are upheld by protecting them from

possible medical prescription errors that can be dangerous, even life-threatening.

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References

Arthritis Foundation. (n.d.). Gout diagnosis. Retrieved from https://www.arthritis.org/about-

arthritis/types/gout/diagnosing.php

Choi, H. K., Mount, D. B., & Reginato, A. M. (2005). Pathogenesis of gout. Annals of Internal

Medicine, 499–516. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?

doi=10.1.1.1016.8590&rep=rep1&type=pdf

Davis, M., Wason, S., & DiGiacinto, J. (2013). Colchicine-antimicrobial drug interactions: What

pharmacists need to know in treating gout. The Consultant Pharmacist, 28, 176–183.

doi:https://doi.org/10.4140/TCP.n.2013.176

The Gout Education Society. (n.d.). Gout treatment options and pain relief. Retrieved from

https://gouteducation.org/medical-professionals/treating-gout/gout-treatment-and-pain-

relief/

Qaseem, A., Harris, R. P., & Forciea, M. A. (2016). Management of acute and recurrent gout: A

Clinical practice guideline from the American College of Physicians. Annals of Internal

Medicine, 166, 58-68. doi:10.7326/m16-0570

Sadiq, N. M., Robinson, K. J., & Terrell, J. M. (2019). Colchicine. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK431102/

U.S. Food and Drug Administration. (2019). Working to reduce medication errors. Retrieved

from https://www.fda.gov/drugs/drug-information-consumers/working-reduce-

medication-errors
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Yasir, M. (2019). Corticosteroid adverse effects. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK531462/

Appendix

CDSS Rule Placement in a Provider Workflow

Figure A1. A common workflow map during a provider visit and where the CDSS rule will be
activated.
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Figure A2. An example of the pop up that will appear on the physician’s computer screen when
prescribing Colchicine.