Colchicine Contraindications and Precautions
- alcoholism
- bone marrow suppression
- breast-feeding
- cardiac disease
- dental disease
- elderly
- GI disease
- hepatic disease
- intramuscular injections
- intravenous administration
- pregnancy
- renal disease
- renal impairment
Colchicine Contraindications and Precautions
Colchicine is contraindicated in patients with severe cardiac disease, hepatic disease, or renal disease because these patient populations are at risk for developing cumulative toxicity. Colchicine should be used with caution in patients exhibiting early manifestations of these disorders. Patients with renal impairment or elevated plasma levels of colchicine due to renal disease can develop a myoneuropathy characterized by proximal weakness and elevated serum creatine kinase (see Adverse Reactions). Although this reaction has been reported in patients receiving colchicine for several years, caution should be used when prescribing colchicine to patients with renal insufficiency. Colchicine is eliminated primarily through biliary pathways; therefore, patients with hepatic disease should be monitored closely during treatment with this agent. The risk of colchicine toxicity may be higher with intraveous therapy than with oral therapy, and is not recommended intravenously in patients with hepatic disease.
Patients with GI disease may be at higher risk of colchicine-induced GI tissue damage. Colchicine’s GI toxicity may be particularly hazardous in this population. Patients with alcoholism are at increased risk of GI toxicity with oral colchicine therapy; intravenous therapy may be preferred with consideration of the patient’s renal and hepatic function.
Colchicine should be used cautiously in patients with preexisting bone marrow suppression. Prolonged administration of colchicine has been associated with bone marrow depression. Blood dyscrasias, such as agranulocytosis, thrombocytopenia, or aplastic anemia, may be exacerbated.
Intramuscular injections should not be administered to patients with platelet counts < 50,000/mm3 who are receiving colchicine. IM injections may cause bleeding, bruising, or hematomas due to thrombocytopenia secondary to colchicine-induced bone marrow suppression.
Colchicine should be used with caution in patients with dental disease. Colchicine can cause myelosuppression (e.g., leukopenia, thrombocytopenia) and there may be an increased risk of infection or bleeding. Dental work should be performed prior to initiating colchicine therapy or deferred until blood counts return to normal.
Colchicine should be used cautiously in elderly or debilitated patients because of susceptibility to cumulative toxicity.
Oral colchicine is classified as pregnancy category C. There are no adequate human studies on the risks associated with this agent during pregnancy or breast-feeding; therefore, colchicine should be used only when clearly needed. The parenteral form of colchicine is classified as pregnancy category D. Evidence of human fetal risk has been documented. The potential benefit to the mother must be weighed against the potential risk to the fetus.
Although colchicine can be administered orally or parenterally, intravenous administration should be avoided due to its toxicity. The risk of leukopenia may be exacerbated with intravenous colchicine administration.
[ Last revised: 4/25/2001 ]
References
. Freeman DL. Frequent doses of intravenous colchicine can be lethal. N Engl J Med 1983;309:310.
. Kuncl RW, Duncan G, Watson D et al. Colchicine myopathy and neuropathy. N Engl J Med 1987;316:1562 - 8.
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