While colchicine poisoning is rare, it results in severe toxicity—even death 10% of the time. Colchicine is a tiny pill with a big impact. It's a medication that's been around for ages but is not widely known.
Originally derived from the autumn crocus flower, colchicine has been used for centuries to treat gout, an excruciatingly painful form of arthritis that causes sudden flare-ups. However, colchicine can be toxic in high doses, which is why it is important to understand more about it.
This article comprehensively examines colchicine poisoning, including its symptoms, treatment options, preventive measures, and long-term effects—educating medical professionals and the general public.
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What is Colchicine?
Learning more about colchicine's uses, safety, and effectiveness is vital to reduce the risk of poisoning or its complications.
Uses of Colchicine
Colchicine is an FDA-approved medicine (brand names Colcrys®, Gloperba®, Lodoco®, and Mitigare®) for gout prevention, treating gout flare-ups, and familial Mediterranean fever—an autoinflammatory genetic disorder.
Although colchicine is FDA-approved for specific conditions, healthcare providers sometimes prescribe it off-label for conditions such as primary biliary cirrhosis, pseudogout, acute and recurrent pericarditis, idiopathic pulmonary fibrosis, hepatic cirrhosis, and several other conditions.
History of Colchicine
Colchicine, an ancient remedy from the Colchicum autumnale plant (autumn crocus), has been used for more than a millennium as a gout and joint pain treatment, dating back to 1500 BCE Egyptian manuscripts.
Mechanism of Action
Colchicine works to ease pain by decreasing inflammation and lessening uric acid buildup in the joints in people with gout.
Its mechanism of action includes binding to tubulin to inhibit polymerization (chemical reactions). However, the mechanism of action in treating familial Mediterranean fever remains under investigation.
Understanding Colchicine Poisoning
Colchicine poisoning is essentially an overdose of colchicine.
What Constitutes an Overdose?
The exact dose of colchicine that causes toxicity is unknown, but it may occur after ingesting doses as low as 7 milligrams over four days.
Doses exceeding 0.8 milligrams per kilogram of body weight have been associated with fatal outcomes in some cases. However, some individuals have survived after ingesting doses exceeding 60 milligrams.
Risk Factors for Colchicine Poisoning
Risk factors for colchicine poisoning include dosing errors, some chronic diseases, and interactions with medications.
Due to the increased risk of toxicity, individuals taking CYP3A4 inhibitors or P-glycoprotein inhibitors, such as certain calcium channel blockers, selective serotonin reuptake inhibitors (SSRIs), and some antibiotics, should consult a healthcare provider.
Colchicine doses can be adjusted to optimize safety, but individuals with liver or kidney impairment should avoid certain combinations of medicines.
Protease inhibitors and grapefruit juice can also interact with colchicine. People with kidney or liver problems should not drink grapefruit juice if they take colchicine, as doing so greatly increases the risk of toxicity.
Individuals with liver or kidney impairment, alcoholism, or gastrointestinal diseases may need colchicine dosage adjustments to avoid potential adverse effects.
Tell your healthcare provider about all medications you're taking, as some should not be taken with colchicine—such as some antiviral medicines.
Accidental poisoning is also a risk, particularly among kids. Keep colchicine out of reach of children.
Symptoms of Colchicine Poisoning
Symptoms of colchicine poisoning to be aware of include:
Early Symptoms
Early symptoms of colchicine poisoning often appear within 24 hours of ingestion and include gastrointestinal symptoms like vomiting, nausea, diarrhea, loss of appetite, or stomach pain.
Common early symptoms include a headache, fever, sore throat, electrolyte imbalance, chills, or other signs of infection—or burning of your skin, throat, or stomach.
Advanced Symptoms
Advanced symptoms of colchicine poisoning include dehydration and multi-organ failure, including liver, kidney, and heart dysfunction. Unusual bruising or bleeding, pale or clammy skin, and slowed breathing are also signs of colchicine overdose.
Other symptoms to watch for include confusion, chest pain, low blood pressure, irregular heartbeat, shock, fatigue, seizures, dizziness, eye pain, and muscle weakness.
Life-threatening complications can develop 24-72 hours after poisoning, often attributed to multi-organ failure.
Long-Term Effects
Potential chronic health problems resulting from colchicine poisoning may include neuropathy (numbness and weakness), myopathy, abnormal blood clotting, skin issues, and muscle dysfunction or pain.
Other possible concerns are aplastic anemia, muscle weakness, hair loss, liver problems, kidney failure, cardiac failure, different forms of organ damage, and low (or zero) sperm counts in men. Some of these long-term effects may be reversible.
Diagnosis of Colchicine Poisoning
Diagnosing colchicine poisoning typically involves:
Clinical Evaluation
Healthcare providers can ask about colchicine and other medication use during a clinical assessment. They should evaluate patients to look for visible signs of colchicine poisoning.
It's also essential to check their vital signs—such as temperature, blood pressure, and heart rate.
Laboratory Tests and Imaging
Key diagnostic tests that help confirm colchicine toxicity include screening for elevated white blood cell count, elevated neutrophils, and high lactate dehydrogenase (LDH) levels.
Tests to consider include complete blood count (CBC), electrolyte tests, micronutrient testing, arterial blood gas analysis, chest X-rays, CT scans, and other imaging techniques, as well as liver, heart, and kidney function tests to screen for complications.
No widely available blood tests exist to measure colchicine levels, making diagnosis primarily clinical directly.
Differential Diagnosis
A differential diagnosis helps distinguish between colchicine poisoning and other toxicities, such as thallium poisoning, cadmium toxicity, or naphthalene poisoning.
It also helps detect or rule out conditions with similar symptoms, such as bacterial dysentery and other infectious diarrheas. Pediatric inflammatory multisystem syndrome and septic shock are also differential diagnoses.
Treatment and Management
Treating colchicine poisoning may entail the following:
Immediate Emergency Response
Immediate emergency responses for colchicine poisoning include stabilization (breathing assistance, rehydration, etc.) and prevention or treatment of shock.
Medical Interventions
There's no specific antidote for colchicine poisoning, and dialysis isn't effective for removing this medicine from the body.
Gastrointestinal decontamination with activated charcoal, gastric lavage, and supportive care are common treatments for patients who seek care soon after ingestion.
Medications, such as N-acetyl-cysteine (NAC), corticosteroids, or antibiotics, are sometimes prescribed for symptom relief or complication prevention.
Recombinant human granulocyte factor, granulocyte-colony stimulating factor, intravenous immunoglobulin, and blood transfusions have been successfully used in treatments in published case studies involving colchicine toxicity.
Integrative Approaches
Integrative approaches for treating colchicine poisoning include rehydration with fluids and electrolytes, parenteral nutrition, vitamins (such as vitamin K and vitamin B12), minerals, and other solutions that can enhance the effectiveness of conventional medicine, lessen symptoms, and reduce the risk of complications.
Supportive treatments such as rehydration and nutritional support may assist recovery but should not replace evidence-based medical interventions.
Long-Term Recovery Strategies
Long-term treatment strategies include closely monitoring patients recovering from severe poisoning, rehabilitation, and management of any organ damage or related complications.
Prevention of Colchicine Poisoning
Reducing the risk of colchicine poisoning is three-fold.
Safe Usage Guidelines
It's vital to take colchicine precisely as prescribed in suggested doses. There isn't a universal best dose for every individual, as dosing recommendations are based on age, the reason for taking the medicine, potential other medication interactions, and if there are other medical conditions.
Tablet forms of colchicine are often available in 0.6 and 0.5 milligram formulations, while capsules usually contain 0.6 milligrams taken once or twice daily. Some practitioners recommend homeopathic topical gels.
Individuals at risk of toxicity often require lower dosing. Keep all medications out of the reach of children.
Public Awareness and Education
Educating patients and caregivers about the risks of colchicine poisoning is highly important to reduce the chance of accidental poisoning and better detect symptoms early, which can save lives.
Regulatory Measures
Policies and regulations established by the FDA and other organizations are critical to controlling colchicine distribution, help prevent misuse, and reduce the risk of toxicity.
Case Studies and Real-Life Examples
There have been numerous case studies involving colchicine poisoning. Many patients have survived (but not all).
Case Study 1: Acute Overdose
One case study of a 13-year-old girl who took a lethal dose of colchicine presented to the hospital with abdominal pain, vomiting, fever, and low blood pressure. She also had low blood platelets, low sodium levels, and kidney injury.
Her treatment included hemodynamic support, intravenous immunoglobulin, empiric antibiotics, methylprednisolone (a corticosteroid), vitamin K, and acetylsalicylic acid. Providers later found out that she had ingested 40 colchicine tablets during a suicide attempt.
Supportive care with immunoglobulins and corticosteroids appeared to be an effective, life-saving treatment for this adolescent suffering from an acute colchicine overdose. She received psychiatric follow-up care after being discharged.
Case Study 2: Chronic Toxicity
Another case involved chronic toxicity in a 61-year-old man with a history of gout who had used colchicine for 23 years. He developed numbness and weakness in his lower limbs and gastric ulcers.
After being given an antibiotic and benzbromarone to reduce uric acid levels, he was prescribed lansoprazole for gastric ulcers and vitamin B12. He was also asked to stop taking colchicine and drinking alcohol. He had no symptoms during his 3-month follow-up appointment.
Lessons Learned
Early recognition of acute or chronic colchicine poisoning and intervention are vital to achieve life-saving outcomes. While about 10% of the cases of colchicine intoxication are fatal, many individuals survive with excellent recovery stories.
Treatments must be highly individualized based on the type of toxicity, symptoms present, and diagnostic test results.
Disclaimer: The case studies and real-life examples provided in this section are for informational purposes only and do not constitute medical advice. Outcomes of colchicine exposure and treatment may vary based on individual circumstances, medical history, and healthcare interventions. If you or someone you know may have been exposed to colchicine in a harmful way, seek immediate medical attention. Always consult a qualified healthcare professional for diagnosis, treatment, and guidance regarding medication use and potential toxicity.
Future Directions in Colchicine Research
Research is ongoing to determine future directions of colchicine use and additional treatments for its poisoning.
Emerging Treatments
Several new therapies and interventions are being developed to treat colchicine poisoning. One example is Fab fragment antibodies, which are currently being studied but not yet available. Colchicine-specific Fabs and engineered lipocalin (Lcn2) could be potentially used as antidotes to reverse colchicine's toxic effects, but more studies are needed.
While N-acetyl cysteine (NAC) possesses antioxidant properties by reducing cell damage and has previously been used to treat colchicine poisoning, additional research is needed to certify its efficacy.
Ongoing Studies
Research is ongoing to find newer, effective ways to treat colchicine toxicity or prevent overdose.
Potential Innovations
Future technologies and approaches for colchicine poisoning should focus on enhancing current treatments, improving safety, and decreasing fatality rates—as well as finding an antidote for colchicine toxicity.
Research is also in progress to determine whether low-dose colchicine is safe and effective for treating heart disease.
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Key Takeaways
- The poisoning of colchicine, a medication commonly used to treat gout and familial Mediterranean fever, can be fatal when left untreated.
- Signs of colchicine poisoning include gastrointestinal symptoms, low blood pressure, fever, shock, breathing difficulties, multi-organ damage, and death in some cases.
- Treatment varies but may include gastric lavage, activated charcoal, N-acetylcysteine (NAC), immunoglobulins, medications, IV infusions, and supportive therapy.
- Prevention measures include educational awareness and guidelines for colchicine use to reduce the risk of overdose.
- Awareness and education are critical in preventing colchicine poisoning in vulnerable population groups. Research is ongoing to find the most effective antidote.
- Want to learn more? Consider reading our related articles, subscribing to our newsletter for more medical insights, and leaving comments below to ask questions or share your experience with colchicine.
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