From the Guidelines
Colchicine is generally not recommended for routine use in ICU patients due to its limited indications and potential for severe side effects and drug interactions. Specific uses of colchicine in ICU may include:
- Acute gout flares: 0.6 mg orally twice daily for 3 days, then 0.6 mg once daily for 7-14 days, as supported by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
- Familial Mediterranean Fever: 0.6 mg once or twice daily.
- Pericarditis: 0.5 mg twice daily for 3 months. However, use caution in ICU patients due to potential side effects and drug interactions, such as gastrointestinal symptoms, myelosuppression, and neuromyopathy, as well as its narrow therapeutic index 1. It's also important to note that colchicine is contraindicated in patients with severe renal or hepatic impairment, and dose adjustments are necessary for patients with renal dysfunction or those taking CYP3A4 inhibitors, such as cyclosporin, clarithromycin, verapamil, and ketoconazole, which can increase colchicine plasma concentration and expose patients to risk of serious side effects 1. Monitor for side effects and drug interactions, especially with commonly used ICU medications like macrolide antibiotics or statins. Colchicine works by inhibiting microtubule polymerization, thereby reducing inflammation, and its anti-inflammatory effects can be beneficial in specific conditions, but its use should be carefully considered against potential risks in critically ill patients. In ICU settings, it is crucial to weigh the benefits of colchicine against its potential risks and consider alternative treatments when possible, prioritizing patient safety and minimizing the risk of adverse events 1.
From the Research
Use of Colchicine in ICU Patients
The use of colchicine in Intensive Care Unit (ICU) patients is primarily for the management and prophylaxis of gout and familial Mediterranean fever, as well as other inflammatory conditions. However, its therapeutic value is limited by its narrow therapeutic index and potential for multisystem toxicity, especially in patients with renal impairment or specific drug interactions 2, 3.
Indications and Contraindications
Colchicine is indicated for the treatment of acute flares of gouty arthritis, familial Mediterranean fever, Behçet's disease, and recurring pericarditis with effusion 3. However, its use is contraindicated in patients with combined renal and hepatic disease, creatinine clearances below 10 cc/min, and extrahepatic biliary obstruction 4.
Dosage and Administration
The dosage of colchicine must be reduced in patients with relevant hepatic and/or renal dysfunction 3, 4. Single intravenous doses should not exceed 2-3 mg, and cumulative total doses for an attack should not be more than 4-5 mg 4. Patients should receive no more colchicine by any route for 7 days 4.
Toxicity and Adverse Effects
Colchicine toxicity can cause severe neuromyopathy, diarrhea, acute on chronic kidney injury, and progressive muscle weakness 2. It can also lead to multiple organ failure, including gastrointestinal failure, bone marrow hematopoietic inhibition, rhabdomyolysis, cardiac damage, hepatocyte damage, and respiratory failure 5. The risk of toxicity is increased in patients with renal impairment, hepatic disease, or specific drug interactions 2, 3, 5.
Key Considerations in ICU Patients
- Colchicine should be used with caution in ICU patients, especially those with renal impairment or hepatic disease 2, 3, 5.
- The dosage of colchicine should be reduced in patients with relevant hepatic and/or renal dysfunction 3, 4.
- Patients should be closely monitored for signs of toxicity, including neuromyopathy, diarrhea, and acute on chronic kidney injury 2, 5.
- Colchicine should be avoided in patients with combined renal and hepatic disease, creatinine clearances below 10 cc/min, and extrahepatic biliary obstruction 4.