Can patients with Chronic Kidney Disease (CKD) take colchicine?

From the Guidelines

Patients with Chronic Kidney Disease (CKD) can take colchicine, but with careful dosage adjustments and monitoring due to the increased risk of toxicity, as indicated by the need to monitor renal function and adjust doses accordingly, especially in those with severe CKD 1.

Key Considerations

• The risk of colchicine toxicity increases if the creatinine clearance (CrCl) is <10 mL/min, necessitating a dose reduction 1.
• For patients with mild to moderate CKD (eGFR 30-89 mL/min), the standard dose may be reduced by 50% or the dosing interval extended.
• In severe CKD (eGFR <30 mL/min) or dialysis patients, colchicine should be used with caution, with doses reduced by 50-75% and extended intervals between doses.

Monitoring and Precautions

• Close monitoring of kidney function is essential because colchicine is primarily eliminated by the kidneys and liver, and impaired kidney function can lead to drug accumulation, increasing the risk of toxicity.
• Common side effects include gastrointestinal symptoms like diarrhea, nausea, and vomiting, which can be early signs of toxicity.
• Drug interactions, particularly with medications that inhibit CYP3A4 or P-glycoprotein, such as certain antibiotics and statins, can further increase colchicine levels, requiring careful management.

Clinical Guidance

• Regular monitoring of kidney function, complete blood counts, and watching for signs of myopathy or neuropathy is recommended during treatment.
• The 2020 American College of Rheumatology guideline for the management of gout supports the use of colchicine for gout flares but emphasizes the importance of considering kidney function in dosing decisions 1.

From the FDA Drug Label

8.6 Renal Impairment Colchicine is significantly excreted in urine in healthy subjects. Clearance of colchicine is decreased in patients with impaired renal function. Total body clearance of colchicine was reduced by 75% in patients with end-stage renal disease undergoing dialysis Prophylaxis of Gout Flares For prophylaxis of gout flares in patients with mild (estimated creatinine clearance Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine. However, in patients with severe impairment, the starting dose should be 0.3 mg/day and any increase in dose should be done with close monitoring. For the prophylaxis of gout flares in patients undergoing dialysis, the starting doses should be 0.3 mg given twice a week with close monitoring [see Dosage and Administration (2.5)].

Patients with Chronic Kidney Disease (CKD) can take colchicine, but the dose may need to be adjusted based on the severity of renal impairment.

• For patients with mild to moderate renal impairment, no dose adjustment is required, but close monitoring for adverse effects is recommended.
• For patients with severe renal impairment, the starting dose should be reduced to 0.3 mg/day, and any increase in dose should be done with close monitoring.
• For patients undergoing dialysis, the starting dose should be 0.3 mg given twice a week, with close monitoring 2.

From the Research

Colchicine Use in CKD Patients

• Colchicine is an approved agent for managing and prophylaxis of gout and familial Mediterranean fever, but its use is limited by its narrow therapeutic index 3.
• Patients with chronic kidney disease (CKD) are at increased risk of colchicine toxicity due to reduced renal clearance 3, 4, 5.
• Colchicine-induced myopathy is a rare but serious side effect that can occur in patients with CKD, especially those with severe renal impairment 3, 4.

Safety and Efficacy of Colchicine in CKD Patients

• A study of 54 patients with severe CKD found that colchicine was well-tolerated and effective in treating crystal-induced arthritis flare at reduced doses 6.
• Another study suggested that colchicine oral solution can be used safely and effectively in patients with renal impairment, but requires dose adjustments based on the degree of renal impairment 7.
• Guidelines recommend exercising caution when using colchicine in patients with CKD and suggest dosage reduction based on level of kidney function 5.

Dosing Adjustments for CKD Patients

• Patients with mild renal impairment (eGFR 60-89 mL/min/1.73 m2) may not require dose adjustment, but those with moderate or severe renal impairment may need reduced doses 7.
• A dose of 0.3-0.5 mg daily may be suitable for patients with moderate renal impairment, while those with severe renal impairment may require even lower doses 7.
• Close monitoring of patients with CKD is necessary to minimize the risk of colchicine toxicity and ensure safe and effective use 3, 4, 5.