Can colchicine be used in patients with impaired renal function?

From the Guidelines

Colchicine should be used with caution in patients with impaired renal function, and dose adjustments are necessary to minimize the risk of toxicity. According to the 2017 updated EULAR evidence-based recommendations for the management of gout 1, colchicine and NSAIDs should be avoided in patients with severe renal impairment. For patients with mild to moderate renal impairment, the dose of colchicine should be reduced, as stated in the guideline. The American College of Physicians also recommends using low-dose colchicine to treat acute gout, with moderate-quality evidence suggesting that lower doses are as effective as higher doses and are associated with fewer gastrointestinal adverse effects 1.

Key Considerations

• Colchicine is contraindicated in patients with severe renal impairment (GFR <30 mL/min) due to the significantly increased risk of toxicity.
• In patients with mild to moderate renal impairment (GFR 30-80 mL/min), the dose of colchicine should be reduced by 50% to minimize the risk of adverse effects.
• Alternative medications like corticosteroids should be considered for conditions like gout flares in patients with significant renal impairment.
• Regular monitoring of renal function, complete blood counts, and clinical assessment for signs of toxicity is crucial when using colchicine in any patient with kidney disease.

Monitoring and Dose Adjustment

• Patients with renal impairment should be closely monitored for signs of colchicine toxicity, including diarrhea, nausea, vomiting, abdominal pain, and muscle weakness.
• Dose adjustments should be made based on the patient's renal function and the presence of any adverse effects.
• The use of colchicine in patients with renal impairment should be carefully weighed against the potential benefits and risks, and alternative treatments should be considered when possible.

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. 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.

Colchicine can be used in patients with impaired renal function, but the dose may need to be adjusted based on the severity of the impairment. Patients with mild to moderate renal impairment may not require dose adjustment, but should be monitored closely for adverse effects. Patients with severe renal impairment should start with a lower dose of 0.3 mg/day and any increase in dose should be done with close monitoring 2.

From the Research

Use of Colchicine in Patients with Impaired Renal Function

• Colchicine can be used in patients with impaired renal function, but with caution and dose adjustment 3, 4, 5, 6, 7
• Patients with severe renal insufficiency or combined hepatic-renal insufficiency should not be prescribed colchicine 3, 4
• Doses should be halved in patients with moderate renal function impairment 3
• Colchicine toxicity is more common in patients with renal impairment, and can cause severe neuromyopathy, myopathy, and acute pancreatitis 5, 6, 7
• Risk factors for colchicine toxicity include renal impairment, liver cirrhosis, higher colchicine dose, and concomitant use of cytochrome P450 3A4 (CYP3A4) inhibitors 5, 6
• Patients with chronic kidney disease, liver cirrhosis, or those taking CYP3A4 inhibitors should be monitored carefully for adverse reactions, and the drug dose should be adjusted accordingly 6

Dose Adjustment and Monitoring

• Small doses of colchicine are recommended in patients with impaired renal function to minimize the risk of toxicity 6
• Patients should be monitored for signs of toxicity, including diarrhea, acute on chronic kidney injury, and progressive muscle weakness 5, 6
• Creatine phosphokinase (CPK) levels should be checked regularly in patients with renal impairment taking colchicine 5, 6
• Electromyography and muscle pathology may be necessary to diagnose colchicine-induced myopathy 6