From the FDA Drug Label
The following adverse reactions have been reported with colchicine ... Hepatobiliary: elevated AST, elevated ALT The FDA drug label does mention that elevated AST and ALT have been reported with colchicine, which are indicators of liver damage. However, it does not explicitly state that colchicine can cause acute liver damage. Therefore, based on the available information, it can be said that colchicine may be associated with liver damage, as evidenced by elevated liver enzymes, but the label does not provide direct evidence of acute liver damage. 1
From the Research
Colchicine can cause acute liver damage, although the risk is relatively low, especially when used at recommended doses and in patients without pre-existing liver or kidney disease. The risk of liver damage is higher with overdose, prolonged use, or when combined with certain medications that affect its metabolism 2. According to a recent study published in 2023, colchicine-induced liver injury may be related to the inhibition of sulfotransferase 1 (SULT1) and decreased production of bioactive sulfated endogenous metabolites 2.
Key Points to Consider
- Colchicine is primarily used to treat gout and familial Mediterranean fever, and liver injury typically occurs with overdose or in patients with pre-existing liver or kidney disease.
- Symptoms of colchicine-induced liver damage include elevated liver enzymes, jaundice, abdominal pain, nausea, and vomiting.
- The mechanism involves mitochondrial toxicity and disruption of cellular functions in hepatocytes.
- Patients taking colchicine should be monitored with periodic liver function tests, especially those with risk factors.
- If signs of liver injury develop, the medication should be discontinued immediately and medical attention sought.
Recent Evidence
A 2022 consensus statement regarding the efficacy and safety of long-term low-dose colchicine in gout and cardiovascular disease found that the clinical benefits of colchicine do not sustain serum levels above the upper limit of safety when used in patients without advanced renal or liver disease 3. Another study published in 2022 reviewed the new horizons for colchicine and found that it is generally safe and well-tolerated in low doses, except for diarrhea, which sometimes leads to drug discontinuation 4.
Recommendations
Patients taking colchicine should be closely monitored for signs of liver injury, and the medication should be used with caution in patients with pre-existing liver or kidney disease. If liver injury is suspected, colchicine should be discontinued immediately, and medical attention should be sought. Targeting the SULT1 enzyme and administration of indoxyl sulfate (IS) and p-cresol sulfate (PCS) may be useful in alleviating colchicine hepatotoxicity 2.