What is the relationship between Colcrys (Colchicine) and cardiology?

From the Guidelines

Colcrys (colchicine) is a valuable adjunct in cardiology, particularly for reducing cardiovascular events in patients with coronary artery disease, as evidenced by a significant 28% reduction in the main secondary endpoint of cardiovascular death, non-fatal MI, or non-fatal stroke in the LODOCO2 trial 1. The use of colchicine in cardiology is supported by recent studies, including the 2024 ESC guidelines for the management of chronic coronary syndromes, which highlight its benefits in reducing cardiovascular events, such as cardiac arrest, non-fatal MI, non-fatal stroke, or unstable angina-driven revascularization 1. Key benefits of colchicine in cardiology include:

• Reduced risk of MI (RR, 0.76; 95% CI, 0.61–0.96) and stroke (RR, 0.48; 95% CI, 0.30–0.77) 1
• Lower risk of unstable angina-driven revascularization (RR, 0.61; 95% CI, 0.42–0.89) 1
• No significant difference in rates of pneumonia or GI disorders when used at a low dose of 0.5 mg daily 1 When prescribing colchicine for cardiac patients, it is essential to monitor for side effects, including gastrointestinal symptoms, and consider dose adjustments for patients with renal or hepatic impairment. The mechanism of action of colchicine, inhibiting microtubule assembly and reducing neutrophil activity, contributes to its anti-inflammatory effects in cardiovascular tissues 1. Overall, the current evidence supports the use of colchicine as a valuable adjunct in cardiology, particularly for reducing cardiovascular events in patients with coronary artery disease, as demonstrated by the LODOCO2 trial and the 2024 ESC guidelines 1.

From the FDA Drug Label

7 DRUG INTERACTIONS

Colchicine is a substrate of the efflux transporter P-glycoprotein (P-gp). Of the cytochrome P450 enzymes tested, CYP3A4 was mainly involved in the metabolism of colchicine. Table 4 provides recommendations as a result of other potentially significant drug interactions. Concomitant Drug Class or FoodNoted or Anticipated OutcomeClinical Comment Digitalis Glycosides: digoxin

The use of Colchicine in cardiology is related to potential interactions with other cardiac medications.

• Digitalis Glycosides: The label mentions digoxin, but does not provide specific recommendations for its use with Colchicine.
• HMG-Co A Reductase Inhibitors and Other Lipid Lowering Drugs may interact with Colchicine, increasing the risk of myopathy and rhabdomyolysis. It is essential to weigh the potential benefits and risks and carefully monitor patients for any signs or symptoms of muscle pain, tenderness, or weakness when using Colchicine with these medications 2.

From the Research

Colcrys and Cardiology

• Colchicine, also known as Colcrys, is an ancient drug that has been used for centuries to treat gout, but its anti-inflammatory effects have also made it efficacious in various cardiovascular indications, such as pericarditis, acute and chronic coronary syndromes, and atrial fibrillation 3.
• The treatment and prevention of pericarditis is the only registered cardiovascular indication for colchicine in Italy, while other indications are off-label 3.
• Colchicine has been shown to be safe and efficacious at low doses (0.5 mg/day) with limited side effects, mainly gastrointestinal 3.
• The drug is metabolized by cytochrome P450 in the liver and mainly excreted into the biliary tract, and it is also excreted, essentially unmodified, by the kidneys 3.

Cardiovascular Indications

• Colchicine has been used to treat acute and recurrent pericarditis, with aspirin and non-steroidal anti-inflammatory drugs (NSAID) being the mainstay of therapy, and colchicine being used as an adjunct, especially for recurrences 4.
• Colchicine monotherapy has been compared to NSAID monotherapy or combination therapy for the prevention of recurrent pericarditis in patients with heart failure with reduced ejection fraction (HFrEF) and/or coronary artery disease (CAD), with no difference in the primary outcome observed between groups 5.
• Colchicine has been shown to be effective in preventing acute coronary syndromes and ischemic stroke, with an efficacy comparable to more established treatments, such as antiplatelet agents and statins 6.

Mechanism of Action

• Colchicine's anti-inflammatory effects are due to its ability to block tubulin polymerization, reduce the function of white blood cells, and interfere with endothelial adhesion and platelet interactions 3.
• Colchicine is also responsible for a non-specific inhibition of the inflammasome, thus reducing the generation of pro-inflammatory cytokines, such as interleukin-1 3.
• The drug's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies 7.