Can colchicine cause leukopenia (low white blood cell count)?

From the Guidelines

Colchicine can cause a low white blood cell count, a condition known as leukopenia, as indicated by its potential side effects including blood dyscrasias 1. This is a significant consideration when prescribing colchicine, especially for patients who may be at higher risk for infections or have compromised immune systems. The mechanism by which colchicine affects white blood cell count is related to its interference with cell division, impacting rapidly dividing cells such as those in the bone marrow 1. Key points to consider include:

• The risk of leukopenia is dose-dependent, suggesting that higher doses or prolonged use of colchicine increase the likelihood of this side effect 1.
• Monitoring of blood counts is recommended, particularly during the initial treatment phase or with higher doses, to promptly identify any adverse effects on white blood cell counts 1.
• Patients should be advised to seek medical attention if they experience symptoms such as fever, sore throat, or unusual infections while taking colchicine, as these could indicate a low white cell count 1.
• The effect of colchicine on white blood cell count is usually reversible upon discontinuation of the medication, although recovery may take several days to weeks 1.
• Patients with pre-existing bone marrow disorders or those taking other medications that can suppress bone marrow function may be at a higher risk for developing leukopenia while taking colchicine 1.

From the FDA Drug Label

1. 2 Blood Dyscrasias Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses.

• Yes, colchicine can cause low white cell count, as evidenced by reports of leukopenia and granulocytopenia in patients taking therapeutic doses of the drug 2.

From the Research

Colchicine and Low White Cell Count

• Colchicine has been associated with low white cell count, also known as leukopenia, in several studies 3, 4, 5, 6.
• A case study published in 2012 reported a patient with chronic lymphocytic leukemia (CLL) who developed leukopenia while taking colchicine for pseudogout 3.
• Another study published in 2003 found that a patient with familial Mediterranean fever (FMF) developed leukopenia each time she took colchicine, but the white cell count increased when the drug was discontinued 4.
• Colchicine-induced leukopenia can also occur in patients taking immunosuppressants, as reported in a 2008 study on two cases of acute leukopenia induced by colchicine in patients with Behçet's disease 5.
• A 2001 study reported a case of neutropenia caused by colchicine not associated with intentional overdose or severe gastrointestinal symptoms 6.
• Treatment with granulocyte colony-stimulating factor (G-CSF) has been shown to increase white cell count in patients with colchicine-induced bone marrow suppression 7.

Mechanism of Colchicine-Induced Leukopenia

• The exact mechanism of colchicine-induced leukopenia is not fully understood, but it is thought to be related to the destruction of circulating leukocytes and inhibition of leukocyte production 5.
• Concurrent use of immunosuppressants may decrease the threshold for hematologic toxicity of colchicine in leukocytes and their precursor cells 5.

Clinical Implications

• Clinicians should monitor cell counts in patients receiving colchicine, especially at higher doses used for acute treatment of gout 6.
• Consideration of the use of G-CSF to shorten the duration of neutropenia is warranted in cases of colchicine toxicity 7.