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Colchicine overdose: the devil is in the detail
Vikram Jayaprakash1, Gillian Ansell, David Galler
1Intensive Care Unit, Department of Anaesthesia, Middlemore Hospital, Otahuhu, Auckland. vikram.j@mac.com
The New Zealand Medical Journal
|February 6, 2007
Summary
Colchicine overdose, often accidental, is frequently fatal, even when prescribed for gout. This case series highlights the underappreciated toxicity and narrow therapeutic index of colchicine, questioning current prescribing practices.
Area of Science:
- Clinical Toxicology
- Pharmacology
- Internal Medicine
Background:
- Colchicine is a widely prescribed medication for gout, Bechet's disease, and familial Mediterranean fever.
- Despite known side effects, the severe, often fatal, consequences of colchicine overdose are frequently underestimated by patients and healthcare providers.
- The narrow therapeutic index of colchicine necessitates careful dosing and patient education.
Purpose of the Study:
- To report a case series of colchicine overdose patients in the Auckland region of New Zealand over 15 years.
- To highlight the high mortality rate associated with colchicine overdose.
- To question the current understanding and prescribing practices of colchicine, particularly for acute gout.
Main Methods:
- Retrospective case series analysis.
- Inclusion of 9 patients presenting with colchicine overdose over a 15-year period.
- Review of clinical outcomes and circumstances of overdose.
Main Results:
- Nine patients presented with colchicine overdose.
- A significant proportion of overdoses were accidental.
- Eight out of nine patients (89%) died as a result of the overdose, indicating a near-universal fatality rate.
Conclusions:
- Colchicine overdose carries an extremely high mortality risk that is often underappreciated.
- Accidental overdoses are a significant concern.
- There is a critical need to reassess prescriber and patient knowledge regarding colchicine toxicity and to potentially re-evaluate current prescribing guidelines.
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