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Gout - Management
Who should avoid taking colchicine?
- Avoid colchicine in people with blood dyscrasias and bone marrow disease [ABPI Medicines Compendium, 2004].
- Ideally colchicine should be avoided in people with poor renal function, poor liver function, gastrointestinal disease, cardiac disease, and the elderly [MHRA, 2009].
- Colchicine has a narrow therapeutic index and is extremely toxic in overdose. These patient groups are at particular risk of toxicity [MHRA, 2009].
- Colchicine is excreted by the kidneys and, in people with renal impairment, there is the potential for accumulation and toxicity [ABPI Medicines Compendium, 2004].
- In overdose, colchicine can cause confusion, reduced cardiac output, cardiac arrhythmias, renal damage, liver damage, respiratory distress, hyperpyrexia, and bone-marrow depression [MHRA, 2009].
- Colchicine is also best avoided in people with severe heart failure as it constricts blood vessels [ABPI Medicines Compendium, 2004].
- In elderly people, who are more prone to dehydration, colchicine is also best avoided because of its relatively high risk of causing diarrhoea [Jordan et al, 2007].
- In the rare event of a pregnant or breastfeeding woman presenting with gout, colchicine should be avoided, and the woman should be referred to a specialist if she requires treatment.
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