Composition, origin
Colchicine is a medicine derived from the colchicum flower.
It is available as a 1 mg tablet, split in two if necessary.
Colchimax® is a tablet that also contains Tiémonium methylsulfate and opium powder. It slows transit slightly. It is not recommended in cases of dialysis or breast-feeding.
Indication
Colchicine has been indicated for familial Mediterranean fever (FMF) under the term "treatment of periodic illness" since 1972.
It must be prescribed on a long-term basis to all FMF patients. Contraindications are exceptional.
It helps prevent disease flare-ups and the onset of inflammatory amyloidosis (AA).
Prescription
In adults, the starting dose is 1 mg/day orally. It can be increased to the minimum effective dose, in increments of 0.5 mg every 3 months or more, up to a maximum of 2.5 mg/day.
For children:
-before age 5, the recommended starting dose is 0.5 mg/day.
- after age 5, 1 mg/day is prescribed.
-from the age of 10, doses are adjusted as for adults.
Tolerance
The main side effect of Colchicine is diarrhea. To counteract this effect, you can:
- divide the dose into two parts (morning and evening) if necessary.
- Take probiotics (e.g. yoghurts with active bifidus, carboleur prescribed by your doctor).
- Use anti-diarrheal agents such as racecadotril/ Tiorfan®. Loperamide/ Imodium® is not recommended.
Fertility, pregnancy & breastfeeding
The potentially deleterious effect of Colchicine on male and female fertility has never been demonstrated.
Colchicine should be continued at usual doses throughout pregnancy: it is not associated with an increased risk of fetal malformation or miscarriage, whereas untreated disease is.
European guidelines endorse and recommend its use during pregnancy and breastfeeding.
The CRAT (www.lecrat.fr) does not agree with the acronym "attention grossesse et médicament = danger" ("caution pregnancy and medication = danger") on Colchicine boxes.
For breast-feeding, we recommend taking Colchicine at the same time as a feed, as its peak concentration in breast milk occurs around 2 hours after oral administration. It is also advisable to take Colchicine in the evening, as night feeds become less frequent and the child is less exposed.
Colchimax®, which contains tiemonium methylsulfate and opium powder, is contraindicated during breast-feeding.
Precautions
Colchicine is a potentially toxic drug if the dosage prescribed by your doctor and certain precautions are not followed.
When taking antibiotics such as macrolides or pristinamycin, the dose should be reduced or temporarily suspended.
In case of renal or hepatic insufficiency, dosage must be adapted.
There's no need to stop taking it in the event of infection, surgery, anesthesia or vaccination,
As a general rule, it is advisable to keep boxes of Colchicine out of sight and reach of young children.
Practical questions
If a dose is forgotten, colchicine should be taken at the same time as it is remembered.
In the event of an attack, it is not advisable to increase the dose of colchicine temporarily, as this has never been shown to be effective.
Colchicine must continue to be taken even in the absence of attacks, to avoid the risk of inflammatory amyloidosis.