Colchicine – a maintenance drug for rheumatic diseases

The drug colchicine (colchicina lirca) belongs to the group of alkaloids. The main component in its composition is isolated from the herbaceous plant Colchicum splendid. The drug is most widely used in the treatment of gout. According to reviews, it quickly relieves pain. But at the same time, the medicine can provoke many negative reactions in the body, so it can only be used as prescribed by a doctor.

Features of the drug

Colchicine, which affects uric acid metabolism, is produced on a plant basis. The active ingredient of the same name in the drug is isolated from Colchicum splendid. This herbaceous plant has been used in folk medicine for a long time to reduce joint pain and prevent the progression of inflammatory processes.

The drug is produced in tablet form. They are most often white, but sometimes have a slightly yellowish tint. Round, biconvex tablets are scored, which makes it easier to adhere to the prescribed dosage.

The medicine has analgesic and anti-inflammatory effects. After taking it, it is possible to quickly stop an acute attack of gout. In addition, the active substance delays the deposition of uric acid microcrystals in tissues.

Probenecid

The active ingredient of this drug is probenecid (benzoic acid). The drug reduces the process of reverse absorption of uric acid (reabsorption) in the urinary tract, which allows stimulating its excretion naturally.

Probenecid

Probenecid reduces the concentration of urates in the blood serum and promotes their dissolution. With systemic use, pain in the joints decreases, they become more mobile and stop deforming. In addition, the process of restoring renal function is underway.

Main indications

The drug colchicil is most often prescribed for the treatment of gout. This disease is characterized by acute joint pain due to impaired uric acid metabolism and the deposition of urate in tissues. The drug is indicated for relieving pain during exacerbation of the disease and slowing its progression.

In addition, colchicil is used, the instructions for use focus on this, for the treatment of other pathologies:

Amyloidosis, when a complex protein-polysaccharide compound, amyloid, is deposited in tissues. This leads to malfunctions in almost all systems and organs in the body.
Inflammatory diseases in otorhinolaryngology and dentistry.
Mediterranean fever, which is a hereditary disease and is associated with the deposition of amyloid in tissues. The main symptom is a periodic sudden increase in body temperature and severe chills.
Phlebitis. In this case, inflammation of the venous wall occurs against the background of pathologies of an infectious and inflammatory nature.
Scleroderma. The disease is characterized by the appearance of scar tissue on the skin and internal organs.
Chondrocalcinosis. In pathology, calcium pyrophosphate crystals are deposited in the area of the articular cartilage and bursa, which causes pain.

Reviews of Colchicum-Dispert

Treatment of gout comes down to stopping the attack and systematic treatment of disorders of purine metabolism. For relief, NSAIDs (recently selective) and the drug Colchicum-Dispert, containing the alkaloid colchicine . The administration of colchicine is an ancient method of stopping an attack and the effect is pronounced if it is used in the first hours of an attack. The drug Colchicum-Dispert helps reverse the development of arthritis within a few hours, but it should be taken every 2 hours until the pain subsides, no more than 16 tablets per day. Due to the occurrence of adverse reactions, patients often fail to increase the dose to the optimal one - nausea, diarrhea , vomiting, and hemorrhagic gastroenteritis . Due to the toxicity of the drug, a combination of small doses of colchicine and NSAIDs . It must be remembered that the toxicity of these drugs increases in people with kidney disease. Reviews most often concern the use of the drug for gout . Everyone notes the rapid relief of pain symptoms.

“... The drug is not cheap, but it really helps. I have tried a lot over the years of illness, but this is the only drug that saves me.”
“... It’s very effective, but you have to buy the original German one (my relatives brought it to me). There are a lot of fakes that don’t help.”
“... I used it and was always effective during an attack. It really helps, but you can’t always find it in the pharmacy.”
“...Quickly relieves pain and eliminates joint swelling.”
“... I used it for the first day and it became a little easier.”
“... It didn’t cause any side effects for me.”
“... Quickly relieves an acute attack, but pain immediately appears in the kidney area.”

Contraindications for use

Colchicil should not be taken if you are hypersensitive to any component of the drug. This means that you need to carefully study what ingredients were used in the production of the tablets.

The drug is not prescribed for severe pathologies of the digestive system. Contraindications also apply to neutropenia, when the blood formula is disturbed. Elderly patients should be treated with colchicil with caution. You should not take the medicine in the following cases:

Confirmed alcoholism.
Presence of purulent infections.
Bone marrow pathologies.
Liver and kidney diseases.

Due to possible negative effects on the fetus, colchicil is not prescribed, the instructions confirm this, during pregnancy. The drug is contraindicated for patients undergoing hemodialysis treatment. No studies have been conducted on the effect of colchicil on a newborn baby during breastfeeding, so it is better not to use it for treatment.

Naproxen Actavis

This is a non-steroidal anti-inflammatory drug in tablet form. The active ingredient is naproxen (derived from naphthylpropionic acid). The tablets are taken for gouty arthritis - they relieve inflammation and reduce joint pain. Gradually, the person begins to move more freely, including in the morning. In addition, Naproxen Actavis has an analgesic effect, helping to relieve gout attacks.

Naproxen Actavis

There are other drugs that can replace Colchicine - Alopron, Allomaron, Febuxostat, Benzobromarone and a number of others. But all of them are inferior to it both in effectiveness and in the degree of therapeutic effect. In addition, such tablets have many contraindications and side effects. Some analogues can negatively affect health, so they are prescribed only to those patients who cannot take drugs based on colchicine or allopurinol.

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Possible adverse reactions

Colchicil, the price of which is quite reasonable, as confirmed by reviews and manufacturers warn, has many side effects. This means that you cannot make a decision about drug treatment on your own.

Most often, when taking the drug, negative reactions from the digestive system are observed. These are various dyspeptic disorders: nausea, vomiting, diarrhea, etc. Such symptoms are accompanied by abdominal pain. Additionally, various problems arise with the functioning of the urinary system.

Less commonly, other side effects occur during treatment with the drug:

The functioning of the hematopoietic system is disrupted. In severe cases, with long-term use, agranulocytosis develops.
Dermatological reactions occur. In severe cases, long-term use causes alopecia.

Drinking alcoholic beverages can cause serious side effects.

Interaction

Compatible with allopurinol and uricosuric drugs. When used with macrolides there is a risk of nephrotoxicity. The activity of this drug is reduced by cytostatics and drugs that acidify urine.

Drugs that alkalize urine have the opposite effect. When used together with Vit. B12 reduces the absorption of the drug from the gastrointestinal tract . Drugs that cause myelosuppression further increase the risk of leukopenia and thrombocytopenia .

Overdose

An overdose of the drug manifests itself with obvious signs within a couple of hours after taking it. Severe vomiting and diarrhea occur, severe abdominal pain and cramps occur. Against the background of negative symptoms, the person’s general condition worsens.

It is difficult to indicate the specific amount of a drug that can provoke an overdose. This depends on the patient's condition and age. That is why the doctor prescribes doses for the treatment of certain pathologies. As a rule, they are minimal for patients with stomach, kidney and liver problems, as well as for the elderly. It is advisable to undergo an examination to assess the condition of the body before taking colchicil.

There is no specific antidote to stabilize the condition in case of overdose. Therefore, symptomatic treatment in a hospital setting is indicated. The condition can be improved by gastric lavage; hemodialysis is not effective. In severe cases, therapy may be needed to maintain respiratory function and control the functioning of the cardiac system.

Drinking alcoholic beverages can cause serious side effects. Also, when treated with colchicil, a deterioration in the speed of reactions may be observed, so it is better to avoid driving vehicles.

A pronounced inflammatory reaction with predominant damage to the lungs is the basis of the pathogenesis of COVID-19. Colchicine is a drug with an anti-inflammatory effect, successfully used in the treatment of gout, rheumatological diseases, and pericarditis. Recent studies have shown that colchicine not only has a favorable cardiovascular safety profile, but also reduces the risk of ischemic events (see COLCOT trial https://www.nejm.org/doi/full/10.1056/NEJMoa1912388).

The JAMA Network published the results of a small, prospective, randomized, open-label study that assessed the efficacy and safety of colchicine therapy in patients with COVID-19. The study included 105 hospitalized patients with COVID-19, median age 64 years. Colchicine was prescribed in a loading dose of 1.5 mg, after 60 minutes – another 0.5 mg, then 0.5 mg 2 times a day for 3 weeks. Almost all patients included in the study also received chloroquine or hydroxychloroquine, as well as azithromycin.

The primary endpoint of the study is clinical deterioration in the course of COVID-19 within 3 weeks from the moment of randomization (by 2 or more points on the standard WHO scale, where 1 point is assigned for good health and 7 for death).

The primary endpoint occurred in 14.0% of patients in the control group and 1.8% of patients in the colchicine group (odds ratio, 0.11; 95% CI, 0.01 to 0.96; P = .02). The figure shows Kaplan-Meier curves reflecting patient survival without deterioration within 3 weeks after randomization.

Figure 1. Kaplan-Meier curves: survival without worsening COVID-19 depending on therapy

The level of markers was also monitored over time: the concentration of CRP, high-sensitivity cardiac troponin, the number of leukocytes and platelets did not differ between groups, while the concentration of D-dimer during colchicine therapy was significantly lower (the average value in the colchicine group was 0.76 [0.41 – 1.59] µg/ml, in the control group – 0.92 [0.68 – 2.77] µg/ml, p = 0.04).

Low-dose colchicine therapy was well tolerated, with diarrhea being the only common side effect (45.5% in the colchicine group vs. 18.0% in the control group; P = 0.003). Diarrhea rarely led to drug withdrawal or electrolyte disturbances. No serious side effects were reported according to study criteria.