BMJ  2004;328:288-289 (31 January), doi:10.1136/bmj.328.7434.288-d

Letter

Colchicine in acute gout

Low dose colchicine was started after usual dose

EDITOR—Morris et al emphasise that in acute gout lower doses of colchicine are effective yet less toxic than traditional regimens.¹ Certain points need, however, to be considered.

In all the three cases quoted the patients initially started taking higher (traditional) doses of colchicine and only after they had experienced adverse effects were their doses reduced. This means a lingering effect of colchicine would be present. Evidence shows that colchicine will be present in leucocytes (site of action) for at least nine days after a single intravenous dose.² To claim that a lower dose of colchicine is effective, should one not start with a lower dose?

Because toxicity is more common with colchicine, non-steroidal anti-inflammatory drugs (NSAIDs, such as indomethacin or naproxen) are preferred.² In one of the three cases mentioned, meloxicam was tried without benefit. Meloxicam is a drug with a long half life, and it needs time for steady state concentration to be achieved.

Colchicine has generally been replaced by less toxic drugs such as NSAIDs,^{3 4} and corticosteroids (preferably via intrasynovial injection)³ for relief of an acute attack. Colchicine should be reserved for patients in whom these other agents are contraindicated or ineffective.³ Although Morris et al claim that they do not advocate an increase in the use of colchicines, it seems that all other avenues were not exhausted. Colchicine has been reported to be equally effective, and the gastrointestinal side effects may be avoided almost completely if it is given intravenously.²

Chengalpattu Medical College, Chengalpattu, Tamil Nadu 603 001, India drsivagnanam{at}hotmail.com

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Competing interests: None declared.

References

1. Morris I, Varughese G, Mattingly P, Colchicine in acute gout, BMJ 2003;327: 1275-6. (29 November.)[Free Full Text]
2. Roberts II LJ, Morrow JD In: Goodman and Gilman's The pharmacological basis of therapeutics. 10th ed. New York: McGraw Hill, 2001: 687-731
3. American Medical Association. Drug evaluations subscription. Chicago: AMA, 1990: 674-6.
4. Roberts WN, Liang MH, Stern SH. Colchicine in acute gout. Reassessment of risks and benefits. JAMA 1987;257: 1920-2.[Abstract]

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