Emergency Medical Minute17 Feb 2025

Episode 944: Colchicine Overdose

Contributor: Aaron Lessen, MD

Educational Pearls:

Colchicine is most commonly used for the prevention and treatment of gout

There is research investigating the anti-inflammatory and cardioprotective effects of colchicine

This drug has a narrow therapeutic index: a small margin between effective dose and toxic dose
Colchicine overdoses can be unintentional or intentional and are associated with poor outcomes

Phase 1: 10 - 24 hours after ingestion

Patient looks well but may have mild symptoms mimicking gastroenteritis

Phase 2: 24 hours - 7 days after ingestion

Multiple organ dysfunction syndrome (MODS)

Phase 3: recovery is usually within a few weeks of ingestion

Treatment for colchicine overdose

Treat early and aggressively

Gastrointestinal decontamination with activated charcoal and orogastric lavage
Dialysis and ECMO for MODS treatment

References

Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Nguyen P, Dubnov-Raz G, Pollak U, Koren G, Bentur Y. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010 Jun;48(5):407-14. doi: 10.3109/15563650.2010.495348. PMID: 20586571.
Gasparyan AY, Ayvazyan L, Yessirkepov M, Kitas GD. Colchicine as an anti-inflammatory and cardioprotective agent. Expert Opin Drug Metab Toxicol. 2015;11(11):1781-94. doi: 10.1517/17425255.2015.1076391. Epub 2015 Aug 4. PMID: 26239119.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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