What are the aims of this leaflet?
This leaflet has been written to help you understand more about colchicine. It tells you what it is, how it works, how it is used to treat skin conditions, and where you can find out more about it.
What is colchicine and how does it work?
Colchicine is an extract of the plant Colchicum autumnale (autumn crocus), used medically since ancient times.
Colchicine modifies the response of the immune system. It has been found to be helpful in conditions with too many neutrophils (a type of white blood cells) in the skin.
What skin conditions are treated with colchicine?
In the UK, colchicine is currently only licensed for the treatment of gout, but is used for many conditions as unlicensed treatment. Colchicine has been used in a number of skin conditions, some of which are quite rare. Some of the skin conditions that can be treated with colchicine include Behcet’s disease, recurrent aphthous ulcers, vasculitis etc. Occasionally colchicine is used in combination with other treatments.
What does “unlicensed” mean in relation to a drug?
An unlicensed drug is one that has not been awarded a Market Authorisation from the UK Medicines Healthcare Products Regulatory Agency (MHRA). Drug licenses are awarded following a rigorous process of evaluation by the MHRA following an application by a pharmaceutical company. Once awarded, the licensed drug can then be marketed and sold in the UK. In the absence of a license, the drug may still be prescribed in the UK, provided there is funding available locally to pay for it. Additionally, there must be a clear body of evidence to confirm that the drug is effective for the condition in question and that safety concerns have been adequately addressed.
Will colchicine cure my skin condition?
Depending on your skin complaint, colchicine may cure or improve it, but it does not work for everybody. When stopping the colchicine however, your skin condition may recur.
How often/when should I use colchicine?
How often or for how long you should use colchicine will depend on your skin condition and other factors; your doctor will advise.
Colchicine is used at a lower dose in skin disease when compared with acute gout, but for a longer duration.
What dose of colchicine should I take?
Your doctor will recommend a treatment schedule to you. It is common to start with one 0.5 milligram (mg) tablet a day and gradually increase to between twice and four times a day.
When should I not use colchicine?
Patients with advanced kidney failure, including those on dialysis, should not use colchicine long term as this may accumulate in the body if the kidneys are not working well. Always refer to your doctor.
In patients aged more than 65 years and in patients with reduced liver function, heart or gastrointestinal disease, colchicine should be used with caution.
What are the common side effects of colchicine?
Stomach pain and diarrhoea are the most common side effects of colchicine. In most cases, this is not harmful and will resolve when the dose is reduced.
What are the rare side effects of colchicine?
Overall, with the low doses of colchicine used in skin disease, severe side effects are rare.
With prolonged use, colchicine can cause a reduction of all blood cells, which may cause anaemia, a tendency to bleed or an inability to fight infection. Following prolonged use, some thinning of hair may be noticed. All these side effects resolve after the colchicine has been stopped.
Colchicine may damage nerves, causing tingling, reduced sensation, and muscle weakness. Very rarely patients can be allergic to colchicine and develop a severe allergic skin rash.
Colchicine poisoning, due to excessive doses, can cause severe abdominal pain, diarrhoea, nausea and vomiting.
How will I be monitored for the side-effects of colchicine treatment?
Regular blood and urine tests are required, initially monthly, and then every three months with continuing treatment.
Can I have immunisations (vaccinations) whilst on colchicine?
Yes, vaccinations are safe whilst on colchicine.
Does colchicine affect fertility or pregnancy?
Men taking colchicine may develop a reduced sperm count, which may reduce their fertility.
Because of risk of damage to the unborn baby, colchicine should not be taken in pregnancy. Colchicine is also present in breast milk, but has not been found to harm the baby. However, it is probably best avoided when breastfeeding.
May I drink alcohol while taking colchicine?
Yes, within recommended limits. Grapefruit juice can however make colchicine more toxic and should be avoided.
Can I take other medications at the same time as colchicine?
Always refer to your doctor, but drugs that may interact with colchicine include:
Statins and fibrates (drugs used to lower the cholesterol level in the blood): the risk of muscle damage is increased when combined with colchicine
Ciclosporin: there may be an increased risk of damage to the muscles and to the kidney
Macrolide antibiotics, e.g. erythromycin, clarithromycin and telithromycin: may increase the risk of colchicine toxicity
Itraconazole and ketoconazole
Antivirals, e.g. Atazanavir, indinavir, ritonavir
Diltiazem, verapamil, quinidine
Where can I get more information about colchicine?
Web links to further information:
http://www.patient.co.uk/medicine/Colchicine.htm (this website addresses colchicine for use in gout)
For details of source materials used please contact the Clinical Standards Unit (firstname.lastname@example.org).
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists; individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED JUNE 2012
UPDATED JUNE 2015
REVIEW DATE JUNE 2018