*This page is not medical advice.  This is for information only.

Summary

Colchicine is an anti-inflammatory drug that is very effective in FMF and sometimes effective in other autoinflammatory conditions. It is prescribed as a tablet. Colchicine should be taken daily, even when no flares are present. The most prevalent side effects of colchicine are digestive tract symptoms. Colchicine can be used safely during pregnancy.  This is normally the first drug that will be prescribed because it is the least expensive.

Colchicine is an anti-inflammatory drug

Colchicine is an anti-inflammatory drug that is very effective in familial Mediterranean fever (FMF). It is widely used, especially as a treatment for gout (a form of joint inflammation caused by precipitation of gout crystals). During the 1970’s, a doctor who treated several FMF patients with colchicine because of gout noticed the reduced frequency of FMF-flares in these patients. Colchicine was then tested in a larger group of patients, and it was found out that colchicine can be used to not only reduce the frequency of the FMF flares but also:

• decreases the severity of the flares;
• sometimes even stops the flares completely;
• prevents complications such as abdominal adhesions or amyloidosis. 

Your colchicine dose is prescribed by your doctor

Colchicine is produced as tablets containing 0.5mg, 0.6mg or 1mg. The total daily dose is prescribed by your doctor. Commonly used doses in FMF are 1 to 1.5 milligrams of colchicine daily. The tablets can be spread over the day or taken as a single dose. When this dose is ineffective, it can be elevated to 2mg, 2.5mg or even 3 mg each day.

Colchicine should be used on a daily basis

You should use colchicine each day as prescribed by your doctor even when there are no flares. If it works, this is the only way to prevent new flares and prevent complications.

It is ineffective to increase the colchicine dose at the time of a flare. This does not make it more effective, but it can lead to serious side effects instead.

Gastrointestinal complaints are the most common side effects of colchicine

The most common side effects of colchicine are gastrointestinal symptoms, like abdominal pain, abdominal distension or diarrhea. Side effects are most frequently seen during the first days to weeks of the treatment and decrease later on. It can be helpful to start on a lower dose and gradually increase the dose.

Long-term use of high doses of colchicine can lead to hair loss, a tingling sensation in the fingers, muscle weakness and decreased numbers of red and white blood cells in the blood.  It is, therefore, important that you never take more than your prescribed dose. 

You need to be careful with colchicine in certain situations

In the carefully paired liver or kidney function, one should be careful with the use of colchicine. If you use colchicine and impaired liver or kidney function are found, contact your doctor immediately.

There are some other drugs that do not combine well with colchicine, as they increase blood levels of colchicine. This can lead to side effects. These drugs are cimetidin (for heartburn), erythromycin (an antibiotic), clarithromycin (also an antibiotic) and tolbutamide (for diabetes). It is important to tell your doctor that you use colchicine when new drugs are prescribed.

Colchicine during pregnancy is safe (see evidence below)

The information leaflet that comes with the colchicine may tell you that you should not use it during pregnancy. Animal tests have shown that colchicine can lead to congenital abnormalities. However, several studies in people with FMF in Turkey and Israel have shown that colchicine treatment during pregnancy is safe. Women on colchicine had as many normal children as women that did not use any drugs. It is even thought that colchicine may be beneficial during pregnancy, as flares of peritoneal inflammation may cause spontaneous abortion or preterm birth. As colchicine prevents the abdominal flares, it also prevents these complications of the abdominal flares.

Colchicine has also proven to be safe during breastfeeding.

In men who use colchicine, there is no negative effect on fertility. Men with FMF who were on colchicine during conception had as many normal children as men who did not use any drugs.

Doctors and other healthcare professionals that do not treat FMF-patients on a regular basis may know little about the harmless effects of colchicine during pregnancy. When you talk to your doctor about this, you can refer you doctor to the following scientific papers. 

Scientific articles on the safety of colchicine during pregnancy and lactation are:

1. Diav-Citrin et al. Pregnancy outcome after in utero exposure to colchicine. Am J Obstet Gynecol. 2010 Aug;203(2):144.e1-6.

2. Ben-Chetrit et al. Pregnancy outcomes in women with familial Mediterranean fever receiving colchicine: is amniocentesis justified? Arthritis Care Res (Hoboken). 2010 Feb;62(2):143-8. 

3. Ben-Chetrit et al. The outcome of pregnancy in the wives of men with familial Mediterranean fever treated with colchicine. Semin Arthritis Rheum. 2004 Oct;34(2):549-52. 

4. Ditkoff et al. Successful pregnancy in a familial Mediterranean fever patient following assisted reproduction. J Assist Reprod Genet. 1996Sep;13(8):684-5.

5. Rabinovitch et al. Colchicine treatment in conception and pregnancy: two hundred thirty-one pregnancies in patients with familial Mediterranean fever. Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):245-6.

6. Herscovici et al. Colchicine use during breastfeeding. Breastfeeding medicine 2015; 10(2):92-95.

With thanks to: Autoinflammatie.nl

Ver. 1.0 24/4/017