Administration in renal impairment.
When colchicine is used for acute gout, licensed product information in the UK suggests a dose reduction or an increased interval between doses in patients with a creatinine clearance (CC) of 10 to 50 mL/min, and contra-indicates its use in patients with severe renal impairment (CC less than 10 mL/min), or those on dialysis. In the USA, no dose reduction is considered necessary in patients with mild to moderate renal impairment (CC 30 to 80 mL/min); patients with severe renal impairment (CC less than 30 mL/min) also do not require a dose reduction, but treatment courses should not be repeated more than once every 2 weeks. In dialysis patients, the total recommended dose for acute gout should be reduced to a single oral dose of 600 micrograms, not repeated more than once every 2 weeks. It was formerly advised that intravenous doses should be reduced by 50% in patients with a CC of between 10 and 50 mL/minute, and it is contra-indicated in those patients with a CC less than 10 mL/minute but such products are no longer licensed in many countries.
In familial Mediterranean fever, US licensed product information suggests that patients with mild to moderate renal impairment (30 to 80 mL/min) should be monitored closely; a reduction in colchicine dose may be necessary. For patients with severe renal impairment (CC less than 30 mL/min) or dialysis patients, an initial oral dose of colchicine 300 micrograms is recommended, with close monitoring after any dose increases.
Colchicine should not be used in patients with renal impairment who are taking P-glycoprotein inhibitors or strong cytochrome P450 isoenzyme CYP3A4 inhibitors.