HDCN Article Review/Hyperlink

Montseny J-J, Meyrier A, Gherardi RK

Brief report. Colchicine toxicity in patients with chronic renal failure

Nephrol Dial Transplant (Oct) 11:2055-2058 1996

Colchicine excretion is impaired in renal failure and use of standard doses can result in severe neuropathy and myopathy associated with elevated CK levels (e.g., Kuncl et al, NEJM, 316:1562, 1987. In this report, 4 cases are presented in whom usual 1 mg/day doses were given to patients with renal insufficiency or failure (one was a transplant patient on cyclosporin). Problems invariably appeared by days 5-8 of therapy. Three of the 4 cases had severe diarrhea, and two of these patients died, one apparently because of pulmonary edema on rehydration, and the other, in whom colchicine was continued until day 13, because of "multifactorial shock". The authors postulate that colchicine may be cardiotoxic (causing refractory heart failure) based on the courses of the two fatalities. There is a report cited in the discussion of colchicine cardiotoxicity in the rat.

Comment: This report is nothing particularly new, except that mortality resulted in two of the cases. The cases were unfortunate and tragic, as colchicine was used to treat arthritis only, where other, safer drugs could have been used. (John T. Daugirdas, M.D., University of Illinois at Chicago)