[e-drug] WHO EDL Committee 2004 and proposed deletions (cont'd)

[Ric Day <R.Day@unsw.edu.au>]

E-drug: WHO EDL Committee 2004 and proposed deletions (cont'd)
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Colleagues,

I would recommend keeping colchicine on the EDL list - in low,
regular daily dosing, it is useful to reduce the rate of attacks of acute
gout in those where life-long hypouricaemic drug therapy is not yet
considered appropriate. For example, an individual may change their
lifestyle (lose weight, cut down protein and alcohol intake) and during
this period the risk of recurrent acute gout can be reduced by low
dose colchicine.

Another good use for the drug, is during the induction period of
hypouricaemic therapy with allopurinol. There is a substantial risk of
acute gout during this period which can be demoralizing for the
patient and lead to poor compliance with allopurinol.

Colchicine costs little and does not cause peptic ulceration like
NSAIDs.

Of course dosage needs to be adjusted down in renal impairment and
overdose is lethal.

It is not a good option for treating attacks of acute gout because of
the GI adverse effects, notably diarrhoea.

Ric Day

Richard Day
Professor of Clinical Pharmacology, UNSW
Director of Clinical Pharmacology & Toxicology, St Vincents Hospital
Sydney

Phone: 61-2-8382-2331
Fax: 61-2-8382-2724
Email:R.Day@unsw.edu.au
Secretary: Irena Williams (61-2-8382-2304;
clinpharm@stvincents.com.au)

Reference:
- Kott T, Day RO, Brooks PM. Colchicine or nonsteroidal anti-
inflammatory drug therapy for prophylaxis against gout during 
commencement of allopurinol therapy. Med J Aust 1993; 159:162-164

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