Medsafe guidelines for prescription of colchicine
• Limit colchicine to second-line therapy
• Colchicine should not be used unless NSAIDs are contraindicated; have low efficacy, or have unacceptable side effects
• Colchicine should no longer be taken "until symptoms of GI upset subside"
• Increase dose interval to 6 hourly (from 2-3 hourly)
• Reduce maximum dose in the first 24 hours to 2.5 mg
• Reduce maximum cumulative dose to 6mg over 4 days (3 mg in elderly)
• Reduce dose in hepatic / renal dysfunction; elderly and low weight states
In current practice, any medical practitioner can prescribe colchicines, and in New Zealand there are currently no limits to the amount that can be dispensed at any one time. An argument can be made to restrict its prescribing to a specialist-only approach, however this would raise problems of access. An alternative approach might be to limiting the amount prescribed and dispensed at one time. In the United Kingdom, pharmacists are only able to dispense a maximum of 6 mg per prescription. This may limit the possibilities for overdose, especially accidental overdose. In our view, prescribers, patients, and their families are not aware of the dangers of this drug in overdose. Whilst this remains the case, changes to current practice are necessary. Furthermore, appropriate patient education in the use of colchicine is vital.