Issues for surgery
For gout - flare up of symptoms if omitted.
For pericarditis [unlicensed indication] – risk of treatment failure if omitted.
Risk of blood dyscrasias if continued (see Further Information).
Advice in the perioperative period
Elective surgery
Continue.
Check full blood count (FBC) pre-operatively (see Further information).
Patients being treated for pericardial disease
Consideration should be given to avoiding non-cardiac elective surgery (NCS) under general anaesthesia until the treatment course is completed.
Emergency surgery
Continue.
Check FBC prior to surgery, if possible (see Further information).
Post-operative advice
Restart post-operatively, at usual dose as soon as next dose is due when enteral intake resumes.
Monitor post-operatively for signs of blood dyscrasias. If patient develops signs or symptoms that could indicate a blood cell dyscrasia, such as fever, stomatitis, sore throat, prolonged bleeding, bruising to skin disorder, treatment with colchicine should be immediately discontinued and a full haematological investigation conducted (see Further information).
Monitor liver and renal function post-operatively.
Consider discontinuing if symptoms of nausea, vomiting, abdominal pain, and diarrhoea occur since it may indicate colchicine toxicity (see Further information).
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Macrolides
Clarithromycin and erythromycin are predicted to increase the exposure to colchicine due to CYP3A4 inhibition, which may lead to colchicine-induced toxicity including fatalities, particularly in the presence of renal or hepatic impairment. Concomitant use of clarithromycin or erythromycin will require an adjustment of the colchicine dose – consult current product literature.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require dose reduction and close monitoring.
Further information
Blood dyscrasias
Colchicine can rarely cause bone marrow depression with agranulocytosis, thrombocytopenia, and aplastic anaemia, particularly with prolonged treatment at therapeutic doses. Blood counts may change gradually or suddenly.
MHRA/CHM advice: Colchicine: reminder on risk of serious and fatal toxicity in overdose (November 2009)
Colchicine has a narrow therapeutic window and a risk of serious and fatal toxicity in overdose. Patients at particular risk are those with renal or hepatic impairment, gastro-intestinal or cardiac disease, and patients at extremes of age. There is often a delay of up to 6 hours before toxicity is apparent; and some features of toxicity may be delayed by 1 week or longer. Healthcare professionals are advised to refer all patients, even in the absence of early symptoms, for immediate medical assessment. Further information on the presentation and management of colchicine overdose is available from TOXBASE.
References
The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. European Heart Journal. 2014; 35:2383-243
Summary of Product Characteristics – Colchicine 500 microgram film coated tablets. Wockhardt UK Ltd. Accessed via www.medicines.org.uk 13/02/2023 [date of revision of the text August 2019]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 13th February 2023]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 13th February 2023]
Colchicine. In: Brayfield A (Ed), Martindale: The complete Drug Reference. London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 14th July 2023]