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Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs

Published online by Cambridge University Press:  04 March 2015

Anjuli Little ,
David Tung ,
Christine Truong ,
Stephen Lapinsky  and
Lisa Burry
Anjuli Little
Affiliation:
Faculty of Medicine, University of Toronto
David Tung
Affiliation:
Department of Pharmacy Services, Medisystems Inc
Christine Truong
Affiliation:
Department of Pharmacy Services, St. Joseph's Hospital
Stephen Lapinsky
Affiliation:
Faculty of Medicine, University of Toronto
Lisa Burry*
Affiliation:
Department of Pharmacy Services, Mount Sinai Hospital, Toronto, ON
*
Department of Pharmacy Services, Mount Sinai Hospital, Toronto, ON; lburry@mtsinai.on.ca

Abstract

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Colchicine has a low therapeutic index. Its toxic effects generally occur at doses ≥ 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited.

Keywords

coingestioncolchicinenonsteroidal antiinflammatory drugoverdose
Type
Case Report • Rapport del cas
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 252 - 256
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Hartung, EF. History of the use of colchicum and related medicaments in gout with suggestions for further research. Ann Rheum Dis 1954;13:190–200, doi:10.1136/ard.13.3.190.Google Scholar
2. Finkelstein, Y, Aks, SE, Hutson, JR, et al. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol 2010;48:407–14, doi:10.3109/15563650.2010.495348.Google Scholar
3. Hood, RL. Colchicine poisoning. J Emerg Med 1994;12:171–7, doi:10.1016/0736-4679(94)90695-5.CrossRefGoogle ScholarPubMed
4. Seegmiller, JE, Howell, RR, Malawista, SE. Mechanism of action of colchicine in acute gouty arthritis. J Clin Invest 1962;41:1399, doi:10.1172/JCI104560.Google Scholar
5. Rochdi, M, Sabouraud, A, Baud, FJ, et al. Toxicokinetics of colchicine in humans: analysis of tissue, plasma and urine data in ten cases. Hum Exp Toxicol 1992;11:510–6, doi:10.1177/096032719201100612.Google Scholar
6. Hunter, AL, Klaasen, CD. Biliary excretion of colchicine. J Pharmacol Exp Ther 1975;192:605–17.Google Scholar
7. Girre, C, Thomas, G, Scherrmann, JM, et al. Modelindependent pharmacokinetics of colchicine after oral administration to healthy volunteers. Fundam Clin Pharmacol 1989;3:537–43, doi:10.1111/j.1472-8206.1989.tb00688.x.CrossRefGoogle ScholarPubMed
8. Bismuth, C, Gaultier, M, Conso, F. Medullary aplasia after acute colchicine poisoning. 20 cases. Nouv Presse Med 1977;6:1625–9.Google Scholar
9. Borron, SW, Scherrmann, JM, Baud, FJ. Markedly altered colchicine kinetics in a fatal intoxication: examination of contributing factors. Hum Exp Toxicol 1996;15:885–90, doi:10.1177/096032719601501104.Google Scholar
10. Maxwell, MJ, Muthu, P, Pritty, PE. Accidental colchicine overdose: a case report and literature review. Emerg Med J 2002;19:265–7, doi:10.1136/emj.19.3.265.Google Scholar
11. Donovan, JW. Colchicine. In: Shannon, MW, Borron, SW, Burns, MJ, editors. Haddad and Winchester’s clinical management of poisoning and drug overdose. Philadelphia: Saunders/Elsevier; 2007.Google Scholar
12. Dickinson, M, Juneja, S. Hematological toxicity of colchicine. Br J Hematol 2009;146:465, doi:10.1111/j.1365-2141.2009.07581.x.Google Scholar
13. Brvar, M, Ploj, T, Kozelj, G, et al. Case report: fatal poisoning with Colchicum autumnale. Crit Care 2004;8:R56–9, doi:10.1186/cc2427.Google Scholar
14. Folpini, A, Furfori, P. Colchicine toxicity – clinical features and treatment. Massive overdose case report. J Clin Toxicol 1995;33:71–7, doi:10.3109/15563659509020219.Google ScholarPubMed
15. Putterman, C, Ben-Chetrit, E, Caraco, Y, et al. Colchicine intoxication: clinical pharmacology, risk factors, features, and management. Semin Arthritis Rheum 1991;21:143–55, doi:10.1016/0049-0172(91)90003-I.Google Scholar
16. Murray, SS, Kramlinger, KG, McMichan, JC, et al. Acute toxicity after excessive ingestion of colchicine. Mayo Clin Proc 1983;58:528–32.Google Scholar
17. Bismuth, C, Fournier, PE, Galliot, M. Biological evaluation of hemoperfusion in acute poisoning. Clin Toxicol 1981;18: 1213–23, doi:10.3109/00099308109035060.Google Scholar
18. Harris, R, Marx, G, Gillett, M, et al. Colchicine-induced bone marrow suppression: treatment with granulocyte colonystimulating factor. J Emerg Med 2000;18:435–40, doi:10.1016/S0736-4679(00)00160-8.Google Scholar
19. Rae, JM, Johnson, MD, Lippman, ME, et al. Rifampin is a selective, pleiotropic inducer of drug metabolism genes in human hepatocytes: studies with cDNA and oligonucleotide expression arrays. J Pharmacol Exp Ther 2001;299:849–57.Google Scholar
20. Westphal, K, Weinbrenner, A, Zschiesche, M, et al. Induction of P-glycoprotein by rifampin increases intestinal excretion of talinolol in human beings: a new type of drug-drug interaction. Clin Pharmacol Ther 2000;68:345–55, doi:10.1067/mcp.2000.109797.Google Scholar
21. Zhang, L, Strong, JM, Qiu, W, et al. Scientific perspectives on drug transporters and their role in drug interactions. Mol Pharmacol 2006;3:62–9, doi:10.1021/mp050095h.Google Scholar
22. Huang, WH, Hsu, CW, Yu, CC. Colchicine overdoseinduced acute renal failure and electrolyte imbalance. Ren Fail 2007;29:367–70, doi:10.1080/08860220601166644.Google Scholar
23. Haylor, J. Prostaglandin synthesis and renal function in man. J Physiol 1980;298:383–96.Google Scholar
24. Horackova, M, Charvat, J, Hasa, J, et al. Life-threatening renal failure caused by vasomotor nephropathy associated with non-steroidal anti-inflammatory drugs. Int J Clin Pharmacol Res 2004;24:117–22.Google Scholar
25. Palmer, BF, Henrich, WL. Clinical acute renal failure with nonsteroidal anti-inflammatory drugs. Semin Nephrol 1995;15:214–27.Google Scholar
26. Borras-Blasco, J, Enriquez, R, Sirvent, AE, et al. Acute renal failure associated with an accidental overdose of colchicine. Int J Clin Pharmacol Ther 2005;43:480–4.Google ScholarPubMed
27. Venturini, CM, Isakson, P, Needleman, P. Non-steroidal antiinflammatory drug-induced renal failure: a brief review of the role of cyclo-oxygenase isoforms. Curr Opin Nephrol Hypertens 1998;7:79–82, doi:10.1097/00041552-199801000-00013.Google Scholar