Gout Medication: Colchicine, Uric Acid and More

by Pravin Shukle, MD

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    Let's move on to a completely different topic. Let's move on to colchicine. Now, colchicine is a selective inhibitor of microtubule assembly. Now what happens is is that you're inhibiting tubulin which is necessary for cell division and motality. So, what is tubulin? We can think of tubulin as a combination of a girdle or something that holds a building up and a communication tube that moves one thing to another from one part of the cell to another. Inhibiting tubulin production actually inhibits a lot of cell function. We call this a general mitotic poison. So in actual fact, we can use these agents in cancers. But in our particular discussion today, we're going to be talking about how it reduces migration and phagocytosis by macrophages. This also helps reduce interleukin B4 which I mentioned to you in the slide before. This also decreases free radical formation which is also a mediator of pain and inflammation. So where do we use colchicine? It's used in acute gout attacks. It's often associated with diarrhoea and in fact, the way that we prescribe this medication is we tell patients take 0.1 mg every hour until they develop diarrhoea, then slow down. And it sounds kind of flippen but it's true it's a very effective agent, it's very very potent, except for the fact that it causes diarrhoea, it would be a perfect drug for treating gout. Chronic gout prevention is treated with 0.6 mg once a day. Now, we also use this for pericarditis treatment and prevention. What we do is we start off with 0.6 mg a day, or sometimes even twice a day, then we go down to once a day, for 3 months. So, treating a patient for 3 months with colchicine actually reduces the recurrence of pericarditis...

    About the Lecture

    The lecture Gout Medication: Colchicine, Uric Acid and More by Pravin Shukle, MD is from the course Inflammation Pharmacology. It contains the following chapters:

    • Drugs in Gout Treatment
    • Uricosurics
    • Xanthine Oxidase Inhibitors

    Included Quiz Questions

    1. Inhibits uric acid formation.
    2. Inhibits microtubule assembly.
    3. Reduces leukotriene B4 production.
    4. Decreases free radical formation.
    5. Reduce migration by macrophages.
    1. Increase dosage until the patient develops diarrhea.
    2. Increase dosage until the patient develops constipation.
    3. Load the patient with excess drug and slowly decrease the dosage.
    4. Follow the formula provided by the manufacturer.
    5. Increase the dosage slowly over several weeks to prevent side effects.
    1. A patient with hyperuricemia and a history of gout attacks.
    2. A pregnant patient.
    3. A patient with a history of atherosclerotic cardiovascular disease.
    4. A patient with stage 1 chronic kidney disease.
    5. A patient with diabetes.
    1. The byproduct of allopurinol inhibits xanthine oxidase.
    2. Allopurinol prevents the formation of microtubules.
    3. Allopurinol prevents the release of leukotriene B4.
    4. Allopurinol is reabsorbed by the collecting tubules of the kidney allowing uric acid to be excreted.
    5. The byproduct of allopurinol inhibits phagocytosis by macrophages.

    Author of lecture Gout Medication: Colchicine, Uric Acid and More

     Pravin Shukle, MD

    Pravin Shukle, MD

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