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Koo, Kim, and Chin: A Case of High dose Colchicine with No Efficacy in a Patient with Chronic Kidney Disease Taking Rifampicin
Case Report

J Rheum Dis 2014;21(6):314-315.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.6.314

A Case of High dose Colchicine with No Efficacy in a Patient with Chronic Kidney Disease Taking Rifampicin

Ho Seok Koo1, Suhnggwon Kim2, 3, Ho Jun Chin4

1Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

3Seoul K Clinic, Seoul, Korea

4Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Corresponding to: Ho Jun Chin, Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam 463-520, Korea. E-mail: mednep@snubh.org

Received 18 August 2013       Revised 4 January 2014       Accepted 9 January 2014

Copyright © 2014 The Korean College of Rheumatology

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 54-year-old male on chronic hemodialysis, who was taking rifampicin for tuberculous lymphadenitis, was admitted for an acute gout attack. After administrating 3.6 mg of colchicine for 2 days, symptoms began to alleviate. Despite the relatively high dosage in this end-stage renal disease patient, there were no adverse effects, such as diarrhea, vomiting, or myopathy. After 1 and 6 hours of 0.6 mg colchicine administration, serum colchicine was 1.3930 ng/mL and 0.2464 ng/mL, respectively. These values were lower than the mean concentrations in 13 other patients with chronic kidney disease (CKD) after the same time intervals (4.34±0.56 ng/mL and 1.49±0.15 ng/mL, respectively). As rifampicin is an inducer of cytochrome P450 3A4, metabolism of colchicine had increased. When taking colchicine and rifampicin simultaneously, a higher colchicine dose may be needed for the treatment of acute gout in patients with CKD.

Keywords: Colchicine, Rifampicin, Acute gout, Renal impairment

REFERENCES

1. Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR Standing Committee for International Clinical Studies Including Therapeutics. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006; 65:1312–24.
crossref
2. United States Food and Drug Administration. Rheumatology information: non-selective non-steroidal anti-inflammatory drugs [internet]. Available from:. http://www.fda.gov/Drugs/ResourcesForYou/HealthProfessionals/ucm106979.htm.
3. Mutual Pharmaceutical Company I. ColcrysⓇ oral tablets: US prescribing information [internet]. Available from. http://www.colcrys.com/assets/pdf/COLCRYS_Full_Prescribing_Information.xml.
4. Terkeltaub RA. Clinical practice. Gout. N Engl J Med. 2003; 349:1647–55.
5. Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010; 62:1060–8.
crossref
6. Nuki G. Colchicine: its mechanism of action and efficacy in crystal-induced inflammation. Curr Rheumatol Rep. 2008; 10:218–27.
crossref
7. Zhou SF. Drugs behave as substrates, inhibitors and inducers of human cytochrome P450 3A4. Curr Drug Metab. 2008; 9:310–22.
crossref
8. Indiana university. Division of clinical pharmacology. P450 Drug interaction table. [internet]. Available from:. http://medicine.iupui.edu/clinpharm/ddis/main-table/.
9. Rochdi M, Sabouraud A, Girre C, Venet R, Scherrmann JM. Pharmacokinetics and absolute bioavailability of colchicine after i.v. and oral administration in healthy human volunteers and elderly subjects. Eur J Clin Pharmacol. 1994; 46:351–4.
crossref

Figure 1.
Time dependent serum level of colchicine. In 13 patients, the serum colchicine concentration curve was drawn according to C0, C1 and C6. We assumed that Tmax was an hour after administration. The lowest line shows the result of the case-study patient. Tmax is the time after administration of a drug when the maximum plasma concentration is reached.
jrd-21-314f1.tif
Table 1.
Laboratory results on day of admission and 1 day before discharge
  Admission 1 day before discharge
WBC count, /mm3 12,580 11,140
Hemoglobin, g/dL 10.4 9.8
Hematocrit, % 34.0 32.1
Platelet, /mm3 143,000 205,000
Total protein, g/dL 6.2 7.8
Albumin, g/dL 2.6 3.2
Total bilirubin, mg/dL 0.5 0.3
ALP, IU/L 61 89
AST (GOT), IU/L 13 19
ALT (GPT), IU/L 2 5
Total cholesterol, IU/L 112 114
Calcium, mg/dL 8.6 8.5
Phosphorus, mg/dL 3.4 4.7
Uric acid, mg/dL 7.7 9.9
CRP, mg/dL 16.5 4.7
BUN, mg/dL 44 37
Creatinine, mg/dL 7.6 9.6

WBC: white blood cell, ALP: Alkaline phosphatase, AST: aspartate aminotransferase, ALT: alanine aminotransferase, BUN: blood urea nitrogen, CRP: C-reactive protein.

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