Gout Medication Colchicine Reduce Myocardial Infarction? 2019 N Engl J
The risk of stroke was 74% lower in the colchicine group than in the placebo group
Colchicine was associated with a 23% lower risk of the primary outcome (death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization) than placebo. https://nejm.org/doi/10.1056/NEJMoa1912388
I agree and I’ve ‘fired’ many. But there are no rheumatologists in my country of residence and I’m working my way through the small pool of available GP’s to find one open-minded enough to work with. I think I’m getting closer.
For those of you who use Colchicine, what dose do you use and where do you procure it? I’m looking for effective ways to prevent ASCVD as statins have bombed out for me. Thanks.
I just ordered 1000 tablets of 0.5mg Colchicine for $70 (including shipping) from Kacchela Medex (Indiamart.com).
The side effects (gut upset is most common) and toxicity (but also the benefit of gout flareup pain control) are dependent on peak plasma levels, while most of the beneficial effect (including ASCVD reduction and anti-inflammation) are based on total daily dosage AJM on Colchicine Pharmacodynamics. The plasma half life from oral Colchicine is around 7-9 hours : since the plasma half life from IV Colchicine is only 19 minutes, this suggests that gut absorption rate is what determines plasma half life. The intra-cellular half life is around 30 hours which is the effective half life of the anti-inflammation effects.
BTW, the long intra-cellular half life means that fatal doses (starting at 7mg, with an LD50 around 20mg) will trigger multiple organ failure around 48 hours after ingestion with few symptoms during the first 36 hours, resulting in a “dead-man-walking” situation, with no treatment options other than emetics during the first 7 hours after ingestion.
To minimize risk of gut upset and toxicity, I plan to start on 1/4 tablet (0.125mg) daily for 2 weeks, then 1/4 tablet twice daily for 2 weeks, then 1/2 tablet (0.25mg) twice daily.
I would be careful also with drug interactions, and it interacts with grapefruit if someone is using that with rapamycin they will probably run into toxicity if not lethality from GFJ or other inhibitor of a similar sort.
I wonder if using only 1/4 tablet twice daily might not be safer, even for those not taking GFJ, since many other supplements have a similar effect as GFJ. The AJM link in my previous message mentions that some doctors feel a lower dose for ASCVD prevention might be safer, but there is no evidence of efficacy yet, so they don’t recommend it. However, generally efficacy for drugs is at best linear in dosage, and typically non-linear, meaning taking half the dose will typically achieve more than 50% of the efficacy of the full dose.
The package of 1000 tablets got through without problems. Breaking tablets into 1/4 was too much work so I settled on taking 1/2 tablet daily for now.
I also started 10mg of Montelukast (Singulair) twice daily (received 1500 tablets from Kocchela Medex for $60 plus shipping), which also has systemic anti-inflammation benefits, so am planning to stick with just 1/2 tablet (0.25mg) of Colchicine per day.
Update on colchicine: I took 0.5mg daily for 7 weeks. It did clear up my psoriasis. But it did nothing for joint pain that has been attributed to psoriatic arthritis, in fact it got a bit worse. I stopped because it interacts with so many drugs: Colchicine Interactions Checker - Drugs.com, including rapamycin. And grapefruit juice. Colchicine in higher doses is toxic, even fatal. It was used as a poison in ancient times. And modern times: Poison expert allegedly poisoned wife—with a shockingly toxic gout drug | Ars Technica
So if you’re going to take it for CAD, do your homework. I may take it once a year for psoriasis, stopping all sups and rapa while doing so.
Role of Colchicine in Cardiovascular Disease Management
Originally published 21 Mar 2024
Arteriosclerosis, Thrombosis, and Vascular Biology. 2024;0
Abstract
Colchicine—an anti-inflammatory alkaloid—has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in extremely high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can even add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration–approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine’s safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.
Colchicine and plaque: A focus on atherosclerosis imaging
Highlights
Colchicine is a well-studied anti-inflammatory medication, more recently, its pivotal role in cardiovascular disease management and atherosclerotic plaque modification has been established.
Colchicine acts on many anti-inflammatory pathways, which translates to cardiovascular event reduction, plaque transformation, and plaque reduction.
Plaque analysis of colchicine effects may be performed invasively or noninvasively, each with its own advantages and limitations.
Colchicine’s role in plaque transformation and positive clinical outcomes paves the way for its incorporation into clinical guidelines and practice.
