Reassessing the safety of intravenous and compounded injectable colchicine in acute gout treatment.

Colchicine has been used for over 2000 years. Intravenous (i.v.) colchicine has been used for the treatment of acute gout since the 1950s. I.v. and oral colchicine were 'grandfathered' before the 1969 FDA Phase III trials for drug toxicity became law. Data on toxic reactions are, therefore, based only on passive surveillance. The risk of toxicity with i.v. use depends on the total dose over a period of time, the presence of comorbid conditions and the size of individual dose. Colchicine toxicity has been compared to arsenic poisoning. Symptoms start 2-5 h after the toxic dose has been ingested and not uncommonly lead to death. Injections of compounded colchicine have been implicated in the deaths of several patients, several of which received off-label i.v. colchicine for back pain. Given that colchicine has the smallest benefit to toxicity ratio of the drugs that are used in the management of acute gout and the fact that acute gout is not life-threatening, one could make a strong case for eliminating the use of i.v. colchicine the treatment of acute gout.