title: Unrecognized fatalities related to colchicine in hospitalized patients.
abstract: BACKGROUND
  Colchicine is commonly used for the treatment of gout and occasionally for other inflammatory diseases. It has a narrow therapeutic index and the potential for severe or fatal toxicity.
  
  
  OBJECTIVE
  We sought to determine (1) the frequency of colchicine toxicity among hospitalized patients taking colchicine who died during an admission, (2) the likelihood that colchicine contributed to death, (3) whether patients were taking interacting medications that could have contributed to toxicity, and (4) whether colchicine dosing among these patients adhered to established guidelines.
  
  
  METHODS
  We conducted an IRB-approved, retrospective chart review at an urban, tertiary care, 1228-bed, university hospital. Subjects included hospitalized patients who received colchicine and died in hospital between 1 January 2000 and 28 February 2007. We reviewed charts for signs and symptoms of colchicine toxicity. An expert panel reviewed each case and classified the likelihood of colchicine toxicity, the likelihood of a causal role of colchicine in the death using the WHO classification system, and the appropriateness of colchicine dosing.
  
  
  RESULTS
  Thirty-seven hospitalized patients who died during the 86-month study period received colchicine. Toxicity was unlikely in 20/37, possible in 8/37, likely in 5/37, and certain in 4/37. A contributing role for colchicine in causing death was unlikely in 24/37, possible in 7/37, likely in 3/37, and certain in 3/37. Colchicine doses (based on creatinine clearance) exceeded the accepted range for 12 patients, including 10 of 17 cases of toxicity and 8 of 13 cases of death classified as possible or higher. Seventeen patients received interacting medications, including 8 of 17 cases of toxicity and 8 of 13 cases of death classified as possible or higher.
  
  
  CONCLUSIONS
  Colchicine toxicity was frequent in this cohort and may have contributed to about one-third of the deaths. Inappropriate dosing of colchicine occurred frequently and was related to toxicity and death.
authors: Division of Emergency Medicine, Washington University, Saint Louis, MO 63110, USA. mullinsm@wusm.wustl.edu
authors: Michael
authors: M
authors: Mullins
authors: Amanda A
authors: AA
authors: Cannarozzi
authors: Thomas C
authors: TC
authors: Bailey
authors: Prabha
authors: P
authors: Ranganathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003078:Colchicine / Q000008:administration & dosage / Q000009:adverse effects*; D054796:Drug Dosage Calculations; D004347:Drug Interactions; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects*; D019983:Guideline Adherence; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors / Q000401:mortality*; D008923:Missouri / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006074:Gout Suppressants; D003078:Colchicine