Kolkisin

Kolkisin, commonly known as colchicine, is a plant-derived alkaloid used as an anti-inflammatory medication. It is obtained from the autumn crocus Colchicum autumnale and has long been employed to treat acute gout attacks and to prevent flares in familial Mediterranean fever (FMF). It may also be used in other inflammatory conditions under specialist supervision.

Mechanism of action: Kolkisin binds to tubulin and inhibits microtubule polymerization. This disrupts cell division and, in inflammatory contexts, reduces neutrophil chemotaxis and degranulation, thereby dampening the inflammatory response.

Pharmacokinetics: It is administered orally with variable absorption and peak concentrations reached within hours. It is primarily metabolized in the liver by CYP3A4 and P-glycoprotein transporters, and is excreted in urine and bile. The elimination half-life in healthy adults is typically around 26–31 hours; clearance diminishes in renal or hepatic impairment and with certain drug interactions.

Safety and adverse effects: Kolkisin has a narrow therapeutic index. Common adverse effects include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. More severe toxicity can involve bone marrow suppression, neuromyopathy, liver or kidney injury, and multi-organ toxicity, especially in overdose or when combined with inhibitors of CYP3A4 or P-glycoprotein or in individuals with renal impairment. Dosing and monitoring require medical supervision to manage interactions and contraindications.

See also: Colchicine; Familial Mediterranean fever; Gout; Pericarditis.