Gout treatment colchicine

Antimitotic (stops cell division) - nausea, vomiting, confusion, delirium Lily family, glory lily, crocus, may apple Colchicine (gout treatment)... 

Microtubule-targeting agents are amply used in chemotherapy and recent evidence suggests that they require of mitochondria for their anti-cancer effectiveness (Figure 6). Microtubule-destabilizing drugs such as alkaloids colchicine (used for gout treatment and familial mediterranean fever [162]) and nocodazole produce increase of free tubulin and in parallel decrease of Av /m in human hepatoma cells [163], In contrast, decrease of free tubulin... 

The active principle of the autumn crocus (Colchicum autumnale), colchicine (48), is one of the very few drugs that have remained in reputable medical use since ancient times. This drug was the only useful treatment available for the excruciating pain associated with crystallization of uric acid in the joints characteristic of gout until the advent of allopurinol. Although the precise mechanism by which colchicine gives this dramatic relief remains undefined, the antimitotic activity of this agent is... 

Allopurinol is well absorbed with a short half-life of 2 to 3 hours. The half-life of oxypurinol approaches 24 hours, allowing allopurinol to be dosed once daily. Oxypurinol is cleared primarily renally and can accumulate in patients with reduced kidney function. Allopurinol should not be started during an acute gout attack because sudden shifts in serum uric acid levels may precipitate or exacerbate gouty arthritis. Rapid shifts in serum uric acid can change the concentration of monosodium urate crystals in synovial fluid, causing more crystals to precipitate. Thus some clinicians advocate a prophylactic dose of colchicine (0.6 mg/day) during initiation of antihyperuricemic therapy. Acute episodes should be treated appropriately before maintenance treatment is started. 

Colchicine (a drug used in treatment of gout) and vinblastine (a cancer chemotherapy agent) may decrease liver uptake of americium. In rats that received an intraperitoneal injection of either colchicine and vinblastine prior to an intravenous or intramuscular injection of americium citrate, liver uptake of americium was lower, relative to controls, and kidney and skeletal americium uptake were higher (Seidel 1984, 1985). The effect is thought to involve disruption of hepatic microtubule formation, which is critical to the formation and intracellular processing of lysosomes, the initial site of accumulation of americium in the liver. 

Colchicine is an antimitotic drug that is highly effective in relieving acute gout attacks but has a low benefit-toxicity ratio. When colchicine is started within the first 24 hours of an acute attack, about two-thirds of patients respond within several hours. The likelihood of success decreases substantially if treatment is delayed longer than 48 hours after symptom onset. 

Colchicine (6) is used in the treatment of a broad range of diseases including acute gout and Mediterranean fever [28] and induces depolymerization of tubulin. This compound (6) distorts the tubulin/microtubule equilibrium by binding to the tubulin dimer and halting mitosis in the metaphase. The reason this approach is such a successful target in cancer therapy is that... 

DETAILS - Colchicine is a plant drug used in the treatment of gout. It is a very efficient poison in view of its very low toxic dose and the fact that an autopsy will show only the symptoms of acute gastroenteritis. This does not, however, mean it is undetectable. It only means that it is likely to be overlooked. It is also very useful as a dart poison, especially when nicotine is used as a binder. Colchicine is great for small caliber (,22)bullets, as they usually won t hold enough of most other poisons to do any good. It dissolves slowly in water, but faster in dilute ethanol (liquor). As with any plant alkaloid, it is best to harvest the... 

Other approaches to induce gastrointestinal discomfort have far more serious toxic effects. The chemical colchicine stops cell division (an antimitotic), producing severe nausea, vomiting, and dehydration, which can lead to delirium, neuropathy, and kidney failure. On the other hand, colchicine is used in the treatment of gout and has been studied as an anticancer agent because it stops cell division. Most toxic of all are plants that produce lectins, and the most toxic of these is the chemical ricin produced by castor beans. Only 5 to 6 seeds are necessary to kill a small child. Fortunately, following oral consumption much of the ricin is destroyed in the stomach. Ricin is extremely effective at stopping protein synthesis, so much so that direct exposure to only 0.1 pg/kg can be fatal. 

Colchicine, an alkaloid obtained from the autumn crocus, has long been used and is relatively selective for the treatment of acute gouty arthritis. Unlike many of the newer agents for use in gout, colchicine has minimal effects on uric acid synthesis and excretion it decreases inflammation associated with this disorder. It is thought that colchicine somehow prevents the release of the chemotactic factors and/or inflammatory cytokines from the neutrophils, and this in turn decreases the attraction of more neutrophils into the affected area (Fig. 37.1).The ability of colchicine to bind to leukocyte microtubules in a reversible covalent complex and cause their depolymerization also may be a factor in decreasing the attraction of the motile leukocytes into the inflamed area. 

The major use of colchicine is as an antiinflammatory agent in the treatment of acute gouty arthritis it is not effective in reducing inflammation in other disorders. It also can be used to prevent attacks. Since colchicine is so rapidly effective in relieving the acute symptoms of gout (substantial improvement is achieved within hours), it has been used as a diagnostic aid in this disorder. 

It is effective for treatment of acute attacks of gout. It has no effect on renal excretion of uric acid. It binds to tubulin, it interferes with function of mitotic spindles, causes depolymerization and disappearance of fibrillar microtubules in granulocytes. In gout, the useful of colchicine is due to the inhibition of the release of glycoproteins from granulocytes in inflamed joint thus preventing precipitation of uric acid crystals and release of lysosomal enzymes. 

Although NSAIDs are now the first-line drugs for acute gout, colchicine was the primary treatment for many years. Colchicine is an alkaloid isolated from the autumn crocus, Colchicum autumnale. Its structure is shown in Figure 36-6. 

Although colchicine is more specific in gout than the NSAIDs, NSAIDs (eg, indomethacin and other NSAIDs [except aspirin]) have replaced it in the treatment of acute gout because of the troublesome diarrhea sometimes associated with colchicine therapy. Colchicine is now used for the prophylaxis of recurrent episodes of gouty arthritis, is effective in preventing attacks of acute Mediterranean fever, and may have a mild beneficial effect in sarcoid arthritis and in hepatic cirrhosis. Although it can be given intravenously, this route should be used cautiously because of increased bone marrow toxicity. 

As with allopurinol, prophylactic treatment with colchicine or NSAIDs should start at the beginning of treatment to avoid gout flares. The most frequent treatment-related adverse events are liver function abnormalities, diarrhea, headache, and nausea. Febuxostat appears to be well tolerated in patients with a history of allopurinol intolerance. 

Colchicine is a poisonous tricyclic tropane alkaloid from the autumn crocus (Colchicum autumnale) and gloriosa lily (Gloriosa superba). This alkaloid is a potent spindle fiber poison, preventing tubulin polymerization.25 Colchicine has been used as an effective anti-inflammatory drug in the treatment of gout and chronic myelocytic leukemia, but therapeutic effects are attainable at toxic or near toxic dosages. For this reason, colchicine and its analogs are primarily used as biochemical tools in the mechanistic study of new mitotic inhibitors. 

Colchicine (23) is a toxic substance occurring in Colchicum autumnale, it contains the nucleus of pyrogallol trimethyl ether. Colchicine has been used in the treatment of acute gout, and in plant genetics research to effect doubling of chromosomes. 

In medicine, colchicine is probably best known for its use in connection with tire treatment of gout. Acute attacks of gout are characteristically and specifically aborted by colchicine. The response noted after administration of the drug also can be useful in diagnosing gout cases where synovial fluid cannot be aspirated and examined for the presence of typical urate crystals. However, colchicine does not affect tire course of acute synovitis in rheumatoid arthrilis. 

Colchicine is an important naturally occurring tropolone derivative. It is isolated from the autumn crocus and is used in medicine for the treatment of gout. It also has an effect on cell division and is used in plant genetic studies to cause doubling of chromosomes. The structure has been confirmed by total synthesis. 

Drugs used in the treatment of gout Colchicine Allopurinol Uricosuric agents... 

In addition to inhibiting prostaglandin synthase, indomethacin and other NSAIDs also inhibit urate crystal phagocytosis. Indomethacin is commonly used as initial treatment of gout as the replacement for colchicine. Three or four doses of 50 mg every 6 hours are given when a response occurs, the dosage is reduced to 25 mg three or four times daily for about 5 days. 

---