Low-Dose Colchicine for Atherosclerosis: Key Points

The following are key points to remember from a state-of-the-art review on the long-term safety of low-dose colchicine for atherosclerosis:

1. Colchicine 0.5 mg daily is FDA-approved for secondary prevention in patients with coronary artery disease (CAD).
2. These recommendations are rooted in the findings of the LoDoCo2 and COLCOT trials that showed a 31% drop in cardiovascular events in patients with clinically stable atherosclerosis. A similar drop of 23% was seen in patients with recent myocardial infarction.
3. The experience of most clinicians with colchicine is for gout and pericarditis. The higher doses used for these conditions are often fraught with side effects.
4. Many clinicians may be hesitant to use the lower dose of colchicine recommended for CAD out of concern of the potential for significant side effects.
5. This review looked at a 20-year experience of continuous use colchicine for a variety of indications.
6. The main finding was that the 0.5 mg daily dose of colchicine in appropriate patients has side effects like placebo. This includes myelosuppression, myotoxicity, and cancer. 
7. There is minimal evidence that colchicine increases the risk of serious or fatal infection.
8. Patients on low-dose colchicine often report mild diarrhea after the medication is started, but it typically resolves quickly.
9. Colchicine at a low dose has no negative effect on bleeding, wound healing, fertility, or pregnancy.
10. This lack of significant adverse effects includes patients who are on statins.
11. Even low-dose colchicine should NOT be used in patients with estimated glomerular filtration rate <45 mL/min/173 m2, cytopenia, advanced liver dysfunction, creatine kinase or alanine transaminase >3 x the upper limits of normal.
12. Colchicine should be held in patients taking clarithromycin, ketoconazole, fluconazole, cyclosporine, ritonavir, or other strong CYP3A4 inhibitors or P-glycoprotein inhibitors.
13. Long-term use of low-dose colchicine in patients with normal renal and hepatic function is otherwise very safe.
14. The clear safety of low-dose colchicine in appropriate patients suggests that it is a medication that should be used far more widely for secondary prevention of CAD in patients with normal renal and hepatic function.