Abstract
Colchicine is one of the oldest known drugs that remains part of the current pharmacopeia. Recent studies have examined the efficacy of colchicine in cardiology with promising results. We conducted a search of electronic databases for studies on colchicine in cardiovascular medicine published through October 2016. As the utilization of colchicine in the management of cardiac conditions grows, it is paramount that internists and cardiologists are familiarized with its benefits and risks. We present a comprehensive review of the role of colchicine in the management of cardiovascular diseases with a strong emphasis on side effects and potential drug interactions.
Similar content being viewed by others
References
Deftereos S, Giannopoulos G, Papoutsidakis N, et al. Colchicine and the heart: Pushing the envelope. J Am Coll Cardiol. 2013;62(20):1817–25. doi:10.1016/j.jacc.2013.08.726.
Nuki G. Colchicine: Its mechanism of action and efficacy in crystal-induced inflammation. Curr Rheumatol Rep. 2008;10(3):218–27. doi:10.1007/s11926-008-0036-3.
Hemkens LG, Ewald H, Gloy VL, et al. Colchicine for prevention of cardiovascular events. Cochrane Database Syst Rev. 2016;1:CD011047. doi:10.1002/14651858.CD011047.pub2.
Verma S, Eikelboom JW, Nidorf SM, et al. Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2015;15:96. doi:10.1186/s12872-015-0068-3.
Sapra S, Bhalla Y, Nandani SS, et al. Colchicine and its various physicochemical and biological aspects. Med Chem Res. 2013;22(2):531–47. doi:10.1007/s00044-012-0077-z.
Slobodnick A, Shah B, Pillinger MH, Krasnokutsky S. Colchicine: old and new. Am J Med. 2015;128(5):461–70. doi:10.1016/j.amjmed.2014.12.010.
Wessler JD, Grip LT, Mendell J, Giugliano RP. The P-glycoprotein transport system and cardiovascular drugs. J Am Coll Cardiol. 2013;61(25):2495–502. doi:10.1016/j.jacc.2013.02.058.
Leung YY, Yao Hui LL, Kraus VB. Colchicine: update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015;45(3):341–50. doi:10.1016/j.semarthrit.2015.06.013.
Casanova P, Artola RT, Mihos CG, Pineda AM, Santana O. The cardiovascular effects of colchicine: a comprehensive review. Cardiol Rev. 2015;23(6):317–22. doi:10.1097/CRD.0000000000000056.
Ridker PM, Lüscher TF. Anti-inflammatory therapies for cardiovascular disease. Eur Heart J. 2014;35(27):1782–91. doi:10.1093/eurheartj/ehu203.
Imazio M, Bobbio M, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the colchicine for acute pericarditis (COPE) trial. Circulation. 2005;112(13):2012–6. doi:10.1161/CIRCULATIONAHA.105.542738.
Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013;369(16):1522–8. doi:10.1056/NEJMoa1208536.
Imazio M, Brucato A, Cemin R, et al. Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med. 2011;155(7):409–14. doi:10.7326/0003-4819-155-7-201110040-00359.
Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet. 2014;383(9936):2232–7. doi:10.1016/S0140-6736(13)62709-9.
Imazio M, Bobbio M, Cecchi E, et al. Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005;165(17):1987–91. doi:10.1001/archinte.165.17.1987.
Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921–64. doi:10.1093/eurheartj/ehv318.
Imazio M, Brucato A, Ferrazzi P, Spodick DH, Adler Y. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown). 2013;14(5):351–3. doi:10.2459/JCM.0b013e328353807d.
Imazio M, Trinchero R, Brucato A, et al. COlchicine for the prevention of the post-pericardiotomy syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J. 2010;31(22):2749–54. doi:10.1093/eurheartj/ehq319.
Imazio M, Brucato A, Ferrazzi P, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA. 2014;312(10):1016–23. doi:10.1001/jama.2014.11026.
Finkelstein Y, Shemesh J, Mahlab K, Abramov D, Bar-El Y, Sagie A, Sharoni E, Sahar G, Smolinsky AK, Schechter T, Vidne BAAY. Colchicine for the prevention of postpericardiotomy syndrome. Herz. 2002;27(8):791–4.
Fomaneg C, Samonte P, Sasondoncillo-Nadal M, Sim-Apura MCL, Padua L. Colchicine use for the primary prevention of postpericardiotomy syndrome (CUPP): a meta-analysis. Cardiology. 2014;128:475.
Miller RH, Horneffer PJ, Gardner TJ, Rykiel MF, Pearson TA. The epidemiology of the postpericardiotomy syndrome: a common complication of cardiac surgery. Am Heart J. 1988;116(5 Part 1):1323–9. doi:10.1016/0002-8703(88)90457-7.
Gunda S, Reddy M, Nath J, et al. Impact of periprocedural colchicine on postprocedural management in patients undergoing a left atrial appendage ligation using LARIAT. J Cardiovasc Electrophysiol. 2016;27(1):60–4. doi:10.1111/jce.12869.
Meurin P, Lelay-Kubas S, Pierre B, et al. Colchicine for postoperative pericardial effusion: a multicentre, double-blind, randomised controlled trial. Heart. 2015;101(21):1711–6. doi:10.1136/heartjnl-2015-307827.
Amoli A, Bozorgi A, HajHossein Talasaz A, et al. Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial. Am Heart J. 2015;170(6):1195–201. doi:10.1016/j.ahj.2015.09.020.
John Camm A, Lip GYH, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33(21):2719–47. doi:10.1093/eurheartj/ehs253.
Falk RH. Atrial Fibrillation. N Engl J Med. 2001;344(14):1067–78. doi:10.1016/j.emc.2011.08.008.
Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol. 2011;57(11):e101–98. doi:10.1016/j.jacc.2010.09.013.
Lu YY, Chen YC, Kao YH, et al. Colchicine modulates calcium homeostasis and electrical property of HL-1 cells. J Cell Mol Med. 2016;20(6):1182–90. doi:10.1111/jcmm.12818.
Singhal R, Chang SL, Chong E, et al. Colchicine suppresses atrial fibrillation in failing heart. Int J Cardiol. 2014;176(3):651–60. doi:10.1016/j.ijcard.2014.07.069.
Koyama T, Sekiguchi Y, Tada H, et al. Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation. Am J Cardiol. 2009;103(9):1249–54. doi:10.1016/j.amjcard.2009.01.010.
McCabe JM, Smith LM, Tseng ZH, et al. Protracted CRP elevation after atrial fibrillation ablation. Pacing Clin Electrophysiol. 2008;31(9):1146–51. doi:10.1111/j.1540-8159.2008.01155.x.
Deftereos S, Giannopoulos G, Kossyvakis C, et al. Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study. J Am Coll Cardiol. 2012;60(18):1790–6. doi:10.1016/j.jacc.2012.07.031.
Deftereos S, Giannopoulos G, Efremidis M, et al. Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: mid-term efficacy and effect on quality of life. Heart Rhythm. 2014;11(4):620–8. doi:10.1016/j.hrthm.2014.02.002.
Tabbalat RA, Hamad NM, Alhaddad IA, Hammoudeh A, Akasheh BF, Khader Y. Effect of colchicine on the incidence of atrial fibrillation in open heart surgery patients: END-AF trial. Am Heart J. 2016;178:102–7. doi:10.1016/j.ahj.2016.05.006.
Saxena A, Shi WY, Bappayya S, et al. Postoperative atrial fibrillation after isolated aortic valve replacement: a cause for concern? Ann Thorac Surg. 2013;95(1):133–40. doi:10.1016/j.athoracsur.2012.08.077.
Saxena A, Kapoor J, Dinh DT, Smith JA, Shardey GC, Newcomb AE. Preoperative atrial fibrillation is an independent predictor of worse early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol. 2015;65(3):224–9. doi:10.1016/j.jjcc.2014.06.003.
Bruins P, Te VH, Yazdanbakhsh AP, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997;96(10):3542–8. doi:10.1161/01.CIR.96.10.3542.
Ishii Y, Schuessler RB, Gaynor SL, et al. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation. 2005;111(22):2881–8. doi:10.1161/CIRCULATIONAHA.104.475194.
Imazio M, Brucato A, Ferrazzi P, et al. Colchicine reduces postoperative atrial fibrillation: results of the colchicine for the prevention of the postpericardiotomy syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011;124(21):2290–5. doi:10.1161/CIRCULATIONAHA.111.026153.
Sarzaeem M, Shayan N, Bagheri J, Jebelli M, Mandegar M. Low dose Colchicine in prevention of atrial fibrillation after coronary artery bypass graft: a double blind clinical trial. Tehran Univ Med J. 2014;72(3):147–54.
Zarpelon CS, Netto MC, Jorge JC, Fabris CC, Desengrini D, Silva DG. Colchicine to reduce atrial fibrillation in the postoperative period of myocardial revascularization. Arq Bras Cardiol. 2016;107(1):4–9. doi:10.5935/abc.20160082.
Lee JZ, Singh N, Howe CL, et al. Colchicine for prevention of post-operative atrial fibrillation: a meta-analysis. JACC Clin Electrophysiol. 2016;2(1):78–85. doi:10.1016/j.jacep.2015.09.016.
Bessissow A. Colchicine for prevention of perioperative atrial fibrillation in patients undergoing thoracic surgery (COP-AF): pilot Study. Masters Thesis, Hamilton (ON): McMaster University; 2016. http://hdl.handle.net/11375/20112
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. J Am Coll Cardiol. 2014;64(21):e1–76. doi:10.1016/j.jacc.2014.03.022.
Braunwald E. Heart failure. JACC Heart Fail. 2013;1(1):1–20. doi:10.1016/j.jchf.2012.10.002.
Sato H, Nagai T, Kuppuswamy D, et al. Microtubule stabilization in pressure overload cardiac hypertrophy. J Cell Biol. 1997;139(4):963–73. doi:10.1083/jcb.139.4.963.
Deftereos S, Giannopoulos G, Panagopoulou V, et al. Anti-inflammatory treatment with colchicine in stable chronic heart failure: a prospective, randomized study. JACC Heart Fail. 2014;2(2):131–7. doi:10.1016/j.jchf.2013.11.006.
Crittenden DB, White CJ, DeBerardine M, et al. Colchicine is associated with a decreased rate of myocardial infarction in gout patients: Interim results from a retrospective cohort study. Arthritis Rheum. 2012;64:S71–2.
Nochaiwong S, Ruengorn C, Panyathong S, Nanta S. Association of colchicine with primary and secondary cardiovascular events in peritoneal dialysis patients: a propensity score analysis. Value Health. 2014;17(7):A757. doi:10.1016/j.jval.2014.08.236.
Ridker PM. The JUPITER trial: Results, controversies, and implications for prevention. Circ Cardiovasc Qual Outcomes. 2009;2(3):279–85. doi:10.1161/CIRCOUTCOMES.109.868299.
Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495–504. doi:10.1056/NEJMoa040583.
Klingenberg R, Luscher TF. Inflammation in coronary artery disease and acute myocardial infarction - is the stage set for novel therapies? Curr Pharm Des. 2012;18(28):4358–69. doi:10.2174/138161212802481219.
Drakopoulou M, Toutouzas K, Michelongona A, Tousoulis D, Stefanadis C. Vulnerable plaque and inflammation: potential clinical strategies. Curr Pharm Des. 2011;17(37):4190–209.
Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol. 2013;61(4):404–10. doi:10.1016/j.jacc.2012.10.027.
Nidorf SM, Eikelboom JW, Thompson PL. Colchicine for secondary prevention of cardiovascular disease. Curr Atheroscler Rep. 2014;16(3):391. doi:10.1007/s11883-013-0391-z.
Nidorf M, Thompson PL. Effect of colchicine (0.5 mg twice daily) on high-sensitivity C-reactive protein independent of aspirin and atorvastatin in patients with stable coronary artery disease. Am J Cardiol. 2007;99(6):805–7. doi:10.1016/j.amjcard.2006.10.039.
Martinez GJ, Robertson S, Barraclough J, et al. Colchicine acutely suppresses local cardiac production of inflammatory cytokines in patients with an acute coronary syndrome. J Am Heart Assoc. 2015;4(8):e002128. doi:10.1161/JAHA.115.002128.
Huang C, Ceng C, Wang C, Zhan H, Ding X. Synergistic effects of colchicine combined with atorvastatin in rats with hyperlipidemia. Lipids Health Dis. 2014;13(1):67. doi:10.1186/1476-511X-13-67.
Shah B, Allen N, Harchandani B, et al. Effect of colchicine on platelet-platelet and platelet-leukocyte interactions: a pilot study in healthy subjects. Inflammation. 2016;39(1):182–9. doi:10.1007/s10753-015-0237-7.
Faloon WW, Webb DI, Race TM. Cholesterol lowering effect of colchicine. Ann Intern Med. 1967;66(5):1058. doi:10.7326/0003-4819-66-5-1058_3.
Ercolani LSW. Metabolic and morphologic effects of colchicine on human T-lymphocyte expression of Fc mu and Fc gamma receptors Title. Cell Immunol. 2014;77(2):222–32.
Bauriedel G, Ganesh S, Uberfuhr P, Welsch U, Höfling B. Growth-inhibiting effect of colchicine on cultured vascular wall myocytes from arteriosclerotic lesions. Z Kardiol. 1992;81(2):92–8.
Nidorf SM, Eikelboom JW, Budgeon C, Thompson PL. Low dose colchicine for secondary prevention of cardiovascular disease [LoDoCo]: a randomized controlled trial. Circulation. 2012;126(23):2787. doi:10.1161/CIR.0b013e318278c90d.
Raju NC, Yi Q, Nidorf M, Fagel ND, Hiralal R, Eikelboom JW. Effect of colchicine compared with placebo on high sensitivity C-reactive protein in patients with acute coronary syndrome or acute stroke: A pilot randomized controlled trial. J Thromb Thrombolysis. 2012;33(1):88–94. doi:10.1007/s11239-011-0637-y.
Deftereos S, Giannopoulos G, Angelidis C, et al. Anti-inflammatory treatment with colchicine in acute myocardial infarction: a pilot study. Circulation. 2015;132(15):1395–403. doi:10.1161/CIRCULATIONAHA.115.017611.
O’Keefe JH, McCallister BD, Bateman TM, Kuhnlein DL, Ligon RW, Hartzler GO. Ineffectiveness of colchicine for the prevention of restenosis after coronary angioplasty. J Am Coll Cardiol. 1992;19(7):1597–600. doi:10.1016/0735-1097(92)90624-V.
Freed M, Safian RD, O’Neill WW, Safian M, Jones D, Grines CL. Combination of lovastatin, enalapril, and colchicine does not prevent restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1995;76(16):1185–8. doi:10.1016/S0002-9149(99)80334-8.
Deftereos S, Giannopoulos G, Raisakis K, et al. Colchicine treatment for the prevention of bare-metal stent restenosis in diabetic patients. J Am Coll Cardiol. 2013;61(16):1679–85. doi:10.1016/j.jacc.2013.01.055.
Giannopoulos G, Angelidis C, Kouritas VK, et al. Usefulness of colchicine to reduce perioperative myocardial damage in patients who underwent on-pump coronary artery bypass grafting. Am J Cardiol. 2015;115(10):1376–81. doi:10.1016/j.amjcard.2015.02.036.
US Food and Drug Administration. Information for healthcare professionals: new safety information for colchicine (marketed as Colcrys). Silver Spring: US FDA; 2013.
US Food and Drug Administration/Center for Drug Evaluation and Research. Pharmacol Rev. 2009. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022352s000_PharmR.pdf
Colcrys® (colchicine) oral tablets: US prescribing information. Philadelphia: Mutual Pharmaceutical Company, Inc.; 2009.
Chung ES, Packer M, Lo KH, Fasanmade AA. Anti-TNF therapy against congestive heart failure (ATTACH) trial. Circulation. 2003;107:3133–40.
Terkeltaub RA, Furst DE, Digiacinto JL, Kook KA, Davis MW. Novel evidence-based colchicine dose-reduction algorithm to predict and prevent colchicine toxicity in the presence of cytochrome P450 3A4/P-glycoprotein inhibitors. Arthritis Rheum. 2011;63(8):2226–37. doi:10.1002/art.30389.
Davis MW, Wason S. Effect of steady-state atorvastatin on the pharmacokinetics of a single dose of colchicine in healthy adults under fasted conditions. Clin Drug Investig. 2014;34(4):259–67. doi:10.1007/s40261-013-0168-8.
Sahin G, Korkmaz C, Yalcin AU. Which statin should be used together with colchicine? Clinical experience in three patients with nephrotic syndrome due to AA type amyloidosis. Rheumatol Int. 2008;28(3):289–91. doi:10.1007/s00296-007-0435-1.
Alayli G, Cengiz K, Cantürk F, Durmuş D, Akyol Y, Menekşe EB. Acute myopathy in a patient with concomitant use of pravastatin and colchicine. Ann Pharmacother. 2005;39(7–8):1358–61. doi:10.1345/aph.1E593.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None of the authors involved with this manuscript have any financial or personal relationships with other people or organizations that could inappropriately influence or bias their work. Therefore, Kevin Chen, Aldo L. Schenone, Nyal Borges, Michael Militello, and Venu Menon have no conflicts of interest that might be relevant to the contents of this manuscript.
Funding
No external funding was used in the preparation of this manuscript.
Author Contributions
Kevin Chen, Aldo Schenone, Nyal Borges, and Venu Menon contributed substantially to the conception and design of the work. All authors were responsible for drafting and key revisions to this manuscript. All authors have approved the final version of the manuscript and are accountable for all aspects related to the accuracy or integrity of this manuscript.
Additional information
K. Chen and A. L. Schenone contributed equally in the manuscript.
Rights and permissions
About this article
Cite this article
Chen, K., Schenone, A.L., Borges, N. et al. Teaching an Old Dog New Tricks: Colchicine in Cardiovascular Medicine. Am J Cardiovasc Drugs 17, 347–360 (2017). https://doi.org/10.1007/s40256-017-0226-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40256-017-0226-3