Colchicine in Pericardial Disease: from the Underlying Biology and Clinical Benefits to the Drug-Drug Interactions in Cardiovascular Medicine
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Purpose of Review
This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease.
Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine.
The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.
KeywordsColchicine Pericardial disease Toxicity Drug interactions
Aldo L. Schenone and Venu Menon contributed substantially to the conception and design of the work. Both authors were responsible for drafting and key revisions to this manuscript. Both authors have approved the final version of the manuscript and are accountable for all aspects related to the accuracy or integrity of this manuscript.
Compliance with Ethical Standards
Conflict of Interest
Both authors involved with this manuscript have no financial or personal relationships with other people or organizations that could inappropriately influence or bias their work. Therefore, Aldo L. Schenone and Venu Menon have no conflicts of interest that might be relevant to the contents of this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.Chen K, Schenone A, Borges N, et al. Teaching an old dog new tricks: colchicine in cardiovascular medicine. Am J Cardiovasc Drugs. Google Scholar
- 8.• Xu B, Harb SC, Cremer PC. New insights into pericarditis: mechanisms of injury and therapeutic targets. Curr Cardiol Rep. 19 https://doi.org/10.1007/s11886-017-0866-6. This study provides a thorough review on the therapeutic targets in pericarditis.
- 12.Dauphin C, E M, A C, et al. Recurrent pericarditis: current challenges and future prospects. Res Rep Clin Cardiol. 2016;7:99–108.Google Scholar
- 23.Colcrys (colchicine) US prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022351lbl.pdf (2011, accessed 23 January 2018).
- 25.Imazio M, Brucato A, Ferrazzi P, Rovere ME, Gandino A, Cemin R, et al. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011;124:2290–5.CrossRefPubMedGoogle Scholar
- 26.Cremer PC, Tariq MU, Karwa A, Alraies MC, Benatti R, Schuster A, Agarwal S, Flamm SD, Kwon DH, Klein AL Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging 8. https://doi.org/10.1161/CIRCIMAGING.114.003125.
- 27.Feng D, Glockner J, Kim K, Martinez M, Syed IS, Araoz P, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011;124:1830–7.CrossRefPubMedGoogle Scholar
- 28.Aviv M, Yeela T, Chezar AC, et al. Does colchicine decrease the rate of recurrence of acute idiopathic pericarditis treated with glucocorticoids? J Cardiol. https://doi.org/10.1016/j.jjcc.2017.10.005.
- 33.FDA/Center for Drug Evaluation and Research. Colchicine Medical Reviews https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022351s000_SumR.pdf (2008).
- 34.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 34.Google Scholar
- 38.•• Wiggins BS, Saseen JJ, Page RL, et al. Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2016;134:e468–95. This consensus document provides clinically relevant data on the coadministration of colchicine and statin. CrossRefPubMedGoogle Scholar
- 40.•• Terkeltaub RA, Furst DE, Digiacinto JL, et al. 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;63:2226–37. This study provides colchicine dosing recommendation for concomitant therapy with CYP3A4 and P-gp inhibitors. CrossRefPubMedGoogle Scholar
- 46.Hemkens Lars G, Ewald H, Gloy Viktoria L, et al. Colchicine for prevention of cardiovascular events. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011047.pub2.