Ways of developing a colchicine intoxication:
(1) suicide
(2) accidental, while self-dosing (during an attack of gout, etc)
(3) accidental, mistaking tablets
(4) excessive dose prescribed
(5) error in formulation, with excessive content
(6) decreased drug elimination due to comorbid condition
(7) decreased drug elimination due to drug interference, with drug accumulation
(8) error in drug schedule (ignoring drug-free interval)
Sources of colchicines:
(1) pharmaceutical
(2) plant (meadow saffron)
Comorbid conditions that may result in a decrease in colchicine elimination:
(1) decreased renal function ( creatinine clearance <= 50 mL per minute)
(2) advanced age (limit not defined; will use >= 65 years)
(3) extrahepatic biliary obstruction
(4) combined renal and hepatic disease
Drugs that may interfere with CYP3A4 include:
(1) diltiazem
(2) grapefruit juice
(3) ketoconazole
(4) erythromycin
(5) oleandomycin
(6) cimetidine (generalized inhibition of P450)
