Decontamination

As colchicine is a highly toxic drug with no effective treatment, early (within 2 hours after ingestion) gastrointestinal decontamination with activated charcoal has a critical role in minimising toxicity. However, activated charcoal may not be tolerated due to colchicine’s toxic gastrointestinal effects (vomiting, diarrhoea). Consult a clinical toxicologist early on the use of activated charcoal in all patients with colchicine poisoning.

Offer activated charcoal to alert and cooperative patients who are able to protect their airway and have ingested:

  • more than 6 mg of colchicine
  • more than 0.1 mg/kg of colchicine
  • more than 0.05 mg/kg colchicine and are at increased risk of toxicity1.

Give activated charcoal to patients who have ingested the following more toxic doses:

  • more than 0.3 mg/kg of colchicine
  • more than 20 mg of colchicine
  • more than 0.1 mg/kg of colchicine and are at increased risk of toxicity1.

In these patients, consider intubation to facilitate administration of activated charcoal2. If the patient is intubated, activated charcoal can be given any time via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Follow decontamination with enhanced elimination using multiple-dose activated charcoal for patients who have ingested:

  • more than 0.5 mg/kg of colchicine
  • more than 0.1 mg/kg of colchicine and are at increased risk of toxicity1.
1 Risk factors for colchicine toxicity include the use of drugs that interact with colchicine, kidney impairment and liver impairment.Return
2 Colchicine poisoning is one of the few indications for giving activated charcoal to patients even if sedation and intubation are required to facilitate administration.Return