Composition, origin
Colchicine is a medicine derived from the colchicum flower.
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It is available as a 1 mg tablet, split in two if necessary.
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Colchimax® is a tablet that also contains Tiémonium methylsulfate and opium powder. It slows transit slightly. It is not recommended in cases of dialysis or breast-feeding.
Indication
Colchicine has been indicated for familial Mediterranean fever (FMF) under the term "treatment of periodic illness" since 1972.
It must be prescribed on a long-term basis to all FMF patients. Contraindications are exceptional.
It helps prevent disease flare-ups and the onset of inflammatory amyloidosis (AA).
Prescription
In adults, the starting dose is 1 mg/day orally. It can be increased to the minimum effective dose, in increments of 0.5 mg every 3 months or more, up to a maximum of 2.5 mg/day.
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For children:
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-before age 5, the recommended starting dose is 0.5 mg/day.
- after age 5, 1 mg/day is prescribed.
-from the age of 10, doses are adjusted as for adults.
Tolerance
The main side effect of Colchicine is diarrhea. To counteract this effect, you can:
- divide the dose into two parts (morning and evening) if necessary.
- Take probiotics (e.g. yoghurts with active bifidus, carboleur prescribed by your doctor).
- Use anti-diarrheal agents such as racecadotril/ Tiorfan®. Loperamide/ Imodium® is not recommended.
Fertility, pregnancy & breastfeeding
The potentially deleterious effect of Colchicine on male and female fertility has never been demonstrated.
Colchicine should be continued at usual doses throughout pregnancy: it is not associated with an increased risk of fetal malformation or miscarriage, whereas untreated disease is.
European guidelines endorse and recommend its use during pregnancy and breastfeeding.
The CRAT (www.lecrat.fr) does not agree with the acronym "attention grossesse et médicament = danger" ("caution pregnancy and medication = danger") on Colchicine boxes.
For breast-feeding, we recommend taking Colchicine at the same time as a feed, as its peak concentration in breast milk occurs around 2 hours after oral administration. It is also advisable to take Colchicine in the evening, as night feeds become less frequent and the child is less exposed.
Colchimax®, which contains tiemonium methylsulfate and opium powder, is contraindicated during breast-feeding.
Precautions
Colchicine is a potentially toxic drug if the dosage prescribed by your doctor and certain precautions are not followed.
When taking antibiotics such as macrolides or pristinamycin, the dose should be reduced or temporarily suspended.
In case of renal or hepatic insufficiency, dosage must be adapted.
There's no need to stop taking it in the event of infection, surgery, anesthesia or vaccination,
As a general rule, it is advisable to keep boxes of Colchicine out of sight and reach of young children.
Practical questions
If a dose is forgotten, colchicine should be taken at the same time as it is remembered.
In the event of an attack, it is not advisable to increase the dose of colchicine temporarily, as this has never been shown to be effective.
Colchicine must continue to be taken even in the absence of attacks, to avoid the risk of inflammatory amyloidosis.
Colchicine
What is Anakinra?
Anakinra is an exceptional drug belonging to the family of biotherapies targeting interleukin-1 (IL-1), one of the molecules responsible for the symptoms of inflammation in autoinflammatory diseases.
It is an IL-1 receptor antagonist, which blocks its effect in the body, thereby blocking the symptoms of inflammation.
Indication and dosage
Anakinra is a 2nd-line drug with indications in:
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Cryopyrinopathies
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Still's disease
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Familial Mediterranean fever in patients with resistance, intolerance or contraindication to colchicine.
It is prescribed by your specialist doctor on an exceptional prescription. Once collected from the pharmacy, it must be kept refrigerated.
It is taken as a subcutaneous injection via a pre-filled syringe at a fixed dose of 100 mg per day. The injection can be performed by the patient himself, or with the help of a home care nurse.
Before prescribing Anakinra
Before starting Anakinra, your specialist will carry out a check-up to rule out any contraindications to treatment, and to rule out any progressive infections (particularly dental or pulmonary).
You will also need to update your mandatory vaccinations with your GP, and get vaccinated against influenza and pneumococcus.
Board of Directors
Take Anakinra out of the fridge 15 to 30 minutes before injection, to bring it to room temperature.
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You can place an ice pack in a cloth on the skin for 15 minutes to anesthetize the skin and 15 minutes after the injection.
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Carefully disinfect the skin around the injection site, varying the injection sites each day (right lower abdomen, then left, right thigh, then left, or right arm, then left).
Do not purge the pre-filled syringe before administration.
Tolerance
Anakinra requires monthly biological monitoring initially, then more frequently every 2-3 months.
The main side effect of Anakinra is redness at the injection site. If administration advice is not sufficient to avoid this redness, your doctor may prescribe a hydrocortisone cream to be applied after the injection.
These reactions usually occur after 2 weeks' use and disappear within 4 to 6 weeks.
Practical questions
In the event of an infection with fever persisting for > 48 hours, you should consult your doctor as soon as possible to review the situation.
Anakinra does not need to be discontinued in the event of scaling, extraction or dental implant placement. Your dentist will prescribe antibiotic therapy to accompany the procedure. In the case of more extensive surgery, your dentist should discuss the possibility of temporarily stopping Anakinra with your specialist.
In the event of surgery, your surgeon will need to discuss with your specialist whether Anakinra should be temporarily discontinued.
Vaccination under Anakinra
The only vaccines contraindicated when taking Anakinra are live attenuated vaccines.
If you need to be vaccinated, particularly if you're traveling in a tropical country, you should inform your specialist so that Anakinra can be temporarily suspended.
Annual flu vaccination is strongly recommended.
Fertility, pregnancy & breastfeeding
Limited data are available on the use of Anakinra in pregnant women. No effect of Anakinra on fertility, early development, embryo-fetal development or peri- and post-natal development has been observed in rats at doses up to 100 times the human therapeutic dose.
As a result, we sometimes prescribe Anakinra for certain autoinflammatory diseases, even during pregnancy, after carefully explaining the benefits and risks to the patient.
Excretion of Anakinra and its metabolites into breast milk is unknown. However, CRAT monitoring data are reassuring, and its use during breast-feeding may be envisaged in agreement with the referring physician and pediatrician.