Intervention
Low-Dose Colchicine
Last updated Sat May 30 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
RCT evidence— LoDoCo2 + COLCOT
What it is
Colchicine is an alkaloid from Colchicum autumnale (autumn crocus), in medicinal use for >2000 years. It binds tubulin and blocks microtubule polymerisation, with downstream anti-inflammatory effects including NLRP3 inflammasome inhibition.
Modern cardiovascular indication
- COLCOT (2019): 0.5 mg/day after recent MI reduced cardiovascular events 23%.
- LoDoCo2 (2020): 0.5 mg/day in stable coronary disease reduced composite events 31%.
- FDA approval (June 2023): low-dose colchicine (Lodoco) for reduction of MI/stroke/coronary revascularisation/CV death in adults with established ASCVD or multiple risk factors.
Other established uses
- Acute gout flare and chronic gout prevention.
- Familial Mediterranean fever.
- Recurrent pericarditis.
- Behçet’s disease.
Drug interactions matter
- Strong CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir) — can cause life-threatening toxicity at standard doses.
- P-gp inhibitors (cyclosporine, verapamil).
- Statins — mild interaction; rare myopathy.
- Caution in renal impairment (no clearance, accumulates).
Acute overdose
Colchicine has a narrow therapeutic window; overdose causes multi-organ failure with no antidote. Keep tablets out of children’s reach.
Related entries
NLRP3 inflammasome, Cardiovascular disease, Canakinumab, hsCRP.
References
- Nidorf, S. M. et al. Colchicine in patients with chronic coronary disease (LoDoCo2). N. Engl. J. Med. 383, 1838–1847 (2020).