A 77 year old male has a past medical history of gout, atrial fibrillation, hypertension, GI ulcer, chronic kidney disease, and anemia.  He presents at this visit with worsening gout symptoms and has been taking Ibuprofen as needed up to four to fives times per day for the last day or two.

His current medications include:

• Warfarin
• Aspirin
• Diltiazem
• Omeprazole
• Allopurinol
• Docusate
• Ferrous Sulfate

With the worsening gout symptoms and minimal response from the ibuprofen, the primary provider orders colchicine 0.6 mg twice daily as needed.

With this order, there is a couple of medication related concerns that jump out at me initially.  The first would be the potential interaction with diltiazem.  Per Lexicomp, the resulting effect of the diltiazem and colchicine interaction would potentially be raised serum concentrations of colchicine.

Another potential concern is that this patient has CKD (chronic kidney disease).  Colchicine is eliminated through the kidney, and in an acute flare where the colchicine is only used minimally, this may not be an issue.  However, if the colchicine is used frequently multiple times consistently, the drug could begin to accumulate potentially causing adverse effects (diarrhea being the major side effect).

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