Colchicine

[Admin]

Colchicine

[Admin]

Colchicine intoxication in four elderly patients: How to prevent it?
Le Bellec ML, de la Gastine B, Mosquet B, Godde F, Bekolo RZ, Gloro R, Leterrier C, Coquerel A.
Rev Med Interne. 2009 Apr 9. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/19362394?dopt=Abstract)
INTRODUCTION: In France, unlike other countries, the use of colchicine is preferred to other anti-inflammatory drugs for the treatment of gout.

CASE REPORTS: We report a case series of four elderly patients (range from 72 to 83years of age) who presented with colchicine intoxication, all notified to the Basse-Normandie pharmacovigilance centre in 2007. For each patient, one or more risk factors were identified: renal failure, high initial dosage, absence of laboratory monitoring.

CONCLUSION: It would be useful to establish specific guidelines for colchicine use in the elderly population.

[Admin]

Colchicine: serious interactions.
Prescrire Int. 2008 Aug;17(96):151-3. (http://www.ncbi.nlm.nih.gov/pubmed/19492485?dopt=Abstract)
(1) Renal failure, either pre-existing or induced by a nephrotoxic drug, increases the risk of adverse effects in patients taking colchicine; (2) Combining colchicines with a macrolide (except for spiramycin) carries a risk of life-threatening pancytopenia; (3) Ciclosporin co-administration can aggravate the neuromuscular adverse effects of colchicine; (4) Combining colchicine with lipid-lowering drugs (statins and fibrates) can cause myopathy; (5) Several mechanisms have been implicated: competition for cytochrome P450 or P-glycoprotein, additive adverse effects (especially on muscle), and colchicine accumulation due to a reduction in its renal excretion; (6) Patients with gout should use colchicine only after failure of symptomatic treatment: ice application, paracetamol, and possibly ibuprofen, a nonsteroidal antiinflammatory drug with well-documented adverse effects; (7) If colchicine is nevertheless used, it should be at the minimum effective

[Admin]

Press Release:
Information for Healthcare Professionals: New Safety Information for Colchicine (marketed as Colcrys)FDA ALERT [07/30/2009]: FDA has now approved the first single-ingredient oral colchicine product, Colcrys, for the treatment of familial Mediterranean fever (FMF) and acute gout flares. Oral colchicine has been used for many years as an unapproved drug with no FDA-approved prescribing information, dosage recommendations, or drug interaction warnings.
During the drug application review, FDA identified two previously uncharacterized safety concerns associated with the use of colchicine (marketed as Colcrys).

First, FDA analyzed safety data for colchicine from adverse events reported to the Agency, the published literature, and company-sponsored pharmacokinetic and drug interaction studies. This analysis revealed cases of fatal colchicine toxicity reported in certain patients taking standard therapeutic doses of colchicine and concomitant medications that interact with colchicine, such as clarithromycin. These reports suggest that drug interactions affecting the gastrointestinal absorption and/or hepatic metabolism of colchicine play a central role in the development of colchicine toxicity.

Second, data submitted supporting the safety and efficacy of Colcrys in acute gout flares demonstrated that a substantially lower dose of colchicine was as effective as the higher dose traditionally used. Moreover, patients receiving the lower dose experienced significantly fewer adverse events compared to the higher dose.

Based on this information, FDA is highlighting important safety considerations found in the approved prescribing information to assure safe use of Colcrys.

FDA recommends:

Healthcare professionals not use P-glycoprotein (P-gp) or strong CYP3A4 inhibitors in patients with renal or hepatic impairment who are currently taking colchicine.
Healthcare professionals consider a dose reduction or interruption of colchicine treatment in patients with normal renal and hepatic function if treatment with a P-gp or a strong CYP3A4 inhibitor is required.
Healthcare professionals prescribe the FDA-approved Colcrys dose for the treatment of acute gout flares: 1.2 mg followed by 0.6mg in 1 hour (total 1.8mg).
Healthcare professionals refer to Colcrys’ approved prescribing information for specific dosing recommendations and additional drug interaction information.
Patients review the Medication Guide for important safety information
This information reflects FDA’s current analysis of data available to FDA concerning this drug. FDA intends to update this sheet when additional information or analyses become available.
To report any unexpected adverse or serious events associated with the use of this drug, please contact the FDA MedWatch programusing the information at the bottom of this page.


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Additional Considerations for Healthcare Professionals

Be aware that there is now an FDA-approved single-ingredient colchicine product, Colcrys
Understand that the recommended dose of Colcrys (colchicine) for Familial Mediterranean Fever (FMF) and acute gout flares are different
Be aware that concomitant use of P-gp and strong CYP3A4 inhibitors may cause severe drug interactions with colchicine, including death
Evaluate patients’ underlying susceptibility for colchicine toxicity due to renal and hepatic impairment or age
Understand that concomitant use of colchicine and P-gp or strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment.
Be aware that Colcrys has a Medication Guide and urge patients, their families, and caregivers to review the Medication Guide carefully
Inform patients who are taking colchicine to check with healthcare professionals before taking any new medicine
Information for patients, family members, and caregivers:

Understand that colchicine (Colcrys) is not a pain medication and should not be used for other causes of pain
Understand that life-threatening and fatal drug interactions can occur with Colcrys if it is given with certain medications. These interactions can occur even at prescribed Colcrys doses, and with medications that are given for a limited time, such as antibiotics
Review the Medication Guide that accompanies Colcrys.
Discuss with healthcare professionals all medications being taken and check with them before starting any new medications
Avoid consuming grapefruit and grapefruit juice while using colchicine
Pay close attention for any signs or symptoms of colchicine toxicity such as muscle weakness or pain, numbness or tingling in the fingers or toes, unusual bleeding or bruising, severe diarrhea or vomiting, feeling weak or tired, increased infections, and pale or gray color of the lips, tongue, or palms of hands. If any of these symptoms occur, seek medical attention right away
Background and Data Summary: Severe Drug Interactions
During the drug application review, FDA analyzed safety data for colchicine-related deaths described in the published literature, adverse events reported to FDA’s Adverse Event Reporting System (AERS), and company-sponsored pharmacokinetic and drug interaction studies. The analysis found 169 deaths associated with the use of oral colchicine.

Of the 169 deaths, 117 were not reported as overdoses; i.e., the majority of reported deaths had colchicine doses within the therapeutic range of less than or equal to 2 mg per day. The reported death cases did not contain information regarding patients’ renal or hepatic function. Sixty of the 117 reported deaths (51%) involved patients who were concomitantly using clarithromycin.* These reports suggest alterations in the pharmacokinetics of colchicine played a central role in the development of toxicity.

The pharmacokinetics of colchicine may be affected in several ways. The absorption of colchicine from the gastrointestinal tract is thought to be limited by the multidrug resistance efflux transporter P-glycoprotein (P-gp). Additionally, colchicine is a substrate of intestinal and hepatic cytochrome P450 3A4 (CYP3A4), which catalyzes demethylation of colchicine to inactive metabolites. Colchicine is primarily eliminated by hepatobiliary excretion through the stool. Renal excretion accounts for 10-20% of colchicine elimination in patients with normal renal function.

Consistent with the current understanding of colchicine metabolism, certain drugs increase the potential for colchicine toxicity via modulation of P-gp and CYP3A4 activity. Life-threatening and fatal drug interactions have been reported in patients treated with colchicine when P-gp and strong CYP3A4 inhibitors, particularly clarithromycin, were also being used. In the majority of cases, the doses of colchicine were within the therapeutic range.

Fatal and non-fatal cases of colchicine toxicity have also been reported in the literature with concomitant use of other CYP3A4 and P-gp inhibitors, such as cyclosporine, erythromycin, and calcium channel antagonists such as verapamil and diltiazem. Other examples of P-gp and strong CYP3A4 inhibitors include telithromycin, ketoconazole, itraconazole, HIV protease inhibitors, and nefazodone. Toxicity has also been reported in a patient who began to regularly consume a liter of grapefruit juice daily while being treated chronically with colchicine. Additionally, cases of myopathy and/or rhabdomyolysis in patients receiving colchicine have been reported with concomitant use of statins, fenofibrate/gemfibrozil, cyclosporine, or digoxin.

Based on this information, FDA concludes there is a risk for severe drug interactions in certain patients treated with colchicine and concomitant P-gp or strong CYP3A4 inhibitors. FDA recommends that P-gp or strong CYP3A4 inhibitors not be used in patients with renal or hepatic impairment who are currently taking colchicine. Furthermore, FDA recommends that healthcare professionals consider a dose reduction or interruption of colchicine in patients with normal renal and hepatic function if treatment with a P-gp or a strong CYP3A4 inhibitor is required. The FDA-approved prescribing information for Colcrys contains recommended dosage adjustments.

* The FDA approved prescribing information for clarithromycin (marketed as Biaxin, Biaxin Filmtab, Biaxin XL) was updated in 2005 and 2006 to include this warning: There have been post-marketing reports of colchicine toxicity with concomitant use of clarithromycin and colchicine, especially in the elderly, some of which occurred in patients with renal insufficiency. Deaths have been reported in some such patients.

Data Summary: Acute Gout

For the treatment of acute gout flares, medical texts typically recommend that patients take orally 1.2mg of colchicine followed by 0.6mg every hour until the flare resolves or until gastrointestinal toxicity occurs. However, adequate studies to determine the optimal dose of colchicine in acute gout flares have never been conducted. As part of the application for approval, the manufacturer of Colcrys submitted data from a clinical trial to evaluate the safety and efficacy of a low-dose regimen of oral colchicine for treatment of acute gout flares compared to the traditional high-dose regimen.

The trial was a multicenter, randomized, double-blind, placebo-controlled trial of patients meeting American College of Rheumatology criteria for gout who were assigned to one of three treatment groups within 12 hours of a gout flare, as follows:

Group 1: high-dose colchicine (1.2 mg, then 0.6 mg hourly for 6 hours [4.8 mg total])
Group 2: low-dose colchicine (1.2 mg, then 0.6 mg in 1 hour [1.8 mg total] followed by 5 placebo doses hourly)
Group 3: placebo (2 capsules, then 1 capsule hourly for 6 hours).
The trial found that a statistically significantly greater proportion of patients in the low-dose (38%) and high-dose (33%) colchicine groups achieved a 50% reduction in pain in the target joint compared to placebo (16%). Additionally, the rate of gastrointestinal adverse events (diarrhea, nausea, vomiting, abdominal pain) was considerably lower in low-dose patients (26%) compared to high-dose patients (77%). In addition, there were no severe adverse events reported in low-dose patients compared to 10 reported in high-dose patients.

These findings suggest that prior use of high-dose colchicine may have exposed patients to increased toxicity with no greater efficacy than the low-dose regimen. Based on this trial, FDA recommends that healthcare professionals prescribe the approved Colcrys dose of 1.2mg at onset of acute gout flare followed by 0.6mg in 1 hour, for a total of 1.8mg, and carefully consider the need for additional subsequent dosing. Healthcare professionals should also monitor patients for signs and symptoms of colchicine toxicity.

[Admin]

Colchicine poisoning: a case report.
Wolf A, Oliver M, Nau A, Boulliat C, Puidupin A, Peytel E, Moalic JL.
Ann Biol Clin (Paris). 2009 Sep-Oct;67(5):581-5.
(http://www.ncbi.nlm.nih.gov/pubmed/19789133?dopt=Abstract)Colchicine is a drug commonly used for treatment of acute and chronic gout. Poisoning is a rare but always serious event. The purpose of this report is to describe the case of a 16-year-old girl who ingested an unknown amount of colchicine in a suicide attempt. At the time of admission she presented with gastrointestinal manifestations and reduced consciousness. After ten days in the intensive care unit she died due to multiple organ failure. This case provides the opportunity not only to review the clinical course and prognostic factors associated with colchicine poisoning but also to underline the difficulty of its management due to the absence of a specific antidote and of emergency pharmacologic doses.

[Admin]

Press Release:
COLCRYS® (COLCHICINE, USP) SHOWS SUPERIOR SAFETY WITH COMPARABLE EFFICACY COMPARED TO HIGH-DOSE COLCHICINE IN TREATMENT OF EARLY ACUTE GOUT FLARES

PHILADELPHIA, March 31, 2010 – A newly-published clinical study demonstrates that Colcrys® (colchicine, USP), a low-dose oral colchicine, is just as effective as high-dose colchicine in reducing pain associated with early acute gout flare, but with a safety profile statistically indistinguishable from placebo.



The study, “High vs. Low-dosing of Oral Colchicine for Early Acute Gout Flare: Twenty-Four Hour Outcome Results of the First Randomized, Placebo-Controlled, Dose Comparison Colchicine Trial,” details the AGREE (Acute Gout Flare Receiving Colchicine Evaluation) trial, the first placebo-controlled comparison of low-dose and high-dose colchicine in the treatment of acute gout flares. The study was published in the April issue of Arthritis & Rheumatism, the official journal of the American College of Rheumatology. AGREE formed the basis for URL Pharma’s New Drug Application (NDA) submission for Colcrys to the U.S. Food and Drug Administration (FDA).



“For centuries, colchicine for the indication of acute gouty arthritis has been dosed at levels higher than clinically necessary,” said Robert A. Terkeltaub, M.D., Section Chief, Rheumatology-Allergy, VA Medical Center San Diego, and Professor of Medicine and Rheumatology Training Program Director, University of California San Diego. “This study is the first to demonstrate that a low-dose colchicine regimen is just as effective as a high-dose regimen in the treatment of early gout flare, defined as within 12 hours of symptom onset. The low dose colchicine regimen of only a total 3 tablets of 0.6 mg given over only one hour avoids the significant toxicities traditionally associated with high doses repeated over many hours, in this case a total of 8 tablets of 0.6 mg colchicine given over 6 hours.” Dr. Terkeltaub was the primary investigator and lead author for the AGREE trial.



Colcrys received approval from the FDA on July 30, 2009 for the treatment of acute gout flares at the first sign of a flare, and for the prevention of gout flares on October 19, 2009. Colcrys is the first and only single-ingredient colchicine to receive FDA approval. Other single-ingredient colchicine products currently on the market have never received regulatory review or approval, and have been traditionally used at doses that cause severe toxicities in nearly all patients.



“The approval of Colcrys was based on strong science that included the AGREE trial and 16 additional clinical studies conducted by URL Pharma that determined, for the first time, the appropriate dose and toxicity profile of colchicine for the treatment of gout,” said Richard H. Roberts, M.D., Ph.D., President, CEO and Chairman, URL Pharma. “These studies uncovered serious, potentially life-threatening interactions with commonly used treatments such as hypertension drugs and antibiotics. Our research represents a major therapeutic step forward for patients, and provides important new guidance for physicians on the safe and appropriate use of colchicine.” The FDA has reported on 169 deaths associated with unapproved colchicine.



Study Details

The multicenter, randomized, double-blind, placebo-controlled, parallel-group study evaluated the safety and efficacy of low- vs. high-dose colchicine in male and postmenopausal female patients aged ≥18 years with a confirmed past diagnosis of gout and ≥2 gout flares within the prior 12 months. A stable regimen of urate-lowering therapy was permitted. A total of 575 patients were randomized into one of three treatment groups: 1) a novel “low-dose” abbreviated colchicine regimen (Colcrys) group; 2) a “high-dose” colchicine regimen group that reflects long-standing medical practice and is still actively taught to physicians; 3) placebo. The primary endpoint was ≥50% pain reduction at 24 hours without rescue medication.



Among 184 patients in the intent-to-treat population, results at 24 hours demonstrated superior safety of Colcrys, without loss of efficacy, relative to high-dose colchicine for early acute gout flares when self-administered within 12 hours of flare onset. The percent of patients responding to treatment was proportionally greater in the Colcrys group compared to the high-dose and placebo arms across the entire pain improvement range. The overall adverse events (AEs) profile for Colcrys was statistically similar to placebo (36.5% versus 27.1%, respectively). The high dose associated with unapproved colchicine resulted in significantly more adverse events when compared to Colcrys and placebo, including diarrhea (76.9%, 23.0% and 13.6 % respectively), nausea (17.3%, 4.1% and 5.1% respectively) and vomiting (17.3% versus 0% for both Colcrys and placebo). All AEs in the low-dose group were mild to moderate in intensity while 19.2% of the high-dose group had AEs of severe intensity, all of which were diarrhea.

[Admin]

Colchicine poisoning: the dark side of an ancient drug.
Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Nguyen P, Dubnov-Raz G, Pollak U, Koren G, Bentur Y.
Clin Toxicol (Phila). 2010 Jun;48(5):407-14.
(http://www.ncbi.nlm.nih.gov/pubmed/20586571?dopt=Abstract)
Introduction. Colchicine is used mainly for the treatment and prevention of gout and for familial Mediterranean fever (FMF). It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. Although colchicine poisoning is sometimes intentional, unintentional toxicity is common and often associated with a poor outcome.

Methods. We performed a systematic review by searching OVID MEDLINE between 1966 and January 2010. The search strategy included "colchicine" and "poisoning" or "overdose" or "toxicity" or "intoxication."

Toxicokinetics. Colchicine is readily absorbed after oral administration, but undergoes extensive first-pass metabolism. It is widely distributed and binds to intracellular elements. Colchicine is primarily metabolized by the liver, undergoes significant enterohepatic re-circulation, and is also excreted by the kidneys.

Therapeutic and toxic doses. The usual adult oral doses for FMF is 1.2-2.4 mg/day; in acute gout 1.2 mg/day and for gout prophylaxis 0.5-0.6 mg/day three to four times a week. High fatality rate was reported after acute ingestions exceeding 0.5 mg/kg. The lowest reported lethal doses of oral colchicine are 7-26 mg.

Drug interactions. CYP 3A4 and P-glycoprotein inhibitors, such as clarithromycin, erythromycin, ketoconazole, ciclosporin, and natural grapefruit juice can increase colchicine concentrations. Co-administration with statins may increase the risk of myopathy. Mechanisms of toxicity. Colchicine's toxicity is an extension of its mechanism of action - binding to tubulin and disrupting the microtubular network. As a result, affected cells experience impaired protein assembly, decreased endocytosis and exocytosis, altered cell morphology, decreased cellular motility, arrest of mitosis, and interrupted cardiac myocyte conduction and contractility. The culmination of these mechanisms leads to multi-organ dysfunction and failure. Reproductive toxicology and lactation. Colchicine was not shown to adversely affect reproductive potential in males or females. It crosses the placenta but there is no evidence of fetal toxicity. Colchicine is excreted into breast milk and considered compatible with lactation.

Clinical features. Colchicine poisoning presents in three sequential and usually overlapping phases: 1) 10-24 h after ingestion - gastrointestinal phase mimicking gastroenteritis may be absent after intravenous administration; 2) 24 h to 7 days after ingestion - multi-organ dysfunction. Death results from rapidly progressive multi-organ failure and sepsis. Delayed presentation, pre-existing renal or liver impairment are associated with poor prognosis. 3) Recovery typically occurs within a few weeks of ingestion, and is generally a complete recovery barring complications of the acute illness. Diagnosis. History of ingestion of tablets, parenteral administration, or consumption of colchicine-containing plants suggest the diagnosis. Colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome (gastroenteritis, hypotension, lactic acidosis, and prerenal azotemia).

Management. Timely gastrointestinal decontamination should be considered with activated charcoal, and very large, recent (<60 min) ingestions may warrant gastric lavage. Supportive treatments including administration of granulocyte colony-stimulating factor are the mainstay of treatment. Although a specific experimental treatment (Fab fragment antibodies) for colchicine poisoning has been used, it is not commercially available.

Conclusion. Although colchicine poisoning is relatively uncommon, it is imperative to recognize its features as it is associated with a high mortality rate when missed.

[die_GOUT_die]

Colchicine is off the market. It was pulled by the FDA.

[hyperuric]

Colchicine is off the market. It was pulled by the FDA.

I don't think that is true, but the new Rx I got is Colchrys. So far, all it has done is give me diarrhea, while the old script would have helped my pain by now.

[die_GOUT_die]

The generic was pulled. Colchrys is available but is out of control expensive. I'm talking like $3 a pill.

[tiger2118]

The new colcrys does not work like colchicine.....

[tiger2118]

you can go to there website and get a 7 free pills for colcrys and a $75.00 off at colcrys.com

[Admin]

Press Release:
Newly-Published Colchicine Safety Data Provide First Evidence-Based Dosing Guidance to Avoid Potentially Serious Interactions With Commonly Prescribed Drugs
PHILADELPHIA, Aug. 11, 2011 /PRNewswire/ -- Newly-published results from a series of colchicine safety studies provide physicians with the first evidence-based dosing guidance for colchicine when co-administered with certain commonly prescribed drugs, helping doctors and patients avoid serious and potentially life-threatening drug-drug interactions.

The study results, published in a paper titled "Evidence Basis of a Novel Colchicine Dose Reduction Algorithm to Predict and Prevent Colchicine Toxicity in the Presence of P-gp/CYP450 3A4 Inhibitors," appear in the August issue of Arthritis & Rheumatism, the journal of the American College of Rheumatology. The paper recommends colchicine dose reductions when used with medications such as immunosuppressants, antibiotics, hypertension drugs, anti-fungals and protease inhibitors.

The seven studies highlighted in the paper formed part of the basis for URL Pharma's New Drug Application (NDA) for Colcrys® (colchicine, USP). Colcrys is the only single-ingredient colchicine product to be reviewed and approved by the U.S. Food and Drug Administration, and is indicated for the prophylaxis and treatment of gout flares, and for the treatment of Familial Mediterranean Fever (FMF).

The studies assessed cyclosporine, an immunosuppressant; clarithromycin and azithromycin, two antibiotics; diltiazem and verapamil, two hypertension drugs; ketoconazole, an anti-fungal drug; and ritonavir, a protease inhibitor. Each of these drugs is known to inhibit cytochrome P450 3A4 (CYP3A4) and/or P-glycoprotein (P-gp).

Each of these drugs, except for azithromycin, was found to interact significantly with standard colchicine dosing regimens, in some cases more than doubling levels of colchicine in the blood and increasing the risk of serious toxicities. Cyclosporine and clarithromycin in particular increased peak colchicine blood levels by nearly 300 percent. The authors recommended that colchicine doses be reduced between one-third and two-thirds for acute flares, and by 50 to 75 percent for flare prophylaxis, when used as concomitant therapy with six of the seven drugs studied. No colchicine dose adjustments were necessary when used with azithromycin.

In the case of ritonavir, the discovery of serious interactions with colchicine prompted the FDA on May 5, 2010 to require that the new dosing recommendations be included in the prescribing information of all protease inhibitors.

"Despite the fact that colchicine has been used for decades in the prevention and treatment of gout flares and for FMF, the pharmacokinetics and metabolism of colchicine have not been extensively studied, until now," said Robert A. Terkeltaub, M.D., Interim Division Chief and Professor of Medicine at the University of California San Diego and the VA Medical Center, and the paper's lead author. "The results of these studies form the foundation of evidence-based dosing guidance for colchicine in the presence of CYP3A4 or P-gp inhibitors that help achieve optimal therapeutic benefit while avoiding dangerous and unnecessary safety risks."

Safety issues resulting from the concurrent use of colchicine with CYP3A4 or P-gp inhibitors have been documented in the past. At least 60 deaths have been linked to colchicine in patients who were also taking clarithromycin, but there have been no published studies characterizing these interactions, nor any suggestions or recommendations to modify colchicine dosing, according to the authors.

"The need to understand, and avoid, colchicine drug-drug interactions is greater than ever, especially in people with gout," said Matthew W. Davis, M.D., R.Ph., Chief Medical Officer, URL Pharma and a co-author of the paper. "Many gout patients struggle with obesity and have multiple co-morbid conditions, including hypertension, diabetes, metabolic syndrome and renal insufficiency, which may require patients to be on multiple medications. These studies are part of our continued investigation of the pharmacokinetics of colchicine, and reflect our ongoing commitment to making the necessary research investments to advance colchicine science."

[llopatin]

Hi,
Does anyone know a Canadian pharmacy which can supply colchicine to US customers, preferably without a prescription? I awfully wary about sending a payment to people I don't know. I'm looking to hear personal experiences from patients, so if you are connected with a seller, please don't respond with an advertisement.
Thank.

[MyFootHurts]

Hi,
Does anyone know a Canadian pharmacy which can supply colchicine to US customers, preferably without a prescription? I awfully wary about sending a payment to people I don't know. I'm looking to hear personal experiences from patients, so if you are connected with a seller, please don't respond with an advertisement.
Thank.

I bought a bunch of colchicine from 4rx.com. No prescription required. The storefront is in St. Kitts and the pills shipped from India. It took about a month for the order to arrive here in the US.

The pills are 0.5mg instead of 0.6mg, but work just fine. My cost, including shipping, worked out to about 35 cents per pill.

Get 10% off with this code: Z89BH32J

[llopatin]

you can go to there website and get a 7 free pills for colcrys and a $75.00 off at colcrys.com

Hmm...7 pills could last a day or 2 in case of an attack. And if you were using it for prophylaxis, well maybe it's a week's worth at most. Not good enough. And by the way, how much is it per pill after the $75 off? I was paying just over 11 cents a pill at Walmart. What's the cost of colcrys going to be?

[Abriton]

Hi,
Does anyone know a Canadian pharmacy which can supply colchicine to US customers, preferably without a prescription? I awfully wary about sending a payment to people I don't know. I'm looking to hear personal experiences from patients, so if you are connected with a seller, please don't respond with an advertisement.
Thank.

Register with Canadadrugsonline.com and fax them your prescription. Colchicine is $65 for 100 0.6 pills with #10 shipping. Takes about 7 days and they are totally reliable. Been using them for a long time. They have other strengths as well.

[petersimon786]

I have seen people in the pain from gouts and must say it’s one of the horrible disease or pain I have seen. But you know that’s a good thing people are becoming aware for this disease and getting information for it’s cure..I am happy to see the results from gout treatment...


treatment for gout (http://gout-treatment.org/gout-treatment.html)