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Colchicine Side Effects — EECC MCQ

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EasyPericardial DiseaseColchicine Side EffectsEECC

A 55-year-old man with recurrent pericarditis on colchicine and low-dose prednisolone asks about the long-term side effects of colchicine. Which adverse effect is most important to monitor for?

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Correct answer: E — GI intolerance (diarrhoea, nausea) is the most common side effect; rare but serious effects include bone marrow suppression and neuromyopathy with prolonged use, requiring periodic FBC monitoring

Colchicine is a cornerstone of pericarditis treatment (Class I for acute and recurrent pericarditis). Common side effects include GI symptoms (diarrhoea in 10-20%, nausea, abdominal pain), which are usually dose-dependent and manageable. Rare but serious adverse effects with prolonged use include: bone marrow suppression (pancytopenia), neuromyopathy (especially with concomitant statin use or renal impairment), and rhabdomyolysis. The 2025 ESC Myocarditis/Pericarditis Guidelines recommend: weight-based dosing (0.5 mg daily if <70 kg; 0.5 mg bd if ≥70 kg), periodic FBC monitoring, and dose adjustment in renal impairment (CrCl <30: dose reduction or avoidance). Colchicine does not cause QT prolongation.

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis; BNF