Colchicine is a lipophilic drug used to treat various conditions, including gout, primary biliary cirrhosis, familial Mediterranean fever, and several other disorders. It possesses a very narrow therapeutic index that predisposes to poisoning. Patients initially present with gastrointestinal complaints followed by multiorgan failure (the liver, heart, and kidneys are mainly affected) and bone marrow suppression that leads to sepsis. The diagnostic workup must confirm the recent use of this drug, whereas a full laboratory workup is necessary to determine the extent of organ damage.
Presentation
The clinical presentation of colchicine poisoning stems from the potent effects of the drug [1] [2] [3]. Colchicine disrupts the assembly of microtubules and higher doses can promote severe disruption of various cellular mechanisms [1] [3] [4]. The majority of studies describe colchicine poisoning in three phases [1] [2] [5]:
- Gastrointestinal phase - Within the first day following the ingestion of higher doses, the first symptoms appear, including diarrhea, nausea, vomiting, and abdominal pain, mimicking gastroenteritis [1] [3].
- Multi-organ damage phase - Considered as the critical period of colchicine poisoning, the first week is characterized by the onset of severe and progressive muscle weakness accompanied by failure of several organs, including the kidneys, liver, and bone marrow [1] [2] [3] [5] [6]. Bone marrow suppression is a known complication that may lead to sepsis, whereas hypovolemic shock and cardiac failure are the most important causes of death from colchicine poisoning [1] [5]. Neuropathy and myopathy are also described in many patients, particularly in cases of chronic ingestion of subtoxic or toxic doses [3] [6]. Some studies also mention neurological symptoms (stupor, coma, seizures, or delirium), dysrhythmias, pancreatitis, and rhabdomyolysis [2].
- Recovery phase - With early and adequate treatment, a complete recovery can occur in a few weeks, although some sequelae, including severe neuromuscular disability, has been documented [6].
Entire Body System
- Fever
Case 3– A five-year-old girl presented to our emergency department for fever and gastroenteritis which started two days ago, and leucopenia (white blood count: 1200/mm3). [archivesofrheumatology.org]
The use of colchicine was due to diagnosis of Familial Mediterranean fever (FMF) in the families of 8 patients, diagnosis of Behçet disease in 1 patient's father, diagnosis of Behçet disease in 1 patient herself, and diagnosis of FMF in 6 patients themselves [ncbi.nlm.nih.gov]
Colchicine is a lipophilic drug used to treat various conditions, including gout, primary biliary cirrhosis, familial Mediterranean fever, and several other disorders. It possesses a very narrow therapeutic index that predisposes to poisoning. [symptoma.com]
- Weakness
Multi-organ damage phase - Considered as the critical period of colchicine poisoning, the first week is characterized by the onset of severe and progressive muscle weakness accompanied by failure of several organs, including the kidneys, liver, and bone [symptoma.com]
Some patients develop neuromyopathy (mild to severe myalgia, muscle weakness, numbness and fatigue) with chronic dosing, mostly without GI symptoms. [dpic.org]
A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum–like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. [pediatrics.aappublications.org]
Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]
The drug has a wide range of applications: used not only in the treatment of weak erection and premature ejaculation, but also to improve potency and endurance of the reproductive system, increase the duration of sexual intercourse. [vumxxdo.gq]
- Anemia
On laboratory investigation severe thrombocytopenia and leukopenia, mild anemia, a moderate increase in aspartate aminotransferase and alanine aminotransferase levels were detected. [pediatrics.aappublications.org]
Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side effects include fetal damage in pregnant women anemia [resource4thepeople.com]
More seriously, Colchicine can reduce the white blood cells count, damage bone marrow and lead to anemia (lower than normal number of red blood cells / not enough hemoglobin). [mypeyronies.com]
Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]
The acute toxicity of colchicine is well known: abdominal pain, gastroenteritis with vomiting and diarrhea, hypokalemia, metabolic acidosis, aplastic anemia complicated by hemorrhage, and infection can result (1,3-6). [thefreelibrary.com]
- Fatigue
Some patients develop neuromyopathy (mild to severe myalgia, muscle weakness, numbness and fatigue) with chronic dosing, mostly without GI symptoms. [dpic.org]
Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]
- Severe Pain
This stimulates mobilization of polymorphonuclear (PMN) leukocytes and other inflammatory mediators to the affected joints, most commonly the great toe or elbow, resulting in severe pain, swelling and an episode of gout. [calpoison.org]
Respiratoric
- Sore Throat
Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]
The next patient has a sore throat. House makes him wait. Cuddy comes in an examines the patient. House acts like he's surprised the patient has a sore throat. Cuddy sends the patient home to drink hot tea. [house.wikia.com]
- Cough
In another scene, Brandon comments on how the cough medicine Cameron gives him has a letter on them which his old ones do not. In the pharmacy, the determined House finds the colchicine pill that looks similar to the cough medicine. [thephysicianslibrary1.blogspot.com]
However, it turns out they gave the patient the cough medicine after all. House has to admit he was wrong although his theory was perfect. However, he now thinks the cough medicine may have caused the problem. [house.wikia.com]
Gastrointestinal
- Vomiting
Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]
A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]
Possible side effects of taking this drug include vomiting, nausea, stomach pain and diarrhea [1, 2, 3, 4]. How much is Colchicine Toxicity? The exact Colchicine dose that causes toxicity symptoms is still unknown. [overdoseinfo.com]
Her only symptom was vomiting on admission. The patient's physical examination revealed lethargy with no other remarkable findings. [thefreelibrary.com]
- Nausea
Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]
A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]
- Diarrhea
Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]
A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]
Possible side effects of taking this drug include vomiting, nausea, stomach pain and diarrhea [1, 2, 3, 4]. How much is Colchicine Toxicity? The exact Colchicine dose that causes toxicity symptoms is still unknown. [overdoseinfo.com]
She complained of abdominal pain, vomiting, and diarrhea. We treated her conservatively and admitted her to the intensive care unit. [ekjm.org]
- Abdominal Pain
Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]
She complained of abdominal pain, vomiting, and diarrhea. We treated her conservatively and admitted her to the intensive care unit. [ekjm.org]
The majority of studies describe colchicine poisoning in three phases: Gastrointestinal phase - Within the first day following the ingestion of higher doses, the first symptoms appear, including diarrhea, nausea, vomiting, and abdominal pain, mimicking [symptoma.com]
Early symptoms include abdominal pain, nausea, vomiting and diarrhoea. Symptoms occurring after 1 to 7 days include: confusion, cardiac, renal and hepatic impairment, respiratory distress, hyperpyrexia and bone marrow depression. [medsafe.govt.nz]
Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]
Cardiovascular
- Hypotension
Delayed symptoms of colchicine toxicity include seizures, cardiac dysrhythmias, hypotension, shock, coagulopathy, pancytopenia and respiratory, renal, and hepatic failure. [calpoison.org]
Colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome (gastroenteritis, hypotension, lactic acidosis, and prerenal azotemia). [ncbi.nlm.nih.gov]
In the ED, she had epigastric pain, nausea, and hypotension, which can develop in stage 1 of colchicine intoxication. [kjccm.org]
In our case the compensatory excretion was not possible since the patient's chronic renal insufficiency was additionally deteriorated by hypotension, hypoxia and rhabdomyolysis due to the colchicine effect on muscle cells. [ccforum.biomedcentral.com]
The patient became hypotensive and a dopamine and dobutamine infusion was started. Unfortunately, the patient subsequently developed bradycardia, which progressed to asystolic cardiac arrest, and he died in the 3rd hour of admission. [thefreelibrary.com]
Liver, Gall & Pancreas
- Hepatomegaly
This includes kidney damage, which causes low urine output and bloody urine ; low white blood cell counts that can last for several days; anemia ; muscular weakness; liver failure ; hepatomegaly ; bone marrow suppression ; thrombocytopenia ; and ascending [en.wikipedia.org]
Musculoskeletal
- Myopathy
Clinical features, pathophysiology, and treatment of polymyositis and dermatomyositis; inclusion body myositis; metabolic myopathies; drug-induced myopathies; muscular dystrophies and neurologic diseases; laboratory testing and imaging; electrophysiological [books.google.com]
Neuropathy and myopathy are also described in many patients, particularly in cases of chronic ingestion of subtoxic or toxic doses. [symptoma.com]
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. [ncbi.nlm.nih.gov]
[…] considered as second-line therapy of gout because it has a narrow therapeutic window and a high rate of side effects. [4] The main untoward effects of colchicine include nausea, vomiting, diarrhoea, and abdominal pain, bone marrow suppression and proximal myopathy [indianjnephrol.org]
Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]
Skin
- Alopecia
Massive generalized alopecia after poisoning by Gloriosa superba. Br Med J 1966;1:1023-4. 10. Duff IF, Mikkelsen WM, Salin RW. Alopecia totalis after desacetylmethylcolchicine therapy of acute gout; report of a case. N Engl J Med 1956;255:769-70. [ijtrichology.com]
It usually starts after day seven when there is resolution of organ failure, rebound leukocytosis and alopecia. Rebound leukocytosis and alopecia occurred in first and third patients in our study. [archivesofrheumatology.org]
One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. CONCLUSIONS: Mortality of colchicine toxicity is high and quick assessment is absolutely required. [ncbi.nlm.nih.gov]
[…] of plasma elimination of drug, due to colchicine attaches plasma proteins in %32–50 ratios.When she had fever, we observed closely clinical view of septic shock.After she was transferred to pediatric service of our hospital, It has been learned that alopecia [journals.lww.com]
- Purpura
Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]
Resistance 1 2 Recruiting Treatment Colchicine / Coronary Artery Disease / Inflammatory Reaction / Severe or persistent diarrhea / Type 2 Diabetes Mellitus / White Blood Cell 1 2 Recruiting Treatment Cutaneous Polyarteritis Nodosa / Henoch-Schönlein Purpura [drugbank.ca]
- Eruptions
Improve your competency and readiness with the latest guidance on volcanic eruptions, extreme sports, splints and slings, wilderness cardiology, living off the land, aerospace medicine, mental health in the wilderness, tactical combat casualty care, and [books.google.com]
Urogenital
- Kidney Failure
Kidney failure can onset, along with severe internal bleeding. Treatment for colchicine poisoning focuses on supportive therapy to keep the patient alive. [wisegeek.net]
Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]
The tests show the antibiotics didn't cause the kidney failure. House informs them the patient is getting better. House tells Wilson he criticizes his fellows to make them feel terrible because it will make them better doctors. [house.wikia.com]
Over the next two days his liver and kidney enzymes were through the roof, a clear sign of multi-organ failure. He was sent to the ICU, placed on a ventilator, and eventually died of heart failure (2). [naturespoisons.com]
failure (including those on dialysis ). [18] About 10-20 percent of a colchicine dose is excreted unchanged by the kidneys; it is not removed by hemodialysis. [en.wikipedia.org]
- Anuria
Oliguria and then anuria ensued and were not responsive to supportive measures. He continued to deteriorate and death occurred approximately 11 hours after admission. [emj.bmj.com]
Nine hours post-admission to the ICU, the patient developed anuria with worsening metabolic acidosis, hyperlactacidemia, and multiorgan dysfunction (respiratory, renal, hepatic, and hematologic), presenting a new episode of cardiac arrest with asystole [cureus.com]
Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]
- Oliguria
He also complained oliguria on day 6. Patient's wife has brought the tuber. It was identified as G. superba. Patient revealed that he had consumed 250 g of the tuber along with water. Patient had no history of any illness. [indianjnephrol.org]
Oliguria and then anuria ensued and were not responsive to supportive measures. He continued to deteriorate and death occurred approximately 11 hours after admission. [emj.bmj.com]
Kidney damage, evidenced by hematuria and oliguria, may occur. Muscular weakness may be marked, and ascending paralysis of the central nervous system may develop; the patient usually remains conscious. Delirium and convulsions may occur. [drugbank.ca]
Neurologic
- Confusion
We report a further case in which two persons confused this highly poisonous plant with wild garlic ( Allium ursinum ), a popular spice in the Central European cuisine. [maltawildplants.com]
Symptoms occurring after 1 to 7 days include: confusion, cardiac, renal and hepatic impairment, respiratory distress, hyperpyrexia and bone marrow depression. [medsafe.govt.nz]
It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. [ncbi.nlm.nih.gov]
Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]
A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum–like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. [pediatrics.aappublications.org]
- Seizure
Some studies also mention neurological symptoms (stupor, coma, seizures, or delirium), dysrhythmias, pancreatitis, and rhabdomyolysis. [symptoma.com]
Delayed symptoms of colchicine toxicity include seizures, cardiac dysrhythmias, hypotension, shock, coagulopathy, pancytopenia and respiratory, renal, and hepatic failure. [calpoison.org]
After the sedative drug (midazolam, 3 mg/hr.) used during the MV was discontinued, seizure-like movements were not observed. [kjccm.org]
Neurologic symptoms are also evident, including seizures, confusion, and delirium ; children may experience hallucinations. [en.wikipedia.org]
- Somnolence
On the second day the patient became somnolent and developed respiratory insufficiency. The echocardiogram showed heart dilatation with diffuse hypokinesia with positive troponin I. [ccforum.biomedcentral.com]
The physical examination revealed state of somnolence, tachypnea, tachycardia, difficulty in breathing, and central cyanosis. [thefreelibrary.com]
- Peripheral Neuropathy
Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]
Workup
Although the presentation of colchicine poisoning consists of nonspecific gastrointestinal and systemic symptoms, the physician must obtain a detailed patient history and conduct a thorough laboratory workup in order to narrow down the differential diagnosis. Colchicine is extensively metabolized in the liver (and in the kidneys to some extent), meaning that several drugs may enhance its effect, eg. statins, antimicrobial drugs (clarithromycin, erythromycin, and ketoconazole), cyclosporine, but also grapefruit juice [1] [7]. For this reason, medication history is particularly important for identifying possible poisoning due to colchicine [1]. After assessing the course and progression of symptoms, a comprehensive laboratory assessment is mandatory. Typical findings in colchicine poisoning are high creatine phosphokinase levels (CPK, or CK), lactic acidosis, azotemia (pre-renal), electrolyte imbalance, and abnormally high liver transaminases, whereas coagulopathies are also found in some cases [1] [2] [6]. Leukocytosis is seen in the initial stages, but severe leukopenia and pancytopenia are detected in the multi-organ damage phase, due to bone marrow suppression [2]. Electrophysiologic studies may be of use in the setting of an undisclosed diagnosis, showing specific patterns of motor unity myopathy in muscles of the trunk and the proximal limbs and complex repetitive discharges [5] [7].
Serum
- Leukopenia
Leukocytosis is seen in the initial stages, but severe leukopenia and pancytopenia are detected in the multi-organ damage phase, due to bone marrow suppression. [symptoma.com]
Subsequent complications include bone marrow suppression with resultant leukopenia, thrombocytopenia (nadir in 4-7 days), and possibly sepsis (1). [emergency.cdc.gov]
On laboratory investigation severe thrombocytopenia and leukopenia, mild anemia, a moderate increase in aspartate aminotransferase and alanine aminotransferase levels were detected. [pediatrics.aappublications.org]
G-CSF has been used for leukopenia (although this may be more useful to treat secondary sepsis rather than colchicine-induced leukopenia). Disposition All patients with deliberate self poisoning with colchicine should be admitted for observation. [lifeinthefastlane.com]
Colony stimulating factors such as G-CSF have been used for the treatment of colchicine-induced leukopenia. [calpoison.org]
Treatment
This alkaloid found in Colchicum autumnale is used primarily in the treatment of gout. [ncbi.nlm.nih.gov]
Colchicine is only indicated for intermittent use and patients will often initiate treatment themselves; therefore the potential exists for a severe drug interaction to occur. [medsafe.govt.nz]
As mentioned earlier, colchicine is used as prophylaxis and treatment for gout flares and for Mediterranean fever treatment. This drug is known to interact with hundreds of medications such as warfarin ( Coumadin ), aspirin and Vitamin C. [overdoseinfo.com]
Treatment for colchicine poisoning focuses on supportive therapy to keep the patient alive. Failing organ systems may be managed with dialysis and mechanical ventilation while the patient receives care. [wisegeek.net]
Prognosis
It is characterized by multiorgan involvement and by poor prognosis associated with overdose. In this article we present four children with colchicine poisoning to emphasize that colchicine poisoning has a large spectrum in childhood. [ncbi.nlm.nih.gov]
Colchicine intoxication is characterized by multiorgan involvement and by the poor prognosis associated with administration of large amounts of the drug. [einstein.pure.elsevier.com]
Early elevation of leukocyte count may predict poor prognosis. Following oral administration, colchicine rapidly and extensively diffuses into tissue. [archivesofrheumatology.org]
Etiology
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty. [emergency.cdc.gov]
Epidemiology
IMMUNOTOXICANTS IN HUMAN BEINGS 296 SURVEILLANCE OF ATRISK HUMANS EXPOSED TO IMMUNOTOXICANTS 297 CLINICAL ASSESSMENT OF IMMUNOTOXICITY 298 CLINICAL IMMUNOLOGY ENDPOINTS TO ASSESS NONSPECIFIC IMMUNITY 300 IMMUNE ENDPOINTS ADOPTED BY THE ATSDR 301 ENVIRONMENTAL EPIDEMIOLOGY [books.google.com]
Probable : A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for colchicine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case [emergency.cdc.gov]
| 2010 199 Epidemiology of hydrogen sulfide poisoning in Japan Iida, K. | 2010 206 Response of the Tokyo Fire Department to hydrogen sulfide poisoning incidents caused by detergents and other household chemicals Ishikawa, Y. | 2010 212 Clinical aspect [tib.eu]
Epidemiology The primary use of colchicine is in the prevention and treatment of painful exacerbations of gouty arthritis. [calpoison.org]
Although cases of multiorgan failure have been described in adults with doses usually higher than 0.8 mg/kg, the epidemiology data are scarce and the intoxication mechanisms are not well-known. [cureus.com]
Pathophysiology
Clinical features, pathophysiology, and treatment of polymyositis and dermatomyositis; inclusion body myositis; metabolic myopathies; drug-induced myopathies; muscular dystrophies and neurologic diseases; laboratory testing and imaging; electrophysiological [books.google.com]
Pathophysiology Colchicine’s effectiveness in treating gout is due to its ability to decrease the response of granulocytes and other inflammatory cells. [calpoison.org]
Medical Center Ljubljana, Ljubljana, Slovenia (5) Professor, Head, Center for Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia (6) Associated Professor, Medical Faculty and Department for Cardiology, Institute for Pathophysiology [ccforum.biomedcentral.com]
We review the literature about the subject, pharmacology of the drug, toxicological pathophysiology, and evidence about therapeutic support. [cureus.com]
Prevention
How to prevent Colchicine Toxicity? An overdose in colchicine can be prevented by following the prescription orders of the physician. Additional dosage of the drug must not be done without the knowledge of the physician. [overdoseinfo.com]
In those patients that survive the initial phase of poisoning, G-CSF offers an effective method of treating the pancytopenia and preventing overwhelming septicaemia. Daily monitoring of the patient's haematological status is strongly recommended. [ncbi.nlm.nih.gov]
Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation. [books.google.com]
This prevents damage to the organs and body tissues and allows the colchicine to be eliminated through the urine. [ema.europa.eu]
But luckily there is an alternative, because natural treatments are effective in relieving and even preventing gout. These treatments can be as simple as eating certain foods and avoiding others. [curegoutpainnow.com]
References
- Finkelstein Y, Aks SE, Hutson JR, et al. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010;48(5):407-414.
- Aghabiklooei A1, Zamani N, Hassanian-Moghaddam H, Nasouhi S, Mashayekhian M. Acute colchicine overdose: report of three cases. Reumatismo. 2014;65(6):307-311.
- Iosfina I, Lan J, Chin C, Werb R, Levin A. Massive Colchicine Overdose with Recovery. Case Rep Nephrol Urol. 2012;2(1):20-24.
- Maxwell MJ, Muthu P, Pritty PE. Accidental colchicine overdose: a case report and literature review. Emerg Med J. 2002;19:265–267.
- Ozdemir R, Bayrakci B, Teksam O. Fatal poisoning in children: acute colchicine intoxication and new treatment approaches. Clin Toxicol (Phila). 2011;49(8):739-743.
- Medani S, Wall C. Colchicine toxicity in renal patients - Are we paying attention? Clin Nephrol. 2016;86(2):100-105.
- Huh K, Joung JY, Jeong H, et al. Colchicine-induced myoneuropathy in a cyclosporine-treated renal transplant recipient. Kidney Res Clin Pract 2013;32(2):74-77.