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Granulocyte-colony stimulating factor in the treatment of colchicine poisoning

Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital

Lester AH Critchley

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories

Elce Au Yeung

Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital

Robert P Young

Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital

Robert J Young

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories

Thomas YK Chan

Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital

Victor KM Goh

The Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong

1 Colchicine is a highly active alkaloid used in the treatment of gouty arthritis and pseudogout. In over dose colchicine inhibits cell division effecting organs with a high rate of cell turn-over, such as the gastrointestinal tract and bone marrow. Early fatality results from cardiovascular collapse and respiratory failure, however pancytopenia and overwhelming septicaemia can occur later.

2 We describe a case of suicidal ingestion of 25 - 30 mg of colchicine in a previously healthy 43-year-old woman. Initial symptoms were mainly gastrointestinal. By day 5 she had developed severe pancytopenia and early sepsis, which were successfully treated using granu locyte colony stimulating factor (G-CSF) 600 µg s.c.

3 In vitro G-CSF is produced by the haematopoietic system. However, G-CSF can now be produced by recombinant DNA cloning technology and thus is available clinically.

4 There is no recognised antidote for colchicine poison ing and treatment is symptomatic. Fab fragments may have a promising future in eliminating colchicine from the body, but are currently not clinically available. In those patients that survive the initial phase of poisoning, G-CSF offers an effective method of treating the pancytopenia and preventing overwhelming septi caemia. Daily monitoring of the patient's haematolo gical status is strongly recommended.

Key Words: colchicine poisoning • pancytopenia • G-CSF • Fab fragments

Human & Experimental Toxicology, Vol. 16, No. 4, 229-232 (1997)
DOI: 10.1177/096032719701600413


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