💊⚕️ New buzz in cardiology – Colchicine (Lodoco) 0.5 mg/day 💥 for chronic coronary disease (CCD). Why? Anti-inflammatory effects 📉 reducing CV risk.
🔍 Evidence suggests adding colchicine to standard care (antiplatelets, statins, etc.) in CCD may prevent 1 CV event per 36 pts treated over 2 yrs. It also helps if started after MI, but colchicine won’t reduce death risk, mainly angina, MI, stroke 🚫. Data is limited for pts w/ eGFR <60.
🚨 Safety concerns: Colchicine has a narrow therapeutic window 🧪. Toxicities like low blood counts or rhabdo risk 📈 rise in pts w/ liver/kidney disease or those on CYP3A4/P-gp inhibitors (e.g., grapefruit 🍊, itraconazole).
🧾 Key Takeaways:
- Lodoco is costly 💰 and often needs prior authorization 📑. Stick to colchicine 0.5 mg, not 0.6 mg – evidence lacking for CV risk reduction w/ higher doses.
- Focus on adherence to standard CCD care (antiplatelets, BP control, cholesterol meds) before adding colchicine.
- Save colchicine for select pts w/ recurrent events despite optimized Rx, only if eGFR >60 & drug interactions avoided.
- Educate pts to report muscle pain 🦵 or GI upset 🚽. Watch for interactions w/ statins (↑ myopathy risk) & other meds.
References
- Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020;383(19):1838-1847.
- Low-Dose colchicine for atherosclerosis: Key points - American College of Cardiology. (2024, April 15). American College of Cardiology. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2024/04/15/14/43/low-dose-colchicine-for
