Colchicine vs LODOCO

Colchicine has been a first-line medication for gout, a painful condition caused by too much uric acid in the blood, for many years. In June 2023, the U.S. Food and Drug Administration (FDA) approved low-dose colchicine (0.5 mg) under the brand name LODOCO. This approval marked colchicine as the first anti-inflammatory medication for preventing heart attacks and strokes in people with existing heart disease or multiple risk factors for cardiovascular disease.

By understanding the distinctions between LODOCO and colchicine, including their uses, dosages, and benefits, you can make more informed decisions about your health care. Whether managing gout or protecting your heart, these medications offer significant benefits when used correctly under a doctor's supervision.

Use

Colchicine for Gout

Typically, for gout treatment, colchicine is used at a slightly higher dose, such as 0.6 mg, and may be taken more than once a day, depending on the doctor's advice.

• To prevent and treat gout attacks and to manage Familial Mediterranean fever (FMF).
• How to Use for Gout: When a gout attack starts, the usual advice is to take two colchicine tablets right away, then one more tablet one hour later. To prevent future gout flares, a lower daily dose is recommended. However, during an active gout attack, avoid taking it daily; a single dose should be spaced out at least three days apart.

Learn more about 9 Drugs to Combat Gout

LODOCO for Heart Health

• LODOCO is a low-dose colchicine tablet (0.5 mg) designed to protect against cardiovascular diseases. It works as an anti-inflammatory and has been shown to significantly reduce the risk of heart-related events by 31% in adults with atherosclerosis or multiple cardiovascular risk factors.
• How to Use: Take one LODOCO tablet by mouth, once a day, with or without food. It can be used on its own or in combination with other standard heart disease treatments, like lipid-lowering medications, to lower the risk of heart attacks, strokes, and other serious cardiovascular events.

Mechanism of action

Colchicine works for gout by reducing inflammation caused by urate crystal deposits in the joints. It inhibits the migration of immune cells to the affected area, thereby easing pain and swelling during gout attacks.

For Familial Mediterranean Fever (FMF), colchicine helps manage symptoms by suppressing inflammation and reducing the frequency and severity of fever episodes characteristic of the condition. Although its exact mechanism in FMF is not fully understood, colchicine's anti- inflammatory properties play an important role in alleviating symptoms and improving your quality of life.

The way LODOCO works to reduce the risk of stroke and heart issues remains unclear. However, it is believed to work by anti-inflammatory effects and interference with certain cellular processes involved in the development of atherosclerosis.

Learn more about Cholesterol and Inflammation

Dosage

When comparing LODOCO and colchicine in the context of dosage, it's important to understand why the seemingly minor difference matters significantly for patient care and treatment outcomes. LODOCO, dosed at 0.5 mg, is tailored specifically for long-term management, prioritizing safety and the reduction of toxicity risks. On the other hand, colchicine, with a typical dosage of 0.6 mg, is formulated for the acute treatment of gout flare-ups rather than for chronic use.

The distinction in dosing—0.5 mg versus 0.6 mg—might appear negligible. However, this difference has serious implications for both efficacy and safety. Colchicine at 0.6 mg is potent and effective in quickly mitigating the painful symptoms of a gout attack. Yet, its strength also means that when used chronically, it significantly raises the risk of colchicine toxicity. This condition is not only dangerous but can exacerbate the likelihood of experiencing serious side effects.

LODOCO, conversely, is engineered with chronic, preventative treatment in mind. Its slightly lower dose of 0.5 mg is not a matter of random choice but a carefully calibrated decision to ensure that patients can use the medication over the long term without the increased risk of toxicity. This dosage aims to maintain the necessary therapeutic benefits while minimizing the potential for side effects that could arise from prolonged exposure to higher levels of the medication in the bloodstream.

Side Effects

When comparing the side effects of LODOCO and colchicine, it's important to remember both medications contain colchicine as their active ingredient, which can lead to similar side effects due to their shared mechanism of action. However, the specific use case and dosage might affect the frequency and severity of these side effects.

Common Side Effects

Colchicine

• Diarrhea
• Nausea
• Fatigue
• Throat pain
• Stomach pain
• Headache

LODOCO

• Diarrhea
• Vomiting
• Stomach cramps or pain
• Muscle pain (Myalgia)

Serious Side Effects

Colchicine

• Muscle pain or weakness
• Severe nausea or vomiting
• Numbness or tingly sensation in fingers or toes
• Fever, chills, body aches, flu-like symptoms
• A pale or gray appearance of lips, tongue, or hands
• Bruising, unusual bleeding, feeling weak or tired

LODOCO

• Blood-related issues (low counts of red and white blood cells, and platelets) which could be life-threatening
• Muscle weakness or neuromuscular toxicity (with symptoms like dark brown urine, severe muscle weakness or pain, fever, or tiredness)

Contraindications and Interactions

Both LODOCO and colchicine have restrictions on use in patients with liver or kidney issues and share a common advisory against the consumption of grapefruit or grapefruit juice. The main difference lies in the specific contraindications and the breadth of known medication interactions, with colchicine having a longer list of medications that could lead to increased levels and potential toxicity if combined.

Contraindications

Colchicine: It's crucial to inform your healthcare provider if you have liver or kidney disease before starting colchicine, as the medication may not be safe or suitable for you.

LODOCO: LODOCO is generally not suitable for people with certain conditions or those taking specific medications. This includes individuals with:

• Renal (kidney) failure
• Severe hepatic (liver) impairment
• Pre-existing blood disorders
• Allergies to colchicine or any of its components Additionally, it's advised to avoid LODOCO if you're on CYP3A4 inhibitors or P-gp inhibitors, like cyclosporine or clarithromycin, due to increased risk of side effects.

Interactions

Colchicine: Consuming grapefruit or grapefruit juice while on colchicine is discouraged due to the risk of heightened side effects. Furthermore, colchicine can interact with a wide range of medications, potentially leading to dangerous levels of colchicine in the body. Some of these include:

• Digoxin
• Itraconazole
• Ketoconazole
• Atazanavir

LODOCO: When taking LODOCO, steer clear of grapefruit and grapefruit juice. These can raise the risk of experiencing side effects by increasing the medication's concentration in your body.

Speak with Your Doctor

It's important to understand that Colchicine is FDA-approved for treating symptoms of gout and Familial Mediterranean Fever. However, the branded medication, LODOCO (colchicine), has FDA approval for preventing heart problems.

Despite sharing the same active ingredient, colchicine, these are distinct medications with varying dosages.

That’s why it is recommended to speak with your healthcare provider to determine which medication is most appropriate for you.