A COMPREHENSIVE INVESTIGATION OF INPATIENT INTRAVENOUS COLCHICINE USESHOWS MORE EDUCATION IS NEEDED

Objective. To test the hypothesis that colchicine therapy for patients in whom treatment was guided by rheumatology consultation was more ap propriately prescribed than therapy for patients not receiving consult ation. Methods. A retrospective chart review of all inpatients with ac ute crystal induced arthritis who received intravenous (iv) colchicine was performed to assess iv colchicine prescribing errors and any adve rse outcomes of iv colchicine therapy. Results. Errors in the prescrib ing of iv colchicine occurred in 5 of 19 patients (26%). A rheumatolog y consultation was not obtained in any of these cases. Overall, there was a significant increase in the prescribing error rate in the no-con sultation versus the consultation groups (p = 0.045). These 5 errors d id not lead to serious adverse outcomes, but leukopenia occurred in on e patient and the white blood cell count decreased from 7.3 to 4.3 cel ls/mm(3) in another patient. Leukopenia also occurred in 3 patients in whom iv colchicine was used appropriately, Conclusion. (1) Previously published guidelines for iv colchicine use appeared successful at pre venting serious colchicine toxicity. (2) These guidelines do not prote ct against leukopenia occurring from colchicine use. (3) Rheumatology consultation may help prevent errors in the use of iv colchicine. (4) Further education is needed in the correct use of iv colchicine.