Colchicine (Colcrys®) is a drug typically indicated for gout or familial Mediterranean fever that we learned about in one of our top drugs sessions. Colchicine is a microtubule disruptor, and it can also be used to reduce the occurrence of atrial fibrillation after someone undergoes an operation or ablation. There has not been much research completed on the effects of colchicine on atrial myocytes (cells in the heart muscle), so that is what this study aimed to find out.
The purpose of this study was to determine if colchicine can regulate calcium (Ca2+) homeostasis and reduce the electrical effects of the extracellular matrix on atrial myocytes. HL-1 cells are a specific type of muscle cell. In this study, HL-1 cells derived from mouse atrial muscle cells were treated with and without (control) colchicine over a 24 hour period.
The results of the study were that colchicine-treated HL-1 cells, in comparison to control cells, had a longer action potential duration with smaller intracellular Ca2+ transients and sarcoplasmic reticulum Ca2+ content by 10% and 47%, respectively. The results of this study show that colchicine acts to prevent atrial fibrillation by controlling atrial electrical activity, regulating Ca2+, and reducing the electrical effects of collagen.
I find this study interesting because I learned that colchicine has another use besides treating gout and familial Mediterranean fever. Gout and atrial fibrillation are two very different medical conditions, so it is interesting that some drugs function in ways that can effect many different pathways in the human body. In all honesty, this study was very complicated and difficult for me to interpret. I still don’t understand everything that was tested, but reading over this study was good practice for developing my literature-reviewing skills. I picked out the information that was most relevant to me as a student pharmacist, which was how colchicine physiologically prevents atrial fibrillation. It will be important as a pharmacist to keep up with literature showing alternate uses for medications so we know how to handle our patients that are taking drugs for non-FDA approved uses.
My question posed to colleagues: What are your thoughts about colchicine being used to prevent atrial fibrillation in post-operative patients?
Lu, YY, Chen, YC, Kao, YH, et al. Colchicine modulates calcium homeostasis and electrical property of HL-1 cells. J Cell Mol Med. 2016;20:1-9.
When prescribing medications for the initiation of a new therapy in patients with multiple chronic diseases, physicians often look to guidelines to determine their recommended treatment option. While this is considered good practice, it is important to not look at the disease state as a singular entity when choosing a therapy for the patient to follow due to the effects that certain conditions have on one another. This study looked to analyze the association between guideline recommended drugs and death in older adults with multiple chronic disease states. To do this, 8578 adults aged 65 and older were monitored though three years of treatment. Patients involved in the study had a variety of disease states including but not limited to atrial fibrillation, chronic kidney disease, depression, diabetes, and hyperlipidemia. Results from the study showed that over 50% of the participants received guideline recommended drugs without the consideration of other disease states. Although 15% of the patients died during the course of the study, researchers were able to determine that cardiovascular medications were associated with a decrease in mortality. Other guideline medications analyzed in the study did not show an association with reduced mortality. Overall, it was determined that choosing medication therapy for patients should only be done after fully analyzing the patients other conditions.
I believe this study is important due to the fact that guideline recommended medications are commonly dispensed in the pharmacy setting. It is thus important for us to understand how guideline drugs interact with each other to protect a patient at the point of treatment initiation. By doing this, we will be able to avoid adverse drug effects that can result due to medication interactions. I believe that this is one of the most important roles of a pharmacist because it helps promote patient well-being and increases the likelihood of medication regiment adherence. The goal of our profession is to protect patients and advise them on how to find ways to live a healthy lifestyle. The easiest way to do this is by starting at the roots of the solution.
Tinoetti M, McAvay G, Trentalange M, et al. Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study. BMJ 2015; 351: h4984