Colchicine overdose: the devil is in the detail.

Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the near universally fatal consequence of a significant overdose is commonly under-appreciated. In this report, we present a case series of 9 patients over the past 15 years (from within the Auckland region of New Zealand) that have presented with a colchicine overdose. Surprisingly, a significant number were accidental overdoses and all cases, apart from one, resulted in death. We question the current knowledge base about the toxicity of this drug amongst prescribers, patients, and their families and its use in the treatment of acute gout. Given its extremely narrow therapeutic index, should the manner in which medical practitioners prescribe this drug be reassessed?