Colchicine

Evidence Level: L5

Predicted Indications: 2

Colchicine

Pharmacist Assessment Report

Colchicine: From Gout and Familial Mediterranean Fever to Plasmodium falciparum Malaria

One-Sentence Summary

Colchicine is an anti-inflammatory drug originally used to treat gout and familial Mediterranean fever (FMF). The TxGNN model predicts it may be effective for Plasmodium falciparum malaria, but this is a computational prediction with 0 clinical trials and only 2 laboratory-level publications behind it, so evidence is very limited.

Quick Overview

Item	Content
Original Indication	Gout; familial Mediterranean fever (the Canadian licence records contain no indication text)
Predicted New Indication	Plasmodium falciparum malaria
TxGNN Prediction Score	0.9960
Evidence Level	L5
Canada Market Status	Marketed (marketed DINs: 4 of 5; dormant: 1)
Number of DINs	5 (marketed: 4)
Recommended Decision	Hold

Why is This Prediction Reasonable?

Currently, detailed mechanism of action data is not available in the compiled data. Based on well-known pharmacology, colchicine binds tubulin and disrupts microtubule polymerization. Plasmodium falciparum relies on microtubules for spindle formation and parasite development, so a tubulin-targeting mechanism is biologically plausible.

The link to the original indications is weak. Gout and FMF are inflammatory conditions treated through colchicine’s effect on neutrophil activity, whereas malaria is a parasitic infection. The prediction therefore rests on a shared target (microtubules) rather than a shared disease process.

The supporting literature does not test colchicine as an antimalarial in people. One paper studies curcumin and microtubule disruption in P. falciparum. The other studies pfmdr1 expression in mammalian cells and chloroquine susceptibility, which concerns drug transport. Colchicine’s narrow therapeutic index and known human toxicity are significant barriers to any antimalarial use. The high score should be read as a model output only.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

PMID	Year	Type	Journal	Key Findings
23505424	2013	Preclinical (in vitro)	PLoS One	Curcumin, not colchicine, disrupts microtubules in P. falciparum; supports microtubules as a parasite target
7511206	1994	Preclinical (cell-based)	Mol Cell Biol	Expressing the parasite pfmdr1 gene in mammalian cells increased chloroquine susceptibility; relates to drug transport, not colchicine efficacy

Canada Market Information

DIN	Product Name	Dosage Form	Approved Indication
02373823	JAMP-COLCHICINE	Not listed	Not listed
02402181	PMS-COLCHICINE	Not listed	Not listed
00572349	COLCHICINE TAB 0.6MG	Not listed	Not listed
02456559	EURO-COLCHICINE	Not listed	Not listed
02519380	MYINFLA	Not listed	Not listed

Safety Considerations

Safety information comes from the drug-disease contraindication links in the knowledge graph, not from the package insert. It should be confirmed against the Health Canada label.

Contraindication signals (knowledge graph):
- Liver failure and impaired renal function
- Blood disorders: hematologic disease, thrombocytopenia, leukopenia, agranulocytosis, neutropenia (including congenital and idiopathic forms), aplastic anemia
- Muscle disorders: myopathy, rhabdomyolysis, familial periodic paralysis
- Gastrointestinal disorders: peptic ulcer disease, diarrheal disease
- Acute urate nephropathy
Drug Interactions (100 recorded; examples below):
- Major: clarithromycin, cobicistat, aprepitant, rolapitant, eliglustat, deferiprone, rosuvastatin, simvastatin
- Moderate: chloroquine, cimetidine, metronidazole, tinidazole, miconazole, ticagrelor, deferasirox, disulfiram

Chloroquine is a moderate interaction, which matters if colchicine were ever considered alongside standard antimalarial therapy.

Conclusion and Next Steps

Decision: Hold

Rationale: The prediction has no clinical trial support, and the only two papers are in vitro or cell-based studies that do not test colchicine against malaria. Colchicine’s toxicity and narrow therapeutic index add a major safety barrier. Better-tolerated, established antimalarials already exist.

To proceed, the following is needed:

In vitro testing of colchicine against P. falciparum (including chloroquine-resistant strains), with a selectivity index compared with human cell toxicity
Detailed mechanism of action data
Health Canada package insert warnings and contraindications
A safety and drug-interaction assessment covering the antimalarial drugs that would be co-administered
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.