Most physicians, i think, are aware of the toxicity of colchicine and know that dose modifications are essential in patients with certain common conditions.

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Take colchicine capsules exactly as your healthcare provider tells you to take itColchicine capsules can be taken with or without foodIf you take too much colchicine capsulescall your healthcare provider or go to the nearest hospital emergency room right awayDo not stop taking colchicine capsules unless your healthcare provider tells you toIf you miss a dose of colchicine capsulestake it as soon as you rememberIf it is almost time for your next doseskip the missed doseTake the next dose at your regular timeDo not take 2 doses at the same timeIf you have a gout flare while taking colchicine capsulestell your healthcare provider.

Published reports on the pharmacokinetics of intravenous colchicine in patients with severe chronic liver diseaseas well as those with alcoholic or primary biliary cirrhosisand normal renal function suggest wide inter-patient variabilityIn some subjects with mild to moderate cirrhosisthe clearance of colchicine is significantly reduced and plasma half-life prolonged compared to healthy subjectsIn subjects with primary biliary cirrhosisno consistent trends were notedSee Hepatic ImpairmentNo pharmacokinetic data are available for patients with severe hepatic impairmentChild-Pugh C

The concomitant use of colchicine capsules and inhibitors of P-glycoproteine.gclarithromycinketoconazolecyclosporineetcshould be avoided due to the potential for serious and life-threatening toxicitySee WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY

Patients with liver or renal impairment should be carefully monitored for adverse effects of colchicinesee section 5.2

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it is important that you do not take more than 12 tablets of colchicine as a course of treatment during any one gout attack.