Use of Colchicine to Treat Severe Constipation in Developmentally Disabled Patients
The developmentally disabled often suffer some of the worst difficulties with constipation, since they more commonly also experience hypotonia, autonomic dysfunction decreasing bowel motility, physical inactivity, and polypharmacy. Based upon an n = 1 experience with a person suffering chronic constipation refractory to traditional measures, Frame and colleagues successfully managed this patient with colchicine 0.5 mg tid. Following this success, Frame et al performed a prospective, double-blind, crossover study of colchicine vs. placebo for eight weeks in developmentally disabled patients who required three or more laxatives to manage chronic constipation.
As defined by an increased number of bowel movements and/or decreased requirement for laxatives, Frame et al found that eight out of 11 patients were improved while on colchicine, and no clinically important side effects occurred.
Colchicine is known to stimulate gastrointestinal activity through neurogenic stimulation. In these patients, treatment produced an average of 4.27 more bowel movements per patient over eight weeks time.
Colchicine can cause adverse effects, but serious toxicity is rare and usually confined to those with renal or hepatic insufficiency. Frame et al suggest that although colchicine is not suggested as a first-line laxative, persons with refractory constipation to standard methods, as are commonly found among the developmentally disabled or nursing home populations, may merit consideration for this intervention.
Frame PS, et al. J Am Board Fam Pract 1998;11:341-346.
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