7 Colchicine Interactions You Should Know About
Key takeaways:
There are many medications that interact with colchicine (Colcrys, Mitigare). These include statins, azole antifungals, and some calcium channel blockers.
The major colchicine interactions raise levels of colchicine in the body. This can lead to an increased risk of side effects like muscle or nerve pain. In serious cases, they can be life-threatening.
Talk with your healthcare provider or pharmacist before starting colchicine. They can check for potential colchicine interactions.
Table of contents
If you have gout, you know how painful a gout attack can be. Gout occurs when a substance called uric acid builds up in the joints. During a gout attack, you may experience pain and swelling in a specific joint. If you experience a gout attack, you’ll want to start medication right away. It gets harder to treat the longer you wait.
Colchicine (Colcrys, Mitigare) is a medication that’s used to prevent and treat gout attacks. It’s an anti-inflammatory medication. It works by blocking multiple inflammatory processes that occur during gout attacks. It’s also approved to treat an autoimmune condition called familial Mediterranean fever.
Like most medications, colchicine can have drug interactions. Most colchicine interactions raise your risk of side effects like muscle pain.
Below, we discuss seven of the most important colchicine interactions to know. But this isn’t a complete list of possible interactions. Before starting colchicine, create an updated list of your medications. Your healthcare provider and pharmacist can use it to check for colchicine interactions.
1. Grapefruit and grapefruit juice
Grapefruit and grapefruit juice can interact with many medications, including colchicine. Colchicine is broken down (metabolized) by the liver. Grapefruit and grapefruit juice block the enzyme (protein) that metabolizes colchicine.
The interaction between colchicine and grapefruit can cause higher levels of colchicine. This can increase the risks of side effects like muscle pain or damage.
It’s a good idea to avoid grapefruit juice and grapefruit while taking colchicine. But if you can’t, talk to your healthcare provider. It’s likely that they’ll decrease your colchicine dose. Or they may suggest an alternative medication.
2. High cholesterol medications
Statins are a group of medications that treat high cholesterol. Some statins are more likely to interact with colchicine than others. These include simvastatin (Zocor, FloLipid), atorvastatin (Lipitor), and lovastatin.
Fibrates are another group of medications that treat high cholesterol (and high triglycerides). They can also interact with colchicine. Fibrates include fenofibrate (Tricor) and gemfibrozil (Lopid).
Colchicine, statins, and fibrates each have muscle aches and pain as a side effect. So when they’re combined, this risk is higher. And, the risk of a more serious side effect — rhabdomyolysis — can also occur.
Rhabdomyolysis is a rare but serious medical condition caused by the breakdown of muscle tissue. It can lead to kidney failure and even death. Common signs of rhabdomyolysis include muscle pain and weakness. This may cause trouble moving your arms and legs. You should also watch for signs of kidney injury, like dark red or brown urine.
The risk is higher if you’re older or have existing kidney or liver problems. If you think you’re experiencing symptoms of rhabdomyolysis, seek immediate medical attention.
Keep in mind that possible colchicine interactions like this one don’t occur in everyone. In fact, statins and colchicine may be prescribed together to prevent heart problems. This is an off-label use of colchicine since it’s not FDA approved for this reason.
If you need colchicine and a statin or fibrate, your healthcare provider may start you at lower doses of either medication. This may be especially important if you have kidney or liver problems. They’ll also monitor you for muscle-related side effects.
3. Azole antifungals
Azoles are a group of medications that treat fungal infections. Examples include yeast infections, thrush and athlete’s foot. Examples of antifungals include ketoconazole, itraconazole (Sporanox), and fluconazole (Diflucan).
Azole antifungals block the enzyme that’s responsible for metabolizing colchicine. Some azoles (like itraconazole and ketoconazole) also block a protein that colchicine binds to. These actions can raise levels of colchicine in the body. This can lead to a greater risk of side effects, like muscle toxicity. It can also lead to rhabdomyolysis. The risk is higher if you’re older, or if you have existing liver or kidney problems.
If you need an azole antifungal and colchicine, talk to your healthcare provider. They may lower your colchicine dose. You should also watch for muscle-related side effects. This includes muscle pain, weakness, or tenderness.
4. Calcium channel blockers
Calcium channel blockers treat high blood pressure, chest pain, and abnormal heart rhythms. Two calcium channel blockers — diltiazem (Cardizem) and verapamil — can interact with colchicine.
These calcium channel blockers block the enzyme that metabolizes colchicine. Like many other colchicine interactions, this can cause high colchicine levels. And this may raise your risk of muscle-related side effects. Verapamil and diltiazem also block a protein that colchicine binds to. This can also raise levels of colchicine.
If you need both a calcium channel blocker and colchicine, you may need a lower dose of colchicine. But don't make changes without talking to your healthcare provider. They may also recommend alternative medications that don't interact.
5. Protease inhibitors
Protease inhibitors are a group of medications used to treat hepatitis C or HIV. They're a type of antiviral. Examples include:
Ritonavir (Norvir) and ritonavir-containing medications, like lopinavir/ritonavir (Kaletra)
Fosamprenavir (Lexiva)
Darunavir (Prezista)
Atazanavir (Reyataz)
Nelfinavir (Viracept)
Tipranavir (Aptivus)
Protease inhibitors block the enzyme that metabolizes colchicine. Some protease inhibitors (like ritonavir) also block a protein that colchicine binds to. These actions can raise levels of colchicine, and cause muscle-related side effects. People with liver or kidney problems shouldn’t receive this combination.
If you take a protease inhibitor, your healthcare provider will likely lower your colchicine dose. Or they may have to switch you to another medication entirely.
6. Macrolide antibiotics
Macrolides are antibiotics that treat many bacterial infections. Examples include clarithromycin, azithromycin (Zithromax), and erythromycin (Ery-Tab).
Like other colchicine interactions, macrolide antibiotics can raise levels of colchicine. This can lead to undesirable side effects of colchicine.
Luckily, other antibiotic options might work if you have an infection while taking colchicine. Talk to your healthcare provider about your options. If a macrolide antibiotic is needed, your provider may lower your dose of colchicine.
7. Cyclosporine
Cyclosporine (Sandimmune) is used to prevent your body from rejecting an organ transplant.
Cyclosporine blocks a protein that colchicine binds to. This raises levels of colchicine, which raises your risk of muscle-related side effects.
If you need cyclosporine, your healthcare provider may prescribe a lower colchicine dose. They’ll also monitor you for muscle and nerve-related side effects.
The bottom line
Colchicine can interact with many medications, including statins, azole antifungals, and macrolide antibiotics. Other potential colchicine interactions may be with calcium channel blockers, protease inhibitors, and cyclosporine. And colchicine’s interactions aren’t just with medications. It can also interact with grapefruit and grapefruit juice.
Many of these interactions can cause high levels of colchicine in your body. This can lead to muscle and nerve-related side effects. More seriously, rhabdomyolysis can occur. If you’re taking a medication that can interact with colchicine, talk to your healthcare provider. They may recommend a lower dose of colchicine. Or they may recommend you stop one of the interacting medications altogether. But don’t make changes to your medications without talking to your provider first.
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References
Bryant Ranch Prepack. (2022). Colchicine [package insert].
Imazio, M., et al. (2021). Colchicine and the heart. European Heart Journal.
Lockheart, S. M., et al. (2021). Colchicine- an old dog with new tricks. Nature Metabolism.
National Organization for Rare Disorders. (2018). Familial Mediterranean fever.
U. S. Food & Drug Administration. (2022). Development and drug interactions- Table of substrates, inhibitors and inducers.
Wessler, J. D., et al. (2013). The P-glycoprotein transport system and cardiovascular drugs. Journal of the American College of Cardiology.
Wiggins, B. S., et al. (2016). Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American Heart Association. Circulation.
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