Colchicine interactions to avoid

Drug interactions | Food interactions | Avoiding interactions | When to see a doctor

Colchicine, known by the brand name Colcrys, is an antigout medication used to prevent and treat gout. Gout is a painful form of inflammatory arthritis that happens when too much uric acid is in the body, causing gout attacks. Additionally, colchicine can be used to treat the genetic condition Familial Mediterranean Fever (FMF) and helps to manage the symptoms of Behcet’s syndrome, pseudogout, and pericarditis. Recently, the U.S. Food and Drug Administration (FDA) approved a form of colchicine called Lodoco for people with atherosclerotic disease or with multiple risk factors for cardiovascular disease to reduce the risk of heart attack and stroke.

Colchicine interacts with digoxin, statins, fibrates, certain hepatitis C medications, azole antifungals, and macrolide antibiotics, among other drug classes. Do not take colchicine with Filspari, Paxlovid, Relyvrio, Reyvow, or Vonjo without consulting a healthcare professional. Colchicine also interacts with grapefruit juice. 


It’s important to be aware of colchicine interactions as other drugs and foods can affect colchicine’s effectiveness and cause or worsen side effects. As a medication that can have toxic effects, drug interactions are critical to avoid, as colchicine toxicity can put people at risk.

RELATED: Colchicine side effects and how to avoid them

Colchicine drug interactions

Various prescription drugs can interact with colchicine, including statins, fibrates, digoxin, certain hepatitis C medications, azole antifungals, and macrolide antibiotics.

Statins

Statins are prescription medications that can treat high cholesterol levels. They are often used to prevent complications in people who have experienced a heart attack or stroke or those who have diabetes. Cholesterol buildup in the arteries can block the flow of blood and lead to an increased risk of a heart attack or stroke. In general, statin medications are well tolerated by most people but do have some risks associated with their use. Statins can cause liver problems and muscle-related effects, including muscle pain, myopathy (unexplained muscle weakness or pain), and rhabdomyolysis. Taking a statin with colchicine can lead to a potentially serious drug interaction.

This drug interaction can cause increased amounts of both colchicine and statins in the body, which can lead to a greater chance of adverse effects. There is an increased risk of muscle-related side effects, including rhabdomyolysis. It’s important to look for signs of muscle pain or weakness. It’s recommended that healthcare providers monitor therapy and consider a dose reduction of one or both drugs. Reach out to the prescribing doctor for further guidance if there are signs of this possible drug interaction.

Examples of common statins include:

• Lipitor (atorvastatin)
• Lescol XL (fluvastatin)
• Altoprev (lovastatin)
• Livalo (pitavastatin)
• Pravastatin
• Crestor (rosuvastatin
• Zocor (simvastatin)

Fibrates

Fibrates are medications that help lower fats (triglycerides) in the blood, a condition often referred to as hypertriglyceridemia. This condition puts people at risk for heart disease and stroke. Fibrates may also help lower bad cholesterol (LDL). For most people, fibrates are well tolerated, but there are serious side effects and drug interactions associated with their use. Like statins, fibrates may cause muscle-related effects, including pain, myopathy (unexplained muscle pain or weakness), and rhabdomyolysis. Concomitant use of fibrates and colchicine may lead to a serious drug interaction.

This drug interaction can cause muscle-related side effects, including rhabdomyolysis. Signs of muscle pain or weakness may indicate a drug interaction between colchicine and fibrates. This risk is highest in people who are older or have kidney problems. The fibrate medication gemfibrozil appears to have the highest risk of muscle toxicity compared to other fibrates. Healthcare providers will likely monitor therapy and consider lowering the dose of one or both medications. Call the doctor’s office if there are signs of this drug interaction.

Examples of common fibrates include:

• Fibricor (fenofibrate)
• Lopid (gemfibrozil)

Digoxin

Digoxin (Lanoxin) is a type of heart medication that can help manage and treat heart failure and certain arrhythmias (irregular heartbeats). While an effective treatment for many people, digoxin has many dangerous side effects and drug interactions. Digoxin has a narrow therapeutic index, which means small differences in the dose or amount in the body can cause serious adverse drug reactions that are life-threatening. People who use digoxin have to be aware of the many drug interactions associated with digoxin use, as it often competes with other drugs for different enzymes and proteins that help the body break down and remove drugs.

If used together, it’s believed that digoxin and colchicine compete for the same protein in the body (p-glycoprotein), which helps remove these two drugs from the body. As a result, digoxin can enhance the adverse effects of colchicine, specifically muscle toxicities. It’s important to look for signs of muscle pain or weakness. Healthcare providers can monitor therapy and consider lowering the dose or changing therapy to a different heart medication. Contact the doctor’s office if there are signs of this drug interaction.

Certain Hepatitis C Medications

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) that is spread through contact with blood from an infected person. The spread of hepatitis C most commonly occurs by sharing needles or other tools used to prepare and inject drugs. Hepatitis C is treatable, and antiviral medications can be used depending on the virus’s genotype (also referred to as type or strain). Many antiviral medications have drug interactions as they may block enzymes important for drug removal from the body or compete for proteins that help clear drugs. These drug interactions can affect the amount of drugs in the body, like colchicine.

The interaction between certain hepatitis C medications and colchicine can lead to increased amounts of colchicine in the body. Higher amounts of colchicine are associated with an increase in adverse effects. These effects range from muscle toxicities to serious blood disorders. Depending on the dosage form of colchicine, it’s best to avoid the combination or decrease the colchicine dose. People with impaired kidney or liver function should check with their doctor to find the safest treatment plan, as they are at an increased risk. Since this interaction can be serious and potentially life-threatening, seek immediate medical assistance if there are signs of a drug interaction.

Examples of common hepatitis C medications include:

• Epclusa (sofosbuvir/velpatasvir)
• Harvoni (ledipasvir/sofosbuvir)
• Mavyret (glecaprevir/pibrentasvir)

RELATED: Hepatitis 101: How to prevent–and—treat an infection

Azole Antifungals

Various antifungal medications treat fungal infections, including a class called azoles (each drug name ends in -azole). Each azole has a different antifungal activity and different adverse effects. A variety of conditions can be treated with azoles, including yeast infection, oral thrush, aspergillosis, and onychomycosis. Azole antifungals have drug interactions that can affect drug metabolism, such as blocking enzymes (such as CYP3A4 inhibitors) used for drug removal from the body or competing for proteins (such as Pgp inhibitors) that help clear drugs. Coadministration of azole antifungals can affect the amount of colchicine in the body.

The interaction between azole antifungals and colchicine can increase the amount of colchicine in the body. As a result, there is a higher chance of colchicine adverse effects. Healthcare providers may decide to avoid the combination or reduce the colchicine dose. It’s important to be aware of the increased adverse effects of colchicine, such as muscle pain or weakness. Those with renal or hepatic impairment should check with their healthcare team to find the safest treatment plan, as they are at a greater risk. Call the doctor’s office if there are concerns about this drug interaction.

Examples of common azole antifungals include:

• Diflucan (fluconazole)
• Sporanox (itraconazole)
• Ketoconazole
• Vfend (voriconazole)

Macrolide Antibiotics

Macrolides are one of many different types of antibiotics that treat bacterial infections. Macrolides can treat various conditions, including ear infections, strep throat, skin infections, and pneumonia. Interactions with macrolides can affect drug metabolism, such as blocking enzymes used for drug removal from the body or competing for proteins that help clear drugs. Similar to other drug interactions, macrolides can affect the amount of colchicine in the body.

Macrolide antibiotics can increase the amount of colchicine in the body, leading to a higher chance of colchicine’s adverse effects. There are ways to reduce the chance of this interaction, as healthcare providers may avoid the combination and select a different antibiotic or lower the colchicine dose. As always, people with impaired kidney or liver function should check with their healthcare providers to find the safest treatment plan due to their increased risk. Reach out to the prescribing doctor for further advice if there are signs of this drug interaction.

Examples of common macrolide antibiotics include:

• Zithromax (azithromycin)
• Clarithromycin
• Erythromycin

Colchicine food interactions

In addition to interactions with medications, there are other types of colchicine interactions. Colchicine can also interact with grapefruit and grapefruit juice.

Colchicine and Grapefruit

Grapefruit juice is a common beverage choice for people and a common offender of interactions with medications. Grapefruit juice and grapefruit can affect how medicines work and should be avoided when taking colchicine. This interaction causes increased concentrations of colchicine in the body. This is likely due to the ability of grapefruit to block enzymes used for drug removal of colchicine. It’s best to take colchicine with a glass of water.

How to minimize colchicine interactions

Steps can be taken to help minimize colchicine interactions. It’s important to keep healthcare providers updated on all medical conditions and confirm they have current medication lists, including prescription drugs, over-the-counter (OTC) medications, herbal products, and supplements. Dangerous drug interactions can even happen with OTC and supplement products. Pharmacists are great resources and can give medical advice and additional drug information when visiting the pharmacy.

Certain medical conditions can help determine if a drug will be safe or not for a person. Colchicine should be used with caution in people with kidney disease or liver disease and will sometimes need dose adjustments. Colchicine is present in the breast milk of breastfeeding women. The decision to breastfeed while taking colchicine should be discussed with the healthcare team as they will consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

When to talk to a healthcare provider about colchicine interactions

While several of the serious drug interactions are included above, many other colchicine drug interactions are not included. Communicating openly with healthcare providers about all medications, supplements, and medical conditions is important to ensure proper drug management and monitoring. For some people, there are alternative medication options for treating their condition. Alternative medications for gout flares include NSAIDs (such as ibuprofen or naproxen) and steroids.