Colchicine interactions

Food & lifestyle

• grapefruit juice

  Major

  Metabolism

  Coadministration with grapefruit juice may increase the serum concentrations of colchicine. Clinical toxicity including myopathy, neuropathy, multiorgan failure, and pancytopenia may occur. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism and P-glycoprotein efflux in the gut wall by certain compounds present in grapefruits.

  What to do: Patients treated with colchicine should be advised to avoid the consumption of grapefruit and grapefruit juice, and to contact their physician if they experience symptoms of colchicine toxicity such as abdominal pain, nausea, vomiting, diarrhea, fatigue, myalgia, asthenia, hyporeflexia, paresthesia, and numbness.

  19 sources

  1. Pettinger WA "Clonidine, a new antihypertensive drug." N Engl J Med 293 (1975): 1179-80
  2. Caraco Y, Putterman C, Rahamimov R, Ben-Chetrit E "Acute colchicine intoxication: possible role of erythromycin administration." J Rheumatol 19 (1992): 494-6
  3. Schiff D, Drislane FW "Rapid-onset colchicine myoneuropathy." Arthritis Rheum 35 (1992): 1535-6
  4. Putterman C, Ben-Chetrit E, Caraco Y, Levy M "Colchicine intoxication: clinical pharmacology, risk factors, features, and management." Semin Arthritis Rheum 21 (1991): 143-55
  5. Boomershine KH "Colchicine-induced rhabdomyolysis." Ann Pharmacother 36 (2002): 824-6
  6. "Severe colchicine-macrolide interactions." Prescrire Int 12 (2003): 18-9
  7. Tateishi T, Soucek P, Caraco Y, Guengerich FP, Wood AJ "Colchicine biotransformation by human liver microsomes. Identification of CYP3A4 as the major isoform responsible for colchicine demethylation." Biochem Pharmacol 53 (1996): 111-6
  8. Dogukan A, Oymak FS, Taskapan H, Guven M, Tokgoz B, Utas C "Acute fatal colchicine intoxication in a patient on continuous ambulatory peritoneal dialysis (CAPD). Possible role of clarithromycin administration." Clin Nephrol 55 (2001): 181-2

  Show all 19 sourcesShow fewer sources

  9. Rollot F, Pajot O, Chauvelot-Moachon L, Nazal EM, Kelaidi C, Blanche P "Acute colchicine intoxication during clarithromycin administration." Ann Pharmacother 38 (2004): 2074-7
  10. Wilbur K, Makowsky M "Colchicine myotoxicity: case reports and literature review." Pharmacotherapy 24 (2004): 1784-92
  11. Hung IF, Wu AK, Cheng VC, et al. "Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study." Clin Infect Dis 41 (2005): 291-300
  12. Cheng VC, Ho PL, Yuen KY "Two probable cases of serious drug interaction between clarithromycin and colchicine." South Med J 98 (2005): 811-3
  13. Akdag I, Ersoy A, Kahvecioglu S, Gullulu M, Dilek K "Acute colchicine intoxication during clarithromycin administration in patients with chronic renal failure." J Nephrol 19 (2006): 515-7
  14. van der Velden W, Huussen J, Ter Laak H, de Sevaux R "Colchicine-induced neuromyopathy in a patient with chronic renal failure: the role of clarithromycin." Neth J Med 66 (2008): 204-6
  15. Goldbart A, Press J, Sofer S, Kapelushnik J "Near fatal acute colchicine intoxication in a child. A case report." Eur J Pediatr 159 (2000): 895-7
  16. "Colchicine: serious interactions." Prescrire Int 17 (2008): 151-3
  17. "Product Information. Colcrys (colchicine)." AR Scientific Inc (2009):
  18. Dahan A, Amidon GL "Grapefruit juice and its constitueants augment colchicine intestinal absorption: potential hazardous interaction and the role of p-glycoprotein." Pharm Res 26 (2009): 883-92
  19. McKinnell J, Tayek JA "Short term treatment with clarithromycin resulting in colchicine-induced rhabdomyolysis." J Clin Rheumatol 15 (2009): 303-5

Conditions

Conditions in which Colchicine needs care, as documented in this source.

• Bone Marrow Failure Disorders

  Major

  The use of colchicine should be used with caution in patients with bone marrow suppression. Patients on long term therapy may require periodic blood counts.

  8 sources

  1. Ferrannini E, Pentimone F "Marrow aplasia following colchicine treatment for gouty arthritis." Clin Exp Rheumatol 2 (1984): 173-5
  2. Liu YK, Hymowitz R, Carroll MG "Marrow aplasia induced by colchicine. A case report." Arthritis Rheum 21 (1978): 731-5
  3. Neuss MN, McCallum RM, Brenckman WD, Silberman HR "Long-term colchicine administration leading to colchicine toxicity and death." Arthritis Rheum 29 (1986): 448-9
  4. Finklestein M, Goldman L, Grace ND, Foley M, Randall N "Granulocytopenia complicating colchicine therapy for primary biliary cirrhosis." Gastroenterology 93 (1987): 1231-5
  5. Stanley MW, Taurog JD, Snover DC "Fatal colchicine toxicity: report of a case." Clin Exp Rheumatol 2 (1984): 167-71
  6. Vedia C, Mascort JJ, Carrasco I, Olive A "Colchicine and thrombopenia." Clin Exp Rheumatol 11 (1993): 458
  7. Wallace SL, Singer JZ, Duncan GJ, Wigley FM, Kuncl RW "Renal function predicts colchicine toxicity: guidelines for the prophylactic use of colchicine in gout." J Rheumatol 18 (1991): 264-9
  8. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):

• Disseminated Intravascular Coagulation

  Major

  Colchicine should be used with caution in patients with disseminated intravascular coagulation. Debilitated patients have an increased risk of developing colchicine toxicity.

  2 sources

  1. Vedia C, Mascort JJ, Carrasco I, Olive A "Colchicine and thrombopenia." Clin Exp Rheumatol 11 (1993): 458
  2. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):

• Heart Failure

  Major

  The use of colchicine should be used with caution in patients with cardiac dysfunction. The possibility of cumulative effects of colchicine is increased in these patients.

  1 source

  1. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):

• Kidney Diseases

  Major

  Colchicine is significantly excreted in urine in healthy subjects. Clearance of colchicine is decreased in patients with impaired renal function. Colchicine dosing must be individualized according to the patient's renal function. Caution must be exercised when colchicine therapy is instituted in these patients. Monitoring creatinine function is recommended in patients on long term therapy.

  4 sources

  1. Older SA, Finbloom DS, Pezeshkpour GH "Colchicine myoneuropathy and renal dysfunction." Ann Rheum Dis 51 (1992): 1343-4
  2. Said R, Hamzeh Y, Tarawneh M, el-Khateeb M, Abdeen M, Shaheen A "Rapid progressive glomerulonephritis in patients with familial Mediterranean fever." Am J Kidney Dis 14 (1989): 412-6
  3. Wallace SL, Singer JZ, Duncan GJ, Wigley FM, Kuncl RW "Renal function predicts colchicine toxicity: guidelines for the prophylactic use of colchicine in gout." J Rheumatol 18 (1991): 264-9
  4. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):

• Liver Diseases

  Major

  The clearance of colchicine may be significantly reduced and plasma half-life prolonged in patients with chronic hepatic impairment compared to healthy subject. No pharmacokinetic data are available for patients with severe hepatic impairment (Child-Pugh C). Caution is recommended when prescribing colchicine to these patients.

  7 sources

  1. Zifroni A, Schaffner F "Long-term follow-up of patients with primary biliary cirrhosis on colchicine therapy." Hepatology 14 (1991): 990-3
  2. Caraco Y, Putterman C, Rahamimov R, Ben-Chetrit E "Acute colchicine intoxication: possible role of erythromycin administration." J Rheumatol 19 (1992): 494-6
  3. Leighton JA, Bay MK, Maldonado AL, Schenker S, Speeg KV "Colchicine clearance is impaired in alcoholic cirrhosis." Hepatology 14 (1991): 1013-5
  4. Stanley MW, Taurog JD, Snover DC "Fatal colchicine toxicity: report of a case." Clin Exp Rheumatol 2 (1984): 167-71
  5. Warnes TW, Smith A, Lee FI, Haboubi NY, Johnson PJ, Hunt L "A controlled trial of colchicine in primary biliary cirrhosis. Trial design and preliminary report." J Hepatol 5 (1987): 1-7
  6. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):
  7. Kocak N, Yuce A, Gurakan F, Ozen H, Gogus S, Kale G, Caglar M "Colchicine in the treatment of hepatic fibrosis in children." Am J Gastroenterol 91 (1996): 179-80

• Water-Electrolyte Imbalance

  Major

  Electrolyte imbalances including hypokalemia and hyponatremia may worsen in patients taking colchicine as the most common adverse effects of colchicine include nausea and vomiting. Therapy with colchicine should be administered with caution in patients with electrolyte imbalances. Monitoring serum electrolytes is recommended in these patients.

  1 source

  1. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):

• Rhabdomyolysis

  Moderate

  Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported with chronic treatment in therapeutic doses. Patients with renal dysfunction and elderly patients, even those with normal renal and hepatic function, are at increased risk. Caution must be exercised when colchicine therapy is instituted in these patients.

  1 source

  1. "Product Information. Colchicine (colchicine)." Lilly, Eli and Company (2001):