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Drug Interactions between colchicine and Crestor

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

colchicine rosuvastatin

Applies to: colchicine and Crestor (rosuvastatin)

MONITOR CLOSELY: Coadministration of colchicine and HMG-CoA reductase inhibitors may increase the risk of myopathy due to a combination of pharmacodynamic and pharmacokinetic effects. These agents are individually myotoxic and may have additive or synergistic effects when used together. In addition, colchicine and some HMG-CoA reductase inhibitors are substrates of the CYP450 3A4 isoenzyme and P-glycoprotein efflux transporter, thus competitive inhibition may occur resulting in increased drug absorption and decreased excretion. The interaction has been associated with case reports of patients who developed muscle weakness and markedly elevated creatine kinase levels within weeks to months of taking colchicine in combination with an HMG-CoA reductase inhibitor. Most of these patients were elderly and/or had preexisting renal impairment. One patient developed progressive muscle weakness leading to shortness of breath and respiratory failure, followed by death. The patient was a heart transplant recipient and had been on long-term cyclosporine, prednisone, and mycophenolate. Four months before the development of proximal muscle weakness, his simvastatin dose was doubled and he was also started on colchicine for acute exacerbation of gout. Colchicine and simvastatin were stopped on admission. During hospitalization, he received high-dose methylprednisolone for continued muscle weakness and was sedated with propofol, but creatine kinase increased to 33,580 U/mL. The muscle biopsy revealed toxic vacuolization, mitochondrial damage, and no evidence of inflammation. The interaction has also been associated with severe rhabdomyolysis resulting in myoglobinuric acute renal failure.

MANAGEMENT: Extreme caution is advised if colchicine is used in combination with HMG-CoA reductase inhibitors, particularly in the elderly and patients with underlying renal or hepatic impairment. Some experts recommend checking the creatine kinase level a week or two after coadministration of these agents and after any dose increase, although such monitoring does not reliably prevent the occurrence of severe myopathy. Patients should be advised to contact their physician if they experience symptoms of toxicity such as abdominal pain, nausea, vomiting, diarrhea, fatigue, myalgia, asthenia, hyporeflexia, paraesthesia, and numbness. The drugs should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

References

  1. Hsu WC, Chen WH, Chang MT, Chiu HC (2002) "Colchicine-induced acute myopathy in a patient with concomitant use of simvastatin." Clin Neuropharmacol, 25, p. 266-8
  2. Wilbur K, Makowsky M (2004) "Colchicine myotoxicity: case reports and literature review." Pharmacotherapy, 24, p. 1784-92
  3. Alayli G, Cengiz K, Canturk F, Durmus D, Akyol Y, Menekse EB (2005) "Acute myopathy in a patient with concomitant use of pravastatin and colchicine." Ann Pharmacother, 39, p. 1358-61
  4. Atasoyu EM, Evrenkaya TR, Solmazgul E (2005) "Possible colchicine rhabdomyolysis in a fluvastatin-treated patient." Ann Pharmacother, 39, p. 1368-9
  5. Tufan A, Dede DS, Cavus S, Altintas ND, Iskit AB, Topeli A (2006) "Rhabdomyolysis in a patient treated with colchicine and atorvastatin." Ann Pharmacother, 40, p. 1466-9
  6. Justiniano M, Dold S, Espinoza LR (2007) "Rapid onset of muscle weakness (rhabdomyolysis) associated with the combined use of simvastatin and colchicine." J Clin Rheumatol, 13, p. 266-8
  7. Francis L, Bonilla E, Soforo E, et al. (2008) "Fatal toxic myopathy attributed to propofol, methylprednisolone, and cyclosporine after prior exposure to colchicine and simvastatin." Clin Rheumatol, 27, p. 129-31
  8. (2008) "Colchicine: serious interactions." Prescrire Int, 17, p. 151-3
  9. (2009) "Product Information. Colcrys (colchicine)." AR Scientific Inc
  10. Montiel V, Huberlant V, Vincent MF, Bonbled F, Hantson P (2010) "Multiple organ failure after an overdose of less than 0.4 mg/kg of colchicine: role of coingestants and drugs during intensive care management." Clin Toxicol (Phila), 48, p. 845-8
View all 10 references

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Drug and food interactions

Major

colchicine food

Applies to: colchicine

GENERALLY AVOID: 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. A published case report describes an eight-year-old patient with familial Mediterranean fever who developed acute clinical colchicine intoxication after ingesting approximately one liter of grapefruit juice per day for two months prior to hospital admission while being treated with colchicine 2 mg/day. Her condition progressed to circulatory shock and multiorgan failure, but she recovered with supportive therapy after 24 days in the hospital. In a study of 21 healthy volunteers, administration of 240 mL grapefruit juice twice a day for 4 days was found to have no significant effect on the pharmacokinetics of a single 0.6 mg dose of colchicine. However, significant interactions have been reported with other CYP450 3A4 inhibitors such as clarithromycin, diltiazem, erythromycin, ketoconazole, ritonavir, and verapamil.

MANAGEMENT: 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.

References

  1. Pettinger WA (1975) "Clonidine, a new antihypertensive drug." N Engl J Med, 293, p. 1179-80
  2. Caraco Y, Putterman C, Rahamimov R, Ben-Chetrit E (1992) "Acute colchicine intoxication: possible role of erythromycin administration." J Rheumatol, 19, p. 494-6
  3. Schiff D, Drislane FW (1992) "Rapid-onset colchicine myoneuropathy." Arthritis Rheum, 35, p. 1535-6
  4. Putterman C, Ben-Chetrit E, Caraco Y, Levy M (1991) "Colchicine intoxication: clinical pharmacology, risk factors, features, and management." Semin Arthritis Rheum, 21, p. 143-55
  5. Boomershine KH (2002) "Colchicine-induced rhabdomyolysis." Ann Pharmacother, 36, p. 824-6
  6. (2003) "Severe colchicine-macrolide interactions." Prescrire Int, 12, p. 18-9
  7. Tateishi T, Soucek P, Caraco Y, Guengerich FP, Wood AJ (1996) "Colchicine biotransformation by human liver microsomes. Identification of CYP3A4 as the major isoform responsible for colchicine demethylation." Biochem Pharmacol, 53, p. 111-6
  8. Dogukan A, Oymak FS, Taskapan H, Guven M, Tokgoz B, Utas C (2001) "Acute fatal colchicine intoxication in a patient on continuous ambulatory peritoneal dialysis (CAPD). Possible role of clarithromycin administration." Clin Nephrol, 55, p. 181-2
  9. Rollot F, Pajot O, Chauvelot-Moachon L, Nazal EM, Kelaidi C, Blanche P (2004) "Acute colchicine intoxication during clarithromycin administration." Ann Pharmacother, 38, p. 2074-7
  10. Wilbur K, Makowsky M (2004) "Colchicine myotoxicity: case reports and literature review." Pharmacotherapy, 24, p. 1784-92
  11. Hung IF, Wu AK, Cheng VC, et al. (2005) "Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study." Clin Infect Dis, 41, p. 291-300
  12. Cheng VC, Ho PL, Yuen KY (2005) "Two probable cases of serious drug interaction between clarithromycin and colchicine." South Med J, 98, p. 811-3
  13. Akdag I, Ersoy A, Kahvecioglu S, Gullulu M, Dilek K (2006) "Acute colchicine intoxication during clarithromycin administration in patients with chronic renal failure." J Nephrol, 19, p. 515-7
  14. van der Velden W, Huussen J, Ter Laak H, de Sevaux R (2008) "Colchicine-induced neuromyopathy in a patient with chronic renal failure: the role of clarithromycin." Neth J Med, 66, p. 204-6
  15. Goldbart A, Press J, Sofer S, Kapelushnik J (2000) "Near fatal acute colchicine intoxication in a child. A case report." Eur J Pediatr, 159, p. 895-7
  16. (2008) "Colchicine: serious interactions." Prescrire Int, 17, p. 151-3
  17. (2009) "Product Information. Colcrys (colchicine)." AR Scientific Inc
  18. Dahan A, Amidon GL (2009) "Grapefruit juice and its constitueants augment colchicine intestinal absorption: potential hazardous interaction and the role of p-glycoprotein." Pharm Res, 26, p. 883-92
  19. McKinnell J, Tayek JA (2009) "Short term treatment with clarithromycin resulting in colchicine-induced rhabdomyolysis." J Clin Rheumatol, 15, p. 303-5
View all 19 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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