Table 3.

Major interactions of colchicine with common use CV and non-CV drugs

Drug (or class) interacting	Interaction	Collateral effects	Reference
Carvedilol	Increase colchicine serum concentrations due to intestinal, renal and liver P-gp inhibition	Neuromyopathy, rhabdomyolysis, hepato- and nephrotoxicity, cardiotoxicity	[70]
Ranolazine
Spironolactone
Ticagrelor	Reduced colchicine clearance due to inhibition of CYP450 3A4, by which colchicine is metabolized	Colchicine toxicity (nausea, vomiting, diarrhea, fatigue, myalgia, paresthesia)	[74]
Digoxin	Increase concentrations of both drugs due to competitive inhibition of P-gp efflux transporter in the intestine, renal proximal tubule and liver	Rhabdomyolysis, digoxin and colchicine toxicity (arrhythmias, GI symptoms, fatigue, myalgia, paresthesia)	7[2]
Antiarrhythmic drugs
Amiodarone	Increase colchicine serum concentrations due to intestinal, renal and liver P-gp inhibition	Neuromyopathy, rhabdomyolysis, hepato- and nephrotoxicity, cardiotoxicity	[70]
Quinidine
Diltiazem	Coadministration with inhibitors of CYP450 3A4 may significantly increase the serum concentrations of colchicine, which is primarily metabolized by the isoenzyme	Myopathy, neuropathy, multiorgan failure, and pancytopenia	[71]
Verapamil
Dronedarone
Statins	Pharmacodynamic and pharmacokinetic interactions. HMG-CoA reductase inhibitors have in fact individually myotoxic effects (additive to those of colchicine) but are also substrates of the CYP450 3A4 isoenzyme and P-glycoprotein efflux transporter, thus competitive inhibition may occur resulting in increased drug absorption and decreased excretion	Muscle weakness and markedly elevated creatine kinase levels; myopathy up to rhabdomyolysis resulting in myoglobinuric and acute renal failure	[72]
Hydroxychloroquine	Additive pharmacodynamic risk of peripheral neuropathy	Peripheral neuropathy	[72]
Antibiotics
Clarithromycin	Inhibition of the CYP450 3A4-mediated metabolism and P-glycoprotein (P-gp)-mediated colchicine transport by clarithromycin resulting in significantly serum colchicine increase	Myopathy, neuropathy, multiorgan failure, pancytopenia	[73]
Other Macrolides	Coadministration with inhibitors of CYP450 3A4 may significantly increase the serum concentrations of colchicine, which is primarily metabolized by the isoenzyme
Ciprofloxacin
Antiviral
Darunavir/ Ritonavir			[73]
Boceprevir/Telaprevir
Antimycotic			[71]
Fluconazole
Ketoconazole

CV cardiovascular; GI  gastrointestinal; P-gp glycoprotein P