Lopinavir
Contraindicated
Textbook
Life-threatening toxicities of colchicine.
The drug is contraindicated in patients with hepatic or renal impairment requiring concomitant therapy with CYP3A4 inhibitors.
Source: G&G 14e · p848, p854
Drug reference
Colchicine
Anti-gout / antimitotic alkaloid · Antigout
Also known as Colchicum alkaloid
START
Acute gout: 1.2 mg, then 0.6 mg after 1 h
TYPICAL MAX
1.8 mg per flare; 1.2 mg/day prophylaxis
STOP IF
Diarrhoea/vomiting, myopathy, or cytopenias develop
WATCH
Renal/hepatic function, CBC, CK; CYP3A4/P-gp inhibitor co-use
CDSCO approvedSchedule HATC M04AC01
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption
- PEAK
- 1.5h · Tmax
- t½
- 1.3d · t½
- DURATION
- 3d · tissue-retained
EXCRETION
Biliary/faecal; ~10–20% renal unchanged
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Generally avoided; FMF — benefit may outweigh risk under specialist care.
FDA category + note
Top interactionssee all 12 →
- LopinavirContraindicatedTextbookG&G 14e · p848, p854
- P Glycoprotein InhibitorContraindicatedTextbookG&G 14e · p848, p854
- ClarithromycinContraindicatedDatabaseDDInter
- RitonavirContraindicatedDatabaseDDInter
Available in India
8 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Binds tubulin and prevents microtubule polymerisation, inhibiting neutrophil chemotaxis, adhesion, and NLRP3 inflammasome activation — suppressing urate-crystal-induced inflammation without affecting urate levels.
Indications
Acute gout flareGout flare prophylaxisFamilial Mediterranean feverPericarditis (acute/recurrent)Behçet disease
Dosing
- Adult
- Acute gout: 1.2 mg PO at onset, then 0.6 mg 1 h later (max 1.8 mg over 1 h); prophylaxis 0.5–0.6 mg once–twice daily. FMF: 1–2 mg/day.
- Pediatric
- FMF: 0.5–2 mg/day by age/weight (specialist).
- Renal adjustment
- CrCl <30: reduce dose / increase interval; avoid prophylaxis with P-gp/CYP3A4 inhibitors. Not dialysable.
- Hepatic adjustment
- Severe impairment: reduce dose; avoid with CYP3A4/P-gp inhibitors.
- Geriatric
- Reduce dose; higher toxicity risk (renal decline).
- Max dose
- 1.8 mg/day for an acute flare; 1.2 mg/day chronic prophylaxis
Pharmacokinetics
Onset
Symptom relief within ~12–24 h (acute gout)
Peak effect
0.5–2 h (Tmax)
Duration
Long intracellular retention (days)
Half-life
~20–40 h (longer in renal impairment)
Bioavailability
~45%
Protein binding
~39%
Metabolism
Hepatic CYP3A4; P-gp substrate
Excretion
Biliary/faecal; ~10–20% renal unchanged
Contraindications
- Concomitant strong CYP3A4 or P-gp inhibitor in patients with renal OR hepatic impairment (fatal toxicity)
- Severe renal impairment with P-gp/CYP3A4 inhibitor
- Hypersensitivity
Side effects
Common
DiarrhoeaNauseaVomitingAbdominal pain
Serious
- Myelosuppression (pancytopenia)
- Rhabdomyolysis/neuromyopathy
- Multi-organ failure in overdose
- Fatal toxicity with CYP3A4/P-gp inhibitors in renal/hepatic impairment
Pregnancy & lactation
Pregnancy
Generally avoided; FMF — benefit may outweigh risk under specialist care.
Lactation
Excreted in milk; considered compatible at usual doses (monitor infant).
Drug interactions
P Glycoprotein Inhibitor
Contraindicated
Textbook
Life-threatening toxicities of colchicine.
The drug is contraindicated in patients with hepatic or renal impairment requiring concomitant therapy with P-glycoprotein inhibitors.
Source: G&G 14e · p848, p854
Clarithromycin
Contraindicated
Database
Life-threatening toxicities of colchicine.
The drug is contraindicated in patients with hepatic or renal impairment requiring concomitant therapy with CYP3A4 inhibitors.
Source: DDInter
Ritonavir
Contraindicated
Database
Life-threatening toxicities of colchicine.
The drug is contraindicated in patients with hepatic or renal impairment requiring concomitant therapy with CYP3A4 inhibitors.
Source: DDInter
Strong Cyp3a4 Inhibitors
Contraindicated
Database
Blocked colchicine metabolism
Avoid; if essential reduce dose drastically and monitor
Source: Kimi deep-research + Cla
Amiodarone
Severe
Database
Drug interaction classified as: excretion.
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Aprepitant
Severe
Database
Life-threatening toxicities of colchicine.
The drug is contraindicated in patients with hepatic or renal impairment requiring concomitant therapy with CYP3A4 inhibitors.
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Atorvastatin
Severe
Database
Rhabdomyolysis (rare but reported).
Monitor for muscle symptoms.
Source: DDInter
Azithromycin
Severe
Database
Drug interaction classified as: excretion.
Source: DDInter
Bepridil
Severe
Database
Drug interaction classified as: excretion
Source: DDInter
Related guidelines
Ask House about Colchicine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20