Amiodarone and Colchicine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Amiodarone
Colchicine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
These two medicines can be a dangerous combination. Amiodarone (Pacerone) is a heart rhythm drug that blocks two of the pathways your body uses to break down and remove colchicine (Colcrys). When those pathways are slowed, colchicine can build up to very high levels. Too much colchicine can cause severe, and in some cases fatal, poisoning.
This is especially risky if your kidneys or liver aren't working well. Please don't stop or change either medicine on your own. Instead, talk with your pharmacist or doctor soon. Your care team can safely manage this by adjusting your colchicine dose or watching you more closely.
Direction: Amiodarone raises colchicine exposure (increased AUC/Cmax), elevating the risk of serious to fatal colchicine toxicity. Colchicine is the affected drug; neither agent's effect is prodrug-dependent here.
- Mechanism: Amiodarone inhibits both P-gp-mediated efflux and CYP3A4-mediated metabolism of colchicine.
- Evidence: Probable; severity contraindicated.
- Management: Coadministration is contraindicated in renal or hepatic impairment (fatal toxicity reported). If combination is unavoidable in patients with normal organ function, reduce colchicine daily dose by 50% to 75% or reduce dose frequency.
- Monitor: for GI symptoms, myelosuppression, neuromyopathy.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Taking colchicine together with P-gp inhibitors is contraindicated1. When colchicine is combined with agents that inhibit both CYP3A4 and P-gp, there is a risk of severe and potentially fatal toxicity. Should it be necessary to give colchicine alongside a P-gp inhibitor, the colchicine dose must be modified, either by cutting the daily amount by 50% to 75% 3 or by decreasing how often it is given. Furthermore, in individuals with renal or hepatic impairment, the joint use of colchicine with P-gp and CYP3A4 inhibitors is contraindicated 3. In such patients with renal and hepatic impairment, pairing these inhibitors with colchicine has produced life-threatening or fatal colchicine toxicity 2.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of colchicine; inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
Keep taking both medicines exactly as prescribed until you speak with your care team, but raise this combination with your pharmacist or prescriber promptly.
- Your team may reduce your colchicine dose (often by 50% to 75%) or space out how often you take it.
- This pairing is avoided entirely if you have kidney or liver problems, because toxicity can be life-threatening.
- Your care team may monitor you more closely and tailor the plan to you.
- Seek help urgently if you develop severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or infections.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Amiodarone and Colchicine together?
Amiodarone can push colchicine to dangerous levels, so this combination is generally contraindicated, especially with kidney or liver problems. Don't change anything yourself; contact your pharmacist or doctor so they can adjust or monitor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Amiodarone and Colchicine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Amiodarone and Colchicine interaction managed?
Keep taking both medicines exactly as prescribed until you speak with your care team, but raise this combination with your pharmacist or prescriber promptly. Your team may reduce your colchicine dose (often by 50% to 75%) or space out how often you take it. This pairing is avoided entirely if you have kidney or liver problems, because toxicity can be life-threatening. Your care team may monitor yo… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Amiodarone or Colchicine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: LODOCO(R) oral tablets, colchicine oral tablets. AGEPHA Pharma USA, LLC (per FDA), Parsippany, NJ, 2023. DailyMed
- Product Information: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
- Hansten PD, Tan MS, Horn JR, et al: Colchicine drug interaction errors and misunderstandings: recommendations for improved evidence-based management. Drug Saf 2023; 46(3):223-242. PubMed
Keep reading about Amiodarone
Keep reading about Colchicine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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