Aprepitant 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
Aprepitant
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.
Aprepitant (Emend, Cinvanti) is a medicine used to prevent nausea, and it can slow down the enzyme in your body that breaks down colchicine (used for gout or familial Mediterranean fever). When colchicine is cleared more slowly, it can build up to higher levels than intended.
That matters because colchicine has a narrow safety window, and too much can cause serious, even life-threatening problems like severe diarrhea, muscle weakness, and effects on the blood and organs. The good news is this is very manageable. Your care team may lower your colchicine dose or space out how often you take it, and watch you closely. Please don't stop or change either medicine on your own, just check with your pharmacist or doctor.
Mechanism: Aprepitant is a moderate CYP3A4 inhibitor. Colchicine is a CYP3A4 (and P-gp) substrate, so inhibition reduces its metabolism and increases plasma exposure. Neither is a prodrug; the effect is increased colchicine levels.
- Effect: increased colchicine AUC/Cmax, raised risk of fatal colchicine toxicity.
- Evidence: theoretical; severity: major; onset: unspecified.
- Management: Avoid coadministration where possible. If required, reduce colchicine daily dose or frequency per labeling (gout flare, prophylaxis, and FMF have specific reductions). Monitor for GI, neuromuscular, and hematologic toxicity; discontinue colchicine if suspected. Avoid in renal or hepatic impairment.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Taking colchicine together with a moderate CYP3A4 inhibitor should be avoided, since this combination can raise colchicine plasma levels and lead to fatal colchicine toxicity. When the two must be given together, modify the colchicine regimen by lowering either the total daily amount or how often it is taken3. For situations requiring concurrent administration, or administration within a 14 day window, the colchicine regimen for a gout flare should be cut back: instead of the usual 1.2 mg (2 tablets) followed one hour later by 0.6 mg (1 tablet), give a single dose of 1.2 mg (2 tablets), and do not repeat the dose sooner than 3 days later. For gout flare prophylaxis, reduce a starting regimen of 0.6 mg twice daily down to 0.6 mg daily, or a starting regimen of 0.6 mg once daily down to 0.3 mg once daily. When colchicine and a moderate CYP3A4 inhibitor must be combined in patients who have familial Mediterranean fever, the daily colchicine total should not exceed 1.2 mg (which may be administered as 0.6 mg twice daily). Watch for indications of colchicine toxicity and stop colchicine right away if it is suspected 2. In addition, the combined use of colchicine and moderate CYP3A4 inhibitors should be avoided in individuals who have renal or hepatic impairment 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
This combination can raise colchicine levels, so your care team manages it carefully rather than leaving it to chance.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your colchicine dose may be reduced or given less often, and the exact amount will be individualized by your care team based on why you take colchicine (gout flare, gout prevention, or familial Mediterranean fever).
- Your team may monitor you more closely for colchicine toxicity.
- Tell your pharmacist or doctor right away about severe diarrhea, vomiting, muscle pain or weakness, numbness, or unusual tiredness.
- Mention any kidney or liver problems, since this combination is usually avoided in those cases.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Aprepitant and Colchicine together?
Aprepitant can slow colchicine breakdown and push its levels dangerously high, so avoid the combination if possible; if both are needed, your doctor will lower the colchicine dose and watch you closely. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Aprepitant and Colchicine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Aprepitant and Colchicine interaction managed?
This combination can raise colchicine levels, so your care team manages it carefully rather than leaving it to chance. Keep taking both as prescribed unless your prescriber tells you otherwise. Your colchicine dose may be reduced or given less often, and the exact amount will be individualized by your care team based on why you take colchicine (gout flare, gout prevention, or familial Mediterranea… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Aprepitant 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: COLCRYS oral tablets, colchicine oral tablets. Takeda Pharmaceuticals America Inc (per FDA), Deerfield, IL, 2020. DailyMed
- Product Information: GLOPERBA(R) oral solution, colchicine oral solution. Romeg Therapeutics LLC (per FDA), Woburn, MA, 2019. DailyMed
Keep reading about Aprepitant
Keep reading about Colchicine
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