Colchicine and Apalutamide: 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
Apalutamide
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.
Here's what's going on. Apalutamide (Erleada) revs up the systems in your body that break down and pump out other medicines, including your gout medicine colchicine. When those systems speed up, your body clears colchicine faster, so there may be less of it working to control your gout.
The good news is this concern is based on how these drugs behave in theory, not on strong real-world reports. If your gout flares seem harder to control while you're on both, that's worth mentioning. Please don't stop or change either medicine on your own, your pharmacist or doctor can adjust things and keep an eye on how well the colchicine is working.
Mechanism: Apalutamide is a strong inducer of CYP3A4 and P-glycoprotein. Colchicine is a substrate of both, so induction is expected to increase colchicine clearance and reduce its exposure (AUC/Cmax), potentially causing loss of efficacy. Neither agent is a prodrug here.
- Direction: reduced colchicine effect
- Magnitude: not quantified for colchicine; apalutamide reduced midazolam AUC ~92% and fexofenadine AUC ~30%
- Evidence: theoretical, extrapolated from probe substrates
- Onset: unspecified (induction is typically delayed, over days to weeks)
- Management: monitor for loss of colchicine activity; consider alternative therapy per apalutamide labeling.
What happens
Reduced P-gp/CYP3A4 substrate exposure
Interaction Deep Dive
Exercise care when apalutamide is combined with substrates of CYP3A4 or P-gp, as such combinations can lower the exposure of those substrates. When single oral doses of transporter substrates were given together with apalutamide, the AUC of fexofenadine (a P-gp substrate) fell by 30%, while pairing a single apalutamide dose with the CYP3A4 substrate midazolam produced a 92% reduction in midazolam AUC. During treatment with apalutamide, it is advisable to replace any drug that relies chiefly on CYP3A4 for its metabolism. Should the drug be maintained, monitor for diminished activity1.
Why it happens (mechanism)
Induction of P-gp-mediated efflux transport by apalutamide; induction of CYP3A4-substrate metabolism by apalutamide
How to manage this interaction
What your care team may do:
- Watch for signs the colchicine isn't working as well, such as returning or worsening gout symptoms.
- Consider whether a different treatment approach makes sense while you're on apalutamide.
- Individualize your plan and monitor you more closely rather than assuming a single fixed change.
What you should do:
- Keep taking both medicines exactly as prescribed.
- Tell your pharmacist or prescriber if your gout flares up or your usual dose seems less effective.
- Don't adjust or stop either drug on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
Common questions
Can I take Colchicine and Apalutamide together?
Apalutamide can speed up how your body clears colchicine, which may make the colchicine work less well; keep taking both as prescribed and tell your care team if your gout symptoms return so they can adjust and monitor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Apalutamide 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 Colchicine and Apalutamide interaction managed?
What your care team may do: Watch for signs the colchicine isn't working as well, such as returning or worsening gout symptoms. Consider whether a different treatment approach makes sense while you're on apalutamide. Individualize your plan and monitor you more closely rather than assuming a single fixed change. What you should do: Keep taking both medicines exactly as prescribed. Tell your pharma… 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 Colchicine or Apalutamide 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 (1)
- Product Information: ERLEADA(R) oral tablets, apalutamide oral tablets. Janssen Products LP (per FDA), Horsham, PA, 2024. DailyMed
Keep reading about Apalutamide
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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