Colchicine and Clarithromycin: 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
Clarithromycin
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.
Taking clarithromycin (Biaxin) with colchicine can be dangerous. Clarithromycin blocks two of the main pathways your body uses to break down and clear colchicine. That means colchicine can build up to very high levels, and colchicine toxicity can be serious and even life-threatening. Warning signs can include severe diarrhea, vomiting, stomach pain, muscle weakness, or feeling very unwell.
The good news is your care team can manage this. In some cases they avoid the combination, and in others they lower your colchicine dose while watching you closely. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor so they can pick the safest plan for you.
Mechanism: Clarithromycin is a dual strong inhibitor of CYP3A4 and P-glycoprotein; colchicine is a substrate of both. Inhibition reduces colchicine metabolism and efflux, increasing colchicine exposure (AUC/Cmax) and risk of toxicity. Neither drug is a prodrug, so the effect is increased colchicine activity.
- Severity: Contraindicated; established evidence; delayed onset.
- Contraindicated in renal or hepatic impairment.
- Normal organ function: dose reduction required (e.g., gout flare 0.6 mg then 0.3 mg, no repeat within 3 days; prophylaxis reduce to 0.3 mg once daily or every other day; FMF max 0.6 mg/day).
- Macrolide co-use linked to higher heart failure and mortality.
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Both CYP3A4 and P-gp metabolize colchicine, which serves as a substrate for each. Because life-threatening and fatal colchicine toxicity has occurred in patients taking therapeutic doses of colchicine together with dual strong CYP3A4 and P-gp inhibitors, this combination is contraindicated1. The pairing of a dual CYP3A4 and P-gp inhibitor with colchicine is likewise contraindicated when renal or hepatic impairment is present. When renal and hepatic function are normal, however, the colchicine dose must be modified 3. In the setting of a gout flare, the colchicine dose should be lowered to a single 1.2 mg dose, with any repeat dose withheld until at least 3 days afterward. For gout flare prophylaxis, an original regimen of 0.6 mg twice daily should be cut to 0.6 mg/day, and an original regimen of 0.6 mg/day should be cut to 0.3 mg/day. For patients who have familial Mediterranean fever and require colchicine along with erythromycin, colchicine should not exceed a maximum daily amount of 1.2 mg (which may be administered as 0.6 mg twice daily) 2. When colchicine was given with a concomitant macrolide, the rates of heart failure and death were significantly greater than when colchicine was combined with a non-macrolide antibiotic 4.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine; inhibition of P-gp-mediated efflux transport of colchicine
How to manage this interaction
This combination is treated cautiously and is sometimes avoided entirely. If you have kidney or liver problems, your team will generally not use them together. In others, your colchicine dose may need to be adjusted and individualized by your care team, and they may monitor you more closely.
- Keep taking both only as prescribed, do not adjust doses yourself.
- Tell your prescriber if you have kidney or liver disease.
- Report severe diarrhea, vomiting, muscle weakness, or numbness right away.
- Mention any colchicine use in the past 14 days when starting clarithromycin.
Ask your pharmacist or doctor whether a different antibiotic is a better option for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
5 reports — tap to read
a) A retrospective cohort study (n=2199) found that colchicine given together with a macrolide (including clarithromycin) was associated with a significantly greater occurrence of heart failure than colchicine combined with a non-macrolide antibiotic (n=12,670), at 18.3% versus 9.1%, respectively (OR, 1.06; 95% CI, 0.67 to 1.67). Mortality was also significantly greater in the colchicine plus macrolide group than in the colchicine plus non-macrolide antibiotic group (3.87% vs 2.28%; OR, 2.06; 95% CI, 1.07 to 3.97). No differences were seen in the risk of rhabdomyolysis diagnosis, pancytopenia, muscle weakness, or acute hepatic failure 4.
b) In a study involving 23 patients, taking a 0.6 mg dose of colchicine together with clarithromycin 250 mg twice daily for 7 days produced increases of 227.2% in colchicine Cmax and 281.5% in AUC relative to baseline 521.
c) In a retrospective study of 116 hospitalized patients, giving clarithromycin and colchicine at the same time was associated with non-significantly higher rates of death and pancytopenia than sequential use during the same hospital stay. Case-control comparisons were performed between patients receiving the two drugs concurrently (therapy overlap; n=88) and those receiving them sequentially (both medications used within the same admission, n=28). Compared with the sequential group, the concomitant group had a non-significantly higher rate of mortality (10.2% vs. 3.6%) and pancytopenia (10.2% vs 0%), though the small sample size may have contributed to the lack of statistical significance. A higher total colchicine dose was significantly and independently linked to pancytopenia (relative risk (RR), 1.89; 95% CI, 1.23 to 2.89). Longer overlap therapy (RR, 2.16; 95% CI, 1.41 to 3.31), baseline renal impairment (RR, 9.1; 95% CI, 1.75 to 47.06), and development of pancytopenia (RR, 23.4; 95% CI, 4.48 to 122.7) were each significantly and independently associated with mortality. Patients who received concomitant therapy and developed pancytopenia had a 25-fold increase in the risk of death 6.
d) In a case series of women with familial Mediterranean fever being treated with colchicine (N=6), starting clarithromycin for Helicobacter pylori gastric infection led to colchicine intoxication. The mean daily colchicine dose was 2 +/- 0.45 mg (range, 1.5 to 2.5 mg/day). Clarithromycin 500 mg twice daily along with omeprazole 20 mg/day and amoxicillin 1 g twice daily was prescribed for 10 to 14 days. Symptoms of colchicine intoxication included abdominal pain, vomiting, diarrhea, general weakness, and myalgia. At admission, all patients had elevated creatinine phosphokinase and elevated liver enzymes; further laboratory abnormalities were hypokalemia (n=3), neutropenia (n=2), pancytopenia (n=1), and hyponatremia (n=1). Colchicine was stopped immediately, and clarithromycin, omeprazole, and amoxicillin were stopped in patients who had not finished the regimen. Colchicine was restarted 1 to 3 weeks after discontinuation at an initial dose of 0.5 mg/day, which was gradually raised to full dose 6 to 12 weeks after reinitiation. Muscle pain was severe in most patients, requiring bed confinement in several and use of a wheelchair in 1 patient. All patients ultimately had resolution of symptoms, and laboratory abnormalities improved in about 10 days 7.
e) Acute colchicine toxicity developed in a 76-year-old man after clarithromycin was added to a stable colchicine regimen for familial Mediterranean fever. The patient had tolerated long-term colchicine 1.5 mg daily before starting a 7-day course of clarithromycin 1 g daily with amoxicillin and omeprazole for Helicobacter gastritis. Four days after starting clarithromycin, he presented with abdominal pain, nausea and vomiting, and bloody diarrhea; severe dehydration, pancytopenia, and hepatic cholestasis developed by day 8. On hospital day 13, the colchicine dose was lowered to 0.5 mg per day. He developed alopecia on day 14 but recovered without further treatment beyond parenteral rehydration. The colchicine dose was returned to pre-clarithromycin levels 4 months later and was tolerated afterward 8.
Common questions
Can I take Colchicine and Clarithromycin together?
Clarithromycin can raise colchicine to toxic, sometimes fatal levels, so the combination is contraindicated in kidney or liver impairment and requires dose reduction and close monitoring otherwise. Do not change either medicine on your own; check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Clarithromycin interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Colchicine and Clarithromycin interaction managed?
This combination is treated cautiously and is sometimes avoided entirely. If you have kidney or liver problems, your team will generally not use them together. In others, your colchicine dose may need to be adjusted and individualized by your care team, and they may monitor you more closely. Keep taking both only as prescribed, do not adjust doses yourself. Tell your prescriber if you have kidney… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Colchicine or Clarithromycin 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 (8)
- 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
- Tan MS, Gomez-Lumbreras A, Villa-Zapata L, et al: Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure. Rheumatol Int 2022; 42(12):2253-2259. PubMed
- Product Information: COLCRYS(TM) oral tablets, colchicine oral tablets. AR Scientific, Inc. Philadelphia, PA, 2009. DailyMed
- Hung IF, Wu AK, Cheng BS, et al: Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study. Clin Infect Dis 2005; 41:291-300. PubMed
- Haj Yahia S, Ben Zvi I, & Livneh A: Colchicine intoxication in familial Mediterranean fever patients using clarithromycin for the treatment of Helicobacter pylori: a series of six patients. Rheumatol Int 2018; 38(1):141-147. PubMed
- Rollot F, Pajot O, Chauvelot-Moachon L et al: Acute colchicine intoxication during clarithromycin administration. 38. Ann Pharmacother. Cincinnati, OH. 2004. PubMed
Keep reading about Clarithromycin
Keep reading about Colchicine
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