Colchicine and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Colchicine
Cyclosporine Injection
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.
What happens
Increased colchicine and cycloSPORINE exposure
Interaction Deep Dive
Concomitant use of colchicine with P-gp inhibitors like cycloSPORINE is contraindicated because life-threatening and fatal colchicine toxicity has been reported in these patients with colchicine taken in therapeutic doses2. Also concomitant use of cycloSPORINE (a CYP3A4 and P-gp inhibitor) and colchicine (a CYP3A4 and P-gp substrate) results in significant increases in colchicine plasma concentrations and is contraindicated in patients with renal or hepatic impairment. Such use should be avoided in all patients, but if colchicine and cycloSPORINE are used concomitantly in patients with normal renal and hepatic function, a dose reduction of colchicine is required 3. The colchicine dose for treatment of gout flare should be reduced to 0.6 mg for 1 dose, with the repeat dose to be given no earlier than 3 days. For prophylaxis of gout flares, reduce the colchicine dose from an original dose of 0.6 mg twice daily to 0.3 mg once daily, or from an original dose of 0.6 mg once daily to 0.3 mg once every other day. In patients with familial Mediterranean fever, the maximum daily colchicine dose should be no more than 0.6 mg (may be given as 0.3 mg twice daily). Monitor for colchicine toxicity and discontinue colchicine immediately if suspected 4. Plasma concentrations of cycloSPORINE may also be increased during concomitant use with colchicine 1.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine metabolism by cycloSPORINE; competition for cytochrome CYP3A4-mediated metabolism
Literature reports
4 reports — tap to read
a) Concomitant use of a single 100 mg dose of cycloSPORINE and a 0.6-mg dose of colchicine resulted in 270% (range, 62% to 606.9%) and 259% (range, 75.8% to 511.9%) increases in colchicine Cmax and AUC, respectively, from baseline in a study of 23 patients 4.
b) A drug interaction was suspected while studying the conversion from azaTHIOprine to cycloSPORINE therapy in four male renal transplant patients. All four patients were receiving azaTHIOprine 1 mg per kg to 2 mg per kg, predniSONE 10 mg daily, and prophylactic colchicine therapy at 1 mg per day to 2 mg per day. The conversion protocol consisted of the gradual addition of cycloSPORINE therapy, starting at 3 mg per kg, to the patient's medication until therapeutic levels of cycloSPORINE were reached. At the very earliest stages of conversion, all patients developed pronounced side effects, ranging from diarrhea, elevation in serum LDH, elevation in serum ALT, hyperbilirubinemia, and elevation in serum creatinine. One patient was hospitalized for general muscular weakness and severe myalgia. After cycloSPORINE was withdrawn, all four patients rapidly improved and adverse clinical symptoms resolved. The authors postulated that the symptoms were a direct result of combined therapy with colchicine and cycloSPORINE 5.
c) A 53-year-old male who had undergone two orthotopic heart transplant procedures was receiving cycloSPORINE 125 mg twice daily, predniSONE 5 mg daily, furosemide 40 mg daily, insulin, and intermittent colchicine 0.5 mg three times daily. He started to complain of muscle pain and weakness which progressed to his inability to rise from a chair. Upon admission to the hospital, his laboratory values revealed a creatinine level of 3.4 mg/dL, uric acid 11 mg/dL, CPK 3003 Units/L, and a cycloSPORINE level of 125 mcg/mL. An echocardiogram and a myocardial biopsy were performed to rule out organ rejection. A quadriceps muscle biopsy showed nonspecific necrotizing myopathy. Colchicine was discontinued, and within several days the patient became asymptomatic while laboratory values returned to normal values within two weeks. The combination of cycloSPORINE and colchicine is believed to have precipitated the myopathy seen in this patient. CycloSPORINE blocks p-glycoprotein, which in turn impairs the liver and renal excretion of colchicine, causing elevated colchicine levels and possible cytotoxic drug accumulation 6.
d) Multiple organ failure occurred in a renal transplant patient who received colchicine and cycloSPORINE concomitantly. In 1997, a 70-year-old male who underwent a cadaveric kidney transplant in 1989 was diagnosed with chronic graft dysfunction. Proteinuria and creatinemia occurred. After 3 years of ramipril therapy, creatinemia was still 3 mg/dL. On January 6, 2001, colchicine was initiated due to acute gouty arthritis. On January 10, his blood levels were: cycloSPORINE BTL 109 nanograms (ng)/mL, uric acid 10.3 mg/dL, creatinemia 2.6 mg/dL, creatinine clearance 23 mL/min, hematocrit 38.6%, leukocytes 5.4 x 10(9), platelets 1.24 x 10(9), and proteinuria 0.8 g/day. The patient complained of constipation, nausea, abdominal pain, asthenia, fatigue, and inability to walk over the next few days. Colchicine administration was suspended on January 22, and he was admitted to the hospital with confusion, arrhythmia, adynamic ileus, and urine retention. The patient was on cycloSPORINE, azaTHIOprine, dilTIAZem, ticlopidine and ramipril. All drugs were discontinued and vancomycin, furosemide, fluids, electrolytes and cutaneous calciparine were administered. Ultrasonographic study of the abdomen showed dilatation of intestinal loops and diffuse meteorism; the ECG showed coronary sinus rhythm. On day 2, the abdomen was unchanged. An abdominal CT scan confirmed dilatation of the large bowel and abundant stool material after 8 days of constipation. On day 4, the patient spontaneously voided abundant feces. CycloSPORINE therapy was reinstated with azaTHIOprine and allopurinol. He improved over the next several days. On day 19, AST, ALT, and CPK levels normalized, cycloSPORINE BTL was 54 ng/mL. This case demonstrates the successive appearance of gastrointestinal disorders, myoneuropathy and multiple organ failure, with rapid and unexpected worsening 7.
Common questions
Can I take Colchicine and Cyclosporine Injection together?
Increased colchicine and cycloSPORINE exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Cyclosporine Injection 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 strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Colchicine or Cyclosporine Injection 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 (7)
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: LODOCO(R) oral tablets, colchicine oral tablets. AGEPHA Pharma USA, LLC (per FDA), Parsippany, NJ, 2023. DailyMed
- Product Information: GLOPERBA(R) oral solution, colchicine oral solution. Romeg Therapeutics LLC (per FDA), Woburn, MA, 2019. DailyMed
- Product Information: COLCRYS oral tablets, colchicine oral tablets. Takeda Pharmaceuticals America Inc (per FDA), Deerfield, IL, 2020. DailyMed
- Yussim A, Bar-Nathan N, Lustig S, et al: Gastrointestinal, hepatorenal, and neuromuscular toxicity caused by cyclosporine-colchicine interaction in renal transplantation. Transplant Proc 1994; 26:2825-2826.
- Gruberg L, Har-Zahav Y, Agranat O, et al: Acute myopathy induced by colchicine in a cyclosporine treated heart transplant recipient: possible role of the multidrug resistance transporter. Transplant Proc 1999; 31:2157-2158. PubMed
- Minetti E & Minetti L: Multiple organ failure in a kidney transplant patient receiving both colchicine and cyclosporine. J Nephrol 2003; 16:421-425. DOI
Keep reading about Colchicine
Keep reading about Cyclosporine Injection
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