Colchicine and Duvelisib: 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
Duvelisib
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.
Duvelisib (Copiktra) can make colchicine build up in your body. Duvelisib slows down the liver enzyme (called CYP3A4) that normally breaks colchicine down and clears it out. When that clean-up slows, colchicine levels can climb higher than intended.
That matters because colchicine has a narrow safety window. Too much can cause serious, even life-threatening problems like severe diarrhea, muscle weakness, and blood or organ damage. Please don't stop or change either medicine on your own. The good news is your care team can manage this safely, often by lowering your colchicine dose or spacing it out and watching you closely. Let your pharmacist or doctor know you take both.
Mechanism: Duvelisib is a moderate CYP3A4 inhibitor; colchicine is a CYP3A4 (and P-gp) substrate. Inhibition reduces colchicine clearance, increasing plasma exposure and the risk of potentially fatal toxicity. Neither is a prodrug here, so this is a straightforward exposure increase.
- Direction: increased colchicine AUC/Cmax
- Evidence: theoretical; severity major
- Management: avoid if possible. If required, reduce colchicine dose or frequency per label (gout flare: 1.2 mg single dose, repeat no sooner than 3 days; prophylaxis: reduce to 0.6 mg/day or 0.3 mg/day; FMF: max 1.2 mg/day).
- Avoid entirely in renal or hepatic impairment. Monitor for colchicine toxicity and discontinue if suspected.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Colchicine should not be taken together with a moderate CYP3A4 inhibitor, because the combination can raise colchicine plasma levels and lead to fatal colchicine toxicity. When the two must be given together, the colchicine dose needs to be modified, either by lowering the total daily amount or by administering it less often3. Specifically, if concurrent use, or use within a 14 day window, is unavoidable, the colchicine regimen for treating a gout flare should be changed: rather than the usual 1.2 mg (2 tablets) followed one hour later by 0.6 mg (1 tablet), give 1.2 mg (2 tablets) as a single dose, and do not repeat the dose sooner than 3 days. For gout flare prophylaxis, cut the colchicine dose from 0.6 mg twice daily down to 0.6 mg daily, or from 0.6 mg once daily down to 0.3 mg once daily. For patients who have familial Mediterranean fever and require both colchicine and a moderate CYP3A4 inhibitor, the daily colchicine total should not exceed 1.2 mg (which may be split as 0.6 mg twice daily). Watch for any signs and symptoms of colchicine toxicity and stop colchicine right away if toxicity is suspected 2. In addition, the concurrent use of colchicine with moderate CYP3A4 inhibitors should be avoided in patients who have renal or hepatic impairment 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise, and make sure they know you take these together.
- Your team may lower your colchicine dose or take it less often while you are on duvelisib. Colchicine doses may need to be adjusted and individualized by your care team.
- Because this combination raises colchicine levels, they may monitor you more closely for side effects.
- Tell your prescriber right away if you notice severe diarrhea, vomiting, muscle pain or weakness, numbness, or unusual tiredness or bleeding.
- This combination is usually avoided in people with kidney or liver problems, so share your full history.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Colchicine and Duvelisib together?
Duvelisib can raise colchicine levels to a dangerous degree, so your care team will likely lower the colchicine dose and watch you closely. Never adjust either drug yourself; check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Duvelisib 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 Duvelisib interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise, and make sure they know you take these together. Your team may lower your colchicine dose or take it less often while you are on duvelisib. Colchicine doses may need to be adjusted and individualized by your care team. Because this combination raises colchicine levels, they may monitor you more closely for side effec… 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 Duvelisib 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 Duvelisib
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist