Colchicine and Elagolix: 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
Elagolix
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 these two together can let colchicine build up in your body. Colchicine (used for gout or pericarditis) is normally pushed back out of your cells by a kind of pump called P-gp. Elagolix (Orilissa) can slow that pump down, so more colchicine stays in your system. Because colchicine has a narrow safety range, even a small buildup can cause serious problems like severe stomach upset, muscle weakness, or effects on your blood cells.
The good news is your care team can manage this. Please don't stop or change either medicine on your own. Instead, check in with your pharmacist or doctor so they can decide the safest plan for you.
Direction: Elagolix inhibits P-gp, reducing colchicine efflux and increasing colchicine exposure, which raises the risk of colchicine toxicity. Neither drug is a prodrug here; colchicine is the affected object drug (a CYP3A4 and P-gp substrate with a narrow therapeutic index).
- Severity: Contraindicated per labeling for colchicine with P-gp inhibitors.
- Evidence: Theoretical (extrapolated from documented toxicity with other P-gp/CYP3A4 inhibitors such as clarithromycin).
- Onset: Unspecified.
- Management: Avoid in renal or hepatic impairment (fatal reactions reported). In normal renal/hepatic function, if coadministration is required, reduce colchicine daily dose or frequency and monitor closely for toxicity (GI, myopathy, myelosuppression).
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Colchicine serves as a substrate for both CYP3A4 and P-gp. Toxic effects have been documented when it was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Similar toxicities have arisen when colchicine was combined with a CYP3A4 inhibitor and when it was combined with a P-gp inhibitor3. Because life-threatening and fatal colchicine toxicity has been reported in patients taking therapeutic doses of colchicine alongside P-gp inhibitors, the concurrent use of these agents is contraindicated 1. This combination is likewise contraindicated in individuals with renal or hepatic impairment, given that life-threatening and fatal drug interactions have been observed. For patients whose renal and hepatic function is normal 2, when colchicine must be given with a P-gp inhibitor, the colchicine dose should be modified by lowering either the daily amount or the frequency of dosing. Close monitoring for colchicine toxicity is warranted 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
Keep taking both exactly as prescribed until you speak with your care team. This combination is flagged as one to avoid, so your prescriber or pharmacist will want to review it.
- Your team may decide to lower your colchicine dose or take it less often if the two must be used together and your kidneys and liver are healthy.
- If you have kidney or liver problems, this combination is generally not used.
- Your team may monitor you more closely for signs of colchicine toxicity, such as severe diarrhea, nausea, muscle pain or weakness, or unusual fatigue.
Report any of these symptoms to your pharmacist or doctor promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Elagolix together?
Elagolix can raise colchicine levels and this combination is contraindicated, so do not use them together without medical guidance; your care team can adjust the colchicine dose and monitor you if needed. Call your pharmacist or doctor before making any change. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Elagolix interaction?
It is rated contraindicated. These should generally not be used together.
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 Elagolix interaction managed?
Keep taking both exactly as prescribed until you speak with your care team. This combination is flagged as one to avoid, so your prescriber or pharmacist will want to review it. Your team may decide to lower your colchicine dose or take it less often if the two must be used together and your kidneys and liver are healthy. If you have kidney or liver problems, this combination is generally not used… 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 Elagolix 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 Elagolix
Keep reading about Colchicine
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