Colchicine and Eliglustat: 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
Eliglustat
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.
Eliglustat (Cerdelga) can cause colchicine to build up in your body. Eliglustat blocks a transporter called P-gp that normally helps push colchicine out of your cells. When that pump is slowed, colchicine levels can rise, and too much colchicine can be dangerous. Signs of colchicine toxicity include stomach pain, diarrhea, muscle weakness, and feeling very unwell.
Because this combination can be serious, doctors generally avoid using these two together. Please do not stop or change either medicine on your own. Talk with your pharmacist or doctor soon so they can review your medicines and choose the safest plan for you.
Direction: Eliglustat inhibits P-glycoprotein, reducing P-gp-mediated efflux of colchicine and increasing colchicine exposure, raising the risk of colchicine toxicity. Colchicine is a CYP3A4 and P-gp substrate; neither drug is a prodrug here.
- Severity: Contraindicated per labeling for colchicine with P-gp inhibitors.
- Evidence: Theoretical for this pair, but extrapolated from documented fatal toxicity with P-gp inhibitors.
- Highest risk: Renal or hepatic impairment (coadministration contraindicated).
- Management: Avoid combination. If required in patients with normal renal/hepatic function, reduce colchicine daily dose or dosing frequency and monitor closely for toxicity (GI symptoms, myopathy, myelosuppression).
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Both CYP3A4 and P-gp metabolize colchicine, which acts as a substrate for each. Cases of toxicity have been documented when colchicine 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 described in patients taking therapeutic doses of colchicine, its concurrent use with P-gp inhibitors 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 reported. For patients whose renal and hepatic function is normal 2, when colchicine must be given alongside a P-gp inhibitor, modify the colchicine dose by lowering either the daily amount or the frequency of dosing, and watch closely for signs of colchicine toxicity 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
This combination is generally avoided. Because eliglustat can raise colchicine levels, your care team will likely look for a safer option, especially if you have any kidney or liver problems.
- Keep taking both medicines as prescribed until you have spoken with your prescriber or pharmacist. Do not stop or change doses on your own.
- If both must be used and your kidney and liver function are normal, your colchicine dose may be reduced or given less often, individualized by your care team, with closer monitoring for toxicity.
- Report stomach pain, diarrhea, vomiting, muscle pain or weakness, or unusual fatigue right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Eliglustat together?
Eliglustat can raise colchicine to dangerous levels by blocking P-gp, so this pairing is usually avoided; contact your prescriber or pharmacist before making any changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Eliglustat 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 Eliglustat interaction managed?
This combination is generally avoided. Because eliglustat can raise colchicine levels, your care team will likely look for a safer option, especially if you have any kidney or liver problems. Keep taking both medicines as prescribed until you have spoken with your prescriber or pharmacist. Do not stop or change doses on your own. If both must be used and your kidney and liver function are normal,… 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 Eliglustat 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 Eliglustat
Keep reading about Colchicine
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