Colchicine and Enasidenib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Enasidenib
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.
What happens
Increased colchicine exposure, an increased risk of colchicine toxicity, reduced colchicine and reduced efficacy of colchicine
Interaction Deep Dive
Concomitant use of colchicine with P-glycoprotein (P-gp) inhibitors like enasidenib is contraindicated2. Concomitant use of colchicine with enasidenib (P-gp inhibitor) has the potential for serious and life-threatening toxicity. If coadministration of colchicine and a P-gp inhibitor is necessary, adjust the dose of colchicine by either reducing the daily dose or reducing the dose frequency. Carefully monitor patients for colchicine toxicity 3. Concomitant use of enasidenib (a CYP3A4 inducer) and colchicine (a CYP3A4 substrate with NTI) may also reduce the exposure of CYP3A4 substrates, where minimal concentration changes may lead to reduced efficacy 1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of colchicine; induction of CYP3A4-substrate metabolism of colchicine
Literature reports
1 report — tap to read
a) In the drug interaction studies, midazolam (a sensitive CYP3A4 substrate) AUC (0 to inf) and Cmax decreased by 43% and 23%, respectively, following concomitant use of multiple doses of enasidenib 100 mg with a single intravenous dose of midazolam 0.03 mg/kg. The decrease in midazolam exposure following oral administration of midazolam is expected to be larger than that following intravenous administration of midazolam. This is due to induction of CYP3A4 first pass metabolism by enasidenib and the reduced bioavailability of the midazolam oral formulation compared to the midazolam intravenous formulation 1.
Common questions
Can I take Colchicine and Enasidenib together?
Increased colchicine exposure, an increased risk of colchicine toxicity, reduced colchicine and reduced efficacy of colchicine Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Enasidenib 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 strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Colchicine or Enasidenib 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: IDHIFA(R) oral tablets, enasidenib oral tablets. Bristol-Myers Squibb (per FDA), Princeton, NJ, 2023. DailyMed
- Product Information: LODOCO(R) oral tablets, colchicine oral tablets. AGEPHA Pharma USA, LLC (per FDA), Parsippany, NJ, 2023. DailyMed
- Product Information: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
Keep reading about Enasidenib
Keep reading about Colchicine
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