Colchicine and Enzalutamide: 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
Enzalutamide
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.
Let's talk about taking enzalutamide (Xtandi) and colchicine together. This combination can be tricky, and it's actually listed as one to avoid. Enzalutamide can block a transporter in your body that normally helps clear colchicine out. When that happens, colchicine can build up to dangerous levels, which can cause serious and even life-threatening problems.
At the same time, enzalutamide can also speed up how your body breaks colchicine down, which could make it work less well. Either way, the amount of colchicine in your body may not be right. The good news is your care team can manage this. Don't stop either medicine on your own. Just talk with your doctor or pharmacist so they can guide you safely.
Effect: Altered colchicine exposure with risk of serious, potentially life-threatening colchicine toxicity. Colchicine is a narrow-therapeutic-index P-gp and CYP3A4 substrate; it is not a prodrug.
Mechanism (dual, opposing):
- Enzalutamide inhibits P-gp-mediated efflux, increasing colchicine exposure (toxicity risk).
- Enzalutamide is a strong CYP3A4 inducer, which may reduce colchicine concentrations (therapeutic failure).
Evidence: Theoretical. Onset: unspecified. Status: Labeled contraindicated.
Management: Avoid coadministration. If unavoidable, individualize colchicine dosing (reduce dose or frequency per P-gp concern) and monitor closely for toxicity; adjust as needed given competing CYP3A4 induction.
What happens
Altered (increased/reduced) colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Taking colchicine together with P-gp inhibitors such as enzalutamide is contraindicated1. When colchicine is given alongside enzalutamide (a P-gp inhibitor), there is a risk of serious and life-threatening toxicity. Should combined administration of colchicine with a P-gp inhibitor be required, modify the colchicine dose by lowering either the daily amount or how often it is given, and closely watch patients for signs of colchicine toxicity2. Enzalutamide is a strong CYP3A4 inducer, while colchicine is a CYP3A4 substrate in which even a slight drop in concentration can lead to therapeutic failure of the substrate; if their coadministration cannot be avoided, raise the colchicine dosage as required3.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of colchicine; induction of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
This pairing is flagged as one to avoid because of the risk of colchicine building up to harmful levels. Here is what typically happens and what you can do:
- Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not adjust doses on your own.
- Your team may reduce your colchicine dose or how often you take it, and they may monitor you more closely for signs of toxicity.
- Because these drugs pull in opposite directions on colchicine levels, your dose may need to be adjusted and individualized by your care team.
- Call your pharmacist or doctor right away if you notice severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or bleeding.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Enzalutamide together?
Enzalutamide and colchicine together are considered a combination to avoid because colchicine can reach toxic levels; if you take both, your care team will individualize your colchicine dose and watch you closely, so check with your doctor or pharmacist before making any changes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Enzalutamide 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 Enzalutamide interaction managed?
This pairing is flagged as one to avoid because of the risk of colchicine building up to harmful levels. Here is what typically happens and what you can do: Keep taking both exactly as prescribed unless your care team tells you otherwise. Do not adjust doses on your own. Your team may reduce your colchicine dose or how often you take it, and they may monitor you more closely for signs of toxicity.… 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 Enzalutamide 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: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
- Product Information: XTANDI® oral capsules, oral tablets, enzalutamide oral capsules, oral tablets. Astellas Pharma US Inc (per FDA), Northbrook, IL, 2025. DailyMed
Keep reading about Enzalutamide
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.
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