Colchicine and Imatinib: 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
Imatinib
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.
Imatinib (Gleevec) can make colchicine build up in your body. Imatinib slows down a liver enzyme (called CYP3A4) that normally helps break colchicine down. When that clean-up slows, more colchicine stays in your blood, and too much colchicine can be very dangerous, even life-threatening.
Watch for warning signs like stomach pain, diarrhea, vomiting, muscle weakness, or unusual tingling, and let your care team know right away. Please don't stop or change either medicine on your own. The good news is your doctor or pharmacist can manage this safely, often by lowering your colchicine dose or spacing it out, and by keeping a closer eye on you.
Mechanism: Imatinib inhibits CYP3A4-mediated metabolism of colchicine (colchicine is also a P-gp substrate). Neither drug is a prodrug; the effect is increased colchicine exposure (higher plasma concentrations) and risk of fatal colchicine toxicity.
- Direction: increased colchicine effect/toxicity
- Evidence: theoretical; severity rated major
- Onset: unspecified
Management: Avoid combination where possible. If required, reduce colchicine dose/frequency per label (gout flare: 1.2 mg once, repeat no sooner than 3 days; prophylaxis: halve dose; FMF max 1.2 mg/day). Monitor for GI, neuromuscular, and hematologic toxicity; discontinue colchicine if suspected. Avoid in renal or hepatic impairment.
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, since the combination can raise colchicine plasma levels and cause fatal colchicine toxicity. When the two must be given together, the colchicine dose should be modified, either by lowering the total daily amount or by decreasing how often it is taken3. For situations requiring concurrent administration or administration within 14 days, the colchicine regimen for a gout flare should be cut from the usual 1.2 mg (2 tablets) followed one hour later by 0.6 mg (1 tablet) down to a single 1.2 mg (2 tablets) dose, and any repeat dose should not occur sooner than 3 days later. When colchicine is used to prevent gout flares, the dose should be lowered from 0.6 mg twice daily to 0.6 mg once daily, or from 0.6 mg once daily to 0.3 mg once daily. For individuals with familial Mediterranean fever who need both colchicine and a moderate CYP3A4 inhibitor, the colchicine daily total should not exceed 1.2 mg (which can be administered as 0.6 mg twice daily). Watch for indications of colchicine toxicity and stop colchicine right away if it is suspected2. In addition, combining colchicine with moderate CYP3A4 inhibitors should be avoided in patients who have renal or hepatic impairment1.
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 let them know you take these two together.
- Your team may lower your colchicine dose or reduce how often you take it, and this dose can be adjusted and individualized for you.
- They may monitor you more closely for signs of colchicine toxicity.
- This combination is generally avoided in people with kidney or liver problems, so make sure your team knows your full history.
- Get help right away if you notice diarrhea, vomiting, belly pain, muscle weakness, or numbness/tingling.
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 Imatinib together?
Imatinib can raise colchicine levels and increase the risk of serious colchicine toxicity, so this combination is usually avoided; if it's needed, your care team will lower your colchicine dose and watch you closely. Call them right away for diarrhea, vomiting, muscle weakness, or tingling. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Imatinib 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 Imatinib interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise, and let them know you take these two together. Your team may lower your colchicine dose or reduce how often you take it, and this dose can be adjusted and individualized for you. They may monitor you more closely for signs of colchicine toxicity. This combination is generally avoided in people with kidney or liver pr… 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 Imatinib 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 Imatinib
Keep reading about Colchicine
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