Colchicine and Mirabegron: 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
Mirabegron
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.
These two medicines can be a risky pair. Mirabegron (Myrbetriq) can slow down a natural "pump" in your body that normally helps clear out colchicine. When that pump is blocked, colchicine can build up to higher levels than intended.
Colchicine has a narrow safety window, so even a modest rise can lead to serious side effects like severe stomach pain, diarrhea, muscle weakness, or worse. This warning is based on how the drugs behave rather than lots of real-world cases, but it is taken seriously. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, who can adjust your colchicine dose and watch you closely.
Mechanism: Colchicine is a P-gp (and CYP3A4) substrate. Mirabegron is a P-gp inhibitor, so it reduces P-gp-mediated colchicine efflux, increasing colchicine exposure and toxicity risk. Neither drug is a prodrug.
- Direction: Increased colchicine plasma levels (increased effect/toxicity).
- Severity: Labeled contraindicated; life-threatening/fatal colchicine toxicity reported with P-gp inhibitors.
- Evidence: Theoretical for this specific pair (class-based, extrapolated from other P-gp inhibitors).
- Management: Avoid in renal or hepatic impairment. If coadministration is required in patients with normal organ function, reduce colchicine daily dose or dosing frequency and monitor closely for toxicity (GI symptoms, myelosuppression, neuromuscular effects).
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Colchicine acts as a substrate for both CYP3A4 and P-gp. Instances of toxicity have been documented when colchicine was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Such toxicities have similarly 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 along with P-gp inhibitors, this combination is contraindicated 1. Likewise, this combination is contraindicated in individuals with renal or hepatic impairment, since life-threatening and fatal drug interactions have been observed. For patients whose renal and hepatic function is normal 2, when colchicine must be coadministered with a P-gp inhibitor, adjust the colchicine dose by lowering either the daily amount or the frequency of dosing. 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
What your care team may do:
- Avoid this combination when possible, and especially avoid it if you have kidney or liver problems.
- If both drugs are truly needed and your kidneys and liver work normally, your team may lower your colchicine dose or space out how often you take it.
- Watch you more closely for signs of colchicine toxicity.
What you should do: Keep taking both exactly as prescribed for now, and reach out to your pharmacist or prescriber promptly. Tell them right away if you notice severe diarrhea, vomiting, stomach pain, muscle weakness or pain, numbness, or unusual tiredness.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Mirabegron together?
Mirabegron can raise colchicine to dangerous levels by blocking its P-gp transport, so this combination is contraindicated and needs prescriber review; do not stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Mirabegron 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 Mirabegron interaction managed?
What your care team may do: Avoid this combination when possible, and especially avoid it if you have kidney or liver problems. If both drugs are truly needed and your kidneys and liver work normally, your team may lower your colchicine dose or space out how often you take it. Watch you more closely for signs of colchicine toxicity. What you should do: Keep taking both exactly as prescribed for no… 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 Mirabegron 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 Mirabegron
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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