Colchicine and Pibrentasvir: 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
Colchicine
Pibrentasvir
No brand names on record
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 add up in a risky way. Colchicine (Colcrys, Mitigare) is normally pumped out of your body by a transporter called P-gp. Pibrentasvir blocks that pump, so more colchicine can stay in your body than intended.
Colchicine has a very narrow safety window, so even a small buildup can cause serious, sometimes life-threatening problems like severe stomach upset, muscle weakness, or effects on blood cells. Because of this, the two are generally not used together. Please do not stop or change either medicine on your own. Talk with your pharmacist or doctor. They can review your kidney and liver health and safely adjust or manage your treatment.
Mechanism: Colchicine is a P-gp (and CYP3A4) substrate. Pibrentasvir inhibits P-gp, reducing colchicine efflux and increasing systemic colchicine exposure, raising the risk of colchicine toxicity. Neither drug is a prodrug, so the effect is a straightforward increase in colchicine levels.
- Direction: increased colchicine exposure/effect (toxicity risk)
- Severity: contraindicated; evidence is theoretical/extrapolated but toxicity is well documented with other P-gp inhibitors
- Contraindicated in renal or hepatic impairment (fatal toxicity reported)
- Management (normal renal/hepatic function, if required): reduce colchicine daily dose or dosing frequency and monitor closely for colchicine toxicity (GI symptoms, myelosuppression, neuromyopathy)
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. Cases of toxicity have been documented when it was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Such toxicities have likewise been seen when colchicine was combined with a CYP3A4 inhibitor and when it was combined with a P-gp inhibitor3. The simultaneous use of colchicine and P-gp inhibitors is contraindicated, since life-threatening and fatal colchicine toxicity has been reported in these individuals even when colchicine was taken at therapeutic doses 1. This combination is also contraindicated in those with renal or hepatic impairment, because life-threatening and fatal drug interactions have been observed. 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. Watch carefully 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:
- Because of the serious risk, this combination is generally avoided, especially if you have kidney or liver problems.
- If both are truly needed and your kidneys and liver work normally, your colchicine dose may need to be reduced or taken less often, individualized by your team.
- Your team may monitor 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. Report any severe diarrhea, vomiting, muscle weakness or pain, tingling, or unusual bruising, fever, or fatigue right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Pibrentasvir together?
Pibrentasvir can raise colchicine levels toward toxic territory, so this pairing is generally avoided; do not change anything yourself and contact your pharmacist or doctor to have it reviewed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Pibrentasvir 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 Pibrentasvir interaction managed?
What your care team may do: Because of the serious risk, this combination is generally avoided, especially if you have kidney or liver problems. If both are truly needed and your kidneys and liver work normally, your colchicine dose may need to be reduced or taken less often, individualized by your team. Your team may monitor you more closely for signs of colchicine toxicity. What you should do: K… 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 Pibrentasvir 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 Colchicine
Keep reading about Pibrentasvir
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