Colchicine and Ribociclib: 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
Ribociclib
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.
Ribociclib (Kisqali) can make colchicine build up in your body. Ribociclib slows down a liver enzyme (called CYP3A4) that normally breaks colchicine down. When that clean-up slows, colchicine levels climb higher than they should, and that raises the risk of serious, even life-threatening side effects like severe diarrhea, muscle weakness, and bone marrow problems.
Because of this, taking these two together needs real caution, and in some situations it should be avoided. Please do not change or stop either medicine on your own. Talk with your pharmacist or doctor. Your care team can lower or space out your colchicine dose and watch you closely so this stays safe.
Mechanism: Ribociclib is a strong CYP3A4 inhibitor; colchicine is a CYP3A4 (and P-gp) substrate. Inhibition reduces colchicine clearance, increasing exposure (AUC/Cmax) and risk of fatal toxicity. Neither drug is a prodrug, so the effect is increased colchicine activity.
- Direction: Increased colchicine effect/toxicity.
- Severity: Contraindicated; probable evidence.
- Contraindicated in renal or hepatic impairment.
- Normal organ function: reduce colchicine dose or frequency (e.g., gout flare 0.6 mg then 0.3 mg 1 h later, no repeat before 3 days; prophylaxis 0.6 mg BID to 0.3 mg daily; FMF max 0.6 mg/day).
- Monitor for GI, myoneuropathy, and myelosuppression.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Because life-threatening and fatal colchicine toxicity has been documented in patients taking colchicine at therapeutic doses alongside strong CYP3A4 inhibitors, the combination is contraindicated1. In individuals with renal or hepatic impairment, giving colchicine together with strong CYP3A4 inhibitors (all protease inhibitors except fosamprenavir included) is likewise contraindicated. For patients whose renal and hepatic function is normal and who are concurrently taking, or have taken within the previous 14 days, a strong CYP3A4 inhibitor, the colchicine dose must be modified. When treating a gout flare, lower the colchicine dose to a single 0.6 mg tablet followed 1 hour later by 0.3 mg, and do not repeat this dosing sooner than 3 days. For gout flare prophylaxis, decrease the colchicine dose from a starting regimen of 0.6 mg twice daily to 0.3 mg once daily, or from a starting regimen of 0.6 mg once daily to 0.3 mg once every other day. When treating familial Mediterranean fever, the daily colchicine dose should not exceed 0.6 mg (which may be split as 0.3 mg twice daily)2. Should colchicine and a CYP3A4 inhibitor need to be given together, adjust colchicine by lowering either the daily dose or the frequency of dosing, and monitor closely for colchicine toxicity3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
The good news: your care team can manage this by tailoring your colchicine dosing and watching you closely.
- Keep taking both medicines as prescribed unless your prescriber tells you otherwise.
- If you have kidney or liver problems, this combination is generally avoided, so make sure your team knows your full history.
- For people with normal kidney and liver function, the colchicine dose may be lowered or given less often, and this will be individualized by your care team.
- Tell your pharmacist or doctor right away about severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or infections.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) While the specific interaction between colchicine and boceprevir has not been investigated, an interaction between colchicine and clarithromycin, a potent CYP3A4 inhibitor, led to fatal colchicine toxicity. When a single 0.6 mg dose of colchicine was given to patients (n=23) who had been receiving clarithromycin 250 mg twice daily for 7 days, colchicine Cmax and AUC rose by 227.2% and 281.5%, respectively 21.
b) In a pharmacokinetic study, giving a single dose of colchicine to patients who had received ritonavir 100 mg twice daily for 5 days (n=18) produced a 184.4% and 296% increase in colchicine Cmax and AUC relative to baseline levels, respectively 41.
Common questions
Can I take Colchicine and Ribociclib together?
Ribociclib raises colchicine levels and the risk of dangerous toxicity, so this combination should be avoided in people with kidney or liver problems and needs a reduced colchicine dose plus close monitoring in everyone else. Do not adjust either drug yourself; check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Ribociclib 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 Ribociclib interaction managed?
The good news: your care team can manage this by tailoring your colchicine dosing and watching you closely. Keep taking both medicines as prescribed unless your prescriber tells you otherwise. If you have kidney or liver problems, this combination is generally avoided, so make sure your team knows your full history. For people with normal kidney and liver function, the colchicine dose may be lower… Management is individual — always follow your own care team's guidance.
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 Ribociclib 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 (4)
- 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
- Product Information: COLCRYS(TM) oral tablets, colchicine oral tablets. AR Scientific, Inc. Philadelphia, PA, 2009. DailyMed
Keep reading about Ribociclib
Keep reading about Colchicine
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