Colchicine and Rolapitant: 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
Rolapitant
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 combination. Rolapitant (Varubi) is used to prevent nausea from chemotherapy, and colchicine (Colcrys, Mitigare and others) treats gout and certain inflammatory conditions. Your body normally uses a kind of "pump" called P-gp to clear colchicine out. Rolapitant can slow that pump down, so colchicine may build up higher than expected.
Too much colchicine can cause serious problems like severe stomach upset, muscle weakness, and blood or organ issues. That is why this combination is flagged as one to avoid unless your care team decides it is truly needed. The good news: your doctor and pharmacist can manage this by choosing a different option or carefully adjusting your dose and watching you closely.
Interaction: Rolapitant is a P-gp inhibitor; colchicine is a CYP3A4/P-gp substrate. Inhibition of P-gp-mediated colchicine efflux increases colchicine exposure and risk of toxicity.
- Direction: increased colchicine AUC/Cmax, enhanced toxicity (increases_drug_effect).
- Severity: contraindicated. Life-threatening and fatal colchicine toxicity has been reported with P-gp inhibitors.
- Evidence: theoretical for this pair; class-based on documented P-gp inhibitor interactions.
- Onset: unspecified.
- Management: Avoid in renal or hepatic impairment. In normal renal/hepatic function, if coadministration is required, reduce colchicine daily dose or frequency and monitor closely for toxicity (GI, myopathy, myelosuppression).
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Both CYP3A4 and P-gp act on colchicine as a substrate. Cases of toxicity have been documented when colchicine was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Toxicity has likewise been seen 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 receiving therapeutic doses, using colchicine at the same time as P-gp inhibitors is contraindicated1. This combination is also contraindicated in individuals with renal or hepatic impairment, given that life-threatening and fatal drug interactions have been observed. For patients whose renal and hepatic function is normal2, 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 toxicity3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
Do not stop or change either medicine on your own. This combination is generally avoided, but your care team can manage it safely.
- Tell your prescriber and pharmacist you are taking both so they can review your kidney and liver function.
- If you have reduced kidney or liver function, this pairing is not recommended, and your team will likely choose an alternative.
- If both are truly needed and your organ function is normal, your care team may reduce the colchicine daily dose or how often you take it, individualized to you.
- Report muscle weakness, severe diarrhea, numbness, or unusual fatigue promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Rolapitant together?
Rolapitant can raise colchicine levels toward toxic amounts, so this combination is normally avoided; if it must be used, only under a doctor's guidance with a lowered colchicine dose and close monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Rolapitant 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 Rolapitant interaction managed?
Do not stop or change either medicine on your own. This combination is generally avoided, but your care team can manage it safely. Tell your prescriber and pharmacist you are taking both so they can review your kidney and liver function. If you have reduced kidney or liver function, this pairing is not recommended, and your team will likely choose an alternative. If both are truly needed and your… 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 Rolapitant 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 Rolapitant
Keep reading about Colchicine
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