Colchicine and Suvorexant: 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
Suvorexant
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.
Let me walk you through this one. Colchicine (for gout) is normally pushed out of your body by a kind of cellular pump called P-gp. Suvorexant (Belsomra, for sleep) can slow that pump down. When the pump slows, colchicine can build up to higher levels than intended, and that raises the risk of serious colchicine side effects like severe stomach upset, muscle pain, or effects on your blood cells.
The good news is that this is very manageable. Please don't stop or change either medicine on your own. Just check in with your pharmacist or doctor. They can look at your kidney and liver health and adjust things safely for you.
Effect: Increased colchicine exposure and risk of colchicine toxicity. Colchicine is a P-gp (and CYP3A4) substrate; suvorexant can inhibit P-gp-mediated colchicine efflux, reducing clearance and raising systemic exposure.
Direction: Increased colchicine effect/toxicity (neither drug is a prodrug).
- Severity: Contraindicated per labeling for P-gp inhibitors.
- Evidence: Theoretical, extrapolated from documented toxicity with other P-gp/CYP3A4 inhibitors.
- Management: Contraindicated in renal or hepatic impairment. In patients with normal renal/hepatic function, if coadministration is required, reduce colchicine daily dose or dosing frequency and monitor closely for toxicity (GI symptoms, myopathy, myelosuppression).
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. Reports of toxicity have emerged when it was given alongside clarithromycin, which inhibits both CYP3A4 and P-gp. Similar toxicities have been documented when colchicine was combined with a CYP3A4 inhibitor and when it was combined with a P-gp inhibitor3. Using colchicine together with P-gp inhibitors is contraindicated, since life-threatening and fatal colchicine toxicity has been reported in such patients even at therapeutic colchicine doses 1. This combination is likewise 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 normal 2, when colchicine and a P-gp inhibitor must be given together, the colchicine dose should be adjusted, either by lowering the daily dose or by decreasing how often it is taken. 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
Here is how a care team typically handles this pairing:
- Keep taking both exactly as prescribed until you speak with your pharmacist or prescriber. Do not stop or adjust either one on your own.
- Your team will review your kidney and liver function, since combining these is not advised if either is impaired.
- If both drugs are truly needed and your kidneys and liver are healthy, your colchicine dose may be reduced, or taken less often, and individualized to you.
- They may monitor you more closely for colchicine toxicity.
Call your doctor promptly if you notice severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or infections.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Suvorexant together?
Combining suvorexant with colchicine can raise colchicine levels and cause serious toxicity, and this combination is contraindicated (especially with any kidney or liver problems). Do not change either medicine yourself; contact your pharmacist or doctor so they can review your kidney/liver function and adjust or monitor safely. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Suvorexant 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 Suvorexant interaction managed?
Here is how a care team typically handles this pairing: Keep taking both exactly as prescribed until you speak with your pharmacist or prescriber. Do not stop or adjust either one on your own. Your team will review your kidney and liver function, since combining these is not advised if either is impaired. If both drugs are truly needed and your kidneys and liver are healthy, your colchicine dose m… 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 Suvorexant 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 Suvorexant
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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