Colchicine and Tacrolimus: 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
Tacrolimus
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.
Taking these two together can let colchicine build up in your body. Tacrolimus slows down a natural "pump" (called P-glycoprotein) that normally helps clear colchicine out. When that pump is blocked, colchicine levels can climb higher than intended.
That matters because too much colchicine can cause serious problems, like bad diarrhea, muscle weakness, nerve tingling, blood count changes, and in severe cases it can be life-threatening. This is a well-established interaction, so please don't ignore it, but also don't panic. Do not stop or change either medicine on your own. Your doctor or pharmacist can manage this safely by lowering your colchicine dose and keeping a closer eye on you.
Effect: Tacrolimus inhibits P-glycoprotein-mediated efflux of colchicine, increasing colchicine plasma concentrations and risk of toxicity. Colchicine is the affected substrate (neither drug is a prodrug here).
Evidence: Established. Severity: Major. Onset: Unspecified.
- Contraindicated in patients with renal or hepatic impairment.
- With normal renal/hepatic function, consider colchicine dose reduction or interruption and monitor for toxicity (GI symptoms, myopathy, neuropathy, myelosuppression).
- Gout flare: limit to one 0.6 mg dose, repeat no sooner than 3 days.
- FMF: max 0.6 mg/day (may give as 0.3 mg twice daily).
What happens
Increased colchicine plasma concentrations and increased risk of toxicity
Interaction Deep Dive
The p-glycoprotein transporter system uses colchicine as a substrate. When colchicine is given together with tacrolimus, colchicine serum levels can rise substantially, leading to grave pharmacodynamic outcomes that include death. This combination should not be used in patients who have renal or hepatic impairment. For patients whose renal and hepatic function is normal, watch for signs and symptoms indicating colchicine toxicity. It may be necessary to reduce the colchicine dose or stop it altogether2. When colchicine and tacrolimus must be used together, the colchicine dose for a gout flare should be lowered to a single 0.6-mg tablet, and any repeat dose should not be administered sooner than 3 days. For patients with familial Mediterranean fever who require concurrent colchicine and tacrolimus, the colchicine dose should not exceed a maximum of 0.6 mg per day (which may be administered as 0.3 mg twice daily) 1.
Why it happens (mechanism)
Inhibition of p-glycoprotein-mediated colchicine transport by tacrolimus
How to manage this interaction
Keep taking both exactly as prescribed and let your care team guide any changes.
- If you have kidney or liver problems, these two are not used together, so make sure your prescribers know your full history.
- With normal kidney and liver function, your team may lower or pause your colchicine and watch you more closely for toxicity.
- For a gout flare, colchicine may be limited to one 0.6 mg dose, with any repeat no sooner than 3 days later.
- For familial Mediterranean fever, the daily colchicine may be capped at 0.6 mg.
Call your pharmacist or doctor promptly if you notice diarrhea, vomiting, muscle weakness, numbness or tingling, or unusual fatigue.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a pharmacokinetic investigation involving patients with familial Mediterranean fever, colchicine AUC and Cmax were markedly greater in kidney transplant recipients who were also taking tacrolimus (n=6) than in patients with native kidneys and a normal glomerular filtration rate (GFR) who received colchicine alone (n=6). The GFR of the kidney transplant patients was between 64 and 99 mL/minute. Colchicine AUC measured 16.9 picomol (pmol)/hr/mL versus 5.3 pmol/hr/mL in the non-transplant patients, and Cmax was 1.18 pmol/mL in the transplant patients compared with 0.32 pmol/mL in the group without transplants 3.
b) Malaise, fatigue, a raised creatine phosphokinase (CPK; 9084 units/L), and elevations in aspartate aminotransferase developed several days after starting colchicine 0.6 mg twice daily in a 62-year-old kidney transplant recipient who had stable renal function (creatinine 1.2 mg/dL) and was concurrently taking tacrolimus. Tacrolimus concentrations remained within therapeutic limits. After colchicine was stopped, CPK fell rapidly to 5204 units/L within 3 days, and muscle and liver enzymes returned to normal within 2 months 4.
Common questions
Can I take Colchicine and Tacrolimus together?
Tacrolimus can raise colchicine levels to dangerous amounts; this combo is off-limits if you have kidney or liver impairment, and otherwise needs a reduced colchicine dose plus close monitoring. Never adjust either drug yourself, and report diarrhea, muscle weakness, or tingling to your care team right away. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Tacrolimus interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
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 Tacrolimus interaction managed?
Keep taking both exactly as prescribed and let your care team guide any changes. If you have kidney or liver problems, these two are not used together, so make sure your prescribers know your full history. With normal kidney and liver function, your team may lower or pause your colchicine and watch you more closely for toxicity. For a gout flare, colchicine may be limited to one 0.6 mg dose, with… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Colchicine or Tacrolimus 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: COLCRYS(TM) oral tablets, colchicine oral tablets. Mutual Pharmaceutical Company, Philadelphia, PA, 2009. DailyMed
- US Food and Drug Administration: Information for Healthcare Professionals: New Safety Information for Colchicine (marketed as Colcrys). US Food and Drug Administration. Rockville, MD. 2009.
- Amanova A, Kendi Celebi Z, Bakar F, et al: Colchicine levels in chronic kidney diseases and kidney transplant recipients using tacrolimus. Clin Transplant 2014; 28(10):1177-1183. PubMed
- Yousuf Bhat Z, Reddy S, Pillai U, et al: Colchicine-induced myopathy in a tacrolimus-treated renal transplant recipient: case report and literature review. Am J Ther 2016; 23(2):e614-e616. PubMed
Keep reading about Tacrolimus
Keep reading about Colchicine
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