Colchicine and Ticagrelor: 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
Ticagrelor
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's talk about taking Brilinta (ticagrelor) and colchicine together. Ticagrelor blocks a protein pump (called P-gp) that normally helps your body clear colchicine out. When that pump is slowed down, colchicine can build up to higher levels than intended.
That matters because too much colchicine can cause serious problems like severe diarrhea, muscle pain and weakness, and in rare cases very dangerous, even life-threatening toxicity. The good news is that your care team knows about this combination and can manage it safely, often by adjusting your colchicine dose or watching you more closely. Please don't stop or change either medicine on your own, just talk with your pharmacist or doctor.
Effect: Ticagrelor (a P-gp inhibitor, with some CYP3A4 activity) reduces colchicine efflux and clearance, increasing colchicine exposure and risk of serious/fatal toxicity. Colchicine is the affected substrate (not a prodrug), so effect is enhanced.
- Direction: Increased colchicine AUC/Cmax.
- Evidence: Probable; severity contraindicated.
- Management: If coadministration is necessary, reduce colchicine daily dose by 50-75% or reduce dosing frequency. Combination is contraindicated in renal or hepatic impairment, where fatal toxicity has occurred.
- Monitor: for GI, myopathy, neuromuscular, and myelosuppressive signs of colchicine toxicity.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Using colchicine together with P-gp inhibitors is contraindicated1. When colchicine is taken alongside CYP3A4 inhibitors that also inhibit P-gp, serious and life-threatening toxicity may result. Should coadministration of colchicine with a P-gp inhibitor be required, the colchicine dose must be modified, either by lowering the daily dose by 50% to 75% 3 or by decreasing how often it is dosed. Furthermore, in patients who have renal or hepatic impairment, the joint use of colchicine with P-gp and CYP3A4 inhibitors is contraindicated 3. In such patients with renal and hepatic impairment, pairing these inhibitors with colchicine has produced life-threatening or fatal colchicine toxicity 2.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of colchicine; inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
This is a serious combination, so your care team will take it seriously too, and it can be managed.
- Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise.
- Your prescriber may lower your colchicine dose (often by half or more) or space out the doses.
- If you have kidney or liver problems, this combination is generally not used, so make sure your team knows your full history.
- Call your care team right away if you notice severe diarrhea, vomiting, muscle pain or weakness, numbness, or unusual tiredness.
Ask your pharmacist to review this pairing whenever either drug is started or changed.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Ticagrelor together?
Ticagrelor can raise colchicine to dangerous levels, so this combination should only be used under a doctor's guidance with a reduced colchicine dose, and it should be avoided entirely if you have kidney or liver problems. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Ticagrelor 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 Ticagrelor interaction managed?
This is a serious combination, so your care team will take it seriously too, and it can be managed. Keep taking both exactly as prescribed unless your doctor or pharmacist tells you otherwise. Your prescriber may lower your colchicine dose (often by half or more) or space out the doses. If you have kidney or liver problems, this combination is generally not used, so make sure your team knows your… 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 Ticagrelor 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: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
- Hansten PD, Tan MS, Horn JR, et al: Colchicine drug interaction errors and misunderstandings: recommendations for improved evidence-based management. Drug Saf 2023; 46(3):223-242. PubMed
Keep reading about Ticagrelor
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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