Colchicine and Troleandomycin: 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
Troleandomycin
No brand names on recordColchicine
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 don't mix well. Troleandomycin is a strong antibiotic that blocks a liver enzyme (called CYP3A4) that your body uses to break down colchicine. When that enzyme is blocked, colchicine builds up to much higher levels than normal.
That matters because too much colchicine can be very dangerous, even life-threatening. This combination is generally not used together. Please don't stop or change either medicine on your own. Instead, talk with your pharmacist or doctor. They can pick a safer antibiotic, or carefully lower your colchicine dose and watch you closely to keep you safe.
Mechanism: Troleandomycin is a strong CYP3A4 inhibitor. Colchicine is a CYP3A4 (and P-gp) substrate, so inhibition reduces its clearance, increasing colchicine exposure (AUC/Cmax) and the risk of fatal toxicity.
- Direction: increased colchicine effect/toxicity (not a prodrug interaction).
- Severity: contraindicated; evidence probable.
- Contraindicated outright in renal or hepatic impairment.
- Normal renal/hepatic function: dose reduction required if given within 14 days of a strong CYP3A4 inhibitor. Gout flare: 0.6 mg once, then 0.3 mg 1 h later, no repeat for 3 days. Prophylaxis: 0.6 mg BID to 0.3 mg daily, or 0.6 mg daily to 0.3 mg every other day. FMF: max 0.6 mg/day.
- Monitor closely for colchicine toxicity (GI, myelosuppression, neuromuscular).
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Because therapeutic doses of colchicine have been linked to reports of fatal and life-threatening colchicine toxicity when combined with strong CYP3A4 inhibitors, giving these agents together is contraindicated1. In individuals with renal or hepatic impairment, the combination of colchicine with strong CYP3A4 inhibitors (which includes every protease inhibitor apart from fosamprenavir) is likewise contraindicated. Patients whose renal and hepatic function is normal, and who are concurrently taking or have taken a strong CYP3A4 inhibitor within the preceding 14 days, require an adjustment of the colchicine dose. When treating a gout flare, lower the colchicine dose to a single 0.6 mg tablet followed by 0.3 mg one hour afterward, and do not repeat this dose any sooner than 3 days. For gout flare prophylaxis, cut the colchicine dose from 0.6 mg twice daily down to 0.3 mg once daily, or from 0.6 mg once daily down to 0.3 mg once every other day. In the treatment of familial Mediterranean fever, the colchicine daily maximum should not exceed 0.6 mg (which may be administered as 0.3 mg twice daily)2. Should colchicine and a CYP3A4 inhibitor need to be given together, modify the colchicine dose by lowering either the total daily amount or the frequency of dosing, and watch closely for signs of colchicine toxicity3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
This is a serious combination that your care team manages carefully. Keep taking your medicines as prescribed and raise this with your pharmacist or prescriber promptly.
- Often the safest step is choosing a different antibiotic instead of troleandomycin.
- If you have any kidney or liver problems, these drugs should not be used together.
- If both must be used and your kidneys and liver are normal, your team will lower your colchicine dose or reduce how often you take it, tailored to why you take colchicine (gout flare, prevention, or familial Mediterranean fever).
- Watch for warning signs such as nausea, vomiting, diarrhea, muscle weakness, or unusual bruising, and report them right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) While the interaction between colchicine and boceprevir has not been examined, an interaction involving 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 were receiving clarithromycin 250 mg twice daily for 7 days, colchicine Cmax rose by 227.2% and AUC rose by 281.5% 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% increase in colchicine Cmax and a 296% increase in AUC relative to baseline levels, respectively 41.
Common questions
Can I take Colchicine and Troleandomycin together?
Troleandomycin can push colchicine to dangerous, potentially fatal levels, so this pairing is contraindicated, especially with kidney or liver problems. Do not combine them without talking to your doctor, who may switch antibiotics or carefully reduce your colchicine dose. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Troleandomycin 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 Troleandomycin interaction managed?
This is a serious combination that your care team manages carefully. Keep taking your medicines as prescribed and raise this with your pharmacist or prescriber promptly. Often the safest step is choosing a different antibiotic instead of troleandomycin. If you have any kidney or liver problems, these drugs should not be used together. If both must be used and your kidneys and liver are normal, you… 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 Troleandomycin 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 Troleandomycin
Keep reading about Colchicine
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