Colchicine and Vorapaxar: 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
Vorapaxar
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.
You've been prescribed both vorapaxar (Zontivity), a blood thinner, and colchicine, which is used for gout and some heart conditions. Here's the concern: vorapaxar can block a transporter (called P-gp) that normally helps your body pump colchicine out. When that pump is slowed down, colchicine can build up to higher levels than intended.
Too much colchicine can cause serious problems like severe diarrhea, muscle weakness, and, in bad cases, life-threatening toxicity. Because of this risk, the two are usually not taken together. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor soon so they can review your kidney and liver health and choose the safest plan for you.
Effect: Vorapaxar may inhibit P-gp-mediated efflux of colchicine, increasing colchicine exposure and risk of toxicity. Colchicine is a P-gp (and CYP3A4) substrate; it is not a prodrug, so raised exposure means enhanced/toxic effect.
- Direction: Increased colchicine AUC/Cmax.
- Severity: Contraindicated per labeling for colchicine with P-gp inhibitors.
- Evidence: Theoretical for this pair; extrapolated from documented P-gp/CYP3A4 inhibitor toxicities.
- Management: Contraindicated in renal or hepatic impairment. In patients with normal renal/hepatic function requiring coadministration, 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
As a substrate of both CYP3A4 and P-gp, colchicine has produced toxicities when given together with clarithromycin, an agent that 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. Because life-threatening and fatal colchicine toxicity has occurred in patients taking therapeutic doses of colchicine alongside P-gp inhibitors, the concurrent use of colchicine with P-gp inhibitors is contraindicated1. This combination is likewise contraindicated in individuals with renal or hepatic impairment, given that life-threatening and fatal drug interactions have been reported. For patients whose renal and hepatic function is normal2, when colchicine must be coadministered with a P-gp inhibitor, modify the colchicine dose by lowering either the daily amount or the frequency of dosing, and watch closely for signs of colchicine toxicity3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
The main thing: keep taking both exactly as prescribed until you speak with your care team. This combination is generally avoided because colchicine can build up to dangerous levels.
- Your team will check your kidney and liver function first, since this combination is not used in people with kidney or liver problems.
- If both drugs are truly needed and your organ function is normal, your colchicine dose may be reduced or spaced out, individualized by your care team, with closer monitoring.
- Report warning signs right away: severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or fatigue.
Ask your pharmacist or prescriber to review this pairing before your next dose.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Colchicine and Vorapaxar together?
Vorapaxar can raise colchicine to potentially toxic levels, and this combination is normally contraindicated. Do not change either drug yourself; contact your pharmacist or doctor promptly to review your kidney and liver function and your plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Vorapaxar 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 Vorapaxar interaction managed?
The main thing: keep taking both exactly as prescribed until you speak with your care team. This combination is generally avoided because colchicine can build up to dangerous levels. Your team will check your kidney and liver function first, since this combination is not used in people with kidney or liver problems. If both drugs are truly needed and your organ function is normal, your colchicine… 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 Vorapaxar 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 Vorapaxar
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist