Colchicine and Voriconazole: 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
Voriconazole
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.
Voriconazole (Vfend) can make colchicine build up in your body to dangerous levels. Voriconazole blocks a liver enzyme (called CYP3A4) that normally breaks colchicine down. When that clean-up slows, colchicine can rise too high, and at high levels colchicine can cause serious, even life-threatening harm.
This is a serious combination, so please don't start, stop, or change either medicine on your own. The good news is your care team can manage this. They may lower your colchicine dose, space it out, or choose a different option, and watch you closely. Reach out to your pharmacist or doctor if you've been prescribed both.
Mechanism: Voriconazole is a strong CYP3A4 inhibitor; colchicine is a CYP3A4 (and P-gp) substrate. Inhibition reduces colchicine clearance, increasing exposure (AUC/Cmax) and the risk of fatal toxicity. Colchicine is active drug, not a prodrug, so the effect is increased colchicine effect/toxicity.
- Direction: increased colchicine exposure.
- Evidence: probable; severity contraindicated.
- Management: Contraindicated in renal or hepatic impairment. In normal renal/hepatic function, reduce colchicine dose or frequency per indication (e.g., gout flare 0.6 mg then 0.3 mg 1 hr later, repeat no sooner than 3 days; prophylaxis 0.3 mg daily or every other day; FMF max 0.6 mg/day).
- Monitor for GI, myelosuppression, neuromuscular toxicity.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Because life-threatening and fatal colchicine toxicity has been documented in patients taking colchicine at therapeutic doses alongside strong CYP3A4 inhibitors, the combination of these agents is contraindicated1. In individuals with renal or hepatic impairment, colchicine must not be used together with strong CYP3A4 inhibitors (this includes every protease inhibitor with the exception of fosamprenavir). When renal and hepatic function are normal, patients who are taking a strong CYP3A4 inhibitor concurrently or who have taken one within the previous 14 days require a colchicine dose adjustment. To treat 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 sooner than 3 days. For gout flare prophylaxis, decrease the colchicine dose from an original 0.6 mg twice daily to 0.3 mg once daily, or from an original 0.6 mg once daily to 0.3 mg every other day. When treating familial Mediterranean fever, do not exceed a maximum colchicine dose of 0.6 mg per day (which may be administered as 0.3 mg twice daily)2. Should coadministration of colchicine with a CYP3A4 inhibitor be necessary, modify the colchicine dose by cutting either the 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
Keep taking both exactly as prescribed until you speak with your care team. This is a high-priority combination, so contact your pharmacist or prescriber promptly.
- If you have kidney or liver problems, this combination is generally not used, and your team will likely choose another approach.
- If your kidney and liver function are normal, your colchicine dose may be reduced or spaced out further, and individualized by your care team.
- Your team may monitor you more closely for signs of colchicine toxicity, such as diarrhea, vomiting, muscle weakness, or numbness.
Report any of those symptoms right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) While the specific interaction between colchicine and boceprevir has not been investigated, an interaction between colchicine and clarithromycin, a potent CYP3A4 inhibitor, produced 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 over 7 days, colchicine Cmax and AUC rose by 227.2% and 281.5%, respectively 21.
b) In a pharmacokinetic study, giving a single dose of colchicine to patients who had taken ritonavir 100 mg twice daily for 5 days (n=18) led to increases in colchicine Cmax and AUC of 184.4% and 296%, respectively, relative to baseline values 41.
Common questions
Can I take Colchicine and Voriconazole together?
Voriconazole can raise colchicine to dangerous levels, so this pairing is avoided (especially with kidney or liver problems); if it must be used with normal organ function, your colchicine dose will be lowered and you'll be watched closely. Talk with your pharmacist or doctor before changing anything. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Colchicine and Voriconazole 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 Voriconazole interaction managed?
Keep taking both exactly as prescribed until you speak with your care team. This is a high-priority combination, so contact your pharmacist or prescriber promptly. If you have kidney or liver problems, this combination is generally not used, and your team will likely choose another approach. If your kidney and liver function are normal, your colchicine dose may be reduced or spaced out further, an… 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 Voriconazole 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 Voriconazole
Keep reading about Colchicine
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