Cyanocobalamin with Colchicine Interaction Details

Brand Names Associated with Cyanocobalamin

Brand Names Associated with Colchicine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

Decreased cyanocobalamin absorption

Interaction Summary

Colchicine therapy is associated with reduced cyanocobalamin absorption, with the greatest reductions observed with tubal administration directly into the ileum. The effects were reversible with colchicine discontinuation .

Severity

Minor

Onset

Delayed

Evidence

Established

How To Manage Interaction

Patients receiving colchicine therapy may require supplemental cyanocobalamin. During therapy, monitor patient for signs/symptoms of cyanocobalamin deficiency, including paresthesia, diminution of the vibration sense and/or position sense, unsteadiness, and poor muscular coordination and ataxia. In patients receiving long-term colchicine therapy, monitor serum levels of cyanocobalamin (vitamin B 12), especially elderly and those with chronic liver or renal failure.

Mechanism Of Interaction

Disruption of intestinal mucosal function

Literature Reports

A) In a subgroup analysis of 11 obese patients given colchicine while maintaining a nutritionally-stable diet, consistent reductions in vitamin B12 absorption were noted in 3 patients administered colchicine (2.6 to 3.9 mg/day) plus 0.25 microcuries/day of cobalt 57-labeled vitamin B12. Schilling tests showed decreased vitamin B12 absorption during colchicine periods, with a decrease to subnormal levels (less than 7%) in 2 of the 3 patients. Vitamin B12 excretion increased between the control and recovery periods for patient 1 (22.5% to 27%), patient 2 (22.2% to 29.5%), and patient 3 (24% to 40%). Levels returned to normal following colchicine withdrawal .

B) Oral colchicine reduced cyanocobalamin absorption in 18 out of 19 patients studied, with the greatest reductions reported with direct delivery to the ileum. Three male and 16 female patients (18 obese and 1 with hyperlipemia) were given a constant diet and administered daily oral doses of 0.1 microcuries of cobalt 57-labeled vitamin B12 followed by 1 mg of intramuscular vitamin B12 two hours later. Urine and feces were analyzed for cobalt 57 during control periods, with administration of colchicine (1.9 to 3.6 mg/day by mouth or tube over 4 to 8 days), and with cascara sagrada fluid extract (18 mL) given during control periods. Overall, there were significant decreases in vitamin B12 absorption during colchicine periods (p less than 0.01), with all but one patient having higher vitamin B12 excretion after colchicine than before. The greatest reductions in absorption (less than 5% excretion) were noted when colchicine was administered by tube directly into the ileum. Three to five days after colchicine withdrawal, vitamin B12 levels returned to baseline in all but one patient .

Cyanocobalamin Overview

• Cyanocobalamin injection is used to treat and prevent a lack of vitamin B₁₂ that may be caused by any of the following: pernicious anemia (lack of a natural substance needed to absorb vitamin B₁₂ from the intestine); certain diseases, infections, or medications that decrease the amount of vitamin B₁₂ absorbed from food; or a vegan diet (strict vegetarian diet that does not allow any animal products, including dairy products and eggs). Lack of vitamin B₁₂ may cause anemia (condition in which the red blood cells do not bring enough oxygen to the organs) and permanent damage to the nerves. Cyanocobalamin injection also may be given as a test to see how well the body can absorb vitamin B₁₂. Cyanocobalamin injection is in a class of medications called vitamins. Because it is injected straight into the bloodstream, it can be used to supply vitamin B₁₂ to people who cannot absorb this vitamin through the intestine.

Colchicine Overview

• Colchicine is used to prevent gout attacks (sudden, severe pain in one or more joints caused by abnormally high levels of a substance called uric acid in the blood) in adults. Colchicine (Colcrys) is also used to relieve the pain of gout attacks when they occur. Colchicine (Colcrys) is also used to treat familial Mediterranean fever (FMF; an inborn condition that causes episodes of fever, pain, and swelling of the stomach area, lungs, and joints) in adults and children 4 years of age and older. Colchicine is not a pain reliever and cannot be used to treat pain that is not caused by gout or FMF. Colchicine is in a class of medications called anti-gout agents. It works by stopping the natural processes that cause swelling and other symptoms of gout and FMF.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.