Gemfibrozil with Colchicine Interaction Details
Brand Names Associated with Gemfibrozil
- Gemfibrozil
- Lopid®
Brand Names Associated with Colchicine
- Colchicine
- Colcrys®
- Gloperba®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
An increased risk of myopathy or rhabdomyolysis
Interaction Summary
Coadministration of colchicine and gemfibrozil may result in myopathy and rhabdomyolysis. If concomitant use of these two drugs is necessary, monitor patients for signs and symptoms of myopathy or rhabdomyolysis (dark-colored urine and/or muscle pain, tenderness, or weakness). Myopathy and rhabdomyolysis were reported when a patient maintained on colchicine was administered gemfibrozil. Synergistic myotoxicity of colchicine and gemfibrozil was the possible mechanisms proposed by the authors in the case report. Monitor creatine kinase and discontinue therapy if myopathy or rhabdomyolysis is diagnosed or suspected . However monitoring of CPK (creatine phosphokinase) will not necessarily prevent the occurrence of severe myopathy. Once colchicine is discontinued, the symptoms generally resolve within one week to several months .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Coadministration of colchicine and gemfibrozil may result in myopathy and rhabdomyolysis. If concomitant use of these two drugs is necessary, monitor patients for signs and symptoms of myopathy or rhabdomyolysis (dark-colored urine and/or muscle pain, tenderness, or weakness). Monitor creatine kinase and discontinue therapy if myopathy or rhabdomyolysis is diagnosed or suspected . However monitoring of CPK (creatine phosphokinase) will not necessarily prevent the occurrence of severe myopathy. Once colchicine is discontinued, the symptoms generally resolve within one week to several months.
Mechanism Of Interaction
Unknown
Literature Reports
A) A 40-year-old man maintained on colchicine 0.5 mg orally every 8 hours for approximately 3 years developed rhabdomyolysis following the addition of gemfibrozil 600 mg every 12 hours to his treatment regimen. His medical history included amyloidosis, hepatitis B-related chronic liver disease, nephrotic syndrome, and hypertriglyceridemia. He was admitted with fatigue, lack of appetite, dark-colored urine, and muscle pain that had lasted for 2 weeks. Important laboratory findings included creatine kinase (CK) of 3559 Units/L (normal 26 to 174 Units/L), urea 108 (normal 10 to 50 mg/dL), creatinine 2.6 (normal 0.7 to 1.5 mg/dL), ALT 165 (normal 10 to 42 Units/L), AST 232 (normal 10 to 42 Units/L), LDH 450 (normal 42 to 128 Units/L) and potassium 6.0 (normal 3.5 to 5.5 mEq/L). All medications (the patient had also been taking essential amino acid tablets and calcitriol) were discontinued, the patient adequately hydrated, and he subsequently improved by day 4. Muscle pain stabilized by day 9. Colchicine and amino acids were restarted and the patient discharged .
Gemfibrozil Overview
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Gemfibrozil is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol and triglycerides (other fatty substances) in the blood in certain people with very high triglycerides who are at risk of pancreatic disease (conditions affecting the pancreas, a gland that produces fluid to break down food and hormones to control blood sugar). Gemfibrozil is also used in people with a combination of low high-density lipoprotein (HDL; 'good cholesterol') levels and high low-density lipoprotein (LDL; 'bad cholesterol') and triglyceride levels to reduce the risk of heart disease. Gemfibrozil is in a class of lipid-regulating medications called fibrates. It works by reducing the production of triglycerides in the liver.
Colchicine Overview
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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:
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.