Idelalisib with Colchicine Interaction Details
Brand Names Associated with Idelalisib
- Idelalisib
- Zydelig®
Brand Names Associated with Colchicine
- Colchicine
- Colcrys®
- Gloperba®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 06, 2023
Interaction Effect
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Summary
Concomitant use of colchicine with strong CYP3A4 inhibitors is contraindicated because life-threatening and fatal colchicine toxicity has been reported in these patients with colchicine taken at therapeutic doses. Concomitant use of colchicine and strong CYP3A4 inhibitors (including all protease inhibitors except fosamprenavir) is contraindicated in patients with renal or hepatic impairment. A colchicine dose adjustment is required in patients with normal renal and hepatic function who are receiving concurrently or have received a strong CYP3A4 inhibitor within the last 14 days. For the treatment of gout flare, reduce the colchicine dose to 0.6 mg tablet for one dose followed by 0.3 mg 1 hour later, with the repeat dose to be given no earlier than 3 days. For the prophylaxis of gout flare, reduce the colchicine dose from an original dose of 0.6 mg twice daily to 0.3 mg once daily or from an original dose of 0.6 mg once daily to 0.3 mg once every other day. For the treatment of familial Mediterranean fever, the maximum daily colchicine dose should be no more than 0.6 mg (may be given as 0.3 mg twice daily) . If coadministration of colchicine and a CYP3A4 inhibitor is required, adjust the dose of colchicine by either reducing the daily dose or reducing the dose frequency. Monitor closely for colchicine toxicity .
Severity
Contraindicated
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concomitant use of colchicine with strong CYP3A4 inhibitors is contraindicated because life-threatening and fatal colchicine toxicity has been reported in these patients with colchicine taken at therapeutic doses. Concomitant use of colchicine and strong CYP3A4 inhibitors (including all protease inhibitors except fosamprenavir) is contraindicated in patients with renal or hepatic impairment. A colchicine dose adjustment is required in patients with normal renal and hepatic function who are receiving concurrently or have received a strong CYP3A4 inhibitor within the last 14 days. For the treatment of gout flare, reduce the colchicine dose to 0.6 mg tablet for one dose followed by 0.3 mg 1 hour later, with the repeat dose to be given no earlier than 3 days. For the prophylaxis of gout flare, reduce the colchicine dose from an original dose of 0.6 mg twice daily to 0.3 mg once daily or from an original dose of 0.6 mg once daily to 0.3 mg once every other day. For the treatment of familial Mediterranean fever, the maximum daily colchicine dose should be no more than 0.6 mg (may be given as 0.3 mg twice daily) . If coadministration of colchicine and a CYP3A4 inhibitor is required, adjust the dose of colchicine by either reducing the daily dose or reducing the dose frequency. Monitor closely for colchicine toxicity .
Mechanism Of Interaction
Inhibition of CYP3A4-mediated metabolism of colchicine
Literature Reports
A) Although the interaction between colchicine and boceprevir has not been studied, an interaction between colchicine and clarithromycin, a strong CYP3A4 inhibitor, resulted in fatal colchicine toxicity. Colchicine Cmax and AUC were increased by 227.2% and 281.5%, respectively, after a single 0.6 mg colchicine dose was administered to patients (n=23) who were being treated with clarithromycin 250 mg twice daily for 7 days .
B) In a pharmacokinetic study, administration of a single-dose of colchicine to patients who received ritonavir 100 mg twice daily for 5 days (n=18) resulted in a 184.4% and 296% increase in colchicine Cmax and AUC compared with baseline levels, respectively .
Idelalisib Overview
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Idelalisib is used along with another medication rituximab (Rituxan) to treat chronic lymphocytic leukemia (CLL; a type of cancer that begins in the white blood cells) in people whose cancer came back after receiving other cancer treatments. It is also used to treat certain types of follicular lymphoma (FL; a type of cancer that begins in the white blood cells) and small lymphocytic lymphoma (SLL:a type of cancer that begins in the white blood cells) in people whose cancer came back after being treated with at least 2 other cancer treatments. Idelalisib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.
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.