Isavuconazonium and Colchicine: 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
Isavuconazonium
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.
These two medicines can be a dangerous mix. Isavuconazonium (Cresemba) is an antifungal that slows down two of the ways your body clears colchicine, a drug used for gout and pericarditis. When those "exit doors" are blocked, colchicine can build up to very high levels in your body.
That matters because too much colchicine can cause severe, even life-threatening problems, like serious diarrhea, muscle damage, and effects on the blood and other organs. This is why the two are usually not used together. Please don't stop either drug on your own. Let your doctor or pharmacist know you're taking both so they can choose the safest plan for you.
Effect: Isavuconazonium markedly increases colchicine exposure, raising the risk of serious or fatal toxicity.
Mechanism: Isavuconazole is both a CYP3A4 inhibitor and a P-gp inhibitor. Colchicine is a substrate of both. Dual inhibition reduces metabolism and efflux, increasing colchicine AUC/Cmax.
- Severity: Contraindicated; evidence probable.
- High-risk: Renal or hepatic impairment (contraindicated combination, fatal cases reported).
- Management: Avoid combination. If unavoidable in patients with normal renal/hepatic function, reduce colchicine daily dose 50 to 75% or reduce frequency, and monitor for toxicity (GI, myelosuppression, myopathy).
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Taking colchicine together with P-gp inhibitors is contraindicated1. When colchicine is combined with inhibitors that act on both CYP3A4 and P-gp, there is potential for toxicity that can be serious and life-threatening. Should it be necessary to give colchicine alongside a P-gp inhibitor, its dose requires modification, either by cutting the daily amount by 50% to 75% 3 or by lowering how often it is administered. In patients who have renal or hepatic impairment, concurrent administration of colchicine with P-gp and CYP3A4 inhibitors is contraindicated 3. In such patients with renal and hepatic impairment, using these inhibitors together with colchicine has led to colchicine toxicity that was life-threatening or fatal 2.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of colchicine; inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
What your care team may do:
- Because this combination can be dangerous, your team will often avoid using them together or choose an alternative antifungal or gout medicine.
- If both are truly needed and your kidneys and liver are healthy, your colchicine dose may need to be reduced (often lowered or given less often) and individualized by your care team.
- This combination is not used in people with kidney or liver problems.
- Your team may monitor you more closely for side effects.
What you should do: Keep taking both exactly as prescribed for now, and promptly tell your pharmacist or prescriber you are on both. Report severe diarrhea, muscle weakness or pain, numbness, or unusual bruising right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Isavuconazonium and Colchicine together?
Isavuconazonium can drive colchicine to toxic, potentially fatal levels, so this pairing is generally avoided; if it must be used, colchicine dosing needs to be lowered and monitored by your care team, and it is not used in people with kidney or liver problems. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Isavuconazonium and Colchicine 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 Isavuconazonium and Colchicine interaction managed?
What your care team may do: Because this combination can be dangerous, your team will often avoid using them together or choose an alternative antifungal or gout medicine. If both are truly needed and your kidneys and liver are healthy, your colchicine dose may need to be reduced (often lowered or given less often) and individualized by your care team. This combination is not used in people with k… 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 Isavuconazonium or Colchicine 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: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
- Hansten PD, Tan MS, Horn JR, et al: Colchicine drug interaction errors and misunderstandings: recommendations for improved evidence-based management. Drug Saf 2023; 46(3):223-242. PubMed
Keep reading about Isavuconazonium
Keep reading about Colchicine
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