Lovastatin with Colchicine Interaction Details

Brand Names Associated with Lovastatin

Brand Names Associated with Colchicine

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

Interaction Effect

An increased risk of myopathy, including rhabdomyolysis

Interaction Summary

Coadministration of colchicine and lovastatin may result in myopathy and rhabdomyolysis. Myopathy was reported when lovastatin was introduced in a patient maintained on colchicine for gout. CYP450 inhibition and synergistic myotoxicity were 2 possible mechanisms proposed by the authors. Coadministration is reasonable when clinically indicated, with monitoring for signs/symptoms of myopathy/rhabdomyolysis (muscle pain, tenderness, weakness) including creatine kinase (CK) levels if symptomatic, especially at treatment initiation, in elderly patients, and with titration of either drug; may consider dose reductions of either drug, especially in those with renal impairment . Monitoring may not necessarily prevent development of severe myopathy. Discontinue colchicine immediately if myopathy is diagnosed/suspected .

Severity

Major

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Coadministration of colchicine and lovastatin is reasonable when clinically indicated, with monitoring for signs/symptoms of myopathy/rhabdomyolysis (muscle pain, tenderness, weakness), including creatine kinase (CK) levels when symptomatic, especially at treatment initiation or with titration of either drug; may consider dose reductions for either drug, especially in those with renal impairment. Use caution in elderly patients. Monitoring may not necessarily prevent the development of a severe myopathy. Discontinue colchicine immediately if myopathy is diagnosed or suspected .

Mechanism Of Interaction

Unknown

Literature Reports

A) The American Heart Association states that concurrent usage of lovastatin and colchicine is reasonable when clinically indicated. Dose reductions may be considered for either lovastatin or colchicine when these drugs are used concurrently due to the potential for competitive inhibition with CYP3A and competitive P-gp-mediated efflux; reduced dosages of colchicine should be considered for patients with renal impairment. Monitoring for muscle-related signs and symptoms of myopathy or rhabdomyolysis is recommended .

B) A 74-year-old man maintained on prophylactic colchicine therapy for gout presented with proximal muscle weakness after 4 weeks of lovastatin therapy to treat hypercholesteremia. On admission, serum creatine kinase was 8370 Units/L (normal 0 to 130 Units/L). Both colchicine and lovastatin were discontinued, and the patient gradually returned to baseline function following physical rehabilitation .

Lovastatin Overview

• Lovastatin is used together with diet, weight-loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Lovastatin is also used to decrease the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Lovastatin is in a class of medications called HMG CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

• Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with lovastatin may help prevent heart disease, angina (chest pain), strokes, and heart attacks.

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.