Sarecycline 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
Sarecycline
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.
Here's the concern with these two together. Colchicine is cleared from your body partly by a natural "pump" called P-gp. Sarecycline may slow that pump down. When the pump slows, colchicine can build up to higher levels than intended, and colchicine can be dangerous at high levels. Serious and even life-threatening problems have happened this way.
Please don't stop or change either medicine on your own. This is something your pharmacist or doctor will want to know about right away, because they can often find a safer plan, adjust your colchicine, or watch you more closely. Reach out to them before your next dose.
Mechanism: Colchicine is a P-gp (and CYP3A4) substrate; sarecycline is proposed to inhibit P-gp-mediated colchicine efflux, reducing clearance and increasing colchicine exposure. Neither drug is a prodrug, so this is a direct increase in colchicine effect and toxicity risk.
- Direction: increased colchicine AUC/Cmax, increased toxicity risk.
- Severity: contraindicated; fatal toxicity reported with P-gp inhibitors at therapeutic colchicine doses.
- Evidence: theoretical, extrapolated from known P-gp/CYP3A4 inhibitor cases.
- Management: avoid in renal/hepatic impairment. If coadministration is unavoidable in normal organ function, reduce colchicine daily dose or frequency and monitor for GI, myelosuppression, and neuromuscular toxicity.
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Colchicine acts as a substrate for both CYP3A4 and P-gp. Reports of toxicity have emerged when colchicine was given together with clarithromycin, which inhibits both CYP3A4 and P-gp. Toxic effects have likewise been documented when colchicine was combined with a CYP3A4 inhibitor as well as when it was combined with a P-gp inhibitor3. Because life-threatening and fatal colchicine toxicity has been reported in patients taking therapeutic doses of colchicine alongside P-gp inhibitors, concurrent use of the two is contraindicated 1. This combination is similarly contraindicated in individuals with renal or hepatic impairment, given that life-threatening and fatal drug interactions have been observed. For patients whose renal and hepatic function is normal 2, the colchicine dose should be modified when coadministration with a P-gp inhibitor cannot be avoided, either by lowering the total daily dose or by decreasing how often it is given. Close monitoring for colchicine toxicity is warranted 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
What your care team may do:
- Often avoid using these together, since combining colchicine with a P-gp inhibitor carries a high toxicity risk.
- Avoid the combination entirely if you have kidney or liver problems.
- If both are truly needed and your kidney and liver function is normal, your colchicine dose may be reduced or spaced out, individualized by your team, with closer monitoring for toxicity.
What you should do: Keep taking both exactly as prescribed for now, but contact your pharmacist or prescriber promptly so they can review the combination. Report any muscle weakness, numbness, severe diarrhea, vomiting, or unusual fatigue right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Sarecycline and Colchicine together?
Combining sarecycline and colchicine can raise colchicine to dangerous levels, and this pairing is generally contraindicated. Don't change your medicines yourself; contact your pharmacist or doctor promptly to find a safer plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sarecycline 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 Sarecycline and Colchicine interaction managed?
What your care team may do: Often avoid using these together, since combining colchicine with a P-gp inhibitor carries a high toxicity risk. Avoid the combination entirely if you have kidney or liver problems. If both are truly needed and your kidney and liver function is normal, your colchicine dose may be reduced or spaced out, individualized by your team, with closer monitoring for toxicity. Wh… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Sarecycline 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: COLCRYS oral tablets, colchicine oral tablets. Takeda Pharmaceuticals America Inc (per FDA), Deerfield, IL, 2020. DailyMed
- Product Information: GLOPERBA(R) oral solution, colchicine oral solution. Romeg Therapeutics LLC (per FDA), Woburn, MA, 2019. DailyMed
Keep reading about Sarecycline
Keep reading about Colchicine
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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