Sofosbuvir 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
Sofosbuvir
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 what's going on. Colchicine (used for gout and inflammation) is normally pushed out of your body by a kind of cellular pump called P-gp. Sofosbuvir, a hepatitis C medicine, can slow that pump down. When the pump slows, colchicine can build up in your body to higher levels than intended.
That matters because too much colchicine can cause serious problems like severe diarrhea, muscle weakness, and even life-threatening toxicity. This combination is actually flagged as one to avoid. Please don't stop or change either medicine on your own. Talk with your pharmacist or doctor. They can adjust your colchicine dose or watch you closely to keep you safe.
Interaction: Sofosbuvir may inhibit P-gp-mediated efflux of colchicine, increasing colchicine exposure and the risk of toxicity. Colchicine is a CYP3A4 and P-gp substrate; neither drug is a prodrug here, so this is a straightforward exposure increase.
- Direction: Increased colchicine AUC/Cmax, potentially serious.
- Evidence: Theoretical (extrapolated from documented P-gp inhibitor cases such as clarithromycin).
- Severity: Labeled contraindicated with P-gp inhibitors; also contraindicated in renal or hepatic impairment.
- Management: Avoid concurrent use. If required in patients with normal renal/hepatic function, reduce colchicine daily dose or dosing frequency and monitor closely for toxicity (GI symptoms, myopathy, neuropathy, cytopenias).
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. Toxic effects have been documented when it was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Such toxicities have likewise been seen when colchicine was combined with a CYP3A4 inhibitor and when it was combined with a P-gp inhibitor3. Because life-threatening and fatal colchicine toxicity has been reported in patients taking therapeutic doses, the simultaneous use of colchicine and P-gp inhibitors is contraindicated 1. This combination is also contraindicated in individuals with renal or hepatic impairment, since life-threatening and fatal drug interactions have been observed. For patients whose renal and hepatic function is normal 2, when colchicine must be given alongside a P-gp inhibitor, adjust the colchicine dose by lowering either the total daily amount or how often it is taken. Watch carefully for signs of colchicine toxicity 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
This is a combination your care team takes seriously. Because of the risk, they will decide whether both drugs can be used together at all, especially since it should be avoided in people with kidney or liver problems.
- Keep taking both medicines exactly as prescribed until you speak with your prescriber or pharmacist.
- If both are truly needed and your kidney and liver function are normal, your team may lower the colchicine dose or space it out further, and monitor you more closely.
- Report signs of colchicine toxicity right away: severe diarrhea, nausea, muscle pain or weakness, numbness, or unusual tiredness.
Ask your pharmacist to review this pairing so it can be managed or an alternative chosen.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Sofosbuvir and Colchicine together?
Sofosbuvir can raise colchicine levels and this pairing is flagged as one to avoid, so check with your pharmacist or doctor before taking them together and watch for colchicine side effects like severe diarrhea or muscle weakness. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sofosbuvir 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 Sofosbuvir and Colchicine interaction managed?
This is a combination your care team takes seriously. Because of the risk, they will decide whether both drugs can be used together at all, especially since it should be avoided in people with kidney or liver problems. Keep taking both medicines exactly as prescribed until you speak with your prescriber or pharmacist. If both are truly needed and your kidney and liver function are normal, your tea… 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 Sofosbuvir 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 Sofosbuvir
Keep reading about Colchicine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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