Spironolactone 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
Spironolactone
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, your gout or anti-inflammatory medicine, is normally pumped out of your body by a protein called P-gp. Spironolactone can slow that pump down. When the pump slows, more colchicine can build up in your body, and that raises the risk of serious colchicine side effects like severe stomach upset, diarrhea, muscle weakness, and other harmful effects.
Please don't stop or change either medicine on your own. The good news is your care team can manage this safely, often by adjusting your colchicine dose and watching you more closely. Reach out to your pharmacist or doctor so they can review both medicines together.
Mechanism: Colchicine is a P-gp (and CYP3A4) substrate. Spironolactone can inhibit P-gp-mediated colchicine efflux, reducing clearance and increasing colchicine exposure (AUC), which raises the risk of dose-related toxicity. Neither agent is a prodrug; this reflects increased active colchicine.
- Direction: increased colchicine effect/toxicity
- Evidence: theoretical (extrapolated from known P-gp inhibitor interactions)
- Severity: labeled contraindicated with P-gp inhibitors
Management: Coadministration is contraindicated in renal or hepatic impairment. In patients with normal renal/hepatic function, if combined use is required, reduce colchicine daily dose or dosing frequency and monitor closely for GI, neuromuscular, and hematologic toxicity.
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Both CYP3A4 and P-gp act on colchicine as a substrate. Cases of toxicity have surfaced when colchicine was given together with clarithromycin, an agent that inhibits both CYP3A4 and P-gp. Comparable toxicities have arisen 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 documented in patients taking therapeutic doses, the concurrent use of colchicine with P-gp inhibitors is contraindicated 1. This combination is likewise 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 coadministration of colchicine with a P-gp inhibitor cannot be avoided, adjust the colchicine dose by lowering either the total daily amount or how often it is given. Watch closely for signs of colchicine toxicity 3.
Why it happens (mechanism)
Inhibition of P-gp-mediated colchicine efflux transport
How to manage this interaction
Keep taking both medicines exactly as prescribed and let your pharmacist or prescriber know you are on this combination so they can review it.
- This combination is generally avoided, and it should not be used if you have kidney or liver problems.
- If your care team decides you do need both, they may lower your colchicine dose or space it out further and monitor you more closely.
- Watch for and promptly report signs of colchicine toxicity: severe or ongoing diarrhea, vomiting, stomach pain, muscle weakness or pain, numbness, unusual bruising, or fever.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Spironolactone and Colchicine together?
Spironolactone can raise colchicine levels and the risk of serious, even life-threatening colchicine toxicity, so this combination is generally avoided, especially with kidney or liver problems. Talk to your pharmacist or doctor before using them together, as your colchicine dose may need to be reduced and monitored closely. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Spironolactone 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 Spironolactone and Colchicine interaction managed?
Keep taking both medicines exactly as prescribed and let your pharmacist or prescriber know you are on this combination so they can review it. This combination is generally avoided, and it should not be used if you have kidney or liver problems. If your care team decides you do need both, they may lower your colchicine dose or space it out further and monitor you more closely. Watch for and prompt… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Spironolactone 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 Spironolactone
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.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist