Sunitinib with Colchicine Interaction Details
Brand Names Associated with Sunitinib
- Sunitinib
- Sutent®
Brand Names Associated with Colchicine
- Colchicine
- Colcrys®
- Gloperba®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 31, 2023
Interaction Effect
Increased colchicine plasma concentrations and increased risk of toxicity
Interaction Summary
Concurrent administration of colchicine and a p-glycoprotein (p-gp) inhibitor, such as sunitinib, in patients with renal or hepatic impairment is contraindicated as life-threatening and fatal drug interactions have occurred. If colchicine is necessary in patients who are receiving a P-gp inhibitor concurrently or within the last 14 days, a dose adjustment is required. For gout flare, reduce the colchicine dose to 0.6 mg for 1 dose; do not give a repeat dose earlier than 3 days. For gout prophylaxis, reduce from an original colchicine dose of 0.6 mg twice daily to 0.3 mg once daily, or from an original dose of 0.6 mg once daily to 0.3 mg once every other day. For familial Mediterranean fever, do not exceed a daily colchicine dose of 0.6 mg. Monitor for symptoms of colchicine toxicity, and discontinue therapy immediately if suspected.
Severity
Contraindicated
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concurrent administration of colchicine and a p-glycoprotein (p-gp) inhibitor, such as sunitinib, in patients with renal or hepatic impairment is contraindicated as life-threatening and fatal drug interactions have occurred. If colchicine is necessary in patients who are receiving a P-gp inhibitor concurrently or within the last 14 days, a dose adjustment is required. For gout flare, reduce the colchicine dose to 0.6 mg for 1 dose, and do not give a repeat dose earlier than 3 days. For gout prophylaxis, reduce from an original colchicine dose of 0.6 mg twice daily to 0.3 mg once daily, or from an original dose of 0.6 mg once daily to 0.3 mg once every other day. For familial Mediterranean fever, do not exceed a daily colchicine dose of 0.6 mg. Monitor for symptoms of colchicine toxicity, and discontinue therapy immediately if suspected.
Mechanism Of Interaction
Inhibition of P-glycoprotein-mediated efflux transport of colchicine
Literature Reports
A) An 82-year-old man previously stable on colchicine for prevention and treatment of acute gout flares experienced significant colchicine toxicity 2 days into a 2-week cycle of sunitinib 50 mg daily, as he was nearly finished with a 10-day burst treatment of colchicine 4.8 mg/day. His initial symptoms were profuse watery diarrhea, shortness of breath, and pleuritic chest pain, however he soon developed metabolic acidosis requiring treatment in the ICU, along with white blood cell abnormalities, pneumonia, profound hypotension with acute cardiovascular collapse and T-wave inversion, and acute systolic heart failure .
Sunitinib Overview
-
Sunitinib is used to treat gastrointestinal stromal tumors (GIST; a type of tumor that grows in the stomach, intestine (bowel), or esophagus (tube that connects the throat with the stomach) in people with tumors that were not treated successfully with imatinib (Gleevec) or people who cannot take imatinib. Sunitinib is also used to treat advanced renal cell carcinoma (RCC, a type of cancer that begins in the cells of the kidneys). Sunitinib is also used to help prevent the return of RCC in people who have RCC that has not spread and have had a kidney removed. Sunitinib is also used to treat pancreatic neuroendocrine tumors (pNET, a type of tumor that begins in certain cells of the pancreas) in people with tumors that have worsened and cannot be treated with surgery. Sunitinib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop or slow the spread of cancer cells and may help shrink tumors.
Colchicine Overview
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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:
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.