Sunitinib 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
Sunitinib
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.
Taking these two together needs care. Sunitinib (Sutent) can slow down a natural 'pump' in your body called P-glycoprotein that normally helps clear colchicine (Colcrys, Gloperba, Mitigare) out. When that pump is blocked, colchicine can build up to high levels.
Colchicine is a drug where even small extra amounts matter. Too much can cause serious problems like severe diarrhea, muscle weakness, and effects on the blood and organs. This can be very dangerous, especially if your kidneys or liver do not work well. The good news is your care team can manage this by adjusting your colchicine dose and watching you closely. Please talk with your doctor or pharmacist before taking both.
Mechanism: Sunitinib inhibits P-glycoprotein-mediated efflux of colchicine, reducing clearance and increasing colchicine plasma concentrations and toxicity risk. Neither drug is a prodrug; this raises colchicine exposure.
Severity: Contraindicated in renal or hepatic impairment (life-threatening/fatal events reported). Evidence: probable. Colchicine is narrow therapeutic index.
Management (if colchicine used with a P-gp inhibitor now or within 14 days):
- Gout flare: 0.6 mg x1 dose; no repeat before 3 days.
- Gout prophylaxis: reduce 0.6 mg BID to 0.3 mg daily, or 0.6 mg daily to 0.3 mg every other day.
- FMF: do not exceed 0.6 mg/day.
- Monitor for colchicine toxicity; discontinue immediately if suspected.
What happens
Increased colchicine plasma concentrations and increased risk of toxicity
Interaction Deep Dive
In patients with renal or hepatic impairment, giving colchicine together with a p-glycoprotein (p-gp) inhibitor such as sunitinib is contraindicated, because interactions that are life-threatening and fatal have been reported. When colchicine cannot be avoided in a patient who is taking a P-gp inhibitor at the same time or has taken one within the previous 14 days, the colchicine dose must be modified. In the setting of a gout flare, lower the colchicine dose to a single 0.6 mg dose, and do not repeat the dose sooner than 3 days. For gout prophylaxis, an original colchicine regimen of 0.6 mg twice daily should be cut to 0.3 mg once daily, and an original regimen of 0.6 mg once daily should be cut to 0.3 mg once every other day. In familial Mediterranean fever, the colchicine dose should not go above 0.6 mg per day. Watch for signs of colchicine toxicity, and stop the drug at once if toxicity is suspected1.
Why it happens (mechanism)
Inhibition of P-glycoprotein-mediated efflux transport of colchicine
How to manage this interaction
Keep taking both only as your care team directs, and let them know you are on both drugs. Your team can manage this by reducing your colchicine dose and monitoring you closely.
- This combination is not used in people with kidney or liver problems because dangerous reactions have happened.
- Colchicine doses may be lowered (for example, smaller amounts and longer gaps between doses) when taken with sunitinib now or within the past 14 days.
- Watch for signs of colchicine toxicity: severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual fatigue.
Get medical help right away and contact your prescriber if any of these occur. Do not change doses on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) An 82-year-old man who had previously been stable on colchicine for the prevention and treatment of acute gout flares developed marked colchicine toxicity 2 days into a 2-week course of sunitinib 50 mg daily, at a point when he was nearly done with a 10-day burst of colchicine 4.8 mg/day. His first symptoms were copious watery diarrhea, shortness of breath, and pleuritic chest pain, but he subsequently developed metabolic acidosis that required ICU management, together with white blood cell abnormalities, pneumonia, severe hypotension with acute cardiovascular collapse and T-wave inversion, and acute systolic heart failure 2.
Common questions
Can I take Sunitinib and Colchicine together?
Sunitinib can make colchicine build up to toxic levels; this combo is off-limits if you have kidney or liver problems, and otherwise colchicine must be dose-reduced and closely monitored. Talk with your doctor or pharmacist before using both. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sunitinib 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 Sunitinib and Colchicine interaction managed?
Keep taking both only as your care team directs, and let them know you are on both drugs. Your team can manage this by reducing your colchicine dose and monitoring you closely. This combination is not used in people with kidney or liver problems because dangerous reactions have happened. Colchicine doses may be lowered (for example, smaller amounts and longer gaps between doses) when taken with su… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Sunitinib 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 (2)
Keep reading about Sunitinib
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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