Telithromycin 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
Telithromycin
No brand names on recordColchicine
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.
Telithromycin is a strong blocker of an enzyme in your body (called CYP3A4) that helps break down colchicine. When that enzyme is blocked, colchicine builds up to much higher levels than normal. That is a serious problem, because too much colchicine can cause severe, even life-threatening poisoning (bad diarrhea and vomiting, muscle weakness, and damage to the blood and organs).
Because of this danger, these two drugs are generally not used together. Please do not stop or change either medicine on your own. Instead, talk with your pharmacist or doctor soon. Your care team can pick a safer antibiotic or carefully adjust and monitor your colchicine.
Mechanism: Telithromycin is a strong CYP3A4 inhibitor (and P-gp inhibitor); it reduces metabolism and clearance of colchicine, markedly increasing colchicine exposure. Colchicine is active drug, not a prodrug, so inhibition increases its toxic effect.
- Result: Elevated colchicine AUC/Cmax with risk of fatal toxicity at therapeutic doses.
- Evidence: Probable; severity contraindicated.
- Renal/hepatic impairment: Combination is absolutely contraindicated.
- Normal renal/hepatic function: If unavoidable, dose-reduce colchicine (gout flare: 0.6 mg then 0.3 mg 1 h later, no repeat before 3 days; prophylaxis: halve to 0.3 mg once daily or every other day; FMF max 0.6 mg/day) and monitor closely for toxicity.
What happens
Increased colchicine exposure and an increased risk of fatal toxicity
Interaction Deep Dive
Combining colchicine with strong CYP3A4 inhibitors is contraindicated, since therapeutic doses of colchicine have been associated with reports of life-threatening and fatal toxicity in such patients1. In individuals with renal or hepatic impairment, coadministration of colchicine and strong CYP3A4 inhibitors (which encompasses every protease inhibitor other than fosamprenavir) is contraindicated. For patients whose renal and hepatic function is normal and who are concurrently taking, or have taken within the previous 14 days, a strong CYP3A4 inhibitor, the colchicine dose must be modified. When treating a gout flare, lower the colchicine dose to a single 0.6 mg tablet followed 1 hour later by 0.3 mg, and do not repeat the dose sooner than 3 days. For gout flare prophylaxis, decrease the colchicine dose from an initial 0.6 mg twice daily to 0.3 mg once daily, or from an initial 0.6 mg once daily to 0.3 mg once every other day. In familial Mediterranean fever, the colchicine dose should not exceed a maximum of 0.6 mg per day (which may be administered as 0.3 mg twice daily)2. When colchicine must be given together with CYP3A4 inhibitors that additionally inhibit P-gp4, adjust the colchicine dose either by lowering the daily amount or by reducing the frequency. Watch closely for signs of colchicine toxicity3.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine
How to manage this interaction
This combination is generally avoided. The safest step is often for your care team to choose a different antibiotic, so keep taking both only as prescribed and check in with your pharmacist or prescriber before making any change.
- If you have kidney or liver problems, this pairing is not used.
- If both are truly needed and your kidneys and liver are normal, your colchicine dose may be reduced and individualized by your care team, and they may monitor you more closely for toxicity.
- Report diarrhea, vomiting, muscle pain or weakness, numbness, or unusual tiredness right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) While the interaction between colchicine and boceprevir has not been investigated, an interaction between colchicine and clarithromycin, a potent CYP3A4 inhibitor, led to fatal colchicine toxicity. Following a single 0.6 mg colchicine dose given to patients (n=23) who were receiving clarithromycin 250 mg twice daily for 7 days, colchicine Cmax and AUC rose by 227.2% and 281.5%, respectively 21.
b) In a pharmacokinetic study, giving a single dose of colchicine to patients who had received ritonavir 100 mg twice daily for 5 days (n=18) produced a 184.4% and 296% rise in colchicine Cmax and AUC relative to baseline levels, respectively 51.
Common questions
Can I take Telithromycin and Colchicine together?
Telithromycin strongly blocks the enzyme that clears colchicine, so colchicine can build up to dangerous, potentially fatal levels; this combination is generally contraindicated, so contact your pharmacist or doctor before using them together. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Telithromycin 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 Telithromycin and Colchicine interaction managed?
This combination is generally avoided. The safest step is often for your care team to choose a different antibiotic, so keep taking both only as prescribed and check in with your pharmacist or prescriber before making any change. If you have kidney or liver problems, this pairing is not used. If both are truly needed and your kidneys and liver are normal, your colchicine dose may be reduced and in… 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 Telithromycin 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 (5)
- 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
- Product Information: MITIGARE(R) oral capsules, colchicine oral capsules. Hikma Specialty USA Inc (per FDA), Columbus, OH, 2024. DailyMed
- Product Information: COLCRYS(TM) oral tablets, colchicine oral tablets. AR Scientific, Inc. Philadelphia, PA, 2009. DailyMed
Keep reading about Telithromycin
Keep reading about Colchicine
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