Verapamil 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
Verapamil
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.
Verapamil can make colchicine build up in your body. Your liver and gut normally break down and push out colchicine using two systems (an enzyme called CYP3A4 and a pump called P-gp). Verapamil slows both of these down, so colchicine can rise to dangerous levels. That matters because too much colchicine can cause serious harm, including severe diarrhea, muscle weakness, blood problems, and in some cases death.
Please do not stop or change either medicine on your own. This is a serious combination, so talk with your pharmacist or doctor right away. They can adjust your colchicine dose, choose a safer option, or watch you closely so you stay safe.
Effect: Verapamil inhibits both CYP3A4-mediated metabolism and P-gp-mediated efflux of colchicine, increasing colchicine exposure and risk of serious or fatal toxicity. Colchicine is the affected substrate (not a prodrug); the interaction increases its effect.
- Severity/evidence: Contraindicated; established.
- Contraindicated outright in renal or hepatic impairment.
- Normal organ function, if unavoidable (concurrent or within 14 days): gout flare, 1.2 mg once, repeat no sooner than 3 days; prophylaxis, reduce 0.6 mg BID to 0.6 mg/day, or 0.6 mg/day to 0.3 mg/day; FMF max 1.2 mg/day.
- Monitor for colchicine toxicity (GI, myelosuppression, neuromuscular); discontinue immediately if suspected.
What happens
Increased colchicine exposure and an increased risk of colchicine toxicity
Interaction Deep Dive
Both CYP3A4 and P-gp metabolize colchicine as a substrate. Giving colchicine together with P-gp inhibitors such as verapamil is contraindicated1, because doing so can raise colchicine plasma levels and lead to severe or fatal colchicine toxicity. Similarly, combining colchicine with an agent that inhibits both CYP3A4 and P-glycoprotein, such as verapamil, is contraindicated in individuals who have renal or hepatic impairment3. When such concomitant use, or use within a 14 day window, is necessary in patients whose renal and hepatic function is normal, the colchicine dose for a gout flare should be lowered to 1.2 mg (2 tablets) as a single dose, with any repeat dose withheld until at least 3 days later; for gout flare prophylaxis, reduce colchicine from an initial 0.6 mg twice daily to 0.6 mg/day, or from an initial 0.6 mg once daily to 0.3 mg once daily. For patients with familial Mediterranean fever who need colchicine and verapamil together, the colchicine daily total should not exceed 1.2 mg (which may be administered as 0.6 mg twice daily). Watch for signs of colchicine toxicity and stop the drug at once if it is suspected2.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of colchicine; inhibition of P-gp-mediated efflux transport of colchicine
How to manage this interaction
This combination is generally avoided, and it should not be used at all if you have kidney or liver problems. Keep taking both medicines exactly as prescribed until your care team guides you, but reach out to them promptly.
- Your prescriber may lower your colchicine dose, which they will tailor to you and your reason for taking it (gout flare, gout prevention, or familial Mediterranean fever).
- They may choose a different medicine instead.
- Your team may monitor you more closely for colchicine toxicity.
Get medical help right away if you notice severe diarrhea, vomiting, muscle weakness or pain, numbness, or unusual bruising or infections.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In the course of postmarketing surveillance, a case of tetraparesis was documented after verapamil and colchicine were given together. Co-administration of verapamil with colchicine is not advised 4.
b) In a study involving 24 patients, taking a 0.6 mg dose of colchicine together with verapamil 240 mg/day for 5 days produced increases of 40.1% and 103.3% in colchicine Cmax and AUC, respectively, compared with baseline 2.
Common questions
Can I take Verapamil and Colchicine together?
Verapamil raises colchicine levels and can cause serious or fatal toxicity, so this combination is contraindicated (especially with kidney or liver disease). Do not change either drug yourself; contact your pharmacist or doctor promptly. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Verapamil 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 Verapamil and Colchicine interaction managed?
This combination is generally avoided, and it should not be used at all if you have kidney or liver problems. Keep taking both medicines exactly as prescribed until your care team guides you, but reach out to them promptly. Your prescriber may lower your colchicine dose, which they will tailor to you and your reason for taking it (gout flare, gout prevention, or familial Mediterranean fever). They… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Verapamil 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 (4)
- 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: TARKA(R) oral tablets, trandolapril/verapamil HCl ER oral tablets. Abbott Laboratories (per FDA), North Chicago, IL, 2011. DailyMed
Keep reading about Verapamil
Keep reading about Colchicine
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