Vonoprazan 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
Vonoprazan
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.
You've been prescribed vonoprazan (for acid/stomach issues) and colchicine (often for gout or pericarditis). Your body clears colchicine using an enzyme called CYP3A. Vonoprazan can gently slow that enzyme down, so colchicine may build up a little higher than usual in your body.
Colchicine is one of those medicines where even a small increase can cause real problems, like stomach upset, diarrhea, muscle aches, or more serious effects. The good news is this is very manageable. Don't stop either medicine on your own. Just check in with your pharmacist or doctor, who can adjust your colchicine dose and keep a closer eye on how you're feeling.
Effect: Vonoprazan is a weak CYP3A inhibitor and may increase exposure of CYP3A substrates. Colchicine is a CYP3A (and P-gp) substrate with a narrow therapeutic index, so even modest AUC increases can precipitate toxicity.
- Direction: Increased colchicine exposure (neither drug is a prodrug).
- Magnitude: Not quantified for colchicine; vonoprazan raised midazolam AUC ~93%.
- Onset: Unspecified. Evidence: Theoretical.
- Management: Monitor for colchicine toxicity (GI symptoms, myopathy, cytopenias, neuromuscular effects). Dose reduction may be needed, individualized by the care team. Exercise added caution in renal/hepatic impairment or with other CYP3A/P-gp inhibitors.
What happens
Increased CYP3A substrates exposure
Interaction Deep Dive
As a weak inhibitor of CYP3A, vonoprazan can raise the exposure of CYP3A substrates, and for such substrates even small changes in concentration may cause serious toxicities. In a study, giving a single 2 mg oral dose of midazolam (a CYP3A4 substrate) after vonoprazan produced a 93% rise in midazolam AUC relative to midazolam given by itself. Combining vonoprazan with clarithromycin, which is a strong CYP3A inhibitor, elevates the risk of heightened exposure and adverse effects even more. Monitor concentrations and/or adverse reactions associated with CYP3A substrates on a frequent basis. A reduction in dosage may be required123.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism by vonoprazan
How to manage this interaction
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. Because colchicine can build up when combined with vonoprazan, your team can manage this safely.
- Your colchicine dose may be adjusted and individualized by your prescriber.
- Your team may monitor you more closely for side effects.
- Report symptoms like ongoing diarrhea, nausea, vomiting, muscle pain or weakness, numbness, or unusual tiredness promptly.
- Tell your pharmacist about any other medicines, especially other acid reducers or antibiotics like clarithromycin.
Bring this up at your next pharmacy or doctor visit so they can tailor your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
Common questions
Can I take Vonoprazan and Colchicine together?
Vonoprazan can raise colchicine levels, and because colchicine is narrow-margin, watch for toxicity like diarrhea or muscle pain. Keep taking both as prescribed and ask your pharmacist or doctor whether your colchicine dose needs adjusting. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Vonoprazan and Colchicine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Vonoprazan and Colchicine interaction managed?
Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. Because colchicine can build up when combined with vonoprazan, your team can manage this safely. Your colchicine dose may be adjusted and individualized by your prescriber. Your team may monitor you more closely for side effects. Report symptoms like ongoing diarrhea, nausea, vomiting, muscle pain or weakne… 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.
Questions for your pharmacist
- Does my dose of Vonoprazan 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: VOQUEZNA(R) oral tablets, vonoprazan oral tablets. Phathom Pharmaceuticals Inc (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) DUAL PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
- Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
Keep reading about Vonoprazan
Keep reading about Colchicine
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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