Colchicine × Ciclosporin

Cyclosporine inhibits both CYP3A4 and P-glycoprotein – the clearance routes of colchicine. Fatal myopathy, neuropathy, and pancytopenia have been reported in transplant patients on both drugs.

Profuse diarrhoea, vomiting, abdominal pain – first signs of toxicity. Pancytopenia (drop in leukocytes, erythrocytes, platelets), muscle weakness, peripheral neuropathy, hepatic and renal injury follow. Fatal cases have been reported.

In Spain the colchicine SmPC contraindicates it during use of CYP3A4 or P-glycoprotein inhibitors and for 14 days afterwards, and cyclosporine blocks both routes. So a patient taking cyclosporine is not given colchicine. An acute gout flare after transplantation is treated with a glucocorticoid, intra-articular or as a short oral course. The FDA label contraindicates the pair in renal or hepatic impairment. With normal renal and hepatic function the FDA allows colchicine at a reduced dose, for example 0.3 mg once daily instead of 0.6 mg twice daily for flare prophylaxis.