renal tubular clearance. Use Caution/Monitor.rosuvastatinSerious - Use Alternative (1)colchicine, rosuvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (incl a fatality).rucaparibMonitor Closely (1)rucaparib will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.rufinamideMonitor Closely (1)rufinamide will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.salicylates (non-asa)Monitor Closely (2)salicylates (non-asa) will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor. salicylates (non-asa) decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.salsalateMonitor Closely (2)salsalate will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor. salsalate decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.saquinavirSerious - Use Alternative (1)saquinavir will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of colchicine with strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment. secobarbitalMonitor Closely (1)secobarbital will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.selexipagMonitor Closely (1)colchicine will increase the level or effect of selexipag by decreasing metabolism. Modify Therapy/Monitor Closely. Reduce selexipag dose to once daily if coadministered with moderate CYP2C8 inhibitors.selinexorSerious - Use Alternative (1)colchicine, selinexor. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.siltuximabMonitor Closely (1)siltuximab, colchicine. Other (see comment). Use Caution/Monitor. Comment: CYP450 activity in the liver is down regulated by infection and inflammation stimuli including cytokines (eg, IL-6); inhibition of IL-6 by siltuximab may restore CYP450 enzymatic activity; caution if coadministered with CYP substrates that have a narrow therapeutic index.simvastatinSerious - Use Alternative (1)colchicine, simvastatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of rhabdomyolysis (incl a fatality).sodium phenylacetateMonitor Closely (1)probenecid increases levels of sodium phenylacetate by decreasing renal clearance. Use Caution/Monitor.sodium phenylbutyrateMonitor Closely (1)probenecid increases levels of sodium phenylbutyrate by decreasing renal clearance. Use Caution/Monitor.sofosbuvir/velpatasvirMonitor Closely (1)sofosbuvir/velpatasvir increases levels of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.Serious - Use Alternative (1)sofosbuvir/velpatasvir will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment. somapacitanMonitor Closely (1)somapacitan decreases effects of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.somatrogonMonitor Closely (1)somatrogon decreases effects of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.somatropinMonitor Closely (1)somatropin decreases effects of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.sotorasibSerious - Use Alternative (1)sotorasib will decrease the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.sulfadiazineMinor (1)probenecid increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.sulfamethoxazoleMinor (1)probenecid increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulfasalazineMonitor Closely (2)sulfasalazine will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor. sulfasalazine decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.sulfisoxazoleMinor (1)probenecid increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulindacMonitor Closely (1)sulindac will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.tazemetostatMonitor Closely (2)tazemetostat will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. colchicine will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.teclistamabMonitor Closely (1)teclistamab will increase the level or effect of colchicine by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed. tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teduglutideMonitor Closely (1)teduglutide increases levels of colchicine by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.telotristat ethylMonitor Closely (1)telotristat ethyl will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.temocillinSerious - Use Alternative (1)temocillin, probenecid. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.tenofovir DFMonitor Closely (1)probenecid increases levels of tenofovir DF by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .tepotinibSerious - Use Alternative (1)tepotinib will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.ticarcillinSerious - Use Alternative (1)ticarcillin, probenecid. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.tinidazoleMonitor Closely (1)colchicine will decrease the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tipranavirMonitor Closely (1)tipranavir increases levels of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Colchicine dose reduction recommended. Contraindicated in patients with renal or hepatic impairment. .tolazamideMonitor Closely (1)probenecid increases levels of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.tolbutamideMonitor Closely (1)probenecid increases levels of tolbutamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.tolfenamic acidMonitor Closely (1)tolfenamic acid will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.tolmetinMonitor Closely (1)tolmetin will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.trandolaprilMinor (1)probenecid increases effects of trandolapril by unspecified interaction mechanism. Minor/Significance Unknown.trofinetideMonitor Closely (1)trofinetide will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).tucatinibMonitor Closely (1)tucatinib will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.Serious - Use Alternative (2)colchicine will increase the level or effect of tucatinib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of tucatinib (a CYP2C8 substrate) with a strong or moderate CYP2C8 inhibitors increases tucatinib plasma concentrations and risk of toxicities. tucatinib will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.ubrogepantMonitor Closely (1)colchicine will decrease the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dose adjustment is recommended with concomitant use of ubrogepant and moderate and weak CYP3A4 inducers. (see Dosage Modifications)ustekinumabMonitor Closely (1)ustekinumab, colchicine. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.valacyclovirMinor (1)probenecid increases levels of valacyclovir by decreasing renal clearance. Minor/Significance Unknown.valganciclovirMonitor Closely (1)probenecid will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.velpatasvirSerious - Use Alternative (1)velpatasvir will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment. vemurafenibSerious - Use Alternative (1)vemurafenib increases levels of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment. .verapamilSerious - Use Alternative (1)verapamil will increase the level or effect of colchicine by Other (see comment). Avoid or Use Alternate Drug. Colchicine is a P-gp and CYP3A4 substrate. Avoid use with drugs that are both P-gp and strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment. voclosporinMonitor Closely (1)voclosporin will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Coadministration of voclosporin (a P-gp inhibitor) increases exposure and risk of adverse reactions of P-gp substrates. For certain P-gp substrates with a narrow therapeutic window, refer to prescribing information of these substrates for dosage modifications, if needed.voriconazoleSerious - Use Alternative (1)voriconazole will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use of colchicine with strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment. voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.willow barkMonitor Closely (2)willow bark will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor. willow bark decreases effects of probenecid by unknown mechanism. Use Caution/Monitor.zidovudineMonitor Closely (1)probenecid increases levels of zidovudine by decreasing metabolism. Use Caution/Monitor. Frequency Not Defined Probenecid CNS: Headache, dizziness Metabolic: Precipitation of acute gouty arthritis Gastrointestinal: Hepatic necrosis, vomiting, nausea, anorexia, sore gums Genitourinary: Nephrotic syndrome, uric acid stones with or without hematuria, renal colic, costovertebral pain, urinary frequency Hypersensitivity: Anaphylaxis, fever, urticaria, pruritus Hematologic: Aplastic anemia, leukopenia, hemolytic anemia which in some patients could be related to genetic deficiency of glucose-6-phosphate dehydrogenase in red blood cells, anemia Integumentary: Dermatitis, alopecia, flushing Colchicine Adverse effects appear to be dose dependent; increased colchicine toxicity may occur with hepatic dysfunction CNS: Peripheral neuritis Musculoskeletal: Muscular weakness Gastrointestinal: Nausea, vomiting, abdominal pain, or diarrhea may be particularly troublesome in the presence of peptic ulcer or spastic colon Hypersensitivity: Urticaria Hematologic: Aplastic anemia, agranulocytosis Integumentary: Dermatitis, purpura, alopecia At toxic doses, may cause severe diarrhea, generalized vascular damage, and renal damage with hematuria and oliguria Contraindications Hypersensitivity Blood dyscrasias Uric acid kidney stones Initiation of therapy during an acute gouty attack Cautions Exacerbation of gout may occur; in such cases additional colchicine or other appropriate therapy required Probenecid increases plasma concentrations of methotrexate; if combination must be