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Colchicine Capsules and Zithromax Tri-Pak

Determining the interaction of Colchicine Capsules and Zithromax Tri-Pak and the possibility of their joint administration.

Check result:

Colchicine Capsules <> Zithromax Tri-Pak

Relevance: 19.10.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Azithromycin may increase the blood levels of colchicine to dangerous levels, increasing the risk of serious side effects that can affect your muscles, blood cells, nervous system, and multiple organs including the liver and kidneys. You may need a lower dose of colchicine if you are currently using azithromycin or have used it within the last 14 days. Let your doctor know if you experience abdominal pain, nausea, vomiting, diarrhea, fever, muscle pain, weakness, fatigue, and/or numbness or tingling in your hands and feet, as these may be early symptoms of colchicine toxicity. You may not be able to take these medications together if you have liver or kidney disease. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

ADJUST DOSE: Coadministration with inhibitors of P-glycoprotein (P-gp) may significantly increase the serum concentrations of colchicine. The mechanism involves enhanced absorption as well as reduced excretion of colchicine due to inhibition of P-gp efflux transporter in the intestine, renal proximal tubule, and liver. In a study of 23 healthy volunteers, administration of a single 0.6 mg dose of colchicine in combination with a single 100 mg dose of the potent P-gp inhibitor cyclosporine resulted in an approximately 3.5-fold increase in colchicine peak plasma concentration (Cmax) and systemic exposure (AUC). Clinical manifestations associated with the interaction have included neuromyopathy, rhabdomyolysis, hepato- and nephrotoxicity, cardiotoxicity, bone marrow suppression, multiorgan failure, and fatality. In a retrospective study of renal transplant recipients at a French hospital, investigators reported that five out of ten patients who received cyclosporine in combination with colchicine experienced muscular symptoms, while none did in the control group that received only cyclosporine. Muscular histology, when performed, was consistent with previous reports of colchicine (i.e., vacuolar) myopathy. Mean duration of colchicine therapy was 12.2 months in the patients with muscular symptoms and 6.8 months in the patients without muscular symptoms. All five patients improved after colchicine withdrawal. No significant differences were found for age, gender ratio, transplant duration, serum creatinine levels, or cumulative steroid dose between case patients and controls. Data are not available for colchicine in combination with other P-gp inhibitors. However, a similar interaction is expected.

MANAGEMENT: Due to the risk of life-threatening and fatal toxicity, patients with renal or hepatic impairment should not be given colchicine in combination with P-glycoprotein inhibitors such as cyclosporine, carvedilol, amiodarone, bepridil, quinidine, quinine, propafenone, ranolazine, spironolactone, tamoxifen, ulipristal, and some tyrosine kinase inhibitors. In patients with normal renal and hepatic function, the dosage of colchicine should be reduced when used with P-gp inhibitors or within 14 days of using them. Some authorities have specified dose adjustments for gout (treatment and prophylaxis) and familial Mediterranean fever. For the treatment of acute gout flares, the adjusted dosage recommended is 0.6 mg for one dose. Administration should not be repeated for at least three days. For the treatment of familial Mediterranean fever, the maximum dosage of colchicine is 0.6 mg/day (may be given as 0.3 mg twice a day) when used in the presence of a P-gp inhibitor. Patients should be advised to contact their physician if they experience symptoms of toxicity such as abdominal pain, nausea, vomiting, diarrhea, fatigue, myalgia, asthenia, hyporeflexia, paresthesia, and numbness.

References

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Garrouste C, Philipponnet C, Kaysi S, Enache I, Tiple A, Heng AE "Severe colchicine intoxication in a renal transplant recipient on cyclosporine." Transplant Proc 44 (2012): 2851-2
Jonsson J, Gelpi JR, Light JA, Aquino A, Maszaros S "Colchicine-induced myoneuropathy in a renal transplant patient." Transplantation 53 (1992): 1369-71
Volpe DA, Hamed SS, Zhang LK "Use of different parameters and equations for calculation of IC50 values in efflux assays: potential sources of variability in IC 50 determination." AAPS J 16 (2014): 172-80
Mounier G, Guy C, Beyens MN, Ratrema M, Massol A, Ollagnier M "Colchicine-induced pancytopenia during therapeutic dose administratioin. French parmacovigilance database survey and literature review." Drug Saf 29 (2006): 911-1010
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Menta R, Rossi E, Guariglia A, David S, Cambi V "Reversible acute cyclosporin nephrotoxicity induced by colchicine administration." Nephrol Dial Transplant 2 (1987): 380-1
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Francis L, Bonilla E, Soforo E, et al. "Fatal toxic myopathy attributed to propofol, methylprednisolone, and cyclosporine after prior exposure to colchicine and simvastatin." Clin Rheumatol 27 (2008): 129-31
Gruberg L, Har-Zahav Y, Agranat O, Freimark D "Acute myopathy induced by colchicine in a cyclosporine treated heart transplant recipient: possible role of the multidrug resistance transporter." Transplant Proc 31 (1999): 2157-8
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Colchicine Capsules

Generic Name: colchicine

Brand name: Colcrys, Mitigare

Synonyms: Colchicine

What is Colchicine Capsules?

Zithromax Tri-Pak

Generic Name: azithromycin

Brand name: Zithromax, Zmax, AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax Tri-Pak, Zithromax Z-Pak, Zithromax IV

Synonyms: Zithromax

What is Zithromax Tri-Pak?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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