Contraindications to Starting Colchicine

Absolute Contraindications

Patients with any degree of renal or hepatic impairment must not receive colchicine with strong P-glycoprotein and/or CYP3A4 inhibitors, as recommended by the European League Against Rheumatism 1
The American College of Rheumatology recommends avoiding colchicine in patients with severe renal impairment (GFR <30 mL/min) due to decreased colchicine clearance 1, 2, 3
Specific contraindicated drugs include cyclosporin, clarithromycin, ketoconazole, ritonavir, and verapamil, as stated by the National Institute for Health and Care Excellence 1, 2, 3

Co-prescription of colchicine with strong P-glycoprotein and/or CYP3A4 inhibitors should be avoided in all patients, regardless of renal function, according to the European Medicines Agency 1, 4
The mechanism involves P-glycoprotein inhibition increasing intracellular colchicine concentrations and CYP3A4 inhibition decreasing hepatic elimination, leading to serious side effects, as reported by the American College of Clinical Pharmacology 3

Patients with moderate renal impairment (CrCl 30-50 mL/min) require dose reduction and close monitoring, as recommended by the Kidney Disease: Improving Global Outcomes initiative 1, 4
For prophylaxis, the dose should be reduced in patients with renal impairment, according to the European League Against Rheumatism 1, 4
Patients on statins with renal impairment are at heightened risk of neurotoxicity and muscular toxicity, as warned by the American Heart Association 1, 4