MAJOR — Use With Caution
FDA-documented interaction. Colchicine dose reduction required. Contraindicated in patients with renal or hepatic impairment.
Evidence level: STRONG
Fluconazole can increase colchicine levels, and since colchicine has a very narrow safety margin, this raises the risk of serious side effects including multi-organ failure.
Fluconazole inhibits CYP3A4 and P-gp. Colchicine is a CYP3A4 and P-gp substrate with narrow therapeutic index. Increased colchicine levels can cause serious toxicity. FDA colchicine label warns about moderate CYP3A4 inhibitors.
If you take colchicine and need fluconazole, your doctor should reduce your colchicine dose. Report any severe nausea, vomiting, or diarrhea immediately.
Take Fluconazole as directed (some require food for absorption, others an empty stomach — check the label). Azole antifungals are potent CYP enzyme inhibitors that can dramatically increase blood levels of many medications. Colchicine levels should be monitored during antifungal treatment.
Higher risk for: those with liver impairment (azole antifungals are hepatotoxic), concurrent CYP3A4 substrate use, elderly, renal impairment, or those on multiple QT-prolonging medications.
Severe nausea, vomiting, diarrhea, abdominal pain, muscle weakness, numbness, low blood counts (fever, infection)
Reduce colchicine dose. Assess renal and hepatic function first. Contraindicated if both impaired. Monitor for colchicine toxicity signs.
Azole antifungals are potent CYP enzyme inhibitors. Ask your doctor about topical antifungal options to avoid systemic interactions, or about terbinafine which has fewer drug interactions than azoles.
Fluconazole can increase colchicine levels, and since colchicine has a very narrow safety margin, this raises the risk of serious side effects including multi-organ failure.
Take Fluconazole as directed (some require food for absorption, others an empty stomach — check the label). Azole antifungals are potent CYP enzyme inhibitors that can dramatically increase blood levels of many medications. Colchicine levels should be monitored during antifungal treatment.
Severe nausea, vomiting, diarrhea, abdominal pain, muscle weakness, numbness, low blood counts (fever, infection)
Azole antifungals are potent CYP enzyme inhibitors. Ask your doctor about topical antifungal options to avoid systemic interactions, or about terbinafine which has fewer drug interactions than azoles.
Reduce colchicine dose. Assess renal and hepatic function first. Contraindicated if both impaired. Monitor for colchicine toxicity signs.
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