Differential pharmacokinetic interaction of cyclosporine and tacrolimus with colchicine in renal allograft recipients

Beaudreuil, Séverine; Schermann, J; Verstuyft, Céline; Barrail-Tran, Aurélie; Smirnova, Maria; Dürrbach, Antoine; Becquemont, Laurent

doi:10.1111/ctr.13405

Cited by 3 publications

(7 citation statements)

References 5 publications

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“…Although colchicine is typically prescribed at relatively low doses (1-1.5 mg/ daily) for Behçet's disease, 19) fatal side effects can still occur, particularly in patients with renal or liver impairment. 7,10) Generally, cyclosporine is prescribed as a switch from colchicine therapy in Behçet's disease, but our results showed that colchicine was added to cyclosporine in 6 of 11 patients ( Table 1). The reasons for this are currently unclear.…”

Section: Discussionmentioning

confidence: 77%

“…14,15) These combinations may cause fatal outcomes and should be avoided. [5][6][7][8][9] Clarithromycin was the most common inappropri- (Table 1; n = 31) and was prescribed by internal medicine (n = 16) and otorhinolaryngology (n = 8). Clarithromycin is widely used to treat acute bacterial rhinosinusitis, strep throat, pneumonia, skin infections, and Helicobacter pylori infection.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] Colchicine is a substrate for CYP3A4 and P-glycoprotein (P-gp) and its concomitant administration with CYP3A4 and/or P-gp inhibitors increases the risk of side effects, particularly in patients with renal or liver impairment. [5][6][7][8][9] For example, studies have shown that clarithromycin strongly inhibits CYP3A4 and P-gp, thereby increasing the risk of fatal side effects such as pancytopenia. 5,6) Similarly, cyclosporine has been reported to interact with colchicine by inhibiting P-gp and CYP3A4.…”

Section: Introductionmentioning

confidence: 99%

“…5,6) Similarly, cyclosporine has been reported to interact with colchicine by inhibiting P-gp and CYP3A4. 7,8) Colchicine may cause lifethreatening side effects by inducing rhabdomyolysis, liver damage, polyneuropathy, cardiotoxicity, and neutropenia in cyclosporine-treated heart transplant patients with renal failure. 7) Additionally, colchicine was reported to interact with medications such as fluconazole, nivolumab, and atorvastatin.…”

Section: Introductionmentioning

confidence: 99%

“…7,8) Colchicine may cause lifethreatening side effects by inducing rhabdomyolysis, liver damage, polyneuropathy, cardiotoxicity, and neutropenia in cyclosporine-treated heart transplant patients with renal failure. 7) Additionally, colchicine was reported to interact with medications such as fluconazole, nivolumab, and atorvastatin. [10][11][12] Although colchicine exhibits important interactions, it is unclear how well these are recognized by clinicians and pharmacists.…”

Section: Introductionmentioning

confidence: 99%

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Prescription of Colchicine with Other Dangerous Concomitant Medications: A Nation-Wide Survey Using the Japanese Claims Database

Imai

Momo

Kashiwagi

et al. 2020

Biological & Pharmaceutical Bulletin

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The anti-inflammatory agent colchicine may cause toxic effects such as rhabdomyolysis, pancytopenia, and acute respiratory distress syndrome in cases of overdose and when patients have renal or liver impairment. As colchicine is a substrate for CYP3A4 and P-glycoprotein (P-gp), drug-drug interactions are important factors that cause fatal colchicine-related side effects. Thus, we conducted a nationwide survey to determine the status of inappropriate colchicine prescriptions in Japan. Patients prescribed the regular use of colchicine from April 2014 to March 2017 were identified using the Japanese large health insurance claims database. As the primary endpoint, we evaluated the concomitant prescription proportions of strong CYP3A4 and/or P-gp inhibitors classified as "contraindications for co-administration" with colchicine in patients with renal or liver impairment. We defined these cases as "inappropriate colchicine prescriptions." Additionally, factors affecting inappropriate colchicine prescriptions were analyzed. Among the 3302 enrolled patients, 43 (1.30%) were inappropriately prescribed colchicine. Of these 43 patients, 11 had baseline renal and/or liver impairment. By multiple regression analysis, the primary diseases "gout" and "Behçet's disease" were extracted as independent factors for inappropriate colchicine prescriptions with odds ratios of 0.40 (95% confidence interval: 0.19-0.84) and 4.93 (95% confidence interval: 2.12-11.5), respectively. We found that approximately 1% of patients had important colchicine interactions. Particularly, Behçet's disease was a risk factor for inappropriate prescriptions, with approximately 25% of patients showing renal and/or liver impairment (classified as "contraindications for co-administration"). These findings may be useful for medical professionals who prescribe colchicine therapy.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prescription of Colchicine with Other Dangerous Concomitant Medications: A Nation-Wide Survey Using the Japanese Claims Database

Imai

Momo

Kashiwagi

et al. 2020

Biological & Pharmaceutical Bulletin

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Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure

et al. 2022

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Colchicine is increasingly used as the number of potential indications expands. However, it also has a narrow therapeutic index that is associated with bothersome to severe side effects. When concomitantly use with medications inhibiting its metabolism, higher plasma levels will result and increase likelihood of colchicine toxicity. We conducted a cohort study using electronic health records comparing encounters with colchicine plus a macrolide and colchicine with an antibiotic non-macrolide. We assessed the relationship between the two groups using adjusted multivariate logistic regression models and the risk of rhabdomyolysis, pancytopenia, muscular weakness, heart failure, acute hepatic failure and death. 12670 patients on colchicine plus an antibiotic non-macrolide were compared to 2199 patients exposed to colchicine plus a macrolide. Patients exposed to colchicine and a macrolide were majority men ( n = 1329, 60.4%) and white ( n = 1485, 67.5%) in their late sixties (mean age in years 68.4, SD 15.6). Heart failure was more frequent in the colchicine plus a macrolide cohort ( n = 402, 18.3%) vs the colchicine non-macrolide one ( n = 1153, 9.1%) ( p < 0.0001) and also had a higher mortality rate [(85 (3.87%) vs 289 (2.28%), p < 0.0001 macrolides vs non-macrolides cohorts, respectively]. When the sample was limited to individuals exposed to either clarithromycin or erythromycin and colchicine, the adjusted OR for acute hepatic failure was 2.47 (95% CI 1.04–5.91) and 2.06 for death (95% CI 1.07–3.97). There is a significant increase in the risk of hepatic failure and mortality when colchicine is concomitantly administered with a macrolide. Colchicine should not be used concomitantly with these antibiotics or should be temporarily discontinued to avoid toxic levels of colchicine. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-022-05201-5.

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Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management

et al. 2022

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Colchicine is useful for the prevention and treatment of gout and a variety of other disorders. It is a substrate for CYP3A4 and P-glycoprotein (P-gp), and concomitant administration with CYP3A4/P-gp inhibitors can cause life-threatening drug–drug interactions (DDIs) such as pancytopenia, multiorgan failure, and cardiac arrhythmias. Colchicine can also cause myotoxicity, and coadministration with other myotoxic drugs may increase the risk of myopathy and rhabdomyolysis. Many sources of DDI information including journal publications, product labels, and online sources have errors or misleading statements regarding which drugs interact with colchicine, as well as suboptimal recommendations for managing the DDIs to minimize patient harm. Furthermore, assessment of the clinical importance of specific colchicine DDIs can vary dramatically from one source to another. In this paper we provide an evidence-based evaluation of which drugs can be expected to interact with colchicine, and which drugs have been stated to interact with colchicine but are unlikely to do so. Based on these evaluations we suggest management options for reducing the risk of potentially severe adverse outcomes from colchicine DDIs. The common recommendation to reduce the dose of colchicine when given with CYP3A4/P-gp inhibitors is likely to result in colchicine toxicity in some patients and therapeutic failure in others. A comprehensive evaluation of the almost 100 reported cases of colchicine DDIs is included in table form in the electronic supplementary material. Colchicine is a valuable drug, but improvements in the information about colchicine DDIs are needed in order to minimize the risk of serious adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01265-1.

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Differential pharmacokinetic interaction of cyclosporine and tacrolimus with colchicine in renal allograft recipients

Cited by 3 publications

References 5 publications

Prescription of Colchicine with Other Dangerous Concomitant Medications: A Nation-Wide Survey Using the Japanese Claims Database

Prescription of Colchicine with Other Dangerous Concomitant Medications: A Nation-Wide Survey Using the Japanese Claims Database

Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure

Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management

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