Is there any risk of interaction between colchicine and NSAIDs?/nA 31-year-old man with familial Me

Fråga: Is there any risk of interaction between colchicine and NSAIDs?

A 31-year-old man with familial Mediterranean fever successfully treated with colchicine (0.5 mg t.i.d.) also has a chronic pain syndrome. He has no known amyloidosis and has normal kidney function.

Sammanfattning: No documented interactions have been found between colchicine and NSAIDs. The coadministration of these drugs is probably safe in a patient with normal renal function.

Svar: Colchicine is partly demethylated and partly deacetylated in the liver and undergoes some degree of metabolism in other tissues. It is also subject to extensive enterohepatic recirculation (1).

The enzymes responsible are not known, but the CYP3A family is probably involved. Coadministration of colchicine with cyclosporine or erythromycin, which are inhibitors of CYP3A4 and the transport protein Pgp (also known as MDR1), can increase the risk of colchicine toxicity, e.g. diarrhea, nausea, vomiting and myelosuppression. However, it is not known whether this interaction is due to decreased metabolism or excretion (2).

No documented interactions have been found between colchicine and NSAIDs. Some NSAIDs, mainly coxibs, are partly metabolised by CYP3A4 (2). Some NSAIDs can inhibit transport proteins such as organic anion transporter (OAT1) and multi-drug resistance protein (MRP1), which is the probable mechanism of the interaction between methotrexate and NSAIDs. These transporters, however, are not involved in colchicine transport and NSAIDs do not seem to inhibit Pgp (3). Drugline no 16919 (year 2000) 2 Colchicine. Drugdex(R) System; Thomson MICROMEDEX, Greenwood Village, Colorado (Edition expires (date)) Lee W, Kim RB. Transporters and renal drug elimination. Annu Rev Pharmacol Toxicol. 2004;44:137-66.