Is there a known interaction between tacrolimus and colchicine?

Fråga: Is there a known interaction between tacrolimus and colchicine?

Sammanfattning: There may be a risk of increased colchicine concentrations, and thus increased risk of muscle-related adverse effects, during concomitant treatment with tacrolimus. If co-treatment cannot be avoided, the colchicine dose should be lowered and the patient and prescriber should be observant of muscle-related adverse effects.

Svar: According to the Sphinx database and Stockley´s Drug Interactions there are no known interactions between tacrolimus and colchicine (1,2). However, both drugs are substrates of CYP3A4 and PgP, which means that the concentration of both drugs could theoretically increase in co-treatment. Because tacrolimus concentrations are monitored regularly, it is predominantly colchicine that one should be observant of, and where dose reduction is possible (3). High colchicine concentrations can cause muscle-related adverse effects, rhabdomyolysis in the most severe cases, which is why one should be observant of such symptoms.

The potential for interaction between cyclosporine and colchicine is well known, but as mentioned above, the risk of interactions between tacrolimus and colchicine has been based on theoretical reasoning. However, a few case reports of colchicine-induced myopathy during concomitant treatment with tacrolimus now exist (4). In a recent, small study the exposure to colchicine was three times higher in renal transplant patients also medicated with tacrolimus, compared to a control group with similar renal function (5). Sfinx interaktionsdatabas. (www.janusinfo.se) Stockley´s Drug interactions www.medicinescomplete.com (acess date 2015-03-13) Drugline no 24161 (year 2011) Yousuf Bhat Z, Reddy S, Pillai U, Doshi M, Wilpula E. Colchicine-induced myopathy in a tacrolimus-treated renal transplant recipient: Case report and literature review. Am J Ther 2014 Apr 11 Amanova A, Kendi Celebi Z, Bakar F, Caglayan MG, Keven K. Colchicine levels in chronic kidney diseases and kidney transplant recipients using tacrolimus, Clin Transplant 2014 Oct;28(10):1177-83