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Colchicine Drug Interactions in HF — EECC MCQ

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ModerateHeart FailureColchicine Drug Interactions in HFEECC

A 60-year-old man with HFrEF on GDMT develops gout. His rheumatologist recommends colchicine. Are there any relevant drug interactions with his HF medications?

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Correct answer: A — Colchicine has a narrow therapeutic index; its clearance is reduced by P-glycoprotein and CYP3A4 inhibitors — importantly, diltiazem and verapamil (if used) increase colchicine toxicity risk, and dose adjustment is needed in renal impairment

Colchicine is metabolised by CYP3A4 and is a substrate for P-glycoprotein (P-gp) transport. Drugs that inhibit CYP3A4 and/or P-gp significantly increase colchicine levels, risking toxicity (bone marrow suppression, neuromyopathy, multi-organ failure). Relevant cardiac P-gp/CYP3A4 inhibitors include: diltiazem, verapamil, amiodarone, and dronedarone. Additionally, statin-colchicine co-prescription (common in cardiovascular patients) can increase the risk of myopathy. Renal impairment (common in HF) reduces colchicine clearance, requiring dose reduction or avoidance at CrCl <30 mL/min. Standard HF medications (beta-blockers, ACEi/ARB, SGLT2i, MRA) do not have significant pharmacokinetic interactions with colchicine.

Reference: BNF; ESC Pharmacology Guidelines