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Colchicine Drug Interactions CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseColchicine Drug Interactions CKDESENeph

A 50-year-old man with CKD G4 develops acute gout. He has CKD from hypertensive nephrosclerosis. His rheumatologist wants to start Colchicine but he is on Atorvastatin and Amlodipine. What specific drug interaction must be checked?

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Correct answer: B — Colchicine has potential interactions with statins (increased myopathy risk) and with CYP3A4 inhibitors (Clarithromycin, Itraconazole – though Amlodipine is a weak inhibitor); in CKD, reduced Colchicine clearance further compounds the risk – dose reduction is essential

Colchicine is metabolised by CYP3A4 and P-glycoprotein. Co-administration with CYP3A4 inhibitors (Clarithromycin, Itraconazole, HIV protease inhibitors) dramatically increases Colchicine toxicity (diarrhoea, myelosuppression, rhabdomyolysis). The statin-Colchicine interaction increases myopathy and rhabdomyolysis risk. In CKD, Colchicine clearance is already reduced (~50% in CKD G3-4). BNF recommends dose reduction in CKD (0.5 mg OD or alternate days in CKD G3-4; avoid in CKD G5/dialysis unless specialist supervision). Amlodipine is a weak CYP3A4 inhibitor and is generally safe, but the statin interaction warrants awareness.

Reference: BNF 2024 – Colchicine; NICE CG169 – Gout