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Gout — SCE Rheumatology MCQ

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HardCrystal arthropathiesGoutSCE Rheumatology

A patient with eGFR 26 mL/min is taking colchicine prophylaxis for gout and now needs clarithromycin for a susceptible non-tuberculous mycobacterial infection. What is the safest interaction decision?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Do not co-administer colchicine and clarithromycin in renal impairment

Explanation lettering: C = shown as A · A = shown as B · B = shown as C · E = shown as D · D = shown as E

B is correct. Colchicine is a CYP3A4 and P-glycoprotein substrate, while clarithromycin inhibits both pathways. The UK SmPC contraindicates the combination in renal or hepatic impairment because accumulation can cause fatal marrow, neuromuscular and multiorgan toxicity. Dose separation does not reverse enzyme inhibition, and laboratory monitoring cannot make a contraindicated exposure safe.

Reference: Colchicine 500 microgram tablets UK SmPC. https://www.medicines.org.uk/emc/product/100968/smpc