Atorvastatin × Colchicine

Additive myopathy and rhabdomyolysis risk. Atorvastatin injures muscle fibre by suppressing ubiquinone synthesis; colchicine disrupts microtubule function in myocytes. Particularly dangerous in older patients and chronic kidney disease.

Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Severe cases progress to rhabdomyolysis with acute kidney injury. Symptoms appear within 1–4 weeks of co-administration.

Avoid prolonged combination. For acute gout, a short colchicine course (3–5 days) at 0.3 mg every other day is acceptable with muscle symptom and creatine kinase monitoring. Alternative for gout: intra-articular or short systemic glucocorticoid.