Colchicine × Ciclosporin

Cyclosporine inhibits both CYP3A4 and P-glycoprotein – the clearance routes of colchicine. Fatal myopathy, neuropathy, and pancytopenia have been reported in transplant patients on both drugs.

Profuse diarrhoea, vomiting, abdominal pain – first signs of toxicity. Pancytopenia (drop in leukocytes, erythrocytes, platelets), muscle weakness, peripheral neuropathy, hepatic and renal injury follow. Fatal cases have been reported.

For patients with renal or hepatic impairment, the combination is not prescribed. With preserved function, colchicine 0.3 mg every other day. For acute gout in a transplant patient, an alternative is intra-articular or short-course systemic glucocorticoid.