Is concomitant use of colchicine and indomethacin safe with minoxidil (Rogaine)?

From the Guidelines

It is not recommended to take colchicine and indomethacin together with minoxidil without consulting a healthcare provider due to potential interactions and side effects. Colchicine, used for gout, and indomethacin, an NSAID for pain and inflammation, can cause gastrointestinal side effects, and taking them together might increase stomach discomfort 1. Additionally, indomethacin may slightly reduce the effectiveness of oral minoxidil for blood pressure since NSAIDs can cause fluid retention and raise blood pressure.

Key Considerations

• Colchicine dose adjustments are recommended when used in conjunction with a CYP3A4 or P-gp inhibitor, although minoxidil is not explicitly mentioned as one of these inhibitors 1.
• Patients receiving combination therapy with medications that may interact should be monitored closely for signs and symptoms of toxicity, given the potential for synergistic effects 1.
• If you're using topical minoxidil for hair loss, there's less concern about interactions with the other medications since very little enters your bloodstream.

Medication Interactions

• The provided evidence primarily discusses interactions between statins and colchicine, highlighting the need for dose adjustments and close monitoring 1.
• While the evidence does not directly address interactions between colchicine, indomethacin, and minoxidil, it emphasizes the importance of careful consideration and medical supervision when combining medications with potential interactions.

Patient-Specific Factors

• Your doctor should review your complete medication list, medical history, and kidney function before approving this combination to ensure it's appropriate for your specific situation.
• Renal impairment may require reduced doses of certain medications, such as colchicine, when used in combination with other drugs 1.

From the Research

Interaction with Minoxidil

• There is no direct evidence in the provided studies regarding the interaction between colchicine, indomethacin, and minoxidil.
• The studies focus on the effects, mechanisms, and safety of colchicine in various conditions, such as gout, familial Mediterranean fever, and recurrent oral ulcers 2, 3, 4, 5.
• Colchicine's pharmacokinetics and mechanism of action are well understood, with it being predominantly metabolized in the gastrointestinal tract and exerting its action through inhibition of microtubule polymerization 4.
• However, there is no information on how colchicine or indomethacin interacts with minoxidil, a medication commonly used for hair loss.

Safety and Efficacy of Colchicine

• Colchicine has been shown to be effective in preventing gout flare and cardiovascular events in patients with gout and cardiovascular disease, with a low dose of 0.5 mg daily 3.
• The safety of colchicine has been evaluated, with the majority of studies suggesting that it does not increase the risk of cancer, sepsis, cytopenia, or myotoxicity when used at low doses and in patients without advanced renal or liver disease 3.
• However, the potential interaction between colchicine, indomethacin, and minoxidil remains unknown due to the lack of direct evidence in the provided studies.