Should colchicine be held on the day of injecting Humira (adalimumab)?

Management of Colchicine with Adalimumab (Humira)

There is no need to hold colchicine on the day of Humira (adalimumab) injection as there are no significant drug interactions between these medications that would require dose adjustment or timing changes. 1

Rationale for Concurrent Administration

• Colchicine and adalimumab work through different mechanisms and do not have clinically significant pharmacokinetic or pharmacodynamic interactions that would necessitate separating their administration 1
• In patients with inflammatory conditions such as Familial Mediterranean Fever (FMF) who may have chronic inflammatory musculoskeletal involvement requiring both medications, these treatments can be used concurrently without special timing considerations 1
• For patients with gout who might be using Humira for another condition, there is no evidence supporting the need to hold colchicine on injection days 1

Important Considerations for Colchicine Use

• Regular monitoring of colchicine therapy is recommended regardless of concomitant adalimumab use, including assessment of:

  • Complete blood counts 1
  • Liver function tests 1
  • Renal function 1
  • Creatine kinase levels if muscle symptoms develop 1

• Colchicine dose should be adjusted based on:

  • Renal function (reduced doses for decreased renal function) 1
  • Presence of drug interactions with CYP3A4 and P-glycoprotein inhibitors (not applicable to adalimumab) 2, 3

Special Situations

• For patients with chronic inflammatory joint involvement in FMF who require both medications:

  • Colchicine remains the mainstay treatment for FMF 1
  • Adalimumab or other biologic DMARDs may be added for musculoskeletal manifestations that are less responsive to colchicine 1
  • Both medications can be administered according to their standard schedules without timing adjustments 1

• For patients with gout requiring colchicine:

  • Standard colchicine dosing for acute gout (1.2 mg followed by 0.6 mg one hour later) or prophylaxis (0.5-1 mg daily) can be maintained regardless of adalimumab administration timing 1, 4

Potential Drug Interaction Concerns

• While colchicine has significant interactions with many medications, adalimumab is not known to affect:

  • Cytochrome P450 3A4 metabolism 2, 3
  • P-glycoprotein transport 2, 3
  • Renal clearance of colchicine 5

• The main colchicine drug interaction concerns involve:

  • Strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) 2, 3
  • P-glycoprotein inhibitors (e.g., cyclosporine) 2, 3
  • Medications that can cause additive myotoxicity (e.g., statins) 5
  • Adalimumab does not fall into any of these categories 2, 3

Monitoring Recommendations

• Continue regular monitoring of colchicine therapy regardless of adalimumab administration 1
• Monitor for signs of colchicine toxicity including:
  • Gastrointestinal symptoms (diarrhea, nausea, vomiting) 1, 6
  • Muscle weakness or pain 1, 6
  • Neurological symptoms 1, 6
• Ensure appropriate colchicine dosing based on indication and patient factors, regardless of adalimumab use 1