Colchicine and Adalimumab Administration Guidance
There is no need to hold colchicine on the day you inject Humira (adalimumab). 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
- Both medications can be administered according to their standard schedules without timing adjustments 1
- For patients with inflammatory conditions requiring both medications (such as gout patients who might be using Humira for another condition), there is no evidence supporting the need to hold colchicine on injection days 2, 1
Important Considerations for Colchicine Use
- Colchicine has a narrow therapeutic index and requires careful dosing to avoid toxicity 3
- Regular monitoring is recommended while on colchicine therapy, including:
- Complete blood counts
- Liver function tests
- Renal function
- Creatine kinase levels if muscle symptoms develop 1
Drug Interactions to Consider
- While colchicine can be safely taken with adalimumab, it has significant interactions with other medications that should be monitored:
- Strong P-glycoprotein and/or CYP3A4 inhibitors (cyclosporin, clarithromycin, ketoconazole, ritonavir) can increase colchicine plasma concentration and risk of toxicity 2, 4
- Colchicine dose should be reduced when used with these inhibitors 5
- Combining colchicine with statins may increase risk of myopathy 6
Dosing Considerations
- For acute gout flares: Colchicine loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 2
- For prophylaxis: Colchicine 0.5-1 mg/day 2
- Dose reduction is necessary in patients with renal impairment 2
- Colchicine should be avoided in patients with severe renal impairment (GFR <30 mL/min) 2
Monitoring for Adverse Effects
- Early signs of colchicine toxicity include diarrhea, abdominal cramping, and vomiting 2
- More severe toxicity can progress to multiorgan failure, bone marrow suppression, and potentially death 2
- Patients should be educated to recognize and report early signs of toxicity 2
Special Situations
- For patients with Familial Mediterranean Fever (FMF) who have chronic inflammatory joint involvement requiring both medications, colchicine remains the mainstay treatment with adalimumab added for musculoskeletal manifestations less responsive to colchicine 1
- In cases of gout with comorbid conditions requiring adalimumab, both medications can be continued according to their standard dosing schedules 1
Remember that while these medications can be taken concurrently, proper monitoring for potential side effects of each medication should continue as usual.