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Monitoring should be increased when colchicine is associated with active substances that are metabolised by, or interact with, the cytochrome P450 system, particularly with isoenzyme CYP3A4 or P glycoprotein.
Anti-infective agents: colchicine toxicity increases when combining treatment with clarithromycin, erythromycin or telithromycin, CYP3A4 substrates and inhibitors, particularly in patients with pre-existing renal disorders. Other CYP3A4 inhibitors such as itraconazole, ketoconazole, indinavir, nelfinavir, ritonavir, saquinavir may increase colchicine toxicity.
Calcium-channel antagonists: verapamil and diltiazem.
Cyclosporine: colchicine must be used with caution together with cyclosporine due to the possible risk of increased nephrotoxicity and myotoxicity.
Vitamins: vitamin B12 absorption may be affected by chronic administration or high doses of colchicine. Vitamin requirements may be increased.
Concomitant use of atorvastatin, simvastatin, pravastatin, fluvastatin, gemfibrozil, fenofibrate, fenofibric acid or bezafibrate (all of which are associated with myotoxicity) may promote the appearance of myopathies. Once treatment with colchicine has been discontinued, the symptoms usually subside in a period of between one week and several months.
Colchicine treatment must not be combined with grapefruit juice intake (CYP3A4 inhibitor) as colchicine toxicity may be enhanced.
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