Version May 2024
Note: Urate-lowering therapy may be initiated during a gout flare or after the flare subsides (Ref).
Gouty arthritis, flare prophylaxis: Oral: Colchicine 0.5 mg/probenecid 500 mg: 1 tablet once daily for 1 week, then 1 tablet twice daily thereafter; may increase dose by 1 tablet every 4 weeks as tolerated if symptoms not controlled or the 24-hour uric acid excretion is <700 mg. Note: Current prescribing information includes dosing up to 4 tablets/day; however, this exceeds the maximum dose of colchicine for gout prophylaxis (1.2 mg/day).
Note: Other agents are preferred over probenecid as first-line urate-lowering therapy in patients with moderate to severe chronic kidney disease (stage ≥3) (Ref). Additional therapeutic considerations may apply; refer to individual agents for information.
GFR >30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.
GFR ≤30 mL/minute: Avoid use, as probenecid may not be effective, and the colchicine dose would not be able to be dose-adjusted for kidney function properly.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Refer to adult dosing.
See individual agents.
Hypersensitivity to colchicine, probenecid, or any component of the formulation; children <2 years of age; blood dyscrasias; uric acid kidney stones; initiation during an acute gout attack.
See individual agents.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Generic: Colchicine 0.5 mg and probenecid 500 mg
Yes
Tablets (Colchicine-Probenecid Oral)
0.5-500 mg (per each): $0.97 - $1.93
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer with food if GI upset occurs. Maintain adequate fluid intake (at least 64 oz water/day).
Hazardous agent (NIOSH 2016 [group 3]).
Colchicine is a hazardous agent. Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends single gloving for administration of intact tablets or capsules (NIOSH 2016).
Gouty arthritis, flare prophylaxis: Treatment of chronic gouty arthritis when complicated by frequent, recurrent acute attacks of gout.
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: Probenecid may increase the serum concentration of Acetaminophen. Probenecid may also limit the formation of at least one major non-toxic metabolite, possibly increasing the potential for formation of the toxic NAPQI metabolite. Management: Consider limiting acetaminophen use in combination with probenecid. Probenecid may reduce clearance of acetaminophen to one of its non-toxic metabolities, increasing the risk for acetaminophen toxicity, even a lower doses. Risk D: Consider therapy modification
Anagliptin: Probenecid may increase the serum concentration of Anagliptin. Risk C: Monitor therapy
Antihepaciviral Combination Products: May increase the serum concentration of Colchicine. Risk X: Avoid combination
Asciminib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Avibactam: Probenecid may increase the serum concentration of Avibactam. Risk X: Avoid combination
Baricitinib: Probenecid may increase the serum concentration of Baricitinib. Management: When baricitinib is combined with probenecid, reduce baricitinib 4 mg daily to 2 mg daily or reduce baricitinib 2 mg daily to 1 mg daily. Don't use probenecid if recommended baricitinib dose is only 1 mg daily. Risk D: Consider therapy modification
Betalactamase Inhibitors: Probenecid may increase the serum concentration of Betalactamase Inhibitors. Management: Coadministration of probenecid with amoxicillin/clavulanate is not recommended per official package labeling. Risk D: Consider therapy modification
Cabozantinib: MRP2 Inhibitors may increase the serum concentration of Cabozantinib. Risk C: Monitor therapy
Cefotaxime: Probenecid may increase the serum concentration of Cefotaxime. Management: Avoid cefotaxime doses greater than 6 grams per day with concurrent probenecid. Any patients receiving this combination should be monitored for evidence of cefotaxime toxicity. Risk D: Consider therapy modification
Cephalosporins: Probenecid may increase the serum concentration of Cephalosporins. Risk C: Monitor therapy
Choline C 11: Colchicine may diminish the therapeutic effect of Choline C 11. Risk C: Monitor therapy
Clofarabine: OAT1/3 Inhibitors may increase the serum concentration of Clofarabine. Risk C: Monitor therapy
Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May decrease the serum concentration of Colchicine. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Colchicine. Management: Avoidance, dose reduction, or increased monitoring for colchicine toxicity may be needed and will depend on brand, indication for colchicine use, renal/hepatic function, and use of a P-gp inhibitor. See full monograph for details. Risk D: Consider therapy modification
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Colchicine. Management: This combination is often contraindicated, but combined use may be permitted with dose adjustment and monitoring. Recommendations vary based on brand, indication, use of P-gp inhibitors, and hepatic/renal function. See interaction monograph for details Risk D: Consider therapy modification
Deferiprone: UGT1A6 Inhibitors may increase the serum concentration of Deferiprone. Risk X: Avoid combination
Dexketoprofen: Probenecid may increase the serum concentration of Dexketoprofen. Risk C: Monitor therapy
Dichlorphenamide: OAT1/3 Inhibitors may increase the serum concentration of Dichlorphenamide. Risk C: Monitor therapy
Digoxin: May enhance the adverse/toxic effect of Colchicine. Risk C: Monitor therapy
Doripenem: Probenecid may increase the serum concentration of Doripenem. This effect is due to probenecid's ability to decrease the active tubular secretion of doripenem. Risk X: Avoid combination
Dyphylline: Probenecid may increase the serum concentration of Dyphylline. Risk C: Monitor therapy
Elacestrant: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Erdafitinib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Management: If coadministration with these narrow therapeutic index/sensitive P-gp substrates is unavoidable, separate erdafitinib administration by at least 6 hours before or after administration of these P-gp substrates. Risk D: Consider therapy modification
Ertapenem: Probenecid may increase the serum concentration of Ertapenem. Risk X: Avoid combination
Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Fibric Acid Derivatives: May enhance the myopathic (rhabdomyolysis) effect of Colchicine. Risk C: Monitor therapy
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Futibatinib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Ganciclovir-Valganciclovir: Probenecid may increase the serum concentration of Ganciclovir-Valganciclovir. Risk C: Monitor therapy
Gemifloxacin: Probenecid may increase the serum concentration of Gemifloxacin. Risk C: Monitor therapy
Gilteritinib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Grapefruit Juice: May increase the serum concentration of Colchicine. Risk X: Avoid combination
HMG-CoA Reductase Inhibitors (Statins): Colchicine may enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Colchicine may increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). HMG-CoA Reductase Inhibitors (Statins) may increase the serum concentration of Colchicine. Risk C: Monitor therapy
Hormonal Contraceptives: Colchicine may enhance the adverse/toxic effect of Hormonal Contraceptives. Risk C: Monitor therapy
Imipenem: Probenecid may increase the serum concentration of Imipenem. Risk C: Monitor therapy
Itraconazole: May increase the serum concentration of Colchicine. Management: Colchicine is contraindicated during and for 2 weeks after itraconazole in patients with impaired renal or hepatic function. In those with normal renal and hepatic function, reduce colchicine dose as directed. See interaction monograph for details. Risk D: Consider therapy modification
Ketoprofen: Probenecid may increase the serum concentration of Ketoprofen. Risk C: Monitor therapy
Ketorolac (Nasal): Probenecid may increase the serum concentration of Ketorolac (Nasal). Risk X: Avoid combination
Ketorolac (Systemic): Probenecid may increase the serum concentration of Ketorolac (Systemic). Risk X: Avoid combination
Lasmiditan: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk X: Avoid combination
Loop Diuretics: Probenecid may diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Risk C: Monitor therapy
LORazepam: Probenecid may increase the serum concentration of LORazepam. Management: Reduce lorazepam dose 50% during coadministration with probenecid. Monitor for increased and prolonged lorazepam effects, particularly CNS depressant effects. Patients using lorazepam ER capsules should be switched to lorazepam tablets. Risk D: Consider therapy modification
Lumacaftor and Ivacaftor: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may decrease the serum concentration of P-glycoprotein/ABCB1 Substrates (High risk with Inhibitors or Inducers). Risk C: Monitor therapy
Meropenem: Probenecid may increase the serum concentration of Meropenem. Risk X: Avoid combination
Methotrexate: Probenecid may increase the serum concentration of Methotrexate. Management: If possible, the concomitant use of methotrexate and probenecid should be avoided. If used concomitantly, monitor closely for increased methotrexate serum concentrations and toxicities. Methotrexate dose reductions may be needed. Risk D: Consider therapy modification
Minoxidil (Systemic): Probenecid may increase the serum concentration of Minoxidil (Systemic). Risk C: Monitor therapy
Mitapivat: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Multivitamins/Fluoride (with ADE): Colchicine may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, colchicine may decrease absorption of cyanocobalamin (vitamin B12). Risk C: Monitor therapy
Multivitamins/Minerals (with AE, No Iron): Colchicine may decrease the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, colchicine may decrease absorption of cyanocobalamin (vitamin B12). Risk C: Monitor therapy
Mycophenolate: Probenecid may increase the serum concentration of Mycophenolate. Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Colchicine. Risk X: Avoid combination
Nitrofurantoin: Probenecid may diminish the therapeutic effect of Nitrofurantoin. Probenecid may increase the serum concentration of Nitrofurantoin. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: Probenecid may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor therapy
Oseltamivir: Probenecid may increase serum concentrations of the active metabolite(s) of Oseltamivir. Risk C: Monitor therapy
Pacritinib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk X: Avoid combination
Pegloticase: Probenecid may enhance the adverse/toxic effect of Pegloticase. Specifically, Probenecid may blunt increases in serum urate that would signal an elevated risk of anaphylaxis and infusion reactions. Risk X: Avoid combination
Penicillins: Probenecid may increase the serum concentration of Penicillins. Risk C: Monitor therapy
Pexidartinib: UGT1A4 Inhibitors may increase the serum concentration of Pexidartinib. Management: If combined use cannot be avoided, pexidartinib dose should be reduced. For the 125 mg capsules: reduce pexidartinib doses of 500 mg or 375 mg daily to 125 mg twice daily. Reduce pexidartinib 250 mg daily to 125 mg once daily. Risk D: Consider therapy modification
P-glycoprotein/ABCB1 Inhibitors: May increase the serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: This combination is often contraindicated, but combined use may be permitted with dose adjustment and monitoring. Recommendations vary based on brand, indication, use of CYP3A4 inhibitors, and hepatic/renal function. See interaction monograph for details. Risk D: Consider therapy modification
Phenprocoumon [INT]: Probenecid may decrease the serum concentration of Phenprocoumon [INT]. Risk C: Monitor therapy
PRALAtrexate: Probenecid may increase the serum concentration of PRALAtrexate. Management: Avoid coadministration of pralatrexate with probenecid. If coadministration cannot be avoided, closely monitor for increased pralatrexate serum concentrations or possible toxicity with concomitant use of probenecid. Risk D: Consider therapy modification
Pretomanid: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor therapy
Propacetamol: Probenecid may increase serum concentrations of the active metabolite(s) of Propacetamol. Specifically, accetaminophen exposure may be increased. Probenecid may also limit the formation of at least one major non-toxic acetaminophen metabolite, possibly increasing the formation of the toxic NAPQI metabolite. Management: Consider limiting the use of propacetamide in patients who are also taking probenecid. Patients may be at an increased risk for toxicity, even if reduced propacetamide doses are used. Risk D: Consider therapy modification
Quinolones: Probenecid may decrease the excretion of Quinolones. Specifically, probenecid may decreased the renal excretion of quinolone antibiotics. Probenecid may increase the serum concentration of Quinolones. Risk C: Monitor therapy
RifAMPin: Probenecid may increase the serum concentration of RifAMPin. Risk C: Monitor therapy
Roxadustat: Probenecid may increase the serum concentration of Roxadustat. Risk C: Monitor therapy
Salicylates: May diminish the therapeutic effect of Probenecid. Risk X: Avoid combination
Sodium Benzoate: Probenecid may diminish the therapeutic effect of Sodium Benzoate. Risk C: Monitor therapy
Sotorasib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Management: Consider avoiding use of sotorasib and narrow therapeutic index/sensitive P-gp substrates. If combined use is unavoidable, monitor for increased toxicities of the substrate and consider a decrease in the substrate dosage. Risk D: Consider therapy modification
Sparsentan: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk X: Avoid combination
Sulbactam: Probenecid may increase the serum concentration of Sulbactam. Management: Recommendations for management of this interaction vary by specific sulbactam-containing product. Coadministration of probenecid with sulbactam/durlobactam is not recommended, but no specific actions are recommended for ampicillin/sulbactam. Risk D: Consider therapy modification
Sulfonylureas: Probenecid may increase the serum concentration of Sulfonylureas. Risk C: Monitor therapy
Tacrolimus (Systemic): May increase the serum concentration of Colchicine. Risk C: Monitor therapy
Taurursodiol: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk X: Avoid combination
Tipranavir: May increase the serum concentration of Colchicine. Management: Colchicine should not be used with tipranavir in patients with impaired renal or hepatic function. In those with normal renal and hepatic function, reduced colchicine doses (as directed) are required if used with tipranavir. Risk D: Consider therapy modification
Urea Cycle Disorder Agents: Probenecid may increase serum concentrations of the active metabolite(s) of Urea Cycle Disorder Agents. Specifically, concentrations of phenylacetate and phenylacetylglutamine may be increased. Risk C: Monitor therapy
Zidovudine: Probenecid may increase the serum concentration of Zidovudine. Risk C: Monitor therapy
See individual agents.
See individual agents.
CBC, renal function, serum uric acid, urinary uric acid.
Uric acid, serum:
Adults:
Normal values:
Males: 3.4 to 7 mg/dL or slightly more
Females: 2.4 to 6 mg/dL or slightly more
Goal during therapy: <6 mg/dL; <5 mg/dL in patients with severe gout (eg, tophi, frequent attacks, chronic arthropathy) (EULAR [Richette 2017]). Levels <3 mg/dL are not recommended long-term (EULAR [Richette 2017]).
Note: Serum uric acid values >7 mg/dL do not necessarily represent clinical gout; the American College of Rheumatology clinical practice guidelines recommend against initiating pharmacologic management of asymptomatic hyperuricemia (ACR [FitzGerald 2020]).
See individual agents.
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