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CYP3A4/P-glycoprotein inhibitors related colchicine toxicity mimicking septic shock
  1. Jinjuta Ngeyvijit1,
  2. Sopita Nuansuwan2 and
  3. Vorakamol Phoophiboon3,4
  1. 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
  2. 2Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
  3. 3Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  4. 4Division of Critical Care Medicine, St.Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Vorakamol Phoophiboon; rakamol{at}


Colchicine toxicity is uncommon when patients receive a therapeutic dose regularly. However, inadvertent drug interactions can result in unpredicted adverse outcomes. The toxicity of colchicine can manifest in various ways, ranging from mild and non-specific symptoms to severe form known as multiple organ dysfunction syndrome. This case highlights (1) the diagnostic challenge that arises when distinguishing between the severe manifestation of colchicine toxicity and septic shock and (2) concomitant prescription of colchicine with potent CYP3A4 and P-glycoprotein inhibitors (ie, clarithromycin) can lead to colchicine toxicity despite normal renal and hepatic clearance. Unfortunately, specific tests of colchicine toxicity were not routinely available. A high index of clinical suspicion and recognition of drug interactions with their common presentations are crucial for making diagnosis and management. Failure to recognise drug toxicity can result in poor outcomes.

  • Drug interactions
  • Adult intensive care
  • Toxicology

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  • Contributors All authors contributed to this manuscript. JN, SN and VP worked on the conception. JN and SN contributed to the design, acquisition of data and drafting of the manuscript. VP reviewed the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.