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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.<\/jats:p>","DOI":"10.1136\/bcr-2023-257186","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T13:01:10Z","timestamp":1696856470000},"page":"e257186","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["CYP3A4\/P-glycoprotein inhibitors related colchicine toxicity mimicking septic shock"],"prefix":"10.1136","volume":"16","author":[{"given":"Jinjuta","family":"Ngeyvijit","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sopita","family":"Nuansuwan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-9448","authenticated-orcid":false,"given":"Vorakamol","family":"Phoophiboon","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Division of Critical Care Medicine, St.Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"2025082701402396000_16.10.e257186.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209707"},{"key":"2025082701402396000_16.10.e257186.2","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1002\/acr.24180","article-title":"American college of rheumatology guideline for the management of gout","volume":"72","author":"FitzGerald","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025082701402396000_16.10.e257186.3","doi-asserted-by":"publisher","DOI":"10.7326\/M16-0570"},{"key":"2025082701402396000_16.10.e257186.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-208690"},{"key":"2025082701402396000_16.10.e257186.5","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E197"},{"key":"2025082701402396000_16.10.e257186.6","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00296-017-3823-1","article-title":"Colchicine intoxication in familial Mediterranean fever patients using Clarithromycin for the treatment of Helicobacter Pylori: a series of six patients","volume":"38","author":"Haj Yahia","year":"2018","journal-title":"Rheumatol Int"},{"key":"2025082701402396000_16.10.e257186.7","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s40264-020-00930-7","article-title":"Evidence of clinically meaningful drug-drug interaction with concomitant use of Colchicine and Clarithromycin","volume":"43","author":"Villa Zapata","year":"2020","journal-title":"Drug Saf"},{"key":"2025082701402396000_16.10.e257186.8","first-page":"515","article-title":"Acute Colchicine intoxication during Clarithromycin administration in patients with chronic renal failure","volume":"19","author":"Akdag","year":"2006","journal-title":"J Nephrol"},{"key":"2025082701402396000_16.10.e257186.9","doi-asserted-by":"publisher","DOI":"10.1086\/431592"},{"key":"2025082701402396000_16.10.e257186.10","first-page":"181","article-title":"Acute fatal Colchicine intoxication in a patient on continuous ambulatory peritoneal dialysis (CAPD). possible role of Clarithromycin administration","volume":"55","author":"Dogukan","year":"2001","journal-title":"Clin Nephrol"},{"key":"2025082701402396000_16.10.e257186.11","doi-asserted-by":"crossref","unstructured":"Malone DC , G\u00f3mez-Lumbreras A , Boyce RD , et al . 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