How do you approach adding colchicine to a patient who is on a stable statin regimen?

This is a good question and a tough situation, since the drug-drug interaction here can be as subtle as myalgias but as severe as rhabdomyolysis (rare but happens). If you can avoid long-term colchicine in this situation, it is always best. These situations (hypercholesterolemia and crystal arthropathy) tend to involve patients with the metabolic syndrome, ie cardiac disease, so everyone gets more nervous about NSAIDs as well as prednisone as a substitute.

First (and foremost) acknowledge the po...

Interactions with P450/3A4 system is a great risk in those patients. I will decrease both medications doses or, after talking to PCP, stop for a short time the statin dose if PCP agrees.