"Safest" is a deceptive term here; rhabdomyolysis resulting from co-administration is better averted by vigilance and creatine kinase monitoring than by relying on "relative" levels of reported adverse events, wouldn't you think?

Thanks for your reply, Stanton. I can't agree with you more. Regular monitoring and checkups is the best way to detect the interaction or side-effects if any and take timely measures, regardless which statin is being co-administered together with colchicine.

I just wonder if the patient already on colchicine has to start taking statin, isn't it wise to start from Simvastatin first, instead of other statins, and closely monitor the co-administration outcome as it seems statistically there is more evidence Simvastatin interacts with colchicine less dangerously than other statins do.

Your opinion?

Though the statins are quite effective (I don't know the data on comparative interaction), stanol esters and soluble fiber are also shown to moderately reduce cholesterol absorption, with low incidence of side effects. (General food intake moderation has also been noted with certain pine nut species, which alter bile secretion and induce dysgeusia. Not recommended, though!) reference: http://www.foodauthority.nsw.gov.au/_Documents/science/pine_nuts_pine_mouth_

emerging_issues.pdf 

In such combination each drug increases toxicity of the other by pharmacodynamic synergism leading to possible serious or life-threatening interaction. Close monitoring for the development of myopathy, including rhabdomyolysis particularly in the presence of renal insufficiency is requiered, start low dose if signs appears then alternative medication is required for either colchicne or simvastatin according to the patient case and physician opinion 

The answer to the question posed in Sahin's title, "Which statin should be used together with colchicine?" [1] is probably "None, if possible" [2]. Suspected drug-drug interactions with colchicine have been reported with different statins [e.g. 3-8], and there is too little information on which to base firm conclusions. The mechanism is not clear, but it is likely to be primarily pharmacodynamic, since colchicine is myopathic [9]; pharmacokinetic mechanisms will add complications in some cases [10].

If colchicine is used to treat acute gout, the statin can be withdrawn until the acute phase has resolved. There are other therapeutic alternatives to colchicine for long-term therapy of hyperuricaemia in patients taking statins.

If colchicine has to be used, e.g. in patients with familial Mediterranean fever, an alternative lipid-modifying agent could be chosen, but use of the lowest possible dose of colchicine and careful monitoring would in any case always be wise [11].

References

1. Sahin G, Korkmaz C, Yalcin AU.  Which statin should be used together with colchicine? Clinical experience in three patients with nephrotic syndrome due to AA type amyloidosis. Rheumatol Int 2008; 28(3): 289-91.

2. Boonmuang P, Nathisuwan S, Chaiyakunapruk N, Suwankesawong W, Pokhagul P, Teerawattanapong N, Supsongserm P. Characterization of Statin-Associated Myopathy Case Reports in Thailand Using the Health Product Vigilance Center Database. Drug Saf 2013 Apr 25. [Epub ahead of print]

3. Hsu WC, Chen WH, Chang MT, Chiu HC. Colchicine-induced acute myopathy in a patient with concomitant use of simvastatin. Clin Neuropharmacol 2002; 25: 266-8.

4. Phanish MK, Krishnamurthy S, Bloodworth LL. Colchicine-induced rhabdomyolysis. Am J Med 2003; 114: 166-7. [atorvastatin]

5. Atasoyu EM, Evrenkaya TR, Solmazgul E. Possible colchicine rhabdomyolysis in a fluvastatin-treated patient. Ann Pharmacother 2005; 39: 1368-9.

6. Alayli G, Cengiz K, Cantürk F, Durmus D, Akyol Y, Menekse EB. Acute myopathy in a patient with concomitant use of pravastatin and colchicine. Ann Pharmacother 2005; 39: 1358-61.

7. Torgovnick J, Sethi N, Arsura E. Colchicine and HMG Co-A reductase inhibitors induced myopathy—a case report. Neurotoxicology 2006; 27(6): 1126-7. [lovastatin]

8. Tufan A, Dede DS, Cavus S, Altintas ND, Iskit AB, Topeli A. Rhabdomyolysis in a patient treated with colchicine and atorvastatin. Ann Pharmacother 2006; 40(7-8): 1466-9.

9. Altman A, Szyper-Kravitz M, Shoenfeld Y. Colchicine-induced rhabdomyolysis. Clin Rheumatol 2007; 26(12): 2197-9.

10. Davis MW, Wason S. Effect of steady-state atorvastatin on the pharmacokinetics of a single dose of colchicine in healthy adults under fasted conditions. Clin Drug Investig 2014; 34(4): 259-67.

11. Anonymous. Colchicine: serious interactions. Prescrire Int 2008; 17(96): 151-3.

In my case, colchicine has been used to treat FMF for over 5 years, 0.5mgx2 a day. Simvastatin has been administered recently to treat high cholesterol level, 10 mg/day.  So far no noticeable interaction, full blood test in 3 weeks, I will let you know if any abnormal findings or interaction. 

What alternatives to colchicine do you know to treat FMF, Jeffrey? 

Colchicine seems to be effective in FMF [1], although the evidence base is not great [2]. Some have used drugs that affect tumor necrosis factor alfa (e.g. etanercept) and IL-1 receptors (e.g. anakinra) in patients who do not respond to colchicine or in addition to it. For more information, see the reviews.

References

1. Shohat M, Halpern GJ. Familial Mediterranean Fever. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K, editors. GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2015. 2000 Aug 8 [updated 2014 Jun 19]. PMID: 20301405

2. Wu B, Xu T, Li Y, Yin X. Interventions for reducing inflammation in familial Mediterranean fever. Cochrane Database Syst Rev 2015; 3: CD010893. PMID: 25791871

Thank you for your comments, Jeffrey. More research should be done to find an equally powerful substitute to colchicine which, in my experience, makes wonders for the absolute majority of FMF patients.