# A client with eGFR 22 mL/min/1.73 m2 takes colchicine and started clarithromycin 3 days ago. The client now has severe diarrhea, generalized weakness, and dark urine. Which action is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522878&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with eGFR 22 mL/min/1.73 m2 takes colchicine and started clarithromycin 3 days ago. The client now has severe diarrhea, generalized weakness, and dark urine. Which action is the priority?

History

Vitals

Labs

Orders

Notes

Stage 4 chronic kidney disease and gout; colchicine taken daily

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1

Administer the next colchicine dose with food.

✕

2

Hold colchicine and clarithromycin, activate urgent evaluation for colchicine toxicity, and obtain renal, blood-count, muscle, hepatic, and rhythm assessment.

✕

3

Treat the diarrhea with an over-the-counter antimotility drug and reassess next week.

✕

4

Increase colchicine because the dark urine indicates undertreated gout.

✕

## Explanation

Renal impairment plus a strong CYP3A4 and P-gp inhibitor can cause fatal colchicine accumulation. Early gastrointestinal symptoms may precede neuromuscular, marrow, hepatic, renal, and cardiovascular failure.

## In-depth explanation

Quick answer
Escalate colchicine plus clarithromycin in renal impairment as a potentially fatal interaction.

Why this is correct
The interaction is contraindicated in renal or hepatic impairment because colchicine exposure can rise sharply and there is no antidote that makes continued dosing safe.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: Colchicine TabletsFatal interactions with P-gp or strong CYP3A4 inhibitors in renal impairment and recognition of multisystem toxicity

## Clinical scenario

Medication-safety review
Verify indication, current assessment, dose and route, organ function, interactions, urgent toxicity cues, authorized action, and measurable follow-up.

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