Colchicine use while Breastfeeding
Drugs containing Colchicine: Colcrys, Probenecid and Colchicine, Proben-C, Mitigare
Colchicine Levels and Effects while Breastfeeding
Summary of Use during Lactation
Limited information indicates that long-term prophylactic maternal doses of colchicine up to 1.5 mg daily produce levels in milk that result in the infant receiving less than 10% of the maternal weight-adjusted dosage. The highest milk levels occur in the 6 to 8 hours after a dose, so avoiding breastfeeding during this time can minimize the infant dose. No adverse effects in breastfed infants have been reported and some authors consider colchicine safe during breastfeeding in women being treated for familial Mediterranean fever.
Maternal Levels. A woman receiving long-term oral colchicine 0.6 mg daily had milk levels of colchicine measured 5 times between 16 and 21 days postpartum. Twice, colchicine was undetectable (<0.5 mcg/L) in milk 40 minutes after a dose. On other occasions, milk colchicine levels were 1.2 mcg/L 40 minutes after a dose, 2.5 mcg/L 50 minutes after a dose and 1.7 mcg/L 55 minutes after a dose.
A woman taking colchicine 1 mg orally once daily had breastmilk colchicine levels of 31 mcg/L at 2 hours after a dose and 24 mcg/L 4 hours after the dose on day 5 postpartum; and 27 mcg/L at 4 hours after the dose and 10 mcg/L at 7 hours after the dose on day 15 postpartum. Using the maximum milk level, the authors estimated that an exclusively breastfed infant would receive 10% of the maternal weight-adjusted dosage in the 8 hours after a dose. They suggested giving colchicine at nighttime and not nursing for 8 hours to minimize infant colchicine exposure.
Four women were receiving long-term colchicine therapy 1 to 1.5 mg once daily. Milk samples were taken before and 1, 3 and 6 hours after a colchicine dose on days 4, 6, 21 and 58 of nursing, respectively, in the 4 women. Colchicine was detectable in all milk samples, including the 24-hour pre-dose samples which were less than 1 mcg/L.. Peak milk levels occurred 1 hour after the dose in 3 women and 3 hours after the dose in the fourth. Peak milk levels ranged from 1.98 and 8.6 mcg/L. At 6 hours after the dose, milk levels ranged from 0.87 and 2.57 mcg/L. Although the authors did not specify which mothers were taking which dose, milk levels were much higher (>1.5 times higher) in the mothers who were 4 and 6 days postpartum compared to those who were 21 and 58 days postpartum. Using the highest measured milk levels, the authors estimated that an exclusively breastfed infant would receive 1.2 mcg/kg daily or less than 10% of an adult colchicine dose.
Infant Levels. Colchicine was undetectable (<5 mcg/L) in 12-hour urine samples taken from a breastfed infant at 5 and 15 days of age whose mother was taking 1 mg of colchicine once daily.
Effects in Breastfed Infants
An infant was breastfed (extent not stated) for 6 months during maternal intake of colchicine 0.6 mg twice daily. No apparent adverse effects were noted.
In 4 infants whose mothers were taking 1 to 1.5 mg of colchicine daily prophylactically for familial Mediterranean fever, no apparent effects were noted on clinical follow-up over at least 10 months. The authors also reported that they recalled another 6 women who breastfed their infants for at least 3 months during colchicine therapy (dosage not stated) and follow-up for at least 2 years revealed no clinical or developmental problems.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
Alternate Drugs to Consider
1. Ben-Chetrit E, Scherrmann JM, Levy M. Colchicine in breast milk of patients with familial Mediterranean fever. Arthritis Rheum. 1996;39:1213-7. PMID: 8670333
2. Dotters-Katz S, Kuller J, Price T. The impact of familial Mediterranean fever on women's health. Obstet Gynecol Surv. 2012;67:357-64. PMID: 22713162
3. Milunsky JM, Milunsky A. Breast-feeding during colchicine therapy for familial Mediterranean fever. J Pediatr. 1991;119(1 pt 1):164. Letter. PMID: 2066854
4. Guillonneau M , Aigrain EJ, Galliot M et al. Colchicine is excreted at high concentrations in human breast milk. Eur J Obstet Gynecol Reprod Biol. 1995;61:177-8. Letter. PMID: 7556843
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