Colchichine

[Carrie]

Hello

I have a client who suffers from familial Mediterranean fever for which she has been prescribed Colchichine at a dose of 1.8mg once daily. My 2017 copy of Meds and Mother's Milk lists it as an L3 but with several cautions. Her doctor is currently advising her not to breastfeed. She has a 2 week old baby. Is there any further info I can provide her on the use of this medication while breastfeeding?

Thanks, Carrie

[admin]

Carrie:

Colchicine is rather controversial, on the one hand that it is well known to be rather toxic, and two, levels in milk are present, but seems to be rather low. I think it would depend to some degree on the mother's situation. If she can afford formula, then I would suggest a half and half regimen. If she cannot afford formula, then go ahead and let her breastfeed. What data we do have suggests no untoward complications "have been found" in infants. They seem to be OK.

Below is about all we know about this drug in breastfeeding mothers.


Tom Hale Ph.D.




A third study of four women who took 1 mg of colchicine daily during pregnancy and lactation also found varying levels of colchicine in breastmilk.[3] The maximum colchicine concentrations occurred within 3 hours in maternal serum and breastmilk, and occurred by close to 1 hour for most of these women. The maximum breastmilk concentrations ranged from 1.98 to 8.6 µg/L, the the serum concentrations were between 3.6 and 6.46 µg/L. By 6 hours the milk levels ranged between 0.87 to 2.57 µg/L and the serum levels were between 1.27 and 3.3 µg/L. The breastfed infants ranged from 4 to 58 days of life at the time of the study and no adverse events were reported during 10 months of follow up. In addition, these authors reported clinical data for an additional 6 women whom they cared for (prior to availability of the lab assay) that breastfed their infants for at least 3 months with no adverse effects during at least 2 years of follow up.

A recent longitudinal study of 37 mother-infant pairs (one set of twins) who breastfed while taking colchicine found no increase in adverse developmental outcomes attributable to the drug.[4] The women were taking an average of 2.4 mg per day and breastfed for an average of 9.1 months. There were no neonatal side effects from colchicine exposure in breast milk (e.g. GI symptoms). When these infants were compared to a non-exposed cohort, no significant differences in growth or developmental/neurological problems were evident after 1-3 years of follow up.

Colchicine is not a preferred medication in breastfeeding mothers as we have many other analgesics and anti-inflammatories that are superior in breastfeeding for the treatment of gouty symptoms. However, if this medication is required the infant should be monitored closely as relative infant doses vary from 2.1-31%.