Also known as Colchicin, Colchicina, Colchicinum

An alkaloid isolated from Colchicum autumnale with anti-gout and anti-inflammatory activities. The exact mechanism of action by which colchicines exerts its effect has not been completely established. Colchicine binds to tubulin, thereby interfering with the polymerization of tubulin, interrupting microtubule dynamics, and disrupting mitosis. This leads to an inhibition of migration of leukocytes and other inflammatory cells, thereby reducing the inflammatory response to deposited urate crystals. Colchicine may also interrupt the cycle of monosodium urate crystal deposition in joint tissues, thereby also preventing the resultant inflammatory response. Overall, colchicine decreases leukocyte chemotaxis/migration and phagocytosis to inflamed areas, and inhibits the formation and release of a chemotactic glycoprotein that is produced during phagocytosis of urate crystals.

Originator: NCI Thesaurus | Source: The website of the National Cancer Institute (http://www.cancer.gov)

Can I take Colchicine while breastfeeding?

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 2 to 4 hours after a dose, so avoiding breastfeeding during this time can minimize the infant dose, although some clinicians simply recommend taking the drug after nursing. No adverse effects in breastfed infants have been reported in case series and a case-control study and some authors consider colchicine safe during breastfeeding in women being treated for familial Mediterranean fever or rheumatic conditions.[1][2][3][4]

Drug levels

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.[5] 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.[6] 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 predose 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.[1]

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.[6]

Effects in breastfed infants

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.[5] 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.[6] 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 predose 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.[1]

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.[6]

Possible effects on lactation

Relevant published information was not found as of the revision date.

Alternate drugs to consider

Ibuprofen, Indomethacin

References

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. Herscovici T, Merlob P, Stahl B et al. Colchicine use during breastfeeding. Breastfeed Med. 2015;10:92-5. PMID: 25646562

4. Gotestam Skorpen C, Hoeltzenbein M, Tincani A et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75:795-810. PMID: 26888948

5. Milunsky JM, Milunsky A. Breast-feeding during colchicine therapy for familial Mediterranean fever. J Pediatr. 1991;119(1 pt 1):164. Letter. PMID: 2066854

6. 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

7. Diav-Citrin O, Shechtman S, Schwartz V et al. Pregnancy outcome after in utero exposure to colchicine. Am J Obstet Gynecol. 2010;203:144.e1-6. PMID: 20579964

Last Revision Date

20160426

Disclaimer:Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Source: LactMed – National Library of Medicine (NLM)

3D Model of the Colchicine molecule

MolView – data visualization platform