To :  Janaki Costello
Re :  Colchicine

Colchicine is an old product that has been used for many years to reduce
the pain associated with gout.  Although it reduces the inflammation
associated with gout and therefore the pain,  it is not a true analgesic,
but simply reduces the inflammation associated with uric acid crystals in
the tissues by inhibiting migration of leukocytes and other cell types to
the region.

Because of its unique effects on cell division, it has been used in a
number of unique autoimmune syndromes.  However, it is quite toxic and the
doses must be closely monitored.  Blood dyscrasias, hepatomegaly, bone
marrow depression are all possible, particularly in infants.

We have no information as to how much is secreted into human milk.  It has
a very short half-life in the plasma compartment(only 20 minutes),  but it
deposits in blood leukocytes, and in many other tissues.  Therefore,  the
elimination half-life is approximately 60 hours or more.  I would worry
that this product after long exposure,  could build up to significant
levels in a breastfeeding infant,  but we don't know this for sure.

The primary symptoms of overdose are GI distress, including diarrhea,
cramps, vomiting.  Colchicine should be discontinued if these symptoms
occur,  or the dosage dropped significantly.

Behcet's syndrome requires rigorous and serious therapy, particularly when
the eye is involved.  I would be extremely hesitant to suggest a mother
withhold therapy(such as steroids and  colchicine) just to support
continued breastfeeding. I would urge this mother to consider discontinuing
breastfeeding if colchicine and high dose steroids are required.  Her
future vision is more important to  her children.

Tom Hale