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