Is Colchicine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Colchicine? Is Colchicine safe for nursing mother and child? Does Colchicine extracts into breast milk? Does Colchicine has any long term or short term side effects on infants? Can Colchicine influence milk supply or can Colchicine decrease milk supply in lactating mothers?

It is used for treatment of Gout, Familial Mediterranean Fever. As well as for other conditions like Amyloidosis, Behçet's Syndrome, Pericarditis, Primary Biliary Cirrhosis and Pyoderma gangrenosum. It is excreted in breast milk in quantities that differ according to different published studies, from no clinically significant in some, until being important in others, but there have been no problems in infants whose mothers were treated, even after months, with undetectable plasma levels in these infants. The concomitant use of macrolide antibiotics and fruit juices (both the mother and the infant) , especially grape-fruit, is not recommended since they may interfere with bile excretion and greatly increase toxicity. The American Academy of Breastfeeding rates it as compatible with breastfeeding. List of Essential Medicines of WHO (2002): compatible with 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]

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.[1] 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.[5] In a study of mothers who took colchicine during pregnancy, 111 of 181 mothers reported breastfeeding (extent not stated) their infants. None of the infants reportedly had colchicine-related adverse effects.[7] A case-control study compared 37 women who took colchicine during breastfeeding their 38 infants to a matched control group of 75 mothers who had taken amoxicillin, but were unexposed to colchicine, and their 76 breastfed infants. Telephone follow-up occurred at 6 to 48 months (average 28 months) after the initial inquiry. Among the colchicine-exposed group, 76% of infants were exclusively breastfed and the mean overall duration of breastfeeding was 9.1 months. No increased risk of adverse effects was noted in the colchicine-exposed infants compared to the control infants. Specifically, no differences in gastrointestinal symptoms, or growth and development parameters were seen.[3] Ten nursing mothers who were being treated with colchicine were reported. None of them had any pathology reported.[8]