For clinicians
Colchicine
colchicine
Looking for the plain-language version? See the patient version of this page.
Bottom lineBottom line: compatible across pregnancy and lactation, and generally continued (for example in familial Mediterranean fever, where continuation reduces flares and amyloidosis risk, and in Behcet's). Reassuring accumulated data. Paternal use compatible.
By reproductive phase
| Phase | Position | Detail | Evidence |
|---|---|---|---|
| Pre-conception | Continue | Continue; discontinuation in FMF risks flares and long-term amyloidosis.[1, 2] | ●●●○moderate evidencestrong |
| 1st trimester | Continue | Continue.[1, 2] | ●●●○moderate evidenceconditional |
| 2nd/3rd trimester | Continue | Continue.[2] | ●●●○moderate evidenceconditional |
| Breastfeeding | Continue | Compatible with lactation.[2, 3] | ●●●○moderate evidenceconditional |
| Paternal | Continue | Compatible with paternal exposure.[2] | ●●○○low evidenceconditional |
Guideline comparison
| Guideline | Position | Strength |
|---|---|---|
| ACR 2020 | Strongly recommend continuing before pregnancy, during pregnancy, and in breastfeeding (Table 3: ++/++/++). Paternal: strongly recommend continuing.[1] | Strong (maternal and paternal) |
| EULAR 2024 | Compatible with pregnancy (2b/B) and lactation (2a/B); continuable in men (2c/C).[2] | Oxford LoE/GoR as shown |
| BSR 2022/23 | Colchicine may be considered during pregnancy (GRADE 1B) and used in breastfeeding (GRADE 2C), based on a systematic review of 550 mostly-FMF pregnancies at 1-2 mg/day showing no significant increase in malformation or miscarriage. Paternal exposure unlikely to be harmful (limited data).[4] | Verified against BSR part 2 (Schreiber 2023) |
=Guideline agreement. VERIFIED AGREEMENT. EULAR 2024 (pregnancy 2b/B, lactation 2a/B, paternal 2c/C) and BSR 2023 part 2 (pregnancy GRADE 1B, breastfeeding GRADE 2C) agree that colchicine may be continued in pregnancy and lactation. BSR anchors this to a systematic review of 550 mostly-FMF pregnancies at 1-2 mg/day.
Key points
| Point | Evidence |
|---|---|
| Continuation in FMF reduces flare and amyloidosis risk; do not stop for pregnancy.[2] | ●●●○moderate evidencestrong |
Monitoring
- Usual colchicine considerations (dose adjustment in renal impairment, interaction review).
References
- Sammaritano LR, et al. 2020 ACR Guideline for the Management of Reproductive Health in RMD. Arthritis Rheumatol. 2020;72(3):529-556. https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.41191
- Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext
- Russell MD, et al. BSR guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory drugs and corticosteroids. Rheumatology (Oxford). 2023;62(4):e48-e88. https://academic.oup.com/rheumatology/article/62/4/e48/6783012
- Schreiber K, Frishman M, Russell MD, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice. Rheumatology (Oxford). 2023;62(4):e89-e104. https://doi.org/10.1093/rheumatology/keac552