Colchicine

• Familial Mediterranean fever (FMF) — continue throughout pregnancy
• Behçet's disease

Binds tubulin → inhibits microtubule polymerisation → disrupts neutrophil chemotaxis and inflammasome activation.

• Do NOT stop for pregnancy — flare/amyloidosis risk outweighs theoretical fetal risk
• No consistent teratogenic signal in large modern series
• Compatible with breastfeeding

Maintenance

0.5–2 mg/day PO (typically 1–1.5 mg/day), in 1–2 divided doses

• CautionRenal or hepatic impairment — reduce dose
• CautionConcurrent strong CYP3A4/P-gp inhibitors (↑ toxicity)

• Diarrhoea, GI upset (dose-related)
• Rare marrow suppression at high dose

• • Crosses the placenta but modern systematic review/meta-analysis (informing EULAR/PReS recommendations) found no compelling evidence of teratogenicity at standard doses.
• • Continuing colchicine prevents FMF flares and reduces the risk of maternal amyloidosis — stopping is the higher-risk option, not the safer one.

• Clarithromycin/strong CYP3A4 inhibitors

  Avoid

  ↑ colchicine toxicity — can be fatal

• Ciclosporin

  Caution

  ↑ myopathy risk

• 💡 A common counselling error is stopping colchicine "to be safe" in pregnancy — this is the opposite of current guidance for FMF.