Thiocolchicoside Safety in Lactation
Thiocolchicoside should be avoided during breastfeeding due to lack of safety data and its formal contraindication in lactation, with safer muscle relaxant alternatives available.
Evidence-Based Contraindication
- Thiocolchicoside is explicitly contraindicated during lactation according to its FDA drug label, with no established safety profile for breastfeeding women 1.
- The only available pregnancy study (18 cases) specifically notes the drug is contraindicated in lactation, though no actual lactation data exists 2.
- No published data exists on thiocolchicoside excretion into breast milk, infant exposure levels, or clinical effects on breastfed infants 2.
Clinical Decision Algorithm
When a breastfeeding woman requires muscle relaxation:
First-line approach: Use non-pharmacologic interventions (physical therapy, heat/cold therapy, rest) whenever clinically appropriate 3.
If medication is necessary:
- For pain control: Prescribe ibuprofen or acetaminophen as first-line analgesics, both extensively studied and safe during lactation 3.
- For muscle spasm with pain: Combine ibuprofen (preferred NSAID with most safety data) with acetaminophen for multimodal analgesia 4, 3.
- Avoid opioids unless absolutely necessary, as they cause infant sedation and drowsiness 5, 3.
Timing strategy: If any medication is used, dose immediately before the infant's longest sleep interval to minimize infant exposure 3.
Important Caveats
- The general principle that "few drugs are absolutely contraindicated during breastfeeding" does not apply to thiocolchicoside, which lacks any safety data and carries a formal contraindication 6, 7.
- The benefits of continued breastfeeding (protection against infection, metabolic disorders, improved maternal-infant bonding) strongly favor using well-studied alternatives rather than risking unknown effects with thiocolchicoside 8, 7.
- Do not advise "pump and dump" - this is not evidence-based for any medication and unnecessarily disrupts breastfeeding 5.