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Methotrexate and breastfeeding toddler

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  • Methotrexate and breastfeeding toddler

    I am being given 2.5mg tablets of methotrexate. I am to take 5 of these one time per week for possible psoriatic arthritis. I am still breastfeeding my 14 month old. My rheumatologist told me I would be fine to continue breastfeeding as there are much higher doses given to children with leukemia....thoughts?

  • #2

    We just finished a study of a mom who took 92 mg IM. The Relative infant dose was only 0.11% of the maternal dose. This is exceedingly low.

    In your case taking 12.5 mg, I would suggest you pump and discard for 10 hours AFTER the dose and return to breastfeeding.

    This would eliminate most of your plasma level and reduce your milk level to negligible amounts. Make sure you supplement you infant with some vitamin with Folic acid.

    Tom Hale Ph.D.

    High-Dose Methotrexate Treatment in a Breastfeeding Mother with Placenta Accreta: A Case Report.

    Baker T ([url] id=29985651[/url])1, Datta P ([url] id=29985651[/url])2, Rewers-Felkins K ([url] 9985651[/url])2, Hale TW ([url] id=29985651[/url])2. Author information ([url][/url])



    Morbidly placenta accreta as a cause of postpartum morbidity is increasing in incidence. One conservative option is use of methotrexate as an adjuvant therapy for the management of placenta accreta. There is concern that use of methotrexate in a lactating mother could potentially expose her neonate to harmful effects of this medication. CASE REPORT:

    Here we report a 29-year-old woman subjected to methotrexate treatment for placenta accreta. Her child was delivered at 32 weeks weighing 3 lbs. On postpartum day 5, this patient was diagnosed with placenta accreta and treated with intramuscular methotrexate for 3 consecutive days. She received 92 mg methotrexate intramuscularly daily, and was advised not to breastfeed. She collected milk samples on day 2, the 0 hour before the second dose and at 1, 2, 4, 8, 12, and 24 hours after taking the dose. A high-performance liquid chromatography mass spectrometry method was developed to measure methotrexate and its metabolite 7-hydroxymethotrexate levels in milk samples. DISCUSSION:

    Very low levels were found for both methotrexate and 7-hydroxymethotrexate in the milk samples obtained. The results indicate that methotrexate or its metabolite receded to minimum concentration over a period of 24 hours. CONCLUSION:

    This case report found the relative infant dose of methotrexate to be 0.11%. Methotrexate does transfer into breast milk, although the levels detected were very low. However, caution should still be used in counseling mothers regarding breastfeeding with this toxic drug. KEYWORDS:

    breast milk; methotrexate; placenta accreta PMID: 29985651 D


    • #3
      Good afternoon Professor,

      We are from Perth, Western Australia.
      My wife is currently exclusively breastfeeding our daughter and she is 7 months old.

      ​My wife has just had a 95 g dose of methotrexate to treat an ectopic pregnancy in the right tube. ​​​​​​The date and time of the injection was 12 noon 20th of January 2019

      Similar to the above, Would a period of 24 hours be sufficient post injection to express and discard her breast milk.

      Kind Regards


      • #4
        KittyJ: Look at the question before yours. I'm sure you meant 95 mg of methotrexate. You'd need to express and discard for a minimum of 10 hours, but 24 hours would be better.

        Tom Hale Ph.d.