No announcement yet.

Breastfeeding and Methotrexate

  • Filter
  • Time
  • Show
Clear All
new posts

  • Breastfeeding and Methotrexate

    I would like some advice as I am getting conflicting information. I'm in Australia. I would like to keep bresstfeeding my 7 month old son, but my rheumatologist wants me to start back on Methotrexate. He's prescribed me 20mg, once a week. I've read on your forums that when on a once a week dose under 50mg, you can pump and discard for 24 hrs. Speaking with our breastfeeding and medications hotline here and the person I was speaking to said she would not breastfeed at all on Methotrexate. I am so confused. I want to do the best by my son.

  • #2
    Dr. Hale and I have discussed this question and consulted with a pediatric oncologist. We give Methotrexate an L4 (out of 5) ("Probably hazardous") in terms of its lactation risk. When it is given in high or frequent doses, as are appropriate for many other disorders, the mother should definitely not breastfeed.

    However, low maternal doses (<50mg) with once a week administration affords the opportunity to "avoid the peak" using the pump-and-discard method for 24 hours to allow most of the medication to clear your system before breastfeeding.

    Our sources indicate that the infant receives about 0.1% of the mother's dose and waiting the 24 hours reduces that exposure by a further 70-90% (2 or 3 half-lives).

    However, methotrexate tends to get into tissues and stay there for long periods of time. Even with low exposure, it is still a potentially hazardous drug for infants. We think you should consider the following:

    1) If you decide to breastfeed, you might ask your physician to prescribe methotrexate's antidote, Leucovorin (active folic acid), to your infant as a safety measure. We use Leucovorin all the time in infants and children who are exposed to methotrexate. It's very safe and it prevents all the possible complications of exposure to methotrexate.

    2) Most of the benefits of breastfeeding are achieved in the first 6 months of life. While still worthwhile at 7 months, the risk of drug exposure may now be greater than the benefit of breastfeeding.

    Ultimately this is your decision.

    -James Abbey, MD

    The following references may be useful to your physician if he or she needs more information:

    1. Johns DG, Rutherford LD, Leighton PC, Vogel CL. Secretion of methotrexate into human milk. Am J Obstet Gynecol 1972; 112(7):978-980.
    2. Grochow LB, Ames MM. A clinician's guide to chemotherapy pharmacokinetics and pharmacodynamics. 1st ed. Baltimore, MD: Williams & Wilkins; 1998.
    3. American Academy of Pediatrics, Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108(3):776-89.


    • #3
      Hello, I have been given a methotrexate injection of 75mg for removing some placental remains 20 days after delivery of my baby.Its been 3 days and I have not given or expressed my milk since then. Is it safe to breast feed my baby now without pumping? Thank you for your reply in advance.
      Last edited by priya; 10-14-2014, 10:52 PM.


      • #4
        We recommend 2-4 days of breastfeeding cessation after getting methotrexate. The high end of that range is for people who are getting large or frequent doses. It should be safe enough for you to resume breastfeeding now. You should probably pump and discard once first, just to get rid of any drug residuals and get your milk flowing again.

        -James Abbey, MD