Methotrexate, plasmoquin, celebrex and panafcort

[ekamman]

I am writing on behalf of a mother of a 3 month old baby (born at 28 weeks, weight 2.2kg now). The mother has rheumatoid Arthritis and has been prescribed Methotrexate 20g once a week, Plasmoquin 1 tablet daily (not sure of dose), Celebrex 1 pill daily (not sure of dose) and Panafcort (2.5g daily). I've passed on information for all these drugs, but obviously the main concern is for the Methotraxate. The doctor is non negotiable on the combination of these drugs.

I read in my copy of "Medications and MOthers' Milk" (2010 edition) that NSAIDs are contraindicated in mothers taking MTX. this is obviously of concern in this case, as the mom is taking celebrex.

A previous post on this forum refers to a 3 year old child where you suggest the risks of breastfeeding with the medication would outweight the benefits. But what about the risk/benefit in such a young/prem baby? I have suggested that she could consider starting the medications and having blood levels checked in the baby after a week or so, and then make a final decision. One mother I know has done this when she went onto MTX with an 18 month old nursing child, and the medication was not detectable in her blood. Would you have any other suggestions?

[admin]

Ekamman:

Of these drugs, the most worrisome is methotrexate. Methotrexate is a potent and potentially dangerous folic acid antimetabolite used in arthritic and other immunologic syndromes. It is also used as an abortifacient in tubal pregnancies. Methotrexate is secreted into breast milk in small amounts.

Further, it has about a 15 hour half-life and it seems to concentrate at higher levels in the gut of infants.

I would not at all recommend its use in an infant, particularly one born premature. While you could measure the levels of methotrexate in maternal or infant plasma, you could not detect it in the gut wall if it is present.

The only possible situation that might work would be for her to take the methotrexate and pump and discard for at least 24 hours. This would dramatically reduce the risk to the infant.

Tom Hale Ph.D.