Diagnosed with RA and breastfeeding

[Duggu]

Hi
I am diagnosed with RA after 2 months of my delivery and some of my joints of ankle and feet got damage(shown in X-ray).My rheumatologist prescribed me methotrexate 10 mg once a week as this the best option for my condition.
I have 2 months old son and i was enjoying breastfeeding him.Now i think i have to stop breastfeeding ,mentally that will be very painful for me.
So,i just want to know is there any schedule i can fix to breastfeed my baby like breastfeeding after 48 hours of taking medication or breastfeeding once or twice a day.
Frankly speaking i do not want to stop breastfeeding when my baby is only 2 months old and i am producing good amount of milk but my health is not supporting me.

Regards
Khushboo

[admin-james]

Dr. Hale and I answered a similar question a while back and consulted with a pediatric oncologist at that time. 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. 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.

-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.