Methotrexate and the nursing child

[triandemnursingmama]

I have just tentatively been diagnosed with sudden-onset severe psoriatic arthritis. The rheumatologist is awaiting the final test results, but is so certain of the diagnosis that he's given me a prescription for methotrexate (six 2.5mg tablets once a week). I'm currently nursing my 3 year old an average of once a day (occasionally twice a day, occasionally skipping a day). I'm wondering if, considering its L3 or L5 rating, if there's any circumstance in which it would be ok to nurse my daughter or if weaning is necessary. I've lost much of my range of motion in my ankles, am having difficulty walking and there is significant damage already (sudden onset 2 months ago), so the doctor's opinion is that I go on medication ASAP to help stop the deterioration.

Thanks for your time!

[admin]

Triandem:

It is not likely that much methotrexate would reach your infant since you are only breastfeeding once daily. However, this drug is somewhat toxic, and I'm wondering if you want to expose your infant (at this late stage, 3 years) to any of this medication. We always advise risk vs benefit. In your situation, I'd suggest the risk, tiny though it may be, is greated than the benefit from breastfeeding.

However, should you decide that you want to continue breastfeeding, then breastfeed the infant, take the medication and wait at least 24 hours before you breastfeed. This would greatly lower the transfer of this drug into milk.

Good luck with your therapy.

Tom Hale Ph.D.