Methotrexate & Breastfeeding and conflicting advice.

[Nosleep2nite]

I receive the Methotrexate injection for an ectopic pregnancy and no doctor mentioned anything about breastfeeding and I of course forgot to ask and went home to breastfeed. I got my shot Wednesday (04/19/2017) of 50mg. I called the infant risk hotline the next day (Thursday-04/20/2017) and they told me she should be okay and that I should pump and dump for the rest of the day and resume breastfeeding tomorrow, which would be Friday (04/21/2017). I pumped a lot breast milk yesterday and fed her from the breast twice.

Now today I just got a phone call from my LC that she read from a book by Thomas Hale published in 2014 that I need to pump and dump for 4 days. I only feed her twice yesterday since the hotline said I coukd resume back to breastfeeding.

I'm conflicted. Should continue to pump and dump or can I go back to breastfeeding. Should I discard the milk I pumped yesterday?

[admin]

Nosleep2nite

Below is my information on methotrexate. Its best to avoid breastfeeding for 24 hours AFTER the injection if 50 mg is used, perhaps a bit longer if larger or routine doses are use. You should be fine at 24 hours.

Tom Hale Ph.D.


In addition, methotrexate is believed to be retained in human tissues (particularly gastrointestinal cells and ovarian cells) for long periods (months).[5] It is apparent that the concentration of methotrexate in human milk is minimal, although due to the toxicity of this agent and the unknown effects on rapidly developing neonatal gastrointestinal cells, it is probably wise to pump and discard the mother's milk for a minimum of 24 hours post dose if given as a single dose (e.g. 50 mg/m2 IM for ectopic pregnancy) or administered once weekly (e.g. for RA). The period in which the mother discards her milk may require extending (consider 4 days of interruption) if the dose used is quite high (>75mg) or if the dose is frequently administered (more than once weekly). Being on scheduled doses more than once a week is likely to be a situation where the mother should not breastfeed at all.