Methotrexate

The Basics

What is Methotrexate?

Used to treat severe psoriasis and to treat severe active rheumatoid arthritis.

Brand names for Methotrexate

Trexall

How Methotrexate is classified

Abortifacient Agents – Nonsteroidal, Antimetabolites, Antineoplastic, Antirheumatic Agents, Folic Acid Antagonists, Immunosuppressive Agents

Methotrexate During Pregnancy

Methotrexate pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Methotrexate while pregnant

Contraindicated in pregnancy. It is abortifacient and increases the risk of aminopterin syndrome, which is characterized by fetal central nervous system, skeletal, and cardiac abnormalities

Taking Methotrexate While Breastfeeding

What are recommendations for lactation if you're taking Methotrexate?

Most sources consider breastfeeding to be contraindicated during maternal high-dose antineoplastic drug therapy with methotrexate. An abstinence period of at least 1 week after chemotherapy doses of methotrexate has been suggested.[1] Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.[3] Limited information indicates that a maternal dose of methotrexate up to 92 mg (1.12 mg/kg) produces low levels in milk, leading some authors to state that low single or weekly doses, such as those used for ectopic pregnancy or rheumatoid arthritis, are of low risk to the breastfed infant,[4][5][6][7][8] although some expert opinion warns against this use.[9][10][11][12][13] Withholding breastfeeding for 24 hours after a weekly low lose of methotrexate may decrease the infant’s dose by 40%.[14][15] If breastfeeding during long-term, low-dose methotrexate use is undertaken, monitoring of the infant’s complete blood count and differential could be considered.

Maternal / infant drug levels

Most sources consider breastfeeding to be contraindicated during maternal high-dose antineoplastic drug therapy with methotrexate. An abstinence period of at least 1 week after chemotherapy doses of methotrexate has been suggested.[1] Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[2] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.[3] Limited information indicates that a maternal dose of methotrexate up to 92 mg (1.12 mg/kg) produces low levels in milk, leading some authors to state that low single or weekly doses, such as those used for ectopic pregnancy or rheumatoid arthritis, are of low risk to the breastfed infant,[4][5][6][7][8] although some expert opinion warns against this use.[9][10][11][12][13] Withholding breastfeeding for 24 hours after a weekly low lose of methotrexate may decrease the infant’s dose by 40%.[14][15] If breastfeeding during long-term, low-dose methotrexate use is undertaken, monitoring of the infant’s complete blood count and differential could be considered.

Possible effects of Methotrexate on milk supply

Relevant published information was not found as of the revision date.

Possible alternatives to Methotrexate

(Rheumatoid Arthritis) Auranofin, Etanercept, Gold Sodium Thiomalate, Hydroxychloroquine, Infliximab, Penicillamine, Sulfasalazine.