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Methotrexate and the Safety of Breastfeeding

CCoPE
Date: 2006-09-28

Question:
I am writing on behalf of an international not-for-profit organization dedicated to reducing deaths and injuries of women from unsafe abortion. We are currently preparing a factsheet on methotrexate for early abortion (up to 49 days LMP). We need to know if a breast-feeding mother should dispose of her breastmilk following the 50 mg/m2 IM or 50 mg po dose of methotrexate, and if so, for how long. Please help.

Answer:
There is a case report (Am J Obstet Gynecol 1972;112:978-980) where 22.5 milligams of oral methotrexate was given daily for choriocarcinoma treatment. For the first 12 hours after the dose, a peak milk level of 2.6 microgram/L was reported. This corresponds to a low level intake to the infant, compared to the pediatric therapeutics dose. Nevertheless, a 12-24 hour interruption of breastfeeding may be warranted, especially if the medical abortion procedure is an elective, the mother can store milk beforehand. The dose in this particular patient is higher than that of the above report, and so at least a 24 hour interruption may be recommended.

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