Rheumatoid Arthritis Medications and Lactation
Rheumatoid Arthritis Medications and Lactation
High-risk medications are generally avoided during breastfeeding, based on reported data and/or a high theoretical likelihood of adverse effects for the nursing infant.
Methotrexate, a folate antagonist, is excreted into breast milk in low concentration but with suggested accumulation in neonatal tissues. Methotrexate was detectable in breast milk and serum 2 h after administration to a 25-year-old woman treated with 22.5 mg/day for choriocarcinoma: the peak milk level was reached between 4 and 10 h later at a concentration of 8% of the plasma concentration. Six milk samples collected over 24 h after an intramuscular dose of 65 mg for ectopic pregnancy showed no evidence of drug, however. Although it is possible that the low once weekly doses used for RA may not pose a great risk to the infant (especially if milk were discarded for the first 24 h after the dose), it is recommended that breastfeeding be avoided because of lack of data and concern for accumulation in neonates.
A pyrimidine synthesis inhibitor, leflunomide has a very long half-life (14 days). No information has been published on levels of leflunomide in breast milk or infant serum. Given the lack of data and the very long half-life, this drug is best avoided during breastfeeding on theoretical grounds.
High-risk Medications
High-risk medications are generally avoided during breastfeeding, based on reported data and/or a high theoretical likelihood of adverse effects for the nursing infant.
Methotrexate
Methotrexate, a folate antagonist, is excreted into breast milk in low concentration but with suggested accumulation in neonatal tissues. Methotrexate was detectable in breast milk and serum 2 h after administration to a 25-year-old woman treated with 22.5 mg/day for choriocarcinoma: the peak milk level was reached between 4 and 10 h later at a concentration of 8% of the plasma concentration. Six milk samples collected over 24 h after an intramuscular dose of 65 mg for ectopic pregnancy showed no evidence of drug, however. Although it is possible that the low once weekly doses used for RA may not pose a great risk to the infant (especially if milk were discarded for the first 24 h after the dose), it is recommended that breastfeeding be avoided because of lack of data and concern for accumulation in neonates.
Leflunomide
A pyrimidine synthesis inhibitor, leflunomide has a very long half-life (14 days). No information has been published on levels of leflunomide in breast milk or infant serum. Given the lack of data and the very long half-life, this drug is best avoided during breastfeeding on theoretical grounds.
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