Is MTX Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use MTX? Is MTX safe for nursing mother and child? Does MTX extracts into breast milk? Does MTX has any long term or short term side effects on infants? Can MTX influence milk supply or can MTX decrease milk supply in lactating mothers?

After a single dose of 65 mg (50 mg/square meter of body surface) as used for abortion no trace has been found in mother’s milk. For this reason it is considered to be safe for the infant while nursing under such an instance. Some authors considered it also to be safe when used on a weekly basis for the long-term treatment of Rheumatoid Arthritis and other Auto-immune diseases since few or nil presence in mother’s milk has been shown, although blood level testing in the infant is recommended. It can minimize exposure interrupting breastfeeding 24 hours after taking the drug, removing and discarding the milk. It is not recommended to nurse when used for treatment of cancer. Drug is cleared from the body after 6 elimination half-lives. Resuming breastfeeding after 4 days of breast milk pump and dump is likely safe .

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.

On day 151 postpartum, weekly methotrexate 25 mg subcutaneously begun a nursing mother. The estimated intake of the infant at that time was 3.4 mcg/kg in the first 24 hours after administration. The mother continued to breastfeed (extent not stated) for an additional 9 months while receiving subcutaneous methotrexate 25 mg weekly. No adverse effects were noted in the infant.[8]