Breastfeeding in ectopic pregnancy

[lou2014]

advice please - i was diagnosed with an ectopic pregnancy on monday and given a single methotrexate dose tuesday, not sure of the dose but think it may be 100mg. am i still ok to pump and dump for 4 days and then resume breastfeeding. i have a very upset and confused 14 month old and would love to know that i can safely continue breastfeeding! he only tends to nurse of a evening fo comfort and maybe twice through the night. thank you

[amedame]

Thank you - two days is much more feasible than four nights of avoiding bedtime. I'm not sure if I can pump - I wasn't clear on whether methotrexate concentrates in milk (should I hand express as often as possible?) or if the drug will clear at the same rate whether milk is expressed or not. Can you clarify that point?

[admin]

Amedame:

In your case with a 2 year old infant, I doubt your milk production is high enough to produce much of a dose to your infant. But I would still recommend at least 2 days withholding of milk. I'd also pump and discard during this time.

Tom Hale Ph.D.

[amedame]

? I'm sorry - I was notified of a reply, and I see that you just responded to Skosche3's question, which was asked back in February (and had already been replied to by another admin). Perhaps mine did not show up as the most recent one when you first looked?

[admin]

Skosche3:

The terminal elimination half-life is 8-15 hours. Thus pumping and discarding your milk for 90 hours would probably be more than enough to make it safe to breastfeed.
We do have some data that it may have a longer half-life or concentrating effect in the GI tract of the infant, but this has nothing to do with your dose.

I'd suggest you've waited more than enough to make it safe to breastfeed.

Tom Hale Ph.D.
Infantrisk Center

[amedame]

Methotrexate for likely ectopic and (barely) nursing toddler

I am likely going to be given a MTX injection later today for a probable ectopic pregnancy (HCG levels have all been 100 or less but are not dropping consistently after one month plus a week) - my son will be two in less than two weeks, and does not nurse often, mostly just before bed (at least twice a week he goes an entire day without when I am out and his father does bedtime), and not for long - it is mostly comfort and I don't think I have much milk volume left. I doubt I would respond to a pump at this point; it's been nearly eight months since I stopped pumping at work, but I don't want to force him to wean completely before he's ready unless truly necessary.

So if I get the standard 50 mg dose of methotrexate, would waiting 48 hours likely be sufficient (without pumping? - I could probably hand express a bit if that would help at all), or would I need to go the full 4 days before resuming nursing?

[admin]

Dear Skosche3

With repeated doses of greater than 50 mg (high dose), the patient should not breastfeed. I would suggest you pump and discard milk for 4 days from your last dose and then resume breastfeeding. Since it has already been 19 days or more since your last dose, i suggest it is probably safe for you to resume breastfeeding.

Tassneem Abdel Karim MD
InfantRisk Center

[Skosche3]

Question about multiple methotrexate doses

I was treated with several doses of methotrexate for a cornual ectopic pregnancy. My does were all inter muscular shots as follows:
Monday, January 13, 65mg
Wednesday, January 15, 88mg
Friday, January 17, 88mg
Sunday, January 19, 88mg
The medicine didn't work and I had to have a right cornual resection (0nly mention in case relevant).
I have been pumping and dumping for the past 19 days (from first dose, 13 days since last dose). I was hoping to start nursing my 10.5 month old son again tomorrow (14 days from last methotrexate dose) but was concerned when I read that in repeated high doses breastfeeding women should not breastfeed. I had heard that 3-4 days was sufficient, but questioned it since that data is usually for one single dose of methotrexate. Could you help me figure out when it would be safe to nurse/save milk for my son? Besides waiting for the methotrexate to be out of my system, are there other nutritional concerns since my folic acid levels are probably lower? My milk is not his only nutritional source, he eats a variety of fruits, vegetables, and infant cereal currently. Would formula be a more nutritional solution at this point? I have resumed taking my prenatal vitamin for at least a week.

[cpride]

Halliesmommy,

Dr. Hale states that "methotrexate is a potent and potentially dangerous folic acid antagonist and antimetabolite used in arthritic and other immunologic syndromes. It is also used as an abortifacient in tubal pregnancies. Methotrexate is secreted into milk in small doses, but the half life increases at high and repeated doses. The drug is believed to be retained in gastrointestinal and ovarian tissue for extended periods (months). Repeated doses of greater than 50 mg (high dose), the patient should not breastfeed. On high dose only, patient may pump and discard milk for 4 days then resume breastfeeding. If a low dose is given once weekly (less than 50 mg), then the mother may pump and discard milk for 24 hours then resume breastfeeding. If the patient must have repeated low dose treatments such as three times per week, then she should not breastfeed. Patients with poor renal function have prolonged methotrexate half-lives." Since you had a one time dose, pumping and discarding for 4 days should be adequate. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Halliesmommy]

I just received 50mg of methotrexate for my ectopic pregnancy. I am currently nursing a 9 month old 4-6 times daily. When can we resume nursing safely? Please reply soon. Thanks for your time

[admin]

Mom to one:

I'd suggest your pediatrician is about right. I'd suggest you pump and discard the milk for 48-72 hours, then resume breastfeeding.

Tom Hale Ph.d.

[Mom to one]

Dr Hale,
About 5 days ago I was given a single dose of methotrexate, not sure of the dosage, to treat my ectopic pregnancy. Prior to this shot, I was nursing my 13 month old about twice daily. The OB who administered the shot said I should not nurse anymore as it's harmful to my daughter. However, my daughter's pediatrician told me it was safe to resume nursing after the 48 hour mark. I've been pumping and dumping to keep my supply up as I'd love to continue nursing for comfort, especially after my loss. Can you please advise me on what to do as I've been given conflicting information. The last thing I want to do is hurt my healthy daughter. Thanks in advance!

[admin]

Nursingmom:

Methotrexate has a dual elimination curve, with a final elimination half-life of about 15 hours. While very little gets into human milk, I'd suggest about a 3 day pumping and discarding prior to putting the infant back on the breast.

Tom Hale Ph.D.

[NursingMom]

Need clarification

Hello. I'd like to get some clarification on the Methotrexate. For a nursing mom who recently had a single dose of 50 mg/m2 of Methotrexate (for a total of 84) to treat an ectopic pregnancy, I'd like to get guidance from Dr. Hale on when it is safe to resume nursing the baby. Thank you in advance.

[admin]

I would not suggest you breastfeed following the use of Methotrexate. It could be hazardous to the infant.
If this is just one dose, then perhaps a waiting period of 48 hours before returning to breastfeeding would be quite safe. But if she is to take more, then you need to be careful not to breastfeed while this drug is being used.

Tom Hale Ph.D.
Professor