Methotrexate in these doses may be okay, but it's difficult to be sure.  It
is true the baby is nursing infrequently and only a little.  I would guess
that this would be fine if there is no other choice.

However, is there no other choice?  I recently was at a conference where I
was asked about methotrexate for rheumatoid arthritis.  The only other
medication the mother was tried on was prednisone.  No NSAID's no nothing
else.

Even if it has to be an immunosuppressive medication, azathioprine is not
bad for breastfeeding mothers (better than methotrexate for sure).  We have
had several mothers breastfeed while on azathioprine.  Hale information
suggests that it is relatively safe.

Jack Newman, MD, FRCPC

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