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Methotrexate Breastfeeding — SCE Dermatology MCQ

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EasyDermatopharmacologyMethotrexate BreastfeedingSCE Dermatology

A 40-year-old woman with psoriasis has just had a baby. She was on Methotrexate before pregnancy (stopped 3 months prior to conception). She wants to restart. How soon after delivery can Methotrexate be restarted?

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Correct answer: B — Methotrexate is CONTRAINDICATED during breastfeeding — it should only be restarted after breastfeeding is completed, OR if the patient chooses not to breastfeed

Methotrexate is excreted in breastmilk and is absolutely contraindicated during breastfeeding due to its antifolate/immunosuppressive/teratogenic properties potentially affecting the infant. If the patient wishes to breastfeed, alternative psoriasis treatments safe in breastfeeding should be used (topical therapies, NB-UVB, short courses of oral Prednisolone if needed). If the patient is not breastfeeding (or when breastfeeding ceases), Methotrexate can be restarted. BAD pregnancy/breastfeeding prescribing guidelines provide detailed safety information for all psoriasis treatments in this context.

Reference: BAD 2018 Prescribing in Pregnancy; BNF