Generic Rheumatrex

METHOTREXATE
(Amethopterin, Folex, Mexate)
Methotrexate is a folic acid antagonist. It is used in the treatment of neoplastic and rheumatic diseases. Methotrexate is administered orally and parenterally. The dose given in one day varies from 5 mg to as much as 22,500 mg in cancer therapy and from 5-25 mg in rheumatic disease.

Teratogenic Risk
Magnitude of teratogenic risk to child born after exposure during gestation: Moderate to high.
Quality and quantity of data on which risk estimate is based: Fair to good.
Features of methotrexate embryopathy have occurred in an infant whose mother took as little as 12.5 mg of methotrexate a week during the first trimester of pregnancy, but the teratogenic risk is probably higher with higher doses.
The effect on the fetus of maternal treatment with methotrexate during the second or third trimester of pregnancy is unknown.

At least four children with a very uncommon and characteristic pattern of congenital anomalies have been born to women treated with methotrexate during the first trimester of pregnancy. These children exhibited abnormal head shape, large fontanelles, craniosynostosis, ocular hypertelorism, and skeletal defects. The pattern of anomalies is strikingly similar to that seen in children born to women who took aminopterin, a closely-related agent early in pregnancy. The frequency of malformations among infants of women treated with methotrexate during pregnancy does not appear to be extremely high and is probably dose-related. Most infants of women treated with low-dose methotrexate during pregnancy appear normal at birth.
The rate of miscarriage is high among women who were treated with methotrexate early in pregnancy. Methotrexate has been used as an abortifacient and in the treatment of ectopic pregnancy.
No increase in the incidence of congenital anomalies was apparent in the children of over 375 women who had been treated with methotrexate for neoplasia prior to becoming pregnant.
Fetal death occurs with increased frequency in pregnant monkeys, mice, rats, cats, and rabbits treated with methotrexate in doses equivalent to or greater than those used in humans. Increased frequencies of malformations were observed among the offspring of mice, rats, and rabbits treated during pregnancy with methotrexate in doses equivalent to or greater than those used in humans. Cleft palate and limb malformations were the anomalies observed most often.

Risk Related to Breast-feeding
Methotrexate is excreted in the breast milk in very low concentrations. The amount of methotrexate that the nursing infant would be expected to ingest is HEALTHY BONES

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