Document Detail

Use of methotrexate in young patients with respect to the reproductive system.
MedLine Citation:
PMID:  21044438     Owner:  NLM     Status:  MEDLINE    
Methotrexate (MTX) is one of the most commonly used drugs in the treatment of inflammatory rheumatic diseases. Unfortunately, MTX is an FDA Pregnancy Category X medication, which means it is contraindicated during pregnancy. The following review of the literature, with international guidelines, gives in addition an overview of current scientific knowledge on the topic. MTX is a teratogenic substance. It accesses the placenta and, for the dosage of 5 to 25 mg per week normally used in rheumatic diseases, can lead to both habitual abortions and anomalies in the neonate. Folic acid antagonism of MTX is the reason. In the rheumatologic setting, small case reports are available for the usage of MTX of 101 pregnant women at the time of conception or during pregnancy, mostly during the first trimester. Individual casuistry also exists. An abortion rate of 23% was found to result from these case reports. The anomaly rate for neonates was >5%. Only a few pregnancies with neonatal anomalies are described with the child's father taking MTX at the time of conception. MTX is taken up (in small amounts) by the mother's milk, and breast feeding under MTX therapy, therefore, is also contraindicated. Detailed and exact information on female patients taking MTX during the reproduction phase, but also for the father-to-be of the child if treated with MTX, with reference to the required contraception until at least three months before a planned conception and stopping of MTX at least at that time, is essential.
E Gromnica-Ihle; K Krüger
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-10-28
Journal Detail:
Title:  Clinical and experimental rheumatology     Volume:  28     ISSN:  0392-856X     ISO Abbreviation:  Clin. Exp. Rheumatol.     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-11-03     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8308521     Medline TA:  Clin Exp Rheumatol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  S80-4     Citation Subset:  IM    
Rheumatology Center St. Bonifatius, Munich, Germany.
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MeSH Terms
Abnormalities, Drug-Induced / etiology*
Abortion, Spontaneous / chemically induced*
Age Factors
Antirheumatic Agents / adverse effects*,  contraindications,  metabolism
Breast Feeding / adverse effects
Fertility / drug effects*
Health Knowledge, Attitudes, Practice
Methotrexate / adverse effects*,  contraindications,  metabolism
Milk, Human / metabolism
Patient Education as Topic
Practice Guidelines as Topic
Rheumatic Diseases / drug therapy*
Risk Assessment
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Antirheumatic Agents; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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