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Taking methimazole right after nursing and waiting for 3 to 4 hours before nursing again should minimize the infant dosage. No cases of thyroid function alteration have been reported among infants exposed to methimazole via breastmilk. Some experts now recommend that methimazole should be considered the antithyroid drug of choice in nursing mothers.[1-3]" /><meta name="og:title" content="Methimazole" /><meta name="og:type" content="book" /><meta name="og:description" content="Maternal methimazole therapy does not affect thyroid function or intellectual development in breastfed infants with doses up to 20 mg daily. Taking methimazole right after nursing and waiting for 3 to 4 hours before nursing again should minimize the infant dosage. No cases of thyroid function alteration have been reported among infants exposed to methimazole via breastmilk. Some experts now recommend that methimazole should be considered the antithyroid drug of choice in nursing mothers.[1-3]" /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK501024/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-lactmed-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/lactmed/LM177/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK501024/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK501024_"><span class="title" itemprop="name">Methimazole</span></h1><p class="small">Last Revision: <span itemprop="dateModified">July 15, 2024</span>.</p><p><em>Estimated reading time: 4 minutes</em></p></div><div class="body-content whole_rhythm" itemprop="text"><p>CASRN: 60-56-0</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/134970546" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134970546" alt="image 134970546 in the ncbi pubchem database" /></a><div id="LM177.Drug_Levels_and_Effects"><h2 id="_LM177_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM177.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Maternal methimazole therapy does not affect thyroid function or intellectual development in breastfed infants with doses up to 20 mg daily. Taking methimazole right after nursing and waiting for 3 to 4 hours before nursing again should minimize the infant dosage. No cases of thyroid function alteration have been reported among infants exposed to methimazole via breastmilk. Some experts now recommend that methimazole should be considered the antithyroid drug of choice in nursing mothers.[<a class="bk_pop" href="#LM177.REF.1">1</a>-<a class="bk_pop" href="#LM177.REF.3">3</a>]</p><p>The American Thyroid Association recommends only monitoring infants for appropriate growth and development during routine pediatric health and wellness evaluations and routine assessment of serum thyroid function in the child is not recommended.[<a class="bk_pop" href="#LM177.REF.4">4</a>] Rare idiosyncratic reactions (e.g., agranulocytosis) might occur, and the infant should be watched for signs of infection. Monitoring of the infant's complete blood count and differential is advisable if there is a suspicion of a drug-induced blood dyscrasia.</p></div><div id="LM177.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> One mother (time postpartum not stated) taking 2.5 mg of methimazole every 12 hours orally had a peak milk level of 67 mcg/L at about 2 hours after nursing.[<a class="bk_pop" href="#LM177.REF.5">5</a>]</p><p>Four lactating women who were 3 to 6 months postpartum received a single dose of methimazole 40 mg orally. Milk levels paralleled serum levels closely at about the same concentration over the next 8 hours during which time an average of 70 mcg of methimazole was excreted into breastmilk. The average peak level of 720 mcg/L occurred at 1 hour after the dose.[<a class="bk_pop" href="#LM177.REF.6">6</a>]</p><p>Six lactating women were given a single oral dose of methimazole 15 mg. Peak milk levels of 320 mcg/L occurred 2 hours after the dose. At 12 hours after the dose, milk levels were 30 mcg/L. The half-life of the drug in milk averaged 4.2 hours.[<a class="bk_pop" href="#LM177.REF.7">7</a>]</p><p><i>Infant Levels.</i> Ten women taking methimazole nursed their infants 2 hours after taking a 10 mg dose of methimazole orally (approximately the time of the peak milk level). Infant serum levels were measured 2 hours after nursing. Seven of the 10 infants had undetectable (<30 mcg/L) serum levels of methimazole, In the other 3, serum levels were 30, 34 and 35 mcg/L.[<a class="bk_pop" href="#LM177.REF.8">8</a>,<a class="bk_pop" href="#LM177.REF.9">9</a>]</p></div><div id="LM177.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Five mothers taking methimazole 5 to 15 mg daily at 6 pm breastfed their infants during the day using expressed milk or formula at night. Thyroid Five mothers taking methimazole 5 to 15 mg daily at 6 pm breastfed their infants during the day using expressed milk or formula at night. Thyroid function test remained normal during 90 days of study and none of the infants showed any clinical signs of hypothyroidism and methimazole was undetectable (<10 mcg/L) in the infants' serum.[<a class="bk_pop" href="#LM177.REF.7">7</a>]</p><p>Twelve mothers taking methimazole 5 mg daily breastfed their infants from the time of delivery. Another 17 women were given methimazole 5 mg twice daily beginning 2 to 8 months postpartum and allowed to breastfeed their infants exclusively with supplementation given to those over 6 months of age. A third group of 6 mothers took methimazole 10 mg twice daily. All infants were normal clinically and had normal thyroid function tests when measured 2 to 4 weeks after the start of therapy.[<a class="bk_pop" href="#LM177.REF.10">10</a>]</p><p>The breastfed infants of 16 mothers who became hypothyroid during methimazole therapy were studied 5 times between birth and 12 months of age in comparison to a control group of 18 breastfed infants whose mothers did not become hypothyroid during methimazole therapy and a group of 24 infants of normal mothers. There were no differences in thyroid function tests of the infants from the 3 groups.[<a class="bk_pop" href="#LM177.REF.9">9</a>]</p><p>Fifty-one infants of mothers who took methimazole during pregnancy and continued during lactation with a dose of 5 mg daily and 88 infants of mothers who took the drug starting 2 to 8 months postpartum were studied. All infants had normal thyroid function tests for up to a year of maternal therapy with doses of 5 to 20 mg daily of methimazole. Fourteen children who had been breastfed as infants were compared to a control group of children whose mothers did not take methimazole. Performance on IQ tests did not differ between the two groups.[<a class="bk_pop" href="#LM177.REF.11">11</a>] Forty-two of these children were restudied after 4 years of age and found to have IQ scores equal to children under the age of 6 in a matched control group.[<a class="bk_pop" href="#LM177.REF.12">12</a>]</p></div><div id="LM177.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM177.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p>
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<a href="/books/n/lactmed/LM230/">Propylthiouracil</a>
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</p></div><div id="LM177.References"><h3>References</h3><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="LM177.REF.1">Karras
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S, Tzotzas
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T, Krassas
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GE. Antithyroid drugs used in the treatment of hyperthyroidism during breast feeding. An update and new perspectives.
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Hormones (Athens)
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2009;8:254-7
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[<a href="https://pubmed.ncbi.nlm.nih.gov/20058397" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20058397</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="LM177.REF.2">Hudzik
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B, Zubelewicz-Szkodzinska
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B. Anti-thyroid drugs during breastfeeding.
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Clin Endocrinol (Oxf)
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2016;85:827-30
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[<a href="https://pubmed.ncbi.nlm.nih.gov/27561657" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27561657</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="LM177.REF.3">Amino
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N, Arata
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N. Thyroid dysfunction following pregnancy and implications for breastfeeding.
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Best Pract Res Clin Endocrinol Metab
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2020;34:101438
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[<a href="https://pubmed.ncbi.nlm.nih.gov/32651061" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32651061</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="LM177.REF.4">Alexander
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EK, Pearce
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EN, Brent
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GA, et al.
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2016 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum.
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Thyroid
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2017;27:315-89
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[<a href="https://pubmed.ncbi.nlm.nih.gov/28056690" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28056690</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="LM177.REF.5">Tegler
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L, Lindström
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B. Antithyroid drugs in milk.
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Lancet
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1980;316:591
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6158636" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6158636</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="LM177.REF.6">Cooper
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DS, Bode
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HH, Nath
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B, et al.
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Methimazole pharmacology in man: Studies using a newly developed radioimmunoassay for methimazole.
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J Clin Endocrinol Metab
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1984;58:473-9
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[<a href="https://pubmed.ncbi.nlm.nih.gov/6546390" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6546390</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="LM177.REF.7">Abe
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Y, Sato
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H, Sakai
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H, et al.
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Antithyroid treatment of maternal hyperthyroidism during lactation.
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Thyroid
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1995;5 (Suppl 1):S108.doi:10.1089/thy.1995.5.ii [<a href="http://dx.crossref.org/10.1089/thy.1995.5.ii" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="LM177.REF.8">Azizi
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F, Heydayati
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M. Thyroid function in breast-fed infants whose mothers take high doses of methimazole.
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J Endocrinol Invest
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2002;25:493-6
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[<a href="https://pubmed.ncbi.nlm.nih.gov/12109618" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12109618</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="LM177.REF.9">Azizi
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F.
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Thyroid function in breast-fed infants is not affected by methimazole-induced maternal hypothyroidism: Results of a retrospective study.
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J Endocrinol Invest
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2003;26:301-4
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[<a href="https://pubmed.ncbi.nlm.nih.gov/12841536" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12841536</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="LM177.REF.10">Azizi
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F.
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Effect of methimazole treatment of maternal thyrotoxicosis on thyroid function in breast-feeding infants.
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J Pediatr
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1996;128:855-8
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[<a href="https://pubmed.ncbi.nlm.nih.gov/8648549" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8648549</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="LM177.REF.11">Azizi
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F, Khoshniat
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M, Bahrainian
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M, et al.
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Thyroid function and intellectual development of infants nursed by mothers taking methimazole.
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J Clin Endocrinol Metab
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2000;85:3233-8.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/10999814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10999814</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="LM177.REF.12">Azizi
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F, Bahrainian
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M, Khamseh
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ME, et al.
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Intellectual development and thyroid function in children who were breast-fed by thyrotoxic mothers taking methimazole.
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J Pediatr Endocrinol Metab
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2003;16:1239-43
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[<a href="https://pubmed.ncbi.nlm.nih.gov/14714745" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14714745</span></a>]</div></dd></dl></div></div><div id="LM177.Substance_Identification"><h2 id="_LM177_Substance_Identification_">Substance Identification</h2><div id="LM177.Substance_Name"><h3>Substance Name</h3><p>Methimazole</p></div><div id="LM177.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>60-56-0</p></div><div id="LM177.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Antithyroid Agents</p><p>Thionamides</p></div></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div><div class="small"><span class="label">Bookshelf ID: NBK501024</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/30000083" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">30000083</a></span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/lactmed/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/lactmed/LM176/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/lactmed/LM426/" title="Next page in this title">Next ></a></div></div></div></div>
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<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK501024&ncbi_domain=lactmed&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK501024/?report=printable&ncbi_app=bookshelf" /></noscript>
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<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
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