Disease-modifying anti-rheumatic drugs (DMARDs) have a varied pharmacology, mainly either modifying the immune response to the disease or modifying the disease process. The choice of drug will depend on a number of variables, including the disease severity, co-morbidity, response to other drugs and patient preference.
DMARDs can be used in combination with each other and/or with corticosteroids, NSAIDs etc. It is, therefore, difficult to suggest an alternative in most situations. The risk of additive adverse effects, from combination therapy, occurring in the breastfed infant must also be considered.
Acting Co-Director, West Midlands Medicines Information Service & UK Drugs in Lactation Advisory Service