American Board of Internal Medicine (ABIM) Certification Practice Exam

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How many months prior to attempting to conceive must women discontinue methotrexate?

1 month
2 months
3 months
6 months

The correct answer is: 3 months

Women are advised to discontinue methotrexate at least three months prior to attempting to conceive due to the drug's teratogenic effects. Methotrexate is a folate antagonist commonly used to treat conditions such as rheumatoid arthritis and certain types of cancer. Its potential to cause severe birth defects necessitates a sufficient washout period to ensure that it has been fully eliminated from the body before conception occurs. Research indicates that the drug can remain in the system for some time after discontinuation, which justifies the three-month timeframe as a precaution to minimize risks to fetal development. This guideline is particularly important for women of childbearing age who are planning pregnancy, emphasizing the need for effective contraception while on the medication. Within this context, discontinuing methotrexate too close to the time of conception could lead to adverse outcomes, making three months the standard recommendation.