Document Detail

Antirheumatic drugs in pregnancy and lactation.
MedLine Citation:
PMID:  16194696     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To review the toxicity issues of commonly used antirheumatic drugs in pregnancy and lactation. METHODS: A review of the medical literature using Medline database via Ovid was performed to identify the toxicities of antirheumatic drugs in pregnancy and lactation. RESULTS: Many rheumatologic diseases in women often first present during the childbearing years. In most cases, antirheumatic therapy is required for their disease control. Glucocorticoids may be used during pregnancy; however, first-trimester use should be avoided if possible and breastfeeding should occur 4 hours after the last dosing. Nonsteroidal antiinflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors should be discontinued 6 to 8 weeks before delivery. NSAIDs are compatible with lactation, although there is potential risk of jaundice and kernicterus. There is insufficient data on COX-2 inhibitors and lactation. Hydroxychloroquine and sulfasalazine may be continued throughout pregnancy and lactation. Methotrexate and leflunomide are contraindicated during pregnancy and lactation. Cyclophosphamide and mycophenolate mofetil should be avoided during pregnancy and lactation. Azathioprine and cyclosporine A could be used with caution during pregnancy if felt there is a need to suppress disease activity. They are not compatible with breastfeeding. There are insufficient data regarding tumor necrosis factor-antagonists, anakinra, and rituximab in relation to pregnancy and lactation. Male patients should be made aware of the effects methotrexate, leflunomide, sulfasalazine, and cyclophosphamide may have on their fertility. CONCLUSIONS: Health care providers should discuss the risks and benefits of antirheumatic therapy during conception, pregnancy, and lactation with their patients. Better maternal and fetal outcomes can be expected if the pregnancy is planned, the rheumatic disease is stable, and if appropriate medication adjustments can be made ahead of time.
Katherine K Temprano; Rama Bandlamudi; Terry L Moore
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Seminars in arthritis and rheumatism     Volume:  35     ISSN:  0049-0172     ISO Abbreviation:  Semin. Arthritis Rheum.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-30     Completed Date:  2006-01-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1306053     Medline TA:  Semin Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  112-21     Citation Subset:  IM    
Division of Rheumatology, Department of Internal Medicine, Saint Louis University, MO 63104, USA.
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MeSH Terms
Antirheumatic Agents / administration & dosage,  therapeutic use*
Dose-Response Relationship, Drug
Pregnancy Complications / drug therapy*
Pregnancy Outcome
Rheumatic Diseases / drug therapy*
Risk Factors
Reg. No./Substance:
0/Antirheumatic Agents

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

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