Document Detail

Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation.
MedLine Citation:
PMID:  1285866     Owner:  NLM     Status:  MEDLINE    
Active rheumatic disease may necessitate the treatment of pregnant and lactating patients with disease modifying (DMARD) or immunosuppressive drugs. This review summarizes data from the literature, and attempts to give some recommendations. Possible teratogenic effects of gold, penicillamine, and chloroquine are still disputed. As long as the issue is not settled, it seems prudent to stop using these agents as soon as pregnancy is diagnosed. Hydroxychloroquine has been used by some rheumatologists for treating pregnant patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) without malformations detected in the neonates. Sulphasalazine does not increase the rate of congenital abnormalities. Selected case reports have not shown any teratogenicity of cyclosporine A so far. However, the drug may cause fetal retardation. The use of standard doses of azathioprine does not increase the risk of congenital anomalies. By contrast, the antitumor agents cyclophosphamide, chlorambucil, and methotrexate are possibly teratogenic when given during early pregnancy, but may be less harmful in late pregnancy. Data on the excretion of DMARD and the cytostatic drugs are sparse. Because of insufficient data, breast feeding is not recommended in patients on antimalarials, penicillamine, cyclosporine A, and cytostatic drugs. Intramuscular gold and sulphasalazine seem to impose no major risk on the nursing infant.
M Ostensen
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of reproductive immunology (New York, N.Y. : 1989)     Volume:  28     ISSN:  1046-7408     ISO Abbreviation:  Am. J. Reprod. Immunol.     Publication Date:    1992 Oct-Dec
Date Detail:
Created Date:  1993-03-18     Completed Date:  1993-03-18     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8912860     Medline TA:  Am J Reprod Immunol     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  148-52     Citation Subset:  IM    
Department of Rheumatology, University Hospital of Trondheim, Norway.
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MeSH Terms
Abnormalities, Drug-Induced / etiology*
Anti-Inflammatory Agents, Non-Steroidal / adverse effects,  therapeutic use*
Autoimmune Diseases / drug therapy*
Chloroquine / adverse effects,  therapeutic use
Fetus / drug effects
Immunosuppressive Agents / adverse effects,  therapeutic use*
Infant, Newborn
Milk, Human / chemistry
Pregnancy Complications / drug therapy*
Pregnancy Outcome
Prenatal Exposure Delayed Effects
Rheumatic Diseases / drug therapy*
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Immunosuppressive Agents; 54-05-7/Chloroquine

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

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