IMMUNOSUPRESSIVE DRUGS
|
Corticosteroids |
Safe |
Safe (C) |
Higher risk of bone loss diabetes, infection, preterm rupture of membranes |
No teratogenicity. (No association to orofacial cleft in recent studies) |
Safe (Monitor newborn) |
Azathioprine |
Safe |
Safe (D) |
Hyperkalemia, worsening hypertension and nephrotoxicity |
No metabolization by the fetal liver |
Safe |
Cyclosporine |
Safe |
Safe (C) |
Risk of hypertensive, hyperglycaemic and nephrotoxic effects |
No teratogenicity. (reports of FGR and SGA) |
Safe |
Tacrolimus |
Safe |
Safe (C) |
Similar to cyclosporine |
No teratogenicity |
Safe |
Hydroxychloroquine |
Safe |
Safe (C) |
Withdrawal may cause lupus flare. |
No teratogenicity |
Safe |
TO BE AVOIDED
|
m-Tor inhibitors (Sirolimus; Everolimus) |
Unsafe
|
Unsafe (C) |
Hyperlipidemia, hyperglycemia, nephrotoxicity |
Unclear. (Toxic in animal studies) |
Unclear |
Mycophenolate |
Unsafe (♀ and ♂ stop > 6 weeks before conception) |
Unsafe (D) |
Gastrointestinal symptoms and dose-related bone marrow suppression |
Teratogenic. Severe fetal cardiovascular and cranial malformations |
Unsafe (Excreted in breast milk) |
Methotrexate |
Unsafe (stop > 3 months before conception) |
Unsafe (X) |
Hepatotoxicity, gastrointestinal symptoms, alopecia, bone marrow suppression |
Teratogenic |
Unsafe (Excreted in breast milk) |
Cyclophosphamide |
Unsafe (♀ and ♂ stop > 3 months before conception) |
Unsafe (D) |
Affects ovarian function and fertility |
Teratogenic. Congenital abnormalities of the skull, ear, face, limb and visceral organs, cytopenia |
Unsafe (Excreted in breast milk. Discontinue breastfeeding during and for 36 hours after treatment) |
BIOLOGIC AGENTS
|
Rituximab |
Unclear (Manufacturer advises to stop 1 year before conception) |
Unclear |
Active passage in the 2nd and 3rd trimester. Administer before or in early pregnancy. |
Avoid unless potential benefits outweighs risks. (Potential risk of neonatal B cell depletion) |
Unclear |
Eculizumab |
Unclear |
Unclear |
Monitor for increased dosage requirements |
Active passage in the 2nd and 3rd trimester. No teratogenicity reported. |
Unclear |
Belimumab |
Unclear (stop > 4 months before conception) |
Unclear |
Active passage in the 2nd and 3rd trimester. Administer before or in early pregnancy |
Studies so far showed no teratogenicity. Limited data. Avoid unless potential benefits outweighs risks. |
Unclear |
OTHER DRUGS |
Aspirin |
Safe |
Safe (C) |
Decreases risk of preeclampsia and FGR. |
No teratogenicity |
Safe |
Low-molecular weight heparin |
Safe |
Safe (C) |
Decreases risk of VTE |
No teratogenicity |
Safe |
Allopurinol |
Safe |
Safe (C) |
None |
No teratogenicity |
Excreted in breast milk. No reported adverse effects |
Iron |
Safe |
Safe (B) |
None |
No teratogenicity |
Safe |
Erythropoietin |
Safe |
Safe (C) |
Risk of hypertension. |
No teratogenicity |
Safe |