Pregnancy | Breast feeding | |||||
---|---|---|---|---|---|---|
Drug | Statement on compatibility of drug with pregnancy based on evidence | Percentage of agreement with statement | Expert opinion on use of drug in clinical practice* | Statement on compatibility of drug with breast feeding based on evidence | Percentage of agreement with statement | Expert opinion on use of drug during breast feeding† |
Non-selective COX inhibitors (classical NSAIDs) | Current evidence indicates no increased rate of congenital malformationsNon-selective COX inhibitors can be continued during the first and second trimesters | 92 | Non-selective COX inhibitors are compatible with breast feeding | 88 | ||
Selective COX II inhibitors | Current evidence is insufficientSelective COX II inhibitors should be avoided in pregnancy | 100 | Among COX II inhibitors only celecoxib has been sufficiently studied; celecoxib is compatible with breast feeding, other COX II inhibitors should be avoided during lactation | 94 | ||
Prednisone | Current evidence indicates no increased rate of congenital malformations Prednisolone/prednisone can be continued at the lowest effective dose throughout pregnancy | 100 | Glucocorticoids are compatible with breast feeding | 100 | ||
Intra-articular/intramuscular glucocorticoids | Current evidence indicates no increased rate of congenital malformationsIntra-articular/ intramuscular glucocorticoids can be given, when required, throughout pregnancy | 100 | ||||
Intravenous glucocorticoids | Current evidence indicates no increased rate of congenital malformations Intravenous glucocorticoids can be given, when required, throughout pregnancy | 100 | ||||
Fluorinated glucocorticoids | Current evidence indicates that fluorinated glucocorticoids should be used with caution because they are less metabolised by the placentaThey should only be used to treat fetal problems | 100 | ||||
Hydroxychloroquine | Current evidence indicates no increased rate of congenital malformations Hydroxychloroquine can be continued throughout pregnancy | 100 | Hydroxychloroquine is compatible with breast feeding | 100 | ||
Chloroquine | Current evidence indicates no increased rate of congenital malformations Chloroquine can be continued throughout pregnancy | 100 | Chloroquine is compatible with breast feeding | 88 | ||
Mepacrine (quinacrine) | Current evidence is insufficientMepacrine should be avoided in pregnancy | 100 | No data exist regarding mepacrine in breast milk, therefore mepacrine should be avoided in breast feeding | 100 | ||
Sulfasalazine | Current evidence indicates no increased rate of congenital malformations Sulfasalazine can be continued at doses up to 2 g/day with concomitant folate supplementation throughout pregnancy | 100 | Sulfasalazine is compatible with breast feeding in the healthy, full-term infant | 94 | ||
Leflunomide | Current evidence is insufficientIn a planned pregnancy, a washout procedure should be completed before pregnancy Leflunomide should be avoided in pregnancy | 100 | No data exist regarding leflunomide in breast milk, therefore leflunomide should be avoided in breast feeding | 100 | ||
Azathioprine | Current evidence indicates no increased rate of congenital malformations Azathioprine can be continued at doses up to 2 mg/kg/day throughout pregnancy | 100 | Azathioprine is compatible with breast feeding | 94 | ||
Methotrexate | Current evidence indicates an increased rate of congenital malformationsIn a planned pregnancy, methotrexate should be withdrawn 1–3 months before pregnancy | 100 | Only small amounts of methotrexate appear in breast milk, but data are limited, therefore methotrexate should be avoided in breast feeding | 100 | ||
Cyclophosphamide | Current evidence indicates an increased rate of congenital malformations Cyclophosphamide must be withdrawn before a planned pregnancy | 100 | There are limited data regarding cyclophosphamide in breast milk, therefore cyclophosphamide should be avoided in breast feeding | 94 | ||
Cyclophosphamide | The use of cyclophosphamide might be justified to treat life-threatening conditions in the second and third trimesters | 100 | ||||
Ciclosporin | Current evidence indicates no increased rate of congenital malformations Ciclosporin can be continued throughout pregnancy at the lowest effective dose | 100 | Ciclosporin is compatible with breast feeding | 100 | ||
Tacrolimus | Current evidence indicates no increased rate of congenital malformations Tacrolimus can be continued throughout pregnancy at the lowest effective dose using trough levels | 100 | Tacrolimus is compatible with breast feeding | 94 | ||
Mycophenolate mofetil (MMF) | Current evidence indicates an increased rate of congenital malformationsIn a planned pregnancy, MMF should be withdrawn 1.5 months before pregnancy | 100 | No data exist regarding MMF in breast milk, therefore MMF should be avoided in breast feeding | 100 | ||
Colchicine | Current evidence indicates no increased rate of congenital malformations Colchicine can be continued at doses up to 1 mg/day throughout pregnancy | 100 | Colchicine is compatible with breast feeding | 100 | ||
Intravenous immunoglobulin | Intravenous immunoglobulin can be used throughout pregnancy | 100 | Intravenous immunoglobulin is compatible with breast feeding | 100 | ||
Tofacitinib | Current evidence is insufficientIn a planned pregnancy treatment with tofacitinib should be stopped 2 months before conception | 100 | No data exist regarding tofacitinib in breast milk, therefore tofacitinib should be avoided in breast feeding | 100 |
*As an expert in the field.
I would recommend the drug in the same way as if the patient was not pregnant.
I would only recommend the drug if I feared at least moderate disease activity in its absence.
I would only recommend the drug if I feared at least severe disease activity in its absence.
I would never recommend the drug in pregnancy.
†As an expert in the field.
I would recommend the drug in the same way as if the patient did not breastfeed.
I would only recommend the drug if I feared at least moderate disease activity in its absence.
I would only recommend the drug if I feared at least severe disease activity in its absence.
I would never recommend the drug while the woman was breast feeding.