ok, i answered a post previously about pregnancy and now that i'm back online, i've done some more checking. this is kinda long, but it is what i've found so far. oh, and never let someone say there isn't anything you can can take during pregnancy. if the benefits outweigh the risks, some meds are considered preferable to others. i had an OB, a rheumy and my son's pediatrician tell me that the breast feeding cunsultant was wrong in saying there was nothing i could take and still breast feed. they all agreed that as in pregnancy, if benefits outweigh the risks, it's possible to medicate in a safer way. sorry this is kinda long. wayney
http://www.emedicine.com/med/topic3259.htm
- Methotrexate is contraindicated in pregnancy because of its teratogenic effects. Craniofacial defects, anencephaly, hydrocephaly, and limb defects have been reported following use of high-dose methotrexate for chemotherapy. The late first trimester appears to be the critical period for this teratogenic effect. Because the active metabolites have a long half-life, methotrexate must be discontinued 3 months prior to conception; treatment with folic acid is continued.
- Leflunomide is contraindicated in patients who are pregnant because of fetal morbidity in animals. Because leflunomide can linger for periods as long as 2 years, administering cholestyramine (8 g tid for 11 d) and testing for plasma levels of the drug on 2 separate occasions after discontinuation are recommended.
- Discontinuing cyclosporine and cyclophosphamide 3 months prior to conception is recommended.
- Azathioprine or gold injections can be used if the benefits outweigh the risks. While fewer women on azathioprine for renal transplant completed their pregnancies, no increase in fetal anomalies was observed.
- The preferred disease-modifying agents during pregnancy are sulfasalazine and hydroxychloroquine.
None of the medications used in the treatment of arthritis is absolutely safe during pregnancy. Hence, the decision to use medications should be made after careful assessment of the risks and benefits in consultation with the patient. Pain control through nonmedical management (eg, paraffin baths, decrease in physical activity, splinting, cold packs) is preferred.
[note from Waynette: This site also goes into listing various meds. NSAIDs etc. Following is info on corticosteroids only.]
Drug Category: Corticosteroids -- Potent anti-inflammatory agents. Relatively safe in low doses (ie, <20 mg) and no consistent adverse effect on fetal health has been observed. May worsen hypertension, edema, and gestational diabetes in pregnancy.
|
Drug Name |
Prednisone (Deltasone) -- May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Metabolized by placenta and lesser concentrations are available for the fetus. Therefore, preparation preferred. |
|
Adult Dose |
5-20 mg/d PO qd; lowest effective dose is prescribed |
|
Pediatric Dose |
Not established |
|
Contraindications |
Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections; GI disease |
|
Interactions |
Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics; may alter levels of warfarin |
|
Pregnancy |
B - Usually safe but benefits must outweigh the risks. |
|
Precautions |
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use; high doses may result in growth retardation of fetus; cleft palate has been observed in animals; if used during pregnancy, newborn must be monitored for adrenal suppression and infection |
|
Drug Name |
Methylprednisolone (Medrol, Solu-Medrol) -- Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability. Metabolized by placenta, and lesser concentrations are available for the fetus. Therefore, preparation preferred. |
|
Adult Dose |
5-20 mg/d PO qd; lowest effective dose is prescribed |
|
Pediatric Dose |
Not established |
|
Contraindications |
Documented hypersensitivity; viral, fungal, or tubercular skin infections |
|
Interactions |
Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics |
|
Pregnancy |
C - Safety for use during pregnancy has not been established. |
|
Precautions |
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use; high doses may result in growth retardation of fetus; cleft palate has been observed in animals; if used during pregnancy, newborn must be monitored for adrenal suppression and infection |
- Hydroxychloroquine is also secreted in breast milk; therefore, use this drug with caution. Hydroxychloroquine can potentially displace bilirubin and result in the development of kernicterus. The drug should be discontinued if the neonate has jaundice.
- Prednisone can be used safely during breastfeeding because very minute amounts are found in breast milk.
- NSAIDs can be used with caution, provided newborns do not have jaundice, because NSAIDs can displace bilirubin and predispose patients to the development of kernicterus.
- Patients must be monitored closely following delivery because most are likely to have arthritis flare-ups during the postpartum period.
- Breastfeeding may increase the likelihood of arthritis flare-up.
http://www.arthritis.org/conditions/drugguide/pregnancy.asp
http://www.arthritis.co.za/pregnancypage.html
Drug safety in pregnancy
The age of medications – both prescription and over the counter medicines, make it crucial for the patients out there, to know all about the drugs they are prescribed and what they mean regarding both benefit and side effect potential. A simple principle is to avoid drugs unless absolutely necessary, and even then to consult your doctor regarding safety of that drug in pregnancy.
The commonest drugs for rheumatic diseases are the analgesics and the anti-inflammatory agents. Analgesics such as paracetamol are felt to be largely safe in pregnancy and no additional precautions are required. Addition of codeine to the preparations however changes the safety profile. Generally codeine is to be avoided. Anti-inflammatory drugs are not dangerous in early phase of pregnancy, to the fetus. Therefore they can be continued until the pregnancy is confirmed, then we generally discontinue them. In later stages of pregnancy – especially in the last third (trimester) of the pregnancy, they are definitely not advised as they can cause a problem with the fetal vessel anatomy – and also result in a bleeding tendency resulting in greater blood loss at delivery, and risk of fetal hemorrhage. In lactation we generally allow the drugs that are short acting and avoid the long acting drugs. The safety of the COXIB drugs, are not tested in pregnancy. No fetal abnormalities have been described but since they are very new, further information will be required before general advice on their use in pregnancy can be given. Until that time, they should be avoided in pregnancy. Females trying to become pregnant should also probably avoid them, as temporary and short-term effects on ovulation and implantation of the ovum (egg) into the uterus may occur in theory, although not documented in practice. Pregnancy developing whilst taking these medications requires simply to stop the drug, and no additional interventions are required.
Disease modifying drugs are more complicated. The use of these medications, keep arthritis in remission, and withdrawal under normal circumstances results in a flare of disease, usually about three weeks after withdrawal. Pregnancy however itself fortunately maintains remission, and therefore withdrawal of the drugs is not practically a problem. The problem however, is that some drugs have to be withdrawn in anticipation of a pregnancy developing. Methotrexate is a typical example of this. The drug should be withdrawn three months prior to a planning pregnancy. The same applies to immune suppressing drugs such as Cyclophosphamide and Chlorambucil. In addition the Methotrexate as used by the male partner, should also be withdrawn three months before trying to plan a pregnancy. These drugs should be discontinued until after lactation has stopped.
The use of Sulphasalazine has never been associated with fetal abnormality, and a lot of experience is known of the drug during pregnancy and lactation. However we still advice discontinuing the drug in a pregnancy and only using it if absolutely necessary.
Antimalarial therapy such as chloroquine, has not been shown to be unsafe in pregnancy or lactation, but again we recommend only using it if absolutely necessary.
Gold therapy by injection is generally not advised. (There are no reports of fetal malformation, however). Withdrawal at least one month in advance is suggested.
Penicillamine, is not advised in pregnancy, and it is recommended that the drug is withdrawn one month prior to planning pregnancy.
Corticosteroids in pregnancy and lactation, are generally considered safe in low dose. Animal studies showing risk of cleft palate are not shown in humans. They offer the therapy of choice in those pregnant patients who are flaring and cannot take the disease modifying drugs or anti-inflammatory drugs.
Cortisone injections can also be used in pregnancy without problems.
http://www.arthritis.co.za/pregnancy.html
NSAIDS: Salicylates - are toxic to the fetus in high dose in animal studies, but not found to cause congenital malformations. But they cause other problems - anemia, prolonged gestation, prolonged labor, peripartum hemorrhage, haematoma / preterm fetal hemorrhages. They must therefore NOT be used in the last several weeks of pregnancy. They are usable in low dose early in pregnancy. The other commercial NSAIDS - can suppress labor Result in premature closure of the fetal ductus arteriosus - required by the fetal circulation. Must not be used in the last several weeks of pregnancy.
Cortisone - has shown to be relatively safe. There is an increase in cleft palate in animals but this has not been shown in humans. High dose causes growth retardation. This would be considered the second line agent of choice after dispirit. BUT the dose must be low. Local cortisone injections ARE SAFE and may be very effective.
Gold- this crosses the placenta. Is teratogenic in fetal mice - but again not seen in humans. Nevertheless I Wouldn’t use it.
Antimalarials...These cross the placenta and theoretically may cause ear and retinal damage. I Wouldn’t use it.---stop if pregnant. Studies however do not show definite problems and many sources maintain that the drug can be used if absolutely necessary.
Penicillamine --Can penetrate the placenta. Fetal connective tissue problems have been described. I wouldn’t use it
Azathioprine.. Reports of growth retardation are seen. Blood abnormality -lymphopenia is seen in the fetus. Transient chromosomal changes can also occur -- Advise against use
Sulphasalazine - No evidence of damage to the fetus is documented. In fact most information comes from patients with inflammatory bowel disease and little information is available in patients with RA. However there are no reports of problems. Use should be restricted to those patients where it is considered as absolutely necessary.
Methotrexate / Chlorambucil / Cyclophosphamide...Can Cause congenital abnormalities, and are contraindicated. They should be stopped at least 3 months before the pregnancy.. If someone gets pregnant on these - do an ultrasound and amniocentesis, to exclude problems and STOP the drug.
NB People planning pregnancy should plan it with the help of the doctor.
http://arthritis.about.com/od/preg/
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