Drug | Recommendation on use during pregnancy | Recommendation on use during breastfeeding |
---|---|---|
* Regular and recurrent use of NSAIDs should be avoided from week 20 of pregnancy onwards. COX-2 selective anti-inflammatory drugs are contraindicated during pregnancy. Use of celecoxib as a limited course of treatment is possible during breastfeeding. ** Folic acid supplementation 0.8 mg is recommended starting when pregnancy is planned and continuing until the end of first trimester. *** Great variation in excretion into breast milk; monitoring of the child is necessary and the drug concentration in the child should be determined, as required. **** Recommended to be discontinued 2 years before pregnancy. Blood concentration of the drug can be reduced by treatment with cholestyramine (8 g three times daily for 11 days) or activated charcoal (50 g four times daily for 11 days). Pregnancy is possible 2 months after the aforementioned medications. ***** Recommendations regarding discontinuation are drug-specific and case-specific. The ability of certolizumab to cross the placenta is poor late in pregnancy and its use may be continued, if required, throughout the pregnancy. ****** When using the dose 40 mg/day or more, a 4-hour break between the administration of the drug and the next breastfeeding session is recommended. ******* When starting the medication, determining the activity of the thiopurine methyltransferase (TPMT) gene and, as necessary, also the NUDT15 gene is recommended. | ||
Acetylsalicylic acid(at a dosage used to treat pain) | Should not be used | Should not be used |
Indomethasin | Should not be used | Should not be used |
Other NSAIDs | May be used, short-acting preparations preferred* (first choice is ibuprofen) | May be used, short-acting preparations preferred* (first choice is ibuprofen) |
Hydroxychloroquine | May be used | May be used |
Azathioprine | May be used ******* | May be used ******* |
Methotrexate | Must be discontinued 3 months before pregnancy | Should not be used |
Cyclophosphamide | Must be discontinued 3 months before pregnancy | Prohibited |
Sulphasalazine** | May be used | May be used |
Cyclosporine | May be used | May be used*** |
Podophyllotoxin | Must be discontinued 3 months before pregnancy | Prohibited |
Mycophenolate | Must be discontinued 3 months before pregnancy | Prohibited |
Leflunomide | Must be discontinued before pregnancy**** | Prohibited |
TNF alpha inhibitors (infliximab, etanercept, adalimumab, certolizumab, golimumab) |
|
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Anakinra | Discontinue when pregnancy is detected | Not recommended, little experience |
Abatacept | Recommended to be discontinued 3 months before pregnancy | Not recommended, little experience |
Rituximab | Recommended to be discontinued 12 months before pregnancy | Not recommended, little experience |
Tocilizumab | Recommended to be discontinued 3 months before pregnancy | Not recommended, little experience |
Glucocorticoids | May be used | May be used****** |
Find out about national or regional teratological information services and consult them, as necessary.