Azathioprine: Safe at doses <2mg/kg/day.
Biologics: If you are on any biologic please discuss your medications with your Rheumatologist when you are starting to think about planning for a baby, so that we can create a shared decision-making care plan that is right for you.
Bisphosphonates: Stop 6 months prior to conception.
Ciclosporin: Can be considered at the lowest effective dose.
Cyclophosphamide: This medication can reduce fertility in men and women. It should be avoided in pregnancy, and stopped at least 3 months before planning.
Leflunomide: This should be stopped at least 2 years prior to trying to get pregnant. A Leflunomide ‘washout procedure’ can be arranged with drug level blood monitoring. Providing the drug is undetectable, patients can conceive 6 months after stopping Leflunomide. There is a risk of birth defects and so reliable contraception should be taken with this medication if you are of child bearing age. It is often therefore avoided in young females. Men wishing to start a family should stop taking Leflunomide at least 3 months before planning a family and take a ‘wash out’ medication.
Mycofenolate Mofetil: Stop least 6 weeks prior to trying to get pregnant. Patients with SLE on MMF are usually switched to Azathioprine.
Methotrexate: Stop at least 3 months prior to trying to get pregnant. Contraception must be taken whilst you are on this medication. In women treated with low dose Methotrexate within 3 months prior to conception, folate supplementation (5mg/day) should be continued prior to and throughout pregnancy
Nifedipine: Safe at doses <60mg/day
NSAIDs: Where possible should be avoided and stopped at 30 weeks. If considered necessary upon consultation with your Rheumatologist this should be prescribed at the lowest effective dose for the shortest possible time.
Sulfasalazine: Supplement with 5mg folic acid daily. It can lead to reversible reduced sperm counts in males.