A pregnant female at 35 wks of pregnancy is disgnosed with SLE. Drugs that can be used to treat are all except
Methotrexate Methotrexate, a cytotoxic drug is absolutely contraindicated in pregnancy and lactation. It is a 'class x' drug. Methotrexate kills chorionic villi and cause fetal death. Methotrexate exposure in 2nd and 3rd trimester may be associated with later developmental abnormalities. associated with later developmental abnormalities. Let's first see? FDA categories for drugs and medications regarding safety during pregnant Category A No risk in controlled clinical trials in humans (Safe) Category B Human data reassuring or animal studies show no risk in absence of human study Category C No adequate and well-controlled studies in humans and either no animal studies or animal studies show teratogenic risk Category D Positive evidence of teratogenic risk but the benefit may outweigh the risks. (This category also contain medication used to treat life-threatening medical conditions, for e.g. systemic caicosteroids, azathioprine, phenytoin, carbamazepine, valproic acid and lithium) Category X Contraindicated in pregnancy Coicosteroids - "Systemic caicosteroids are category D if used in 1st trimester, however, they are not considered to represent a major teratogenic risk." - William's Obstetrics - Prednisolone can be used in pregnancy but should be used at the lowest effective doses and for the shoest time required - Harrison Sulphasalazine - Category B drug, is safe in pregnancy - It is used occasionally to control mild to severe inflammatory ahritis - Swiet's medical disorders in Obstetric Practice Hydroxy chloroquine - May be used safely for the treatment of SLE during pregnancy - It is a category C drug Pharmacological treatment of S,,.1,E in pregnancy Drugs FDA classification Recommendation for use in pregnancy NSA1Ds (aspirin) B First and Second TM - Pain control in later 1st & 2nd D Third TM TM only - Discontinue in 3rd TM Coicosteroids* Prednisolone D As needed to control inflammatory symptoms Immunosuppressive and cytotoxic agents Azathioprine ine D Continue if taking prior to pregnancy Cycloplzosphamide D -------------------------------- life threatening SLE Avoid if possible, Use only in Contraindicated - discontinue 3 Methotrexate X m prior to pregnancy Discontinue prior to pregnancy, Mycofenolate mofetil D switch to azathioprine Antimalarial Hydroxychloroquine C Continue if taking prior to pregnancy TM- Trimester *Some books categorise coicosteroids in category C & some in category B too
Coicosteroids
Sulphasalazine
Methotrexate
Hydroxychloroquine