Azathioprine is the nonsteroidal IS of choice for MG in pregnancy in Europe but is considered high risk in the United States. Some immunosuppressives, such as imuran (azathioprine) have been continued during lupus pregnancy when necessary to control maternal lupus. receive thiopurines (azathioprine (AZA), mercaptopurine (MP) and to a lesser extent tioguanine) with proven efficacy in maintaining steroid-free remission.1 Although the evidence for the use of thiopurines in UC is not as strong as in patients with CD, it has been demon-strated that in patients with steroid-dependent UC, 53% achieved steroid-free Mercaptopurine - between 0.75mg and 1.5mg per kilogram of body weight a day. This is not an estimate of the half-life of azathioprine itself, but is the decay rate for all . Immunomodulators, such as Azathioprine (Imuran®), 6-mercaptopurine (6-MP, Question Quite a few of my female patients with rheumatic diseases and inflammatory bowel disease are using azathioprine. The use of azathioprine during pregnancy needs to be supervised in specialist units. Azathioprine falls into category D. It has been shown that use of azathioprine in pregnant women caused some babies to be born with problems. S-azathioprine and decays with a half-life of 5 hours. marjy33405 over a year ago. These medications are closely related to […] Immunosuppressants help "calm" (or control) your body's immune system. Azathioprine (Imuran ®) is used to treat severe eczema that has not responded to other treatments, a number of auto-immune illnesses such as lupus, inflammatory bowel disease, rheumatoid arthritis and psoriasis, and to prevent the rejection of transplanted organs.Another form of the same medicine called mercaptopurine (Puri-Nethol ®, Xaluprine ®) is used to treat certain forms . AZA crosses the placenta, but the fetal liver lacks the enzyme inosinate pyrophosphorylase . If you are pregnant, planning to become pregnant or breastfeeding this should be discussed with your doctor before taking this medication. Immunosuppressants. Sixty percent of the . However, the exposure to azathioprine during pregnancy in humans was not associated with an increased risk of congenital defects, nor to adverse foetal outcomes. For pregnant women: Azathioprine is a category D pregnancy drug. That means two things:. There is no definitive evidence that azathioprine is harmful in pregnancy however, some studies have shown an association with premature birth and small-for-date babies. Previous studies have demonstrated potential risks. Crohn's disease and ulcerative colitis. On two occasions, after 8 days and after 3 months of maternal therapy, neither 6-MMPN nor 6-thioguaninenucleotides were detectable in the blood of the infant. severe inflammation of the liver, skin or arteries. The amount you take (the dose) depends on your age, body weight and how active your Crohn's or Colitis is. Azathioprine is contraindicated for the treatment of rheumatoid arthritis in pregnant women. As many such patients are young, the potential for pregnant women to be exposed to allopurinol is increasing. You may be started on a low dose which is then increased gradually. Many agree that it is safe to continue whilst breastfeeding too now, although I believe the evidence for this is more recent and is taking time to filter through. The recorded modest increase of low birth weight or atrial or ventricular septal defects is . The pneumococcal vaccine should be repeated at 10-yearly intervals if given before A woman began taking azathioprine 100 mg (1.4 mg/kg) daily for Crohn's disease while breastfeeding (extent not stated) her 3-month-old infant. Answer An increasing body of evidence from prospective cohort studies suggests that azathioprine is safe for the fetus during pregnancy. It is important that you tell us if you are pregnant or planning on getting pregnant so that we can review all of your medicines and monitor you more closely. Maximum serum radioactivity occurs at 1 to 2 hours after oral . There is no definitive evidence that azathioprine is harmful in pregnancy however, some studies have shown an association with premature birth and small-for-date babies. Treatment should not generally be initiated during pregnancy. Congenital anomalies, including polydactyly, plagiocephaly, congenital heart disease, hypospadias, and bilateral talipes equinovarus have occurred. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. All patients wanting to become pregnant who are taking either azathioprine or mercaptopurine should discuss this with their specialist. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you. Azathioprine (AZA), sold under the brand name Imuran, among others, is an immunosuppressive medication. CSA is compatible throughout pregnancy at the lowest effective dose (LOE 1, GOR B, SOA 100%). Pregnancy: Azathioprine can cause fetal harm when administered to a pregnant woman. Azathioprine in pregnancy. Azathioprine and/or its metabolites have been found in low concentrations in foetal blood and amniotic fluid after maternal administration of azathioprine. Azathioprine has been prescribed for several decades to pregnant women with kidney transplants without an increase in birth defects or pregnancy loss. There are no controlled data in human pregnancy. I have been taking Azathioprine for nearly a year now. What is known about the risks? This drug should not be used for treating rheumatoid arthritis in pregnant women 3. Present in milk in low concentration. A retrospective cohort study of 476 women taking azathioprine early in pregnancy reported an increased risk of ventricular and atrial septal defects, as well as preterm birth . . Azathioprine is a type of medicine called an immunosuppressant. This medicine helps treat inflammatory conditions such as: rheumatoid arthritis. Azathioprine (Imuran) Mercaptopurine (6-MP) (Purinethol) The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. The objective of this study was to evaluate the risk of adverse fetal outcome in systemic lupus erythematosus (SLE) women exposed to azathioprine during pregnancy. 35. Azathioprine has not been associated with an increased risk of spontaneous abortion, congenital defects, or still-birth in humans; however, rates of fetal growth restriction from 15% to 40% have been reported for patients treated during pregnancy with azathioprine and glucocorticoids because of a renal transplant, even when they had normal . BACKGROUND: Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Azathioprine has been used during pregnancy for many years in the management of solid organ transplantation, IBD, malignancy and rheumatic diseases. Azathioprine must not be used during pregnancy without careful assessment of risks and benefit (see section 4.3). Pregnancy and breast feeding Treatment with azathioprine should not generally be initiated during pregnancy, but it may be reasonable to continue during pregnancy. Question Quite a few of my female patients with rheumatic diseases and inflammatory bowel disease are using azathioprine. Conclusion: Although Azathioprine is an option in patients with lupus nephritis who are planning pregnancy, there is a need to identify patients at risk of a disease flare on switching from MMF. advised against pregnancy, but there have been many normal pregnancies while on the drug (5-15). It has a role as an antineoplastic agent, an . Whenever possible, use of azathioprine in pregnant patients should be avoided. This medicine helps treat inflammatory conditions such as: rheumatoid arthritis. There is no definitive evidence that azathioprine is harmful in pregnancy. Crohn's disease and ulcerative colitis. Pregnancy: Azathioprine can cause fetal harm when administered to a pregnant woman. Shared Care Guideline: Azathioprine (adults) - for inflammatory conditions Version 4.1 May 2021 Page 5 of 11 Please note: the yearly influenza vaccine is recommended in patients on azathioprine therapy. In addition, 6 pregnant mice were treated with 30 mg. per kilogram of azathioprine on days 12 to 14 of pregnancy (3 animals) or days 15 to 17 (3 animals), killed on day 18 of pregnancy, and microhematocrit and morphologic examination of peripheral blood and bone marrow carried out. The patients were evaluated at least onc … It is taken by mouth or injected into a vein.. Common side effects include bone-marrow suppression and . Animal studies have revealed evidence of teratogenicity. i got pregnant and had my little boy in 2010 all whilst staying on aza, i then had a resection of 10cm in 2011, and i had my little girl in nov 2012. i have never came off aza, the only downside i was told is that i couldnt breastfeed whilst on it. I was diagnosed with Crohn's disease 15 years age. Azathioprine was classified as a category D drug in pregnancy by the United States Food and Drug Administration because congenital malformations were detected in treated mice [41,42]. However, they might be recommended with caution during pregnancy by some physicians to combat a serious flare-up. Breast feeding. Azathioprine. Azathioprine should be used during pregnancy only if the potential benefit justifies the potential risk. Results Fertility studies. Azathioprine may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. Azathioprine and 6-MP are knowingly given for medical reasons during pregnancy. The use of azathioprine (AZA) in the treatment of autoimmune diseases during pregnancy are believed to be relatively safe, particularly taking into account the potential risks for mother and fetus . Azathioprine, either alone or more usually in combination with corticosteroids and/or other procedures, has been used with clinical benefit which may include reduction of dosage or discontinuation of corticosteroids, in a proportion of patients suffering from the following: severe rheumatoid arthritis, systemic lupus erythematosus . Azathioprine should not be given during pregnancy without careful weighing of risk versus benefit. Hi Sezvic, Most rheumatologists now agree that azathioprine is safe to continue during pregnancy based on the most recent reviews of clinical evidence. Paul_Howard Partner 3 years ago. What is it? Azathioprine and 6-MP have been studied in over 1,500 pregnancies and have not been shown to increase the chance of birth defects. Based on limited evidence, CSA is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). Azathioprine is well absorbed following oral administration. In the United States, approximately 0.5% of the population, or 1.6 million people, have inflammatory bowel disease (IBD)—Crohn's disease (CD) and ulcerative colitis (UC).1,2 Of those, roughly half are women, and most will carry the diagnosis during their reproductive years.3 Caring for this complex population is a challenge for the multidisciplinary group of providers involved, compounded . 35. i have been on azathioprine (150mg) for about 8 years now. Summary Azathioprine is a prodrug and is rapidly metabolised to its active metabolite mercaptopurine (6-MP). I was taking 75mg to begin with then I found out that I was pregnant about 2-3 months after starting the treatment (4weeks until due date now) and my rheumatologist then lowered my dose to 50mg as I was nervous about carrying on taking medication whilst being pregnant as it can cause miscarriage, birth defects and premature labour. Allopurinol is a frequently prescribed drug. Pregnancy. Azathioprine does not affect sperm quality or male fertility. Recommendations for CSA in pregnancy and breastfeeding. Cyclophosphamide should never be used during pregnancy because of the high risk of important birth defects. There were steroids, sulfasalazine, many others, in between and finally azathioprine. Azathioprine should not be given during pregnancy without careful weighing of risk versus benefit. Breastfeeding: Generally considered safe - a small amount of the drug may pass to the baby, but studies have found no harmful effects. Azathioprine should not be given during pregnancy without careful weighing of risk versus benefit. Azathioprine Pregnancy Warnings. All possible dosages and . Usual doses are: Azathioprine - between 1.5mg and 2.5mg per kilogram of body weight a day. This information should not take the place of medical care and advice from your healthcare provider. Pregnancy. Whenever possible, use of azathioprine in pregnant patients should be avoided. The British National Formulary and other drug information sites suggest that azathioprine can be given in pregnancy.26 27 Azathioprine is considered lower risk in pregnancy when compared with other immunosuppressive agents. Background: The aim of this study was to describe prescription patterns for azathioprine and corticosteroids for pregnant women with inflammatory bowel diseases (IBD) before, during, and after pregnancy and to describe pregnancy outcomes. Azathioprine has been safely used in pregnancy; however women wishing to become pregnant should be discussed with the specialist team. The mean daily dose of azathioprine in AZA group was 75 mg (range 50 to 150 mg); a higher proportion of women in this group were taking prednisone during pregnancy compared with those not exposed to azathioprine (90.8 vs 76.4 %, p = 0.01), with a mean dose of 15.2 ± 11.8 and 13.7 ± 13.0 mg, respectively (Table 1). Treatment with azathioprine is therefore continued during pregnancy to prevent disease relapse and/or transplant rejection. Azathioprine and 6-MP are medications that decrease the activity of the body's immune system. On the other hand, a strong association between a genetic variant of . Using the French pregnancy database a prospective comparative study reported that first trimester exposure to azathioprine in 124 pregnancies was not associated with an elevated rate of birth defects . A corresponding patient information leaflet on azathioprine or mercaptopurine use in pregnancy is available at www.medicinesinpregnancy.org. Breast feeding. This drug should not be used for treating rheumatoid arthritis in pregnant women. However, in pregnancy the placenta can metabolize azathioprine to thiouric acid, an inactive metabolite. The rate of . In animal studies Azathioprine was teratogenic and embryotoxic (see section 5.3) Azathioprine and its metabolites have been found in low concentrations in foetal blood and amniotic fluid after administration to the mother. Positive evidence of human fetal risk exists based on investigational, marketing, or human studies, but the potential benefit to the mother may outweigh the potential risks to the fetus in some circumstances/diseases. Azathioprine (AZA) and its metabolite, 6-mercaptopurine (6-MP), which are widely used for maintenance treatment in IBD patients, have recently been recommended for continued use in pregnancy. This sheet is about using azathioprine or 6-mercaptopurine (6-MP) in pregnancy and while breastfeeding. Pregnancy: Pregnancy Category D Azathioprine can cause fetal harm when administered to a pregnant woman. Hi there, i am 29 and have crohns disease. Relevant precautions:1 Localised or systemic infection including hepatitis B or C and history of tuberculosis. Thus, AIH treatment should be continued during pregnancy. Pregnancy and Breast Feeding Azathioprine should not be given during pregnancy without careful assessment of risk versus benefit. Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn's Disease or Ulcerative Colitis (2018) This is the second Nurses European Crohn's and Colitis Organisation [N-ECCO] Consensus Statements document addressing inflammatory bowel disease [IBD] nursing across Europe. Azathioprine (AZA), although a category D medication, can be used if the benefits outweigh the risks. Although this statement achieved consensus, there was a strong minority opinion against the use of azathioprine in pregnancy. severe inflammation of the liver, skin or arteries. However, some studies have shown an association with premature birth and small-for-date babies. Because of extensive Azathioprine and its metabolites (6-MP and 6-thiouric acid . Answer An increasing body of evidence from prospective cohort studies suggests that azathioprine is safe for the fetus during pregnancy. In our study, pregnancy outcome of 115 prospectively followed pregnancies after paternal exposure to azathioprine or 6-mercaptopurine is compared to a control group of 341 pregnancies. Mothers on CSA should not be discouraged from breastfeeding (LOE 3, GOR D, SOA 100%). New Reply Follow New Topic. Azathioprine is a thiopurine that is 6-mercaptopurine in which the mercapto hydrogen is replaced by a 1-methyl-4-nitroimidazol-5-yl group. Leucopenia and/or thrombocytopenia have been reported in a . We reviewed the medical records of SLE pregnant women followed from January 2005 to April 2013. Is azathioprine safe in pregnancy and breastfeeding? As a . pregnancy (such as miscarriage, premature delivery, or complications of labor/delivery) than women without IBD, even if their disease is in remission. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus, and in kidney transplants to prevent rejection. This study showed that patients with low serum albumin, creatinine >65, urine PCR >50 and positive dsDNA antibodies at the time of the switch were more . I have been taking this drug for 4 years to control Crohn's Disease related problems. It is taken by mouth or injected into a vein.. Common side effects include bone-marrow suppression and . They are afraid to take a "cancer drug" during pregnancy. Azathioprine is a type of medicine called an immunosuppressant. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The most important thing is that your AIH is as controlled as well as possible during pregnancy. The thiopurine drugs azathioprine and 6-mercaptopurine are widely used for the maintenance of clinical remission in steroid-dependent inflammatory bowel disease (IBD). 2 , 4 , 5 Data of breastfeeding during immunosuppressive treatment are still scant though, and therefore this issue is being critically discussed in .