Table 2

Safety of drugs used for myasthenia in pregnancy and breast feeding

DrugAdverse effectsCommentsSafe in pregnancySafe in breast feeding
PyridostigmineNone reportedUse as normal—may need more frequent dosesYesYes
PrednisoloneNo convincing data for increased risk of cleft lip/palate Increased risk of GDM, hypertension, infectionsUse as normal—lowest effective dose. Screen for GDMYesYes
AzathioprineLeucopeniaUse as normal. Monitor WBC and LFTsYesYes
Ciclosporin/TacrolimusIncreased risk of GDM and hypertension with tacrolimusUse as normal. Screen for GDM
Monitor WBC, LFTs and creatinine
YesYes
Mycophenolate MofetilTeratogenic; quoted risks up to 25%Withdraw or switch to an alternative immunosuppressant drug prepregnancy. Do not stop abruptly if unplanned pregnancyNoUnknown
MethotrexateTeratogenic; quoted risks up to 15–20%Stop prepregnancy if possible. Allow 3 months wash out prepregnancy. Don't stop abruptly if unplanned pregnancy but give 5 mg folic acid dailyNoNo
Intravenous immunoglobulinNone reportedYesYes
  • GDM, gestational diabetes; LFTs, liver function tests; WBC, white blood cell count.