Safety of drugs used for myasthenia in pregnancy and breast feeding
| Drug | Adverse effects | Comments | Safe in pregnancy | Safe in breast feeding |
|---|---|---|---|---|
| Pyridostigmine | None reported | Use as normal—may need more frequent doses | Yes | Yes |
| Prednisolone | No convincing data for increased risk of cleft lip/palate Increased risk of GDM, hypertension, infections | Use as normal—lowest effective dose. Screen for GDM | Yes | Yes |
| Azathioprine | Leucopenia | Use as normal. Monitor WBC and LFTs | Yes | Yes |
| Ciclosporin/Tacrolimus | Increased risk of GDM and hypertension with tacrolimus | Use as normal. Screen for GDM Monitor WBC, LFTs and creatinine | Yes | Yes |
| Mycophenolate Mofetil | Teratogenic; quoted risks up to 25% | Withdraw or switch to an alternative immunosuppressant drug prepregnancy. Do not stop abruptly if unplanned pregnancy | No | Unknown |
| Methotrexate | Teratogenic; 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 daily | No | No |
| Intravenous immunoglobulin | None reported | Yes | Yes |
GDM, gestational diabetes; LFTs, liver function tests; WBC, white blood cell count.