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12-04-2010, 08:28 PM   #1
Jess722
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Is Azathioprine safe during pregnancy??

Hi! I'm new to this forum and I am ecstatic to have found this thread! It is exactly what I have been looking for. I have been diagnosed with Crohn's Disease for 2 years now. Other than my initial diagnosis, I have only had one flare up where I was hospitalized. My CD has been fairly manageable for the most part. 4 days ago I was experiencing some cramping in my abdomin and decided to go to the ER. Luckily I went because that's when they discovered that I'm pregnant. I am so happy about this wonderful news but also very scared. Since finding out I am pregnant I visited my GI. He told me I need to stay on my CD mediciation, Azathioprine, because if I don't I risk having a flare up and can lose the baby. But the ER doctor and my general physician tell me not to take it because it passes through the fetal cord and can result in fetal fetality or birth defects. Both options are scary I don't know what to do and I would really like some insight on others experiences. Thanks for taking the time to read this! God bless!

Last edited by Jess722; 12-04-2010 at 08:31 PM.
12-04-2010, 11:26 PM   #2
Lydia
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The amount they give to crohns patients is way less than they give to organ recipients. At that dose its really unlikely to cause problems and its way safer than flaring during pregnancy. I will post a video for your information by the Mayo clinic.

It really does cover all bases including breastfeeding and all types of crohn's drugs. Hope that helps.

http://crohnstoday.com/the-impact-of...ancy/#more-147
12-05-2010, 01:02 AM   #3
Jess722
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Thank you Lydia!! This definitely helps me in making this tough decision.
12-26-2010, 10:28 PM   #4
corker77
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Congrats!!!! I myself found out I was pregnant 3 months into the pregnancy...surprise! That was almost 5 years ago to the day and my baby boy and I are fine. I too went to my GI as soon as I found out, questioning if I should continue the pregnancy and/or treatment? That was my first concern... effects of the drugs on my unborn baby. He reassured me that there was a chance of birth defects, but no greater than the average woman, unmedicated. He let me choose what I thought was best knowing all the facts. I chose to stay on all my medication (the highest dose available at the time for crohn's-I eventually did come off it as it was not effective anymore) and I have a very healthy 4 year old boy! VERY healthy I did't check out the link suggested above- it may say all this already- or the opposite. Of course I do not know your individual case, but if sharing my own experience with you helps at all, great! If you have any further questions maybe I can help. Good luck with everything!
01-04-2011, 04:56 AM   #5
violetcreams
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I'm into my 22nd week of pregnancy now & am continuing to taka aza, budesonide, pentasa & mebeverine. Baby's doing really well & so am I. I need to stay well in order for the baby to do well. Absolute priority.
01-04-2011, 03:34 PM   #6
Astra
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Congratulations!

There's a thread and a link on here about treatment, can't think where tho!
But basically the doc in the report said that to come off all meds during pregnancy would do the baby more harm if you started flaring severely, and the baby not getting any nutrients. He said it's safer to stay on Aza and be symptom free.
xxx
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Dx Crohn's in TI 2005 symptoms for 15 years prior

BEEN ON -Azathioprine, 6MP, Prednisolone, Pentasa, Budesonide, Metronidazole, Humira, Methotrexate,

NOW ON -Amitriptyline 25mg
21/02/14 Right hemicolectomy surgery




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01-07-2011, 07:09 PM   #7
Jess722
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Thanks for the replies! After much debate & research I decided to stay on Aza and I feel confident in my choice. So technically I only went 1 week without taking it and I feel so much better now that I'm back on it. Best wishes to everyone!
01-08-2011, 07:08 PM   #8
Manzyb
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Hey Jess! How are you feeling? Are you doing good still?
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01-23-2011, 06:24 PM   #9
faith76
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Hi!
I'm new to this site and am so happy I found this thread, as this has been my concern as well! I'm approaching 35 and am hoping to get pregnant soon. I am currently on 100mg of azathioprine. My OB, a high-risk OB, and my two gastros advised me that it's more important to stay on the azathioprine; however, my eye doctor, who prescribed me azathiroprine to treat my iritis (inflammation of the iris---an autoimmune disease that's associated with IBD) is adamant about me taking it. It's so frustrating when doctors have different opinions. I'm so happy to know that people are feeling well on it. Best of luck to you all!
02-23-2011, 05:15 PM   #10
Esraa
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my doctor told me there is an alternative to imuran ... Have he told any of u??
an injection that could be taken every 2 weeks ?
03-16-2011, 01:18 PM   #11
HealthyforYears
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I've been on 150 mg Aza (Imuran) for about 13 years. I'm 5 months pregnant and was advised to stay on it. The most important thing is that the mother is healthy. So far, everything is normal and we've had no issues. I'm having a 3D scan in 3 weeks to check for any skeletal defects, but all of the blood work and the amnio have come back fine. My concern is now turning to breastfeeding while on Imruan. I've heard/read conflicting advice. Does anyone have any input regarding this?
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03-16-2011, 01:35 PM   #12
Terriernut
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I've read it's safe during pregnancy, but not necessarily during breastfeeding. Personally, I would ask my pharmacist as they will know more about drugs than most Dr's...yes, it's true! Then I'd ask the Dr.

I've got a prescription to start Azathioprine...but I've not filled it yet...bit scared of it to be honest.
Misty
03-16-2011, 02:13 PM   #13
Lydia
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There are lots of mothers who breastfeed on Imuran. It is considered to be generally safe. Some take it and then pump and dump 2 hours later, and some dont even do that. Most medications peak in milk 2 hours after ingestion.
04-04-2011, 11:41 AM   #14
Jess722
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Hi everyone! It's been awhile since I've been on here. I am now 5 months into my pregnancy and so far eveything is going pretty good. I am actually experiencing my first flare up since getting pregnant, which is kind of scary. But other than this minor setback I'm feeling good. I am still taking Azathioprine, along with Folic Acid and my Prenatal vitamins. Baby is kicking and doing flips and has a steady heartbeat at 150 bpm. We have an ultrasound scheduled for tomorrow to find out the sex....yay! Hopefully our baby will sit still long enough for us to see if they're a boy or girl. I'll keep everyone posted on me & baby's condition. Thanks everyone for you concerns. God bless!
05-18-2011, 02:25 PM   #15
MacCartI
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Hi, I'm new to this forum too and so glad it exists! I've got 'UC as yet unspecified' with some Crohn's features and some UC features. Diagnosed in 1996, it was never that bad really, till I got pregnant in 2008. I was already in a flare-up when I conceived, which may not have been that clever, but things got really bad really quickly. The main culprits were malabsorption of nutrients so really bad anaemia, low immune system so constant kidney infections and -- the worst -- an anal fissure that wouldn't heal and that eventually led to an abcess. The reason I'm telling this grim story is because my pregnancy resulted in a perfectly healthy, wonderful baby girl who is now almost 2. She was born a bit early (at 37.5 weeks) and tiny (1.95 kg), but in great shape and with a will to thrive that totally took us by surprise. I'm not recommending drug taking during pregnancy, but if you -- like me -- find you have to take massive doses of steroids, frequent antibiotics, an epidural (for an operation on my bum), 2 blood transfusions (for anaemia), infliximab (one infusion -- and fortunately I only needed one for my UC/CD to behave -- 8 weeks before delivering), etc etc, don't despair! I'm now trying to conceive again, in better condition this time, so fingers crossed. Best wishes to you all.
05-18-2011, 02:41 PM   #16
Terriernut
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Wow! What a sweet baby girl...Girls are TOUGH arent they?? I wonder though, being a grandma now, (thru my partner, I couldnt have children) how on earth you take care of a baby while so sick? Oh bless your heart!

Misty
05-18-2011, 03:08 PM   #17
MacCartI
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Well, my story gets better after pregnancy you see. Infliximab, which was finally administered at 29 weeks after all else had failed, covered me really well for the end of the pregnancy and it has continued to work really well since then. My tummy has been in remission since then, so I even managed to breastfeed Beatrice for 9 months. I did, in the end, have a flare-up of mouth ulcers (hundreds of them all over my mouth, tongue, gums, cheeks...) which meant I started to lose weight and go a bit downhill again. So I gave up breastfeeding (a really hard decision) and they started me on pred. I'm off pred now and well again, and if it weren't for the odd mouth ulcer (the bane of my life) I'd have forgotten just how ill I can be.

Good luck with your grandchildren Misty. Grandmas are great!

Last edited by MacCartI; 05-18-2011 at 03:09 PM. Reason: slip of the keyboard...
07-04-2011, 05:43 AM   #18
Julie1971
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Hi Jess

Hope you're still doing well - you'll be 7 months by now? I know this is a bit of an old thread but felt I had to add my bit. Have had Crohn's Disease for over 20 years and been on Aza/Imuran(100mg a day) since 2003. After my last surgery in April 2009, we had IVF which worked first time and I was ecstatic to be pregnant at last, with twins. Had to stay on Aza though as my Dr said the risk to me was too great to me to come off it (the worst thing for the baby being a bad flare up during pregnancy) It isn't an easy thing taking such strong meds during pregnancy, but I knew I had to be sensible about it. Unfortunately one of the twins stopped growing at 9.5 weeks (nobody knows why). Our other one was a little fighter though and we found out he was a boy at our 20 week scan. I kept really, really well during pregnancy - absolutely loved being pregnant. I had a great Ob who kept a really close eye on me and had lots of growth scans but he was healthy and growing all the way through. We had a C section booked for 38 weeks, but our boy had other ideas and I started labour (slowly) at 37 weeks on the dot. A few days later after 16 hours of pretty sore labour Jack was born weighing 6lbs 14 oz and was just perfect. He's now the most adorable, happy, healthy 11 month old baby and is the absolute joy of our lives. He has made everything I have gone through worthwhile and more!!

Anyway, still feeling well, we decided to have another try at IVF and although the hormones all caused my bowel to swell up this time, everything has settled down again and I am pleased to say I have just got a positive pregnancy test this morning. So we're doing it all again (still on Imuran) and everything crossed for health and another great outcome.

As I was feeling well at the end of my pregnancy I made the decision to come off the Imuran so I could breast feed Jack I know there is some discussion about it being safe to breast feed on it, but I wasn't happy with what I read. Anyway, managed to be off it and feed him until 5 months, when I felt the Crohn's starting to rumble a bit. I went back on it and everything stabilised again in a few months.

Wishing you all the very very best!

xJulie

ps - one side effect of the Aza can be a slightly early baby, so I would be prepared for that (it came as a bit of a shock to me to go in to labour at 37 weeks!
07-14-2011, 03:45 PM   #19
mohammed
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their is conflict , some doctor do not advice to take imran during pregnancy but other doctors have patients on imuran and they are doing well and delivering totally fine baby.
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surgical :
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08-01-2011, 10:55 PM   #20
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I faced the same dilemma and chose to go off azathioprine, against my doctors wishes. I'm 20 weeks and doing fairly good, but worry about getting a flare-up!
08-02-2011, 09:49 AM   #21
xJillx
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Most women seem to do well while pregnant. The body's immune system naturally suppresses itself so not to harm the baby. So, just take good care of yourself (and baby) and try not to stress about it too much. Good luck and keep us posted!

Are you going to start your azathioprine again after giving birth? These is some debate about the postpartum period being difficult, however, results are unclear being that the reason could be many mothers stop their medication to breastfeed.
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I am still sick and so confused...
08-04-2011, 10:20 AM   #22
Smiley
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Hi All,

I have just found this forum and it is exactly what I need right now.
I was diagnosed with a severe form of Chrohn's last year, November 2010. I presented with a ruptured bowel, so direct to the operating table. 4 weeks later I was leaving the hospital with a stoma. 6 months later luckily it was being removed- back to some sort of normaility.
My consultant recommended I start on Azathioprine right aways due to the way I presented- I was not keen so didn't start taking it. It is now August and I have just done an MRI- which shows nothing :-) and a colonoscopy- which shows a slight inflamation and presence of Crohn's where I had the resection.
My husband and I fell pregant but lost the baby, and have decided to wait a few months before we try again.
Following my recent results my consultant is adamant that I start on Aza before I fall pregnant, as the risk of flare up would be worse than the Aza- I am so confused!!!
I am 35 and don't want to risk harming my 'future' unborn child, and recognise the benefits of breasfeading, both for it's health and emotional development...

Sorry just saw the consultant today and needed to share with people who understand...

I welcome any opinions you may want to send my way and thank you for giving me the oportunity to unburden...
08-12-2011, 10:10 AM   #23
Lydia
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Hi All,

I have just found this forum and it is exactly what I need right now.
I was diagnosed with a severe form of Chrohn's last year, November 2010. I presented with a ruptured bowel, so direct to the operating table. 4 weeks later I was leaving the hospital with a stoma. 6 months later luckily it was being removed- back to some sort of normaility.
My consultant recommended I start on Azathioprine right aways due to the way I presented- I was not keen so didn't start taking it. It is now August and I have just done an MRI- which shows nothing :-) and a colonoscopy- which shows a slight inflamation and presence of Crohn's where I had the resection.
My husband and I fell pregant but lost the baby, and have decided to wait a few months before we try again.
Following my recent results my consultant is adamant that I start on Aza before I fall pregnant, as the risk of flare up would be worse than the Aza- I am so confused!!!
I am 35 and don't want to risk harming my 'future' unborn child, and recognise the benefits of breasfeading, both for it's health and emotional development...

Sorry just saw the consultant today and needed to share with people who understand...

I welcome any opinions you may want to send my way and thank you for giving me the oportunity to unburden...
I am in the same boat. I failed remicade and now I am on imuran. I am on a bunch of other drugs while I wait for the imuran to work so we are on birth control for a few months. When we start trying again I decided that I will stay on imuran during pregnancy. My GI says the benefits are greater than the risk. He has never had a patient give birth to a child with birth defects on imuran, and I trust him. I also found a stat in my research that said that 9 out of 10 GI doctors prefer their patients stay on imuran while pregnant.

Breastfeeding is also really important to me so I actually found the research that has to do with breastfeeding on imuran, and it seems pretty safe to me. I was in unmedicated remission with my first child, so I didnt have to worry about this stuff the first time around. I really enjoyed nursing my baby, and I cant imagine missing out on it.

Here is the actual research regarding imruan and breastfeeding.
http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~9pRBwT:1

Azathioprine
CASRN: 446-86-6
[Chemical structure for Azathioprine]
For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Authors of some older papers recommend against breastfeeding during azathioprine use, citing concern over possible immunosuppression, growth retardation and carcinogenesis.[1][2][3] However, these concerns appear to be based on theoretical grounds and more recent expert opinion is that azathioprine is a low risk to the nursing infant and breastfeeding can continue during therapy for inflammatory bowel disease. Studies women with inflammatory bowel disease, systemic lupus erythematosus or transplantation taking doses of azathioprine up to 200 mg daily for immunosuppression have found either low or unmeasurable levels of the active metabolites in milk and infant serum. No adverse infant effects have been reported. Some evidence indicates a lack of adverse effects on the health and development of infants exposed to azathioprine during breastfeeding up to 3 years of age, but long-term follow-up for effects such as carcinogenesis have not been performed. Mothers with decreased activity of the enzyme that detoxifies azathioprine metabolites may transmit higher levels of drug to their infants in breastmilk. Breastfeeding during azathioprine use is usually acceptable.[4][5] It might be desirable to monitor exclusively breastfed infants with a complete blood count with differential, and liver function tests if azathioprine is used during lactation, although some authors feel that monitoring is unnecessary.[6] Avoiding breastfeeding for 4 to 6 hours after a dose should markedly decrease the dose received by the infant in breastmilk.


Drug Levels:
Azathioprine is rapidly metabolized to the active metabolite mercaptopurine which is further metabolized to active metabolites including 6-methylmercaptopurine, thioguanine, 6-thioguanine nucleoside (6-TGN) and 6-methylmercaptopurine nucleosides (6-MMPN). The enzyme thiopurine methyltransferase (TPMT) is responsible for metabolism of 6-TGN. Deficiencies in this enzyme can lead to excessive toxicity.

Maternal Levels. Mercaptopurine milk levels were measured in 2 patients receiving azathioprine following renal transplantation. In one mother who was 2 days postpartum, peak colostrum levels occurred 2 and 8 hours after a 75 mg oral dose and were 3.4 and 4.5 mcg/L, respectively. In the other mother who was 7 days postpartum, a peak mercaptopurine milk level of 18 mcg/L occurred 2 hours after a 25 mg oral dose.[7] The milk levels of these 2 mothers correspond to 0.05% and 0.6% of the maternal weight-adjusted dosages, respectively. Infant serum levels were not measured.

Four women receiving an immunomodulator to treat inflammatory bowel disease had metabolite levels measured in milk during the first 6 weeks postpartum. The abstract does not mention the specific drug and dose being taken, but the azathioprine metabolites 6-methylmercaptopurine (6-MMP) and 6-thioguanine nucleoside (6-TGN) were measured. Although therapeutic levels were found in maternal serum, 6-MMP (<650 mcg/L) and 6-TGN (<123 mcg/L) were undetectable in milk (time of collection not stated).[8]

A case series described 2 mothers who took azathioprine 100 mg daily while breastfeeding. Each mother collected milk samples over a 24-hour period, 5 and 6 samples, respectively. Mercaptopurine was undetectable (<5 mcg/L) in all of the samples. The authors estimated that the maximum dose of mercaptopurine that a completely breastfed infant would receive would be 0.09% of the maternal weight-adjusted dosage or 0.07% of the dose given to infants following cardiac transplantation.[9]

Ten women who were taking azathioprine 75 to 150 mg daily at the time of delivery for systemic lupus erythematosus (n = 7), renal transplant (n = 2) or Crohn's disease (n = 1) donated milk samples on days 3 to 4, 7 to 10 and 28 postpartum. Milk was collected before the single daily dose and at each breastfeed for 12 to 18 hours for a total of 31 samples. Only one woman taking azathioprine 100 mg daily had mercaptopurine detected in her milk. On day 28 postpartum, milk mercaptopurine concentrations were 1.2 mcg/L at 3 hours and 7.6 mcg/L at 6 hours after the dose.[10]

Eight lactating women who were 1.5 to 7 months postpartum were taking azathioprine in dosages ranging from 75 to 200 mg daily for inflammatory bowel disease. All of the women had normal TPMT phenotypes. Peak mercaptopurine milk concentrations occurred within the first 4 hours after ingesting of the dose of azathioprine and ranged from 2 to 50 mcg/L. By 5 hours after the dose, the milk concentrations of mercaptopurine had dropped markedly in all patients. The authors estimated that the "worst case" infant intake of mercaptopurine would 0.0075 mg/kg daily which is less than 1% of the maternal weight-adjusted dosage.[11]

Infant Levels. Four infants were breastfed (3 exclusively, 1 rarely received formula) during maternal use of azathioprine orally in dosages of 1.2 to 2.1 mg/kg daily. All of the mothers and infants had the normal TPMT *1/*1 genotype and all of the mothers had normal enzyme activity. At 3 to 3.5 months of age, all of the infants had undetectable blood levels of 6-TGN and 6-MMPN.[12] The authors later updated this report to include 2 previously unreported mother-infant pairs. These infant also had undetectable blood levels of 6-TGN and 6-MMPN.

Seven infants were breastfed during maternal intake of azathioprine in single oral doses of 75 to 150 mg daily. None had detectable mercaptopurine or thioguanine in their blood obtained between days 1 and 28 postpartum.[10]

Three infants whose mothers were taking azathioprine for inflammatory bowel disease (n = 2) or systemic lupus erythematosus (n = 1) were breastfed during maternal use of azathioprine. Azathioprine doses were 100 mg (plus prednisolone), 150 mg (plus infliximab) and 175 mg daily. In 1 infant, thioguanine was low, but detectable in blood at 3 days of age and 6-MMPN was undetectable; at 3 weeks of age, neither metabolite was detectable. In another infant, neither metabolite was detectable at 3 weeks of age. Neither assay limits nor specific maternal doses were stated in the published abstract.[13]

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. 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. The assay limit was not stated.[14]


Effects in Breastfed Infants:
Three infants were breastfed during long-term maternal azathioprine 75 to 100 mg daily and methylprednisolone use following renal transplantation. All three infants had no abnormal blood counts, no increased frequency of infections and above average growth rates.[7][15] In one mother, the IgA levels in breastmilk were measured and found to be normal.[7]

One infant was breastfed for 6 days after birth in a mother who was taking azathioprine 75 mg daily in addition to cyclosporine. Nursing was interrupted for 4 days, then partial breastfeeding was reestablished. The infant showed no signs of renal or neurologic toxicity or hirsutism during long-term follow up.[16]

Twelve infants were breastfed for up to 12 months during maternal use of azathioprine 50 to 100 mg daily (6 with concomitant cyclosporine) following kidney or kidney-pancreas transplantation. Kidney function was normal in all infants when measured after breastfeeding had ceased. The growth and psychomotor development of all infants was normal.[17]

One infant was exclusively breastfed for 10.5 months during maternal use of azathioprine 100 mg daily, cyclosporine and prednisone. Partial breastfeeding continued for 2 years. The infant thrived with normal growth at 12 months. The mother also breastfed a second child while on the same drug regimen.[18]

Four infants were breastfed (3 exclusively, 1 rarely received formula) during maternal use of azathioprine orally in dosages of 1.2 to 2.1 mg/kg daily. At 3 to 3.5 months of age, all infants were healthy and were within the 50th to 95th percentiles on growth charts.[12] The authors reported 2 additional infants who received azathioprine via breastmilk with no adverse reactions detected.[19]

In another case series, 4 infants were breastfed (partially in 1 case, not stated in the others) during maternal use of azathioprine. Two mothers were taking 100 mg daily, 1 took 75 mg daily and 1 took 50 mg daily and partially breastfed her preterm infant. All were taking several other medications concurrently. One infant was followed up at 1 month, 2 at 2 months and 1 at 1 year of age. No adverse event were reported in any of the infants and were growing and developing normally.[9]

Six infants whose mothers were breastfeeding and taking azathioprine were monitored monthly for the duration of their breastfeeding with blood counts and for evidence of infection. One infant developed a low blood count and breastfeeding was discontinued; the other 5 infants continued to breastfeed apparently without harm. The dosages of azathioprine, concurrent medications and the extent of breastfeeding were not reported in the brief published abstract.[20]

Ten infants, 3 preterm, were breastfed during maternal intake of azathioprine in single oral doses of 75 to 150 mg daily. No signs of immunosuppression were seen in the infants during the first 28 days postpartum. In 7 of the infants, white cell and neutrophil counts were performed between days 1 and 28 postpartum. One infant had a borderline low neutrophil count but a normal white cell count.[10]

Three infants whose mothers were taking azathioprine for inflammatory bowel disease (n = 2) or systemic lupus erythematosus (n = 1) were breastfed during maternal use of azathioprine. Azathioprine doses were 100 mg (plus prednisolone), 150 mg (plus infliximab) and 175 mg daily. The first infant was breastfed for 12 months and the other 2 were breastfed for up to 4 months; the extent of breastfeeding was not stated. The infants' blood cell counts were normal at birth or 3 weeks of age and follow-ups at 24, 22 and 4 months of age, respectively, found normal growth and no recurrent infections.[13]

A survey of women with autoimmune hepatitis found that 8 infants of 4 women had been breastfed (extent not stated) during maternal azathioprine use in unspecified dosages. No adverse effects were reported by the mothers.[21]

An infant was breastfed (extent not stated) from birth to the age of 3 months during maternal therapy with azathioprine 100 mg (1.4 mg/kg) daily. During the 6 months of follow-up, the infant thrived and had no infections.[14]

A nonrandomized, prospective study followed the infants of 23 women with inflammatory bowel disease who were treated in one clinic. Mothers who received azathioprine (median dose 150 mg daily; range 100 to 250 mg daily) for treatment breastfed for a median of 6 months (range 1 to 18 months) and those who did not take azathioprine breastfed for a median of 8 months (range 3.5 to 23 months). Follow-up occurred at a median of 3.3 years in the azathioprine-exposed infants (n = 15) and 4.7 years in the unexposed infants (n = 15). No differences were found in mental or physical development between the two groups of infants. More infants who were unexposed to azathioprine had more than 2 colds annually and conjunctivitis episodes than in the unexposed group. No difference was seen in the numbers of other infections between the groups.[22]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:
(Immunosuppression) Cyclosporine, Tacrolimus, (Inflammatory Bowel Disease) Budesonide, Infliximab, Mesalamine, Prednisone, (Systemic Lupus Erythematosus) Hydroxychloroquine, Prednisone


References:
1. Ramsey-Goldman R, Schilling E. Optimum use of disease-modifying and immunosuppressive antirheumatic agents during pregnancy and lactation. Clin Immunother. 1996;5:40-58.
2. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation. Arch Intern Med. 2000;160:610-9. PMID: 10724046
3. Rayburn WF. Connective tissue disorders and pregnancy. Recommendations for prescribing. J Reprod Med. 1998;43:341-9. PMID: 9583066
4. Ha C, Dassopoulos T. Thiopurine therapy in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol. 2010;4 :575-88. PMID: 20932143
5. van der Woude CJ, Kolacek S, Dotan I et al. European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohn's Colitis. 2010;4:493-510. PMID: 21122553
6. Christensen LA, Dahlerup JF, Nielsen MJ et alK. Azathioprine treatment during lactation: authors' reply. Aliment Pharmacol Ther. 2009 ;30:91. PMID: 19566905
7. Coulam CB, Moyer TP, Jiang NS et al. Breast-feeding after renal transplantation. Transplant Proc. 1982;13:605-9. PMID: 6817481
8. Kane SV, Present DH. Metabolites to immunomodulators are not detected in breast milk. Am J Gastroenterol. 2004;99 (10 Suppl. S):S246-7. Abstract 761.
9. Moretti ME, Verjee Z, Ito S, Koren G. Breast-feeding during maternal use of azathioprine. Ann Pharmacother. 2006;40:2269-72. PMID: 17132809
10. Sau A, Clarke S, Bass J et al. Azathioprine and breastfeeding-is it safe? BJOG. 2007;114:498-501. PMID: 17261122
11. Christensen LA, Dahlerup JF, Nielsen MJ et al. Azathioprine treatment during lactation. Aliment Pharmacol Ther. 2008;28:1209-13. PMID: 18761704
12. Gardiner SJ, Gearry RB, Roberts RL et al. Exposure to thiopurine drugs through breast milk is low based on metabolite concentrations in mother-infant pairs. Br J Clin Pharmacol. 2006;62:453-6. PMID: 16995866
13. Bernard N, Garayt C, Chol F et al. Prospective clinical and biological follow-up of three breastfed babies from azathioprine-treated mothers. Fundam Clin Pharmacol. 2007;21 (Suppl. 1) :62-3. Abstract.
14. Zelinkova Z, De Boer IP, Van Dijke MJ et al. Azathioprine treatment during lactation. Aliment Pharmacol Ther. 2009;30:90-1; author reply 91. PMID: 19566905
15. Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppresive therapy and breast-feeding after renal transplantation. Nephron. 1984;37:68. Letter. PMID: 6371564
16. Madill JE, Levy G, Greig P. Pregnancy and breast-feeding while receiving cyclosporine A. In: Williams BAH S-GD, eds. Trends in organ transplantation. New York: Springer Publishing Company, 1996:109-21.
17. Nyberg G, Haljamae U, Frisenette-Fich C et al. Breast-feeding during treatment with cyclosporine. Transplantation. 1998;65:253-5. PMID: 9458024
18. Munoz-Flores-Thiagarajan KD, Easterling T, Davis C et al. Breast-feeding by a cyclosporine-treated mother. Obstet Gynecol. 2001;97(5 pt 2):816-8. PMID: 11336764
19. Gardiner SJ, Gearry RB, Roberts RL et al. Comment: breast-feeding during maternal use of azathioprine. Ann Pharmacother. 2007. PMID: 17389671
20. Khare MM, Lott J, Currie A, Howarth E. Is it safe to continue azathioprine in breast feeding mothers? J Obstet Gynaecol. 2003;23 (Suppl 1):S48. Abstract 53.
21. Werner M, Bjornsson E, Prytz H et al. Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding? Scand J Gastroenterol. 2007;42:986-91. PMID: 17613929
22. Angelberger S, Reinisch W, Messerschmidt A et al. Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding. J Crohns Colitis. 2011;5:95-100. PMID: 21453877



Substance Identification:


Substance Name: Azathioprine

CAS Registry Number: 446-86-6

Drug Class:
Immunosuppressants

Administrative Information:


LactMed Record Number:
20


Last Revision Date:
20110503

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
08-16-2011, 02:50 AM   #24
Smiley
New Member
 
Join Date: Aug 2011
Hi Lydia,
Thank you for your post and for your advice. I will have a look at the research you suggested.
I have just found out that I am pregnant, we wanted to wait but I guess mother nature has other plans...
Will have to see my consultant again as this changes things- don't want to start on Azathioprine now...
Let's see what happens
01-03-2012, 12:02 PM   #25
~Manders~
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Join Date: Dec 2011
Location: Ontario, Canada

My Support Groups:
Jess - you should have had the baby by now. Any updates?? How are things now? Are you still taking Aza? Are you breastfeeding? Hope all is well!!

My husband and I will be TTC in about 6 months, and I'm currently on 3.5 pills of Azathioprine (not sure what that is in mg, but I think 175?) I only flare every 2 or 3 months...and it lasts no more than 2 or 3 days. I'm considering going off Aza to see how my body reacts without it before TTCing. Any thoughts? It seems that Aza is ok during pregnancy, but I'm thinking that if I don't have to chance it, why should I?? I don't know...there is just so much to think about!! It's very confusing!
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http://www.crohnsforum.com/showthread.php?t=30351
03-10-2012, 07:44 PM   #26
rbuckman
New Member
 
Join Date: Mar 2012
Location: Sydney, New South Wales, Australia
Hi there,

I have been taking 50mg of Imuran since 2001. I found out I was pregnant at 5 weeks and was instructed by my specialist to go onto 7.5mg of prednisone for the first trimester. I went back onto Imuran at 16 weeks and I am now 33 weeks and bub is growing well. I plan on breastfeeding while taking Imuran but will check with my specialist if I need to take any precautions.
01-05-2013, 09:34 PM   #27
Ingee
 
Join Date: Jan 2013
Location: Dunedin, New Zealand
Hi All. I am a new user. My name is Ingrid and I am 29years old. I live in NZ. I was diagnosed 10years ago with Rhuematoid arthritis and was on methotrexate until march 2012 when my husband and I decided we wanted to start ttc. We then switch on to azathioprine and I have just found out I am 8 weeks pregnant. It is really hard to find much information on RA and the use of azathioprine and pregnancy but there is a lot of information on it use with Crohn's. Therefore I hope none of you mind that an RA imposter has joined your forum. I am having a dating scan tomorrow and will find out exactly how far along I am. I have an obstrician and she has advised me to have a csection due to the chance of low birth weight which is a risk of azathioprine. I am fine with this as this is my 1st child. I have been reading the posts above on breat feeding and there is some really positive research there. This forum has helped me feel so much more positive. Who has had a amnio to check everything is ok? Would love to hear more from your experiences. xoxoxo
02-02-2013, 01:46 PM   #28
Rebecca85
Senior Member
 
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Join Date: Apr 2010
Location: Nottingham, UK
Hi, I gave birth to a little girl 3 months ago. I took aza throughout pregnancy and am now breastfeeding still on aza. My little girl is perfectly healthy. I was classed as a high risk pregnancy and given extra growth scans because of the risk of low birth weight. Well as it happens she was big! I had gestational diabetes, and once that was under control she stopped growing so quickly and was 6lb 14oz at birth (2 weeks before due date).

I was told that I could choose natural or c section birth. I wanted to go natural. But then Robyn was breech so I ended up with a section anyway.
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Crohn's in the terminal ileum, dxed Jun '10

125mg azathioprine
4g Pentasa
02-02-2013, 06:38 PM   #29
Ingee
 
Join Date: Jan 2013
Location: Dunedin, New Zealand
Hi Rebecca
Thanks that is really helpful! I am going for my 13 week scan tomorrow. Did you have an amnio when you were pregnant with Robyn? I have been advised to have one to make sure the baby is ok. I have a feeling that I may end up with gestational diabetes as I also take steriods and this may contribute to it. I am so glad that everything went well for you and to know that you are breast feeding now. Have they tested your milk to see how much azathioprine Robyn gets? I have read alot that says you should take your meds 8-9 hours before breast feeding and that you should pump and dump your first lot of milk in the morning if you take your meds at night as this is when the azathioprine will be at the highest concentrated amount in your milk. What are you doing? Its really helpful to hear what others are doing. Thanks for replying and enjoy your precious bundle!
02-20-2013, 06:58 AM   #30
Rebecca85
Senior Member
 
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Join Date: Apr 2010
Location: Nottingham, UK
I didn't have an amnio, I wasn't aware that we were at increased risk for anything other than low birth weight.

My milk hasn't been tested, but I split my dose (50mg in the morning and 50mg in the evening). Most of the studies done on aza have been on transplant patients taking larger amounts- and even then not all patients have aza in their milk, and those that do have such a tiny amount it works out at a fraction of a 2mg per kg dose.

Take meds 8-9 hours before breastfeeding? Let me know how that works out! Robyn has only gone 8 hours between feeds once and that was because she was really poorly! A more realistic maximum is 4 hours between feeds.
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