Paternal safety of anti-rheumatic medications

Publication date: Available online 8 October 2019Source: Best Practice & Research Clinical Obstetrics & GynaecologyAuthor(s): Bonnie L. BermasAbstractResearch into the safety of medications used to treat rheumatic diseases in men wishing to conceive is lacking. When evaluating medication safety for potential fathers, there are two major reproductive issues to consider first whether a drug induces infertility and second whether a drug can cause adverse pregnancy outcomes. Cyclopshophamide is the only medication used in rheumatic disease management that causes irreversible infertility. All men prescribed cyclophosphamide should be counseled on fertility preservation including sperm banking. Sulfasalazine can cause reversible azoospermia; when conception is delayed, this medication should be held for three months and semen analysis should be performed. There are limited dated on the teratogenic risk of paternal exposure to medications. Men wanting to conceive should avoid cyclophosphamide and thalidomide. Methotrexate; NSAIDs; glucocorticoids; sulfasalazine; the immunosuppressive agents azathioprine, 6-mercaptopurine, cyclosporine, tacrolimus and mycophenolate mofetil; colchicine; TNF-alpha blockers; hydroxychloroquine; IVIG; rituximab, abatacept and anikinra are compatible with paternal exposure. There are insufficient data to conclude safety of the other biologics and small molecules.
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research