Arthritis medication during pregnancy

Which arthritis drugs are safe if you're pregnant?

If you’re pregnant or planning a pregnancy, it’s important to discuss your arthritis treatment plan with your doctor.

This section goes through the most commonly used drugs for arthritis. The information has been taken from the British Society for Rheumatology (BSR) and updated with more recent guidance from the American College of Rheumatology (ACR) to highlight which drugs are safe to take.

We have produced two tables which summarise which drugs are safe to take in pregnancy:

Summary table of pregnancy safety for painkillers, NSAIDs, anticoagulants, bisphosphonates and hypertensives (PDF, 622 KB).

Summary table of pregnancy safety for steroids, DMARDs, anti-TNFs and other biologics (PDF, 640 KB).

The information in these tables and in this section is meant to be used as a rough guide to aid in deciding the best medication route for you. Please discuss this drug information with your doctor, and don’t stop taking your medication without speaking with them first.

For more information on each of these drugs, you can visit the drugs section of our website and select the drug you wish to know more about.

Painkillers

Paracetamol is safe to use throughout pregnancy. But it’s usually advised to only use it as and when you need it, as continuous use may increase the risk of childhood asthma.

Codeine should be fine to take throughout the pregnancy, but caution is advised when breastfeeding as it could affect the baby.

There aren’t many studies that have looked into the safety of tramadol, but it should be OK to take during pregnancy and on a short-term basis when breastfeeding.

There isn’t much data on paracetamol, codeine or tramadol use in men trying for a baby. But it’s unlikely to be harmful as they are all fine for women to take when trying for a baby.

Other long-term pain treatments

Amitriptyline is fine to take throughout pregnancy and should also be fine to take at a low dose during breastfeeding. There aren’t any studies on how it could affect a man wanting to try for a baby. But as it’s fine for the mother to take, it should also be safe for a man wanting to father a child.

There is no data on the use of gabapentin or pregabalin throughout pregnancy or breastfeeding. So, these drugs should be avoided for the time being, until there’s more information available.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs include ibuprofen, naproxen, diclofenac and indomethacin. Some studies suggest that taking NSAIDs in the first three months of pregnancy may increase the risk of miscarriage. As such, BSR guidelines advise cautious use of these drugs in early pregnancy. The guidelines also recommend stopping NSAIDs completely after 32 weeks of pregnancy.

Aspirin is also an NSAID, but unlike other NSAIDs, low-dose aspirin can be taken safely throughout pregnancy.

Cox-2 inhibitors should be avoided during pregnancy due to the lack of information available.

A common problem with NSAIDs is indigestion, which is also common during pregnancy. Antacid medication usually helps, but if it’s very troublesome, you should tell your doctor.

Steroids

Steroid tablets can be taken during pregnancy but it’s important you discuss what you’re taking with your doctor.

If you’ve been on high doses of steroids for a long time, you may be given an extra boost of steroids to help your body cope with the stress of labour.

Prednisolone is safe to take during pregnancy and breastfeeding. Men are also fine to take it when trying for a baby.

Methylprednisolone works in a similar way to prednisolone, so is also fine to take.

Women taking steroids throughout pregnancy are advised to take supplements of calcium and vitamin D to help prevent osteoporosis.

Steroids, particularly if taken for a long time, or at high doses, can increase the risk of some pregnancy complications like gestational diabetes. So, your doctor will try to keep you on the lowest possible dose for the shortest possible time.

Disease-modifying anti-rheumatic drugs (DMARDs)

Hydroxychloroquine

Hydroxychloroquine is often taken to prevent malaria as well as to treat arthritis and lupus. It can be taken during pregnancy and while breastfeeding. A study showed that women with lupus who continued taking this drug during pregnancy were able to control their condition much better than those who stopped.

Methotrexate

Methotrexate should be stopped three months before you become pregnant. If you become pregnant while taking methotrexate, or if you’ve had less than a three-month break from the drug, it’s important you speak to your doctor as soon as possible. They might have to conduct additional baby scans to make sure everything is OK. You’ll also be prescribed a higher dose of folic acid (5mg a day) to take throughout the pregnancy.

It used to be recommended that men stop methotrexate three months before trying for a baby, but research now shows it’s fine to continue.

Sulfasalazine

Women can continue taking sulfasalazine when trying for a baby and during pregnancy. You will need to take folic acid tablets of 5mg per day, which need to be prescribed by your doctor. Breastfeeding should also be fine if the baby is healthy, but you should be cautious if the baby is premature.

Sulfasalazine may affect sperm count, but this side effect is reversible. Current guidelines say that it’s not necessary for men to stop taking sulfasalazine before trying to conceive. If you’ve been trying to father a child for a year or more while on sulfasalazine, you should discuss this with your doctor and arrange to see a fertility specialist to rule out other issues.

Leflunomide

Leflunomide should not be taken if pregnant or breastfeeding. If you’re a woman considering pregnancy, you should discuss stopping with your doctor. You may need a washout treatment to help remove it from your body more quickly. After this, you’ll be started on a drug that can be taken safely during pregnancy.

Based on very limited research, men should be fine to take leflunomide.

Azathioprine

Azathioprine can be taken in pregnancy and while breastfeeding, but you may need to be on a lower dose.

Ciclosporin and tacrolimus

Ciclosporin and tacrolimus can be taken in pregnancy. But it’s likely you’ll be closely monitored to make sure your blood sugar levels, blood pressure, kidney function and drug levels are all OK.

Cyclophosphamide

Cyclophosphamide can affect fertility and shouldn’t be taken if planning a pregnancy. Before starting this drug, it's important to tell your doctor if you want to have children. You should discuss with your doctor whether to have some sperm stored or given medication to protect your ovaries before treatment is started.

Cyclophosphamide is only considered during pregnancy if your condition becomes life threatening.

Mycophenolate mofetil

You should stop taking mycophenolate six weeks before trying for a baby. It’s important you discuss this with your doctor so that you can switch onto a drug that’s safe to take during pregnancy. You shouldn’t take this drug while breastfeeding.

Based on very limited research, men should be OK to take mycophenolate mofetil.

IVIg

Intravenous immunoglobulins are fine to take throughout pregnancy and breastfeeding.

The data is limited for men wanting to try for a baby. But because it’s not harmful to pregnant women, it’s unlikely to be harmful to men hoping to father a child.

Anti-TNF biologics

Anti-TNF drugs include infliximab, etanercept, adalimumab, certolizumab pegol and golimumab.

BSR guidelines advise that etanercept and adalimumab should be avoided during the last three months of pregnancy, and that infliximab should be stopped at 16 weeks, for the baby to be drug-free at birth and able to have a normal vaccination schedule.

Increasing evidence also shows that golimumab can be taken safely in the first six months of pregnancy and then stopped in the last three months so the baby can have a normal vaccination schedule.

The main concern with many biologics is that they can pass to the baby in the later stages of pregnancy. So, any live vaccines would need to be avoided until the drugs have left the baby’s system.

If your doctor is concerned about you flaring, then the drugs can be continued throughout the entire pregnancy, but newborn babies should not be given live vaccines until they are at least seven months old. This would include vaccines such as the rotavirus vaccine or BCG.

Only tiny amounts of certolizumab pegol are passed on from mother to baby. So, this drug can be taken safely during the whole length of the pregnancy.

You should be OK to breastfeed on all anti-TNFs but the research can be limited so it’s important to discuss this with your doctor.

Based on limited research, men should be OK to try for a baby on all anti-TNFs.

Other biologics

Other biological therapies include rituximab, tocilizumab, abatacept, anakinra, belimumab, ustekinumab and secukinumab.

At the moment, there is limited data on all of these drugs, and they are generally avoided during pregnancy. However, if your condition has been difficult to control with other drugs and is well-controlled on one of these, you should discuss with your doctor the risks and benefits of continuing them in pregnancy to keep your condition under control.

It’s generally recommended that rituximab should be stopped six months before pregnancy. However, if you accidentally continue taking any of the drugs in this group of biologics in early pregnancy, it’s unlikely to be harmful to your baby.

There is limited research on breastfeeding for this group of drugs, so discuss this with your doctor.

Based on limited evidence, rituximab should be fine to take by men wanting to try for a baby. There is no data on any of the other biologics in this group, but they’re also unlikely to be harmful to men.