Is it Safe to Conceive While on Methotrexate?

Stephen Paget, MD

Disclosures

January 26, 2011

Question:

Is it safe to conceive while either the man or woman is taking methotrexate?

Response from Stephen Paget, MD
Professor of Medicine, Weill Cornell Medical College; Physician-in-Chief, Center for Rheumatology, Hospital for Special Surgery, New York, NY

It is not safe to conceive while a man is taking methotrexate, as methotrexate can have 2 negative effects: infertility and the chance of a developmental defect in the fetus/child. Only a few pregnancies with neonatal anomalies are described when a child's father took methotrexate at the time of conception, but, although rare, it is a good reason for caution. Thus, the same rule that applies to women should apply to men: Contraception should be required until at least 3 months before a planned conception, and stopping use of methotrexate, at least at that time, is essential.

While one may debate the safety of one drug or another for women in the setting of pregnancy, the following drugs commonly used in rheumatologic conditions are generally considered contraindicated for women during pregnancy: anti-TNF medications, abatacept, rituximab, tocilizumab, leflunomide, cyclophosphamide, cyclosporine A, d-penicillamine, and sulfasalazine. We do use hydroxychloroquine and azathioprine during pregnancy in women with systemic lupus erythematosus in whom the discontinuation of these drugs would be harmful to both the mother and the fetus.

Regarding men with rheumatoid arthritis, the data, as noted above, are strongest for avoiding methotrexate for at least 3 months before trying to conceive. The physician must make decisions on a case-by-case basis regarding the other contraindicated drugs listed above.

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