Ostensen M
Klinik für Rheumatologie und Klinische Immunologie/Allergologie, Inselspital Bern, Universitätsklinik, Bern.
Z Rheumatol. 2006 May;65(3):217-20, 222-4. doi: 10.1007/s00393-006-0052-5.
Antirheumatic drugs can have a negative effect on reproduction in both men and women. Possible negative effects are impairment of fertility, harmful effects on the fetus and adverse effects on the breastfed child. In women non-steroidal antiinflammatory drugs (NSAID) and cyclophosphamide can impair fertility. In men infertility can result from the use of salazopyrine and cyclophosphamide. A desire for children should be taken into account before the start of disease modifying drugs (DMARD). Treatment with NSAID is possible at some stages of pregnancy as well as during lactation. A limited number of DMARD is compatible with pregnancy and is presented. Cytostatic drugs and leflunomide must be prophylactically withdrawn before a planned pregnancy. TNF alpha antagonists should be discontinued at the start of pregnancy. Safe birth control must be practised during therapy with drugs that are gonadotoxic or teratogenic. Treatment with immunosuppressive drugs during lactation is limited because of insufficient documentation of safety for the breastfed child.
抗风湿药物可能对男性和女性的生殖功能产生负面影响。可能的负面影响包括生育能力受损、对胎儿的有害影响以及对母乳喂养婴儿的不良反应。在女性中，非甾体抗炎药（NSAID）和环磷酰胺会损害生育能力。在男性中，使用柳氮磺胺吡啶和环磷酰胺可能导致不育。在开始使用改善病情抗风湿药（DMARD）之前，应考虑生育意愿。在怀孕的某些阶段以及哺乳期可以使用NSAID进行治疗。少数DMARD与怀孕兼容，并已列出。在计划怀孕前，必须预防性停用细胞毒性药物和来氟米特。在怀孕开始时应停用肿瘤坏死因子α拮抗剂。在使用具有性腺毒性或致畸性的药物治疗期间，必须采取安全的避孕措施。由于缺乏关于母乳喂养婴儿安全性的充分资料，哺乳期使用免疫抑制药物的治疗受到限制。
