Which drugs are considered safest during pregnancy?

Hi,

I have been on Remicade since last October. It was a lifesaver (my first dose pretty much brought me back to normal overnight after being in the hospital) but before my last two infusions I started to flare - at 6 weeks and then at 3.5 weeks. We discussed upping my dosage or increasing the frequency. In June, I started the SCD and it has made a huge difference. I started the diet right before my last symptoms started and a week before my last infusion I was back to normal (it took about a month on the diet). Due to a scheduling conflict, I ended up getting my last infusion at 9 weeks. I'm now at 8 weeks from that infusion, no symptoms and feeling great!

I met with my GI yesterday and he is letting me come off Remicade. We discussed moving the infusions further apart, but he thought it wasn't in my system after 8 weeks anyway, so it is not the only thing keeping me in remission. Additionally, I agreed to start taking another "milder" medication in its place. We agreed on Lialda while I was there, but he was pretty open to letting me decide which one I wanted to try.

My GI knows that my husband and I would like to try to have a baby soon, so he looked up the pregnancy class on each medication as we discussed it. He told me Lialda was Class B for pregnancy (and that is the best I'll get for a UC med) but that you can't take it while breastfeeding. Ideally, I'd like to find a medication that is safe for both. Does anyone have an idea of which meds are considered the safest for both pregnancy and breastfeeding? I will ask my OBGYN but thought I would check here in case someone has done the research.

Thank you!

Cimzia can be used during pregnancy and breastfeeding.

I'm not sure why your doc would say you can't be on Lialda while breastfeeding. I had a baby six months ago, breastfed/pumped at work until she was about five months (the pump and I didn't "get along," so once I went back to work my supply slowly dropped). Mesalamine (the active ingredient in Lialda) can cross into the breastmilk, but analysis of breastmilk showed that it's either not detectable or is present in very, very, very low levels. There's just ONE report of bloody diarrhea in an infant whose mom was on mesalamine, and who knows if the mesalamine was really the cause.

I personally felt it was quite safe to breastfeed while on mesalamine, as did my OBGYN, GI and sister (she's an MD).

This article talks about the risks of the different meds both in pregnancy and breastfeeding:
http://onlinelibrary.wiley.com/doi/10.1002/ibd.20532/pdf

Your doctor is not an expert on medications and breastfeeding, that is clear. Please go to infantrisk.org where you will find a lot of info about the different meds we use and their risks during pregnancy and breastfeeding. This website is where Dr. Hale, the nationally recognized expert on this topic, posts his findings. He has also written a book, Medications and Mother's Milk, which your local La Leche league leader should have access to.

The biggest risk with mesalamines and breastfeeding is the small possibility of diarrhea in the nursing infant. I nursed both of my kids while taking Asacol (a low dose, for sure) and I never understood how one would know if a breastfed infant had diarrhea. Seriously, infant poop is a liquid affair. I suppose if my infant passed mucous that would be noticable, but other than that, no.

The newer mesalamines like Lialda might have different risks that I don't understand, but I'd be looking to Dr. Hale to help me there.

Remicade, by the way, is completely safe during breastfeeding.

Lizzie - you and I are in the same boat! I just had an appt with my GI and asked the same thing.... I am on Lialda and trying to get pregnant and want to remain on it while pregnant and breastfeeding. I got the same response as you - class B, completely fine while pregnant and likely okay but need further discussion for breastfeeding. I am happy to see a couple responses on here indicate that mesalamine is safe for breastfeeding. I would be very nervous to stop. I figured as long as I can be pregnant on it, I can figure out the breastfeeding part later! Good luck to you!

I also have nothing but good things to say about Lialda. I was on Asacol/6MP for years and never completely in remission, then went off both to switch to Lialda and Align with very successful results. I only had moderate UC to begin with, but cannot say enough good about the switch!