Imuran Use In Pregnancy & Lactation

Fertility: Relief of chronic renal insufficiency by renal transplantation involving the administration of azathioprine has been accompanied by improved fertility in both male and female transplant recipients.
The specific effect of azathioprine therapy on human fertility is unknown but there are reports of successful fatherhood/motherhood after receiving treatment. Several studies report that azathioprine at standard doses does not appear to affect male fertility.
Pregnancy: Substantial transplacental and transamniotic transmission of azathioprine and its metabolites from the mother to the foetus have been shown to occur.
Azathioprine should not be given to patients who are pregnant or likely to become pregnant in the near future without careful assessment of risk versus benefit.
Evidence of the teratogenicity of azathioprine in man is equivocal. As with all cytotoxic chemotherapy, adequate contraceptive precautions should be advised when either partner is receiving azathioprine.
There have been reports of intra-uterine growth retardation, premature birth and low birth weight following maternal exposure to azathioprine, particularly in combination with corticosteroids. There have also been reports of spontaneous abortion following either maternal or paternal exposure.
Leukopenia and/or thrombocytopenia have been reported in a proportion of neonates whose mothers took azathioprine throughout their pregnancies. Extra care in haematological monitoring is advised during pregnancy.
Breastfeeding: 6-Mercaptopurine has been identified in the colostrum and breast-milk of women receiving azathioprine treatment. It is recommended that mothers receiving azathioprine should not breastfeed.