Pregnancy and multiple sclerosis (MS): drug safety

Unsafe DMTs in pregnancy

• Alemtuzumab
• Cladribine
• Dimethylfumarate
• Fingolimod
• Teriflunomide

Safe DMTs in pregnancy

DMTs to be used in exceptional circumstances in pregnancy

Potentially safe DMTs during breastfeeding

Unsafe and potentially unsafe non-DMT medications in pregnancy

Safe non-DMT medications in pregnancy and breastfeeding

Non-DMT medications to use with caution in pregnancy and breastfeeding

Management of infants

References

1. Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex PA. UK consensus on pregnancy in multiple sclerosis: 'Association of British Neurologists' guidelines. Pract Neurol 2019; 19:106-114.
2. Iyer P, Dobson R. Multiple sclerosis in pregnancy: a commentary on disease modification and symptomatic drug therapies. Neurol Ther 2023; 12:1-10.
3. Winkelmann A, Rommer PS, Hecker M, Zettl UK. Intravenous immunoglobulin treatment in multiple sclerosis: A prospective, rater-blinded analysis of relapse rates during pregnancy and the postnatal period. CNS Neurosci Ther 2018; 25:78-85.
4. Subei AM, Cohen JA. Sphingosine 1-phosphate receptor modulators in multiple sclerosis. CNS Drugs 2015; 29:565-575.
5. Alroughani R, Altintas A, Al Jumah M, et al. Pregnancy and the use of disease-modifying therapies in patients with multiple sclerosis: benefits versus risks. Mult Scler Int 2016; 2016:1034912.
6. And 4 more. Subscribe to see the full list

Related checklists

• Pregnancy and multiple sclerosis (MS): pre-conception management
• Pregnancy and multiple sclerosis (MS): relapse management
• Pregnancy and multiple sclerosis (MS): breastfeeding management