Cellcept and pregnancy

[GDMichigan]

I'm a patient with autoimmune hepatitis type II, and my doctor has just perscribed cellcept in an attempt to reduce or stop use of prednizone.  It is really important to me to try and have a child, but I'm afraid if I start cellcept that I shouldn't get pregnant.  I know cellcept is a class D drug, and discussed my concern with my doctor.  She said that patient on cellcept have had successful pregnancies, even though she legally would have to tell me that it is not recomended because of the class D warning, but she didn't seem overly concerned about the fact that I want to get pregnant someday.  I'm 26 years on and married, and not ready to give up hope of having my own child.  I am considering just staying on Prednizone for a little while longer and getting pregnant, and then going on cellcept.  I have been on cellcept one week tomorrow, and think it would not be too late to discontinue (after talking to my doctor again) since I am also still on 40mg of prednizone every day.  Do you have any opinions about cellcept and pregnancy?

[Thomas D Schiano, MD]

you can check the liver transplant pregnancy registry (dr vincent armenti runs it) about this specifically but I think most phyisicians feel that cellcept is safe.  Autoimmune hepatitis can get much worse during pregnancy and high doses of steroids could make fluid retention and HTN worse.  You definitely cannot stay on that high hose of prednisone regardless as it will have enormous side affects.  I would recommend the cellcept to get you down or off steroids.  have you tried azathioprine?  This is a more time tested steroid sparing agent than cellcept and there is really no concern on its use during pregnancy.

[Thomas D Schiano, MD]

frankly i am not sure that cellcept is better than azathioprine.  It is generally used when the latter is not tolerated. the issue with azathioprine is that often a suboptimal dose is used.  what is standard is 1-2 mg/kg body weight so typically 75-150mg daily.  What dose were you taking and much do you weigh (sorry for asking)?

[GDMichigan]

Thank you for the reply, yes I have tried Azothiprine, but as I tapered Prednizone each time, I would flare up a again.  My Prednisone dosage has been up and down for the last 12 years, and all the drugs my doctors have perscribed have been tolerated, but nothing has been able to get me off Prednisone.  Because my platelets are low, my doctor says Cellcept would be preferred to Azothiprine.