Medicine Matters rheumatology

a. Switch from MMF to azathioprine (1.5–2 mg/kg/day) and wait 6–12 months to assess lupus activity. Add hydroxychloroquine and heparin (prophylactic dosages) at positive pregnancy test. Stop ramipril at positive pregnancy test.

b. Switch from MMF to cyclosporine-A (3 mg/kg/day), wait 2–3 months to assess lupus activity. Stop ramipril at positive pregnancy test. Stop LDASA at week 12 and start heparin twice a day.

c. Switch from MMF to azathioprine (1.5–2 mg/kg/day), add hydroxychloroquine, wait 6–12 months to assess lupus activity. Stop ramipril at least 2 months prior to conception. Start heparin after 20 weeks of gestation.

d. Switch from MMF to azathioprine (1.5–2 mg/kg/day), add hydroxychloroquine and wait 6–12 months to assess lupus activity. Start enoxaparin 4000 IU/day at positive pregnancy test. Stop ramipril at positive pregnancy test.

View answer