Mycophenolate counselling — SCE Rheumatology MCQ

Correct answer: D — Delay mycophenolate, explain fetal risk, establish reliable contraception and complete recommended pregnancy testing

Mycophenolate is a powerful human teratogen associated with increased risks of pregnancy loss and congenital malformations. It should not be started in a woman who could become pregnant but is not using reliable contraception. She requires counselling about teratogenicity and pregnancy planning, establishment of reliable contraception, and completion of pregnancy testing; the SmPC recommends two negative tests, with the second 8–10 days after the first. Contraception must continue during treatment and for six weeks after stopping. A single negative test does not remove the risk of subsequent conception, so starting now or deferring contraception until follow-up is unsafe. Leflunomide is also unsuitable in pregnancy and is not an induction treatment for lupus nephritis. Conception should not be encouraged during active nephritis, and NSAIDs do not replace disease-modifying immunosuppression.

Reference: Electronic Medicines Compendium (eMC). Mycophenolate mofetil 500 mg film-coated tablets — Summary of Product Characteristics, sections 4.3, 4.4 and 4.6 (pregnancy prevention, contraception and pregnancy testing); current version accessed 2025. https://www.medicines.org.uk/emc/product/11559/smpc