A 30-year-old male on methotrexate 7.5 mg once daily for arthritis attends clinic for starting family. Wife takes no other medication apart from OCP. What should be the advice before conceiving?

Ans: A (Husband should stop methotrexate and wife should continue contraception for 3 months) Ref: Internet Source (e Therapeutic Guidelines Complete --Use of Anti-Rheumatic Drugs in Pregnancy) and Textbook of Management of Psoriasis by Nikhil YawalkarExplanation:Methotrexate interferes with the biosynthesis of purines via the enzyme dihydrofolate reductase.A teratogenic syndrome called Ami nopterin syndrome has been described in women being treated for malignancies on higher doses of methotrexate than used in rheumatoid arthritis i.e., higher than 10 to 25 mg per week.Am inopterin Syndromeo Skeletal abnormalities of skull and limbs,o Microcephaly; ando Facial dysmorphism.Animal studies show a widely varying species susceptibility to this drug.Several small studies of human use of methotrexate suggest increased risk of abnormality after exposure during a critical period from 8 to 10 weeks gestation. A safe contraception and ceasing methotrexate before conception are recommended.Contraception is essential in fertile women during treatment with methotrexate and for 3 months following its discontinuation due to its teratogenic properties and prolonged presence in tissues.The same duration of contraception (3 months} is also advisable in men as methotrexate reduces spermatogenesis.