Contraception Management in Behçet's Disease Patients on Azathioprine

Introduction to Contraception Safety

The British Journal of Dermatology guidelines indicate that azathioprine does not interact pharmacologically with levonorgestrel or ethinyl estradiol, suggesting that patients with Behçet's disease taking Imuran can safely continue Camrese Lo 1, 2, 3
The decision to continue Camrese Lo depends primarily on the patient's thrombotic risk profile, not the azathioprine use, according to Arthritis and Rheumatology 4

Patients without a history of thrombotic events, such as deep vein thrombosis, pulmonary embolism, or stroke, may continue Camrese Lo, as stated by Arthritis and Rheumatology 4
The absence of antiphospholipid antibodies is a favorable factor for continuing Camrese Lo, as indicated by Arthritis and Rheumatology and the American College of Rheumatology 4, 5
A history of venous or arterial thrombosis is a contraindication to continuing Camrese Lo, according to Arthritis and Rheumatology 4

The American College of Obstetricians and Gynecologists recommends considering alternative contraception, such as levonorgestrel IUD, which is highly effective and avoids systemic estrogen exposure, as stated by Arthritis and Rheumatology 4, 5
Progestin-only pills are acceptable alternatives, according to Arthritis and Rheumatology 4
Depot medroxyprogesterone acetate (DMPA) should be avoided due to potential thrombogenic effects, as warned by Arthritis and Rheumatology and the American College of Rheumatology 4, 8

The British Journal of Dermatology recommends continuing routine monitoring for azathioprine toxicity, regardless of contraceptive choice 1, 2, 3
Azathioprine has demonstrated efficacy in Behçet's disease, particularly for preventing ocular complications and reducing extraocular manifestations, as reported by the American Academy of Ophthalmology and the British Journal of Dermatology 9, 2, 3

The American College of Cardiology suggests that the combination of azathioprine with corticosteroids is standard therapy for severe Behçet's disease, and that the decision to continue Camrese Lo should be individualized based on thrombotic risk factors 1, 2, 7
The American College of Rheumatology recommends against assuming all patients with Behçet's disease have contraindications to estrogen-containing contraceptives, and against overlooking antiphospholipid antibody testing 4, 5