Hydroxychloroquine
Hydroxychloroquine is an anti-malarial medication that was found to have an immunoregulatory property and has been used in many autoimmune diseases such as systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). It works on suppressing the inflammatory cytokines and antiphospholipid antibodies. The decision to add the hydroxychloroquine to the protocol is based on the immunological testing. An eye exam should be performed prior to starting this medication.
Potential adverse effects include but not limited to potential eye toxicity. This adverse effect can occur mainly in patients taking this medication for more than 5-10 years. There is no associated increased risk of birth defects.
Tacrolimus
Tacrolimus is an immunosuppressant medication, mainly used as anti-rejection medication in patients undergoing organ transplant to prevent the body from rejecting the transplanted organ. It suppresses the T-cells thus regulating the immune system.
A recent study has shown that Tacrolimus works on suppressing the T-helper 1 to T-helper 2 ratio and thus improving the reproductive outcome. Tacrolimus is added to the protocol based on immune testing. The adverse effect includes but not limited to high blood pressure, abnormal kidney function and headache. Studies didn’t find an associated risk of birth defect in a pregnant patient taking Tacrolimus. Patients should be monitored very closely for any adverse effect.