There are few studies in the literature regarding the safety of glaucoma mediations during breast-feeding. Any medication with any degree of systemic absorption must be assumed to have a measurable level in breast milk. Due to the extreme reluctance to used any medications in pregnant and lactating women, these data are difficult to
Pregnancy and Pediatric Patients 235 Table 13.1 FDA Category Classifications for Glaucoma Medications
Drug Class Pregnancy Category
Prostaglandin analogs Class C
Beta blockers Class C Alpha-adrenergic agonists
Brimonidine Class B
Apraclonidine Class C
Carbonate anhydrase inhibitors Class C
Nonspecific adrenergic agonist3 Class B
Fixed-combination timolol-dorzolamide Class C
Cholinergic drugs Class C
obtain. In one study, timolol 0.5% and betaxolol were found in breast milk.10 In fact, breast milk had higher timolol levels than did serum measured simultaneously (5.6 ng/mL vs. 0.93 ng/mL).10 The authors concluded that this level of timolol was not of concern if the infant has normal renal and hepatic function; however, if treatment is absolutely necessary, the infant must be monitored carefully for any possible side effects. Punctal occlusion or other methods of reducing systemic uptake of any topically applied medicine are beneficial in this scenario.
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