I asked my father to comment on the glaucome medications as he is an expert in
the field. Here is his response:
I think there is a little overreaction here. Of the three medications, only
Cosopt has an ingredient that gets into breast milk (timolol). It is a pretty
well-tolerated medication by babies and is used frequently systemically
by pediatric cardiologists in baby's with heart problems. Timolol, if it gets
into the baby's system will slow the heart rate and reduce blood pressure but it
usually is not a significant problem. However, if she can get by without it,
it is probably better. Alphagan is bad when given directly to babies or children
under 6 ( causes wide varaiations in blood pressure and heart rate that may
require hospitalization). As far as I know, there is no evidence it actually
gets into breast milk. Hyoscine is like atropine, is not a glaucoma
medication and is relatively safe (it suggests that she has glaucoma secondary
to uveitis/iritis). She should ask her ophthalmologist if she can reduce or
suspend her glaucoma meds or some of them during breast feeding. If not, the
following meds are relatively safe for lactating mothers: dorzolamide (the other
ingredient in Cosopt) or brinzolamide (a cousin of dorzolamide) and latanoprost
(Xalatan) (some don't like to use it in people with uveitis but actually that is
due more to rumor than science). Hyoscine could be changed to low dose
homatropine and used once a day at which dose level it should be very safe. If
she is using her meds in one eye only, that reduces the risk significantly.
Finally, one can reduce by 90% the amount of medication that gets into the
general system from eyedrops by gently closing the eyes immediately after the
eye drop is administered and putting gentle pressure with a finger where the eye
meets the nose for at least 2 minutes.
On the other hand, she has to weigh how severe her glaucoma is and the potential
consequences of losing sight against her desire to breast feed and how much risk
she is willing to take for her baby. I think an extensive discussion with her
ophthalmologist is definitely in order - immediately.
Robert L. Stamper, M.D., Professor of Ophthalmology, University of California
San Francisco, Director of Glaucoma Service.
More info in my textbook: Becker - Shaffer's Diagnosis and Therapy of the
Glaucoma's - 8th Edition, Elsevier, 2009
Also, here is a reference of a review article that may be helpful: Surv
Ophthalmol. 2001 Mar-Apr;45(5):449-54. Management of glaucoma in pregnancy and
lactation. Johnson SM, Martinez M, Freedman S.
Department of Ophthalmology, University of North Carolina Hospitals, Chapel
Hill,
NC, USA. A 30-year-old pregnant woman with glaucoma is presented. The
management of her case is used as a basis for a discussion of the use of
glaucoma medications, including newer formulations, during pregnancy and
lactation.
Alison Levy, RN, LEC, aspiring LC
San Diego, CA
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