Although most ophthalmic medications have low systemic concentrations, this is not true for all eye medications. Dorzolamide (note correct spelling) is systemically absorbed. The ocular administration of dorzolamide three times a day equals an oral dose of 2 mg three times a day. Fortunately for the breastfeeding mother, dorzolamide is 33% bound to plasma proteins and accumulates in RBCs where it is bound to carbonic anhydrase. This should mean that not much of the drug enters breastmilk. Dorzolamide is a sulfonamide, so the mother should monitor the infant for any possible sulfa adverse reactions. When dorzolamide was administered to lactating rats, decreases in body weight of 5 to 7% occurred, BUT the oral dose given to the rats was 94 times the recommended human ophthalmic dose. Although the manufacturer states that a decision should be made whether to discontinue nursing or discontinue the drug, it does make the above 94 times statement and also states that the importance of the drug to the mother should be taken into account. Given the above information, hopefully the mother will decide to use the medication and continue to breastfeed. Frank J. Nice, DPA, CPHP