Glaucoma Treatment During Pregnancy And Breastfeeding

Many medicines are known to have adverse effects during pregnancy; others are known to be safe, but in a large number of cases there is no firm evidence to decide on risk or safety. Drug molecules which are comparatively small can pass easily through the placenta from the mother into the babies bloodstream. However, the quantity of drug delivered in an eye drop is very small when compared with the amount in a tablet. Drug molecules also pass into breast milk, especially those which dissolve easily in fat. Drugs in breast milk may theoretically cause hypersensitivity in the infant even when concentrations are too low for a pharmacological effect.

It should me kept in mind that: Drug research cannot be carried out in women who are or might be pregnant, or who are breast feeding. The drug manufacturers therefore cannot recommend the use of drugs in such people. The use of any drug when pregnant or breast feeding must be under the supervision of your eye care doctor.

The most important thing, if you are pregnant or trying to conceive, is to consult your family practice physician and your eye care provider about the glaucoma eye drops (or tablets) which you are taking. Your doctor’s will balance the potential benefits of medical treatment against any possible risks to decide whether or not a particular drug should be used. An alternative medication may be suggested, it is very important that glaucoma treatment is not discontinued without consulting your eye care provider.

The eye drops and tablets listed below may have effects on the developing baby during pregnancy or breast feeding and, as with all drugs, should be discussed with your doctor’s before use.

For safety the FDA has categorized drugs as A, B, C, D and X; A poses the least risk, while X poses the most. Drugs in categories A and B such as antihistamines, antibiotics and vitamins are relatively safe in pregnant women. Consider these drugs if the benefits outweigh the remote risks of fetal harm. You cannot rule out risk with category C drugs. Category D drugs show positive evidence of risk. Category X drugs are contraindicated in pregnancy.

Beta blocking Eye Drops:

Beta Blockers are class C drugs. They have been noted to cause neonatal and postnatal bradycardia and hypoglycemia. These can pass into the breast milk but it is considered unlikely that they will cause serious adverse effects from normal eye drop doses. However, their use should still be discussed with your eye care doctor. Examples of these drops are: Timoptic, Ocupress, Betagan, Betoptic, Metipranolol, and Cosopt.

Carbonic Anhydrase Inhibitors (CIA):

CIS’s are class C drugs. These pass into breast milk and may reduce the milk supply. The British National Formulary states “the amount is too small to be harmful to the baby” however, the manufacture of Dorzolamide (Trusopt) advises against use in pregnancy or during breast feeding. The use of these drugs must be discussed with your doctor’s. Examples of these drugs are: Diamox Tablets, Diamox SR Capsules, Daranide Tablets, Trusopt and Azopt Eye Drops and Cosopt (part of this combo drug).

Adrenaline:

These are class C drugs. The eye drops could cause an increased heart rate in the infant during breast feeding and their use must be discussed with your doctor. Examples of these drugs are: Propine, Epinal, Eppy/N, , Epifrin, and Glaucoma.

Pilocarpine:

Pilocarpine is a Class C drug. There is no evidence of risk to a baby during pregnancy at the doses used for chronic glaucoma. The drug is known to pass into breast milk but adverse effects are unlikely.

Alpha Adrenergic:

Alphagan is a category B drug. It is relatively safe to use in pregnancy. However, it can be related to bracdycardia, hypertension and apnea in children younger than 2 months, with the potential for toxicity in human breast milk; should be used cautiously in lactating mothers.

Prostaglandins:

Prostaglandins are category C drugs. No adequate and well controlled studies of prostaglandins in pregnant women are yet available. Exercise caution in lactating mothers; we don not know whether prostaglandins are excreted in human milk. Examples of these are Xalatan, Travatan, Rescula and Lumigan.

Drug Name
FDA Category
Pregnancy comment
Breast feeding comment
Suggestion
Iopidine or ApraclonidineCEmbryocidal at 60 MHRODUnknownCaution in nursing mothers.
Betoptic or BetaxololCPost implantation loss at above 12 mg/kg.  Not teratogenic and no adverse effects at sub toxic dose levels.UnknownCaution in nursing mothers.
Lumigan or BimatoprostCAbortion at 33 to 97 times the MHROD.  Teratotoxicity at 41 MHRODExcreted in breast milk in animals.Caution in nursing mothers.
Alphagan or BrimonidineBNo impaired fertility or harm to fetus at 100 MHRODExcreted in breast milk in animals.Discontinue nursing or discontinue medication where possible.
Azopt or BrinzolamideCDevelopmental toxicity and fetal variations at 125 times MHROD. Decreased fetal weightUnknown.  Decrease in body weight with 312 MHRODCaution in nursing mothers.
Ocupress or CarteololCSkeletal defects at 212 MHROD.  Resorptions at 1052 MHROD.  Decreased fetal weight at 5264 MHRODExcreted in breast milk in animals.Caution in nursing mothers.
Propine or DipivefrinBNo adequate and controlled studies.UnknownCaution in nursing mothers.
Trusopt or DorzolamideCDefects in vertebral bodies at 31 MHROD, metabolic acidosis at this dosage.Decreases in body weight fain and delay in postnatal development at 94 MHRODExtreme caution due to risk for serious adverse reaction in nursing infant.
Xalatan or LatanoprostCFetotoxicity at 80 times MHRODUnknownCaution in nursing mothers.
Betagan pr LevobunololCFetotoxicity at 80 times MHRODUnknownCaution in nursing mothers.
Optipranolol or MetipranololCFetotoxicity at 50mg/kg during organogenesis.UnknownCaution in nursing mothers.
PilocarpineCUnknownUnknownCaution in nursing mothers.
Timoptic or TimololCFetal resorptions increased at 100 to 1000 times MHRODExcreted in breast milk in animals.Discontinue nursing or discontinue medication where possible.
Travatan or TravoprostCTeratogenic at 250 times MRHOD, skeletal malformations.  Post implantation losses greater at 7.5 to 75 MHROD.  Not recommended in pregnancy or in women trying to become pregnant.Excreted in breast milk in animals.Caution in nursing mothers.
Rescula or UnoprostoneCTeratotoxicity and increased miscarriages or resorption at 60 to 1000 times MHROD.Excreted in breast milk in animals.Caution in nursing mothers.

        MHROD= normal levels