Brimonidine and Breastfeeding

Summary of use during lactation

Limited information indicates that maternal use of brimonidine 0.2% ophthalmic drops do not adversely affect their nursing infants. However, some authors and the manufacturer warn of possible CNS depression, apnea, lethargy, bradycardia with brimonidine and recommend against its use during breastfeeding.[1-3] To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue. Topical brimonidine gel used to treat rosacea has not been studied during breastfeeding. It is unlikely that the topical gel would affect the breastfed infant, but the manufacturer states that it should not be used during nursing. Until more data are available, an alternative topical agent might be preferred

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A woman used brimonidine 0.2%, timolol gel-forming solution 0.5%, dipivefrin 0.2%, and dorzolamide 0.5% drops for glaucoma while nursing a newborn. The frequency of medication use and extent of nursing were not stated. All medications were given immediately after nursing with punctal occlusion of the tear duct. The infant's vital signs were closely monitored with no signs of bradycardia or apnea.[4] A woman was using ophthalmic drops containing 0.5% timolol and 0.2% brimonidine twice daily in the right eye for 6 months. During this time, she breastfed her infant (extent not stated) apparently without harm to her infant.[5]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Topical for Rosacea) Azelaic Acid; Metronidazole

References

1. Belkin A, Chen T, DeOliveria AR, et al. A practical guide to the pregnant and breastfeeding patient with glaucoma. Ophthalmol Glaucoma 2020;3:79-89.32672600 PubMed
2. Blumen-Ohana E, Sellem E. Pregnancy & glaucoma: SFO-SFG recommendations. J Fr Ophtalmol 2020;43:63-6.31813552 PubMed
3. Kumari R, Saha BC, Onkar A, et al. Management of glaucoma in pregnancy - balancing safety with efficacy. Ther Adv Ophthalmol 2021;13:25158414211022876.34263134 PubMed
4. Johnson SM, Martínez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol 2001;45:449-54.11274697 PubMed
5. Madadi P, Koren G, Freeman DJ, et al. Timolol concentrations in breast milk of a woman treated for glaucoma: Calculation of neonatal exposure. J Glaucoma 2008;17:329-31.18552619 PubMed