Brimonidine

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 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

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.

Alternate 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. [PubMed: 32672600]

2.

Blumen-Ohana E, Sellem E. J Fr Ophtalmol. 2020;43:63–6. [Pregnancy & glaucoma: SFO-SFG recommendations] [PubMed: 31813552]

3.

Kumari R, Saha BC, Onkar A, et al. Management of glaucoma in pregnancy - balancing safety with efficacy. Ther Adv Ophthalmol. 2021;13:25158414211022876. [PMC free article: PMC8243098] [PubMed: 34263134]

4.

Johnson SM, Martínez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001;45:449–54. [PubMed: 11274697]

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. [PubMed: 18552619]

Substance Name

Brimonidine

CAS Registry Number

59803-98-4

Drug Class

Breast Feeding

Lactation

Milk, Human

Adrenergic alpha-2 Receptor Agonists

Antiglaucoma Agents