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Alcaftadine is a histamine H1-receptor antagonist for ophthalmic use to prevent itching associated with allergic conjunctivitis in adults and children from 2 years of age. Topical administration once daily as eye drops.
At the time of the last update, we found no published data on its excretion in breast milk.
It reaches peak plasma concentrations of less than 120 pg/ml (Bohets 2011, Allergan 2011), so passage into milk must be negligible.
The small dose and low plasma absorption of most topical ophthalmic preparations make passage of significant amounts into breast milk unlikely.
For ophthalmic administration, absorption can be minimised by pressing the tear duct (inner canthus of the eye) with the finger for 1-2 minutes and administering the dose immediately after breastfeeding. (Belkin 2020, Blumen 2020)