Last update Aug. 6, 2021

Brimonidine Tartrate

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Sympathomimetic alpha-2 adrenergic receptor agonist.
Indicated in the treatment of ocular hypertension, glaucoma and facial erythema of rosacea
Topical administration in the form of eye drops, one drop every 12 hours or as a facial cream, one application every 24 hours.

At the date of the last update, the authors did not find any published data on its excretion in breast milk.

Plasma concentrations are low with ophthalmic treatment and much lower after cutaneous and facial administration (Allergan 2020, EMA 2019 and 2018), which makes the passage to breast milk in significant concentration unlikely.

Although some authors advise against it during lactation due to the possible transition to breast milk (Belkin 2020, Blumen 2020, Salim 2014, Coleman 2005), the truth is that at least two infants of mothers treated with brimonidine (one of them, for 6 months) did not present any clinical problems (Madadi 2008, Johnson 2001).

Systemic absorption should be minimized by pressing the tear duct (inner corner of the eye) with the finger for 1 to 5 minutes and administering the dose immediately after breastfeeding (Belkin 2020, Méndez 2012).

Alternatives

  • Acetazolamide ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Dorzolamide Hydrochloride (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Latanoprost ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Timolol Maleate ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Brimonidine Tartrate in other languages or writings:

Tradenames

Main tradenames from several countries containing Brimonidine Tartrate in its composition:

Pharmacokinetics

Variable Value Unit
Molecular weight 442 daltons
Protein Binding 29 %
pKa 8.3 -
Tmax 0.5 -2 hours
2 - 3 hours

References

  1. Allergan. Brimonidina (oftálmica). Ficha técnica. 2020 Full text (in our servers)
  2. Blumen-Ohana E, Sellem E. [Pregnancy & glaucoma: SFO-SFG recommendations]. J Fr Ophtalmol. 2020 Jan;43(1):63-66. Abstract
  3. Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM; American Glaucoma Society and the Canadian Glaucoma Society.. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma. 2020 Mar - Apr;3(2):79-89. Abstract
  4. EMA Brimonidine (ophtalmic). Drug Summary. 2019 Full text (in our servers)
  5. EMA. Brimonidine (dermatological). Drug Summary. 2018 Full text (in our servers)
  6. EMA. Brimonidina (dermatológica). Ficha técnica. 2018 Full text (in our servers)
  7. Salim S. Glaucoma in pregnancy. Curr Opin Ophthalmol. 2014 Mar;25(2):93-7. Abstract
  8. Méndez-Hernández C. Uso de fármacos antiglaucomatosos durante el embarazo y lactancia. [Use of glaucoma medications during pregnancy and breastfeeding]. Arch Soc Esp Oftalmol. 2012 Dec;87(12):389-91. Abstract
  9. Madadi P, Koren G, Freeman DJ, Oertel R, Campbell RJ, Trope GE. Timolol concentrations in breast milk of a woman treated for glaucoma: calculation of neonatal exposure. J Glaucoma. 2008 Jun-Jul;17(4):329-31. Abstract
  10. Coleman AL, Mosaed S, Kamal D. Medical therapy in pregnancy. J Glaucoma. 2005 Oct;14(5):414-6. No abstract available. Abstract
  11. Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001 Mar-Apr;45(5):449-54. Abstract

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