Topical meds can be risky for pregnant or nursing patients

July 1, 2011

A number of topical medications commonly prescribed by optometrists may place the fetus at risk when the patient is pregnant or may be passed on to the infant when the mother is nursing.

Key Points

Azusa, CA-A number of topical medications commonly prescribed by optometrists may place the fetus at risk when the patient is pregnant or may be passed on to the infant when the mother is nursing. There is an unfortunate paucity of information to guide the prescribing optometrist in this area, according to Milton M. Hom, OD, FAAO. Dr. Hom is a private practitioner here.

Exposure risk

"If you understand the lifecycle of the fetus in terms of risk, you'll see that late in the first trimester is a very critical time," Dr. Hom said.

"If you can take your treatment and push it out of that first trimester and delay it as late as possible, you can reduce the risk to the fetus," he advised.

General guidelines

There are some general guidelines optometrists can follow to minimize risks to the fetus, Dr. Hom said. Nasolacrimal occlusion combined with eye closure minimizes systemic drug absorption, and some experts recommend it for all pregnant patients. Optometrists can also choose the "safest" possible drug, and prescribe the smallest effective dose for the shortest possible treatment cycle.

In addition, in 1979 the FDA introduced the pregnancy category classification of drugs in terms of fetal risk:

Dr. Hom said that, unfortunately, more than 90% of ocular drugs fall into Category C.

"When more than 90% of the ocular topical drugs are Category C, meaning they're basically a question mark, the FDA classification system isn't particularly useful to optometrists," Dr. Hom said. The FDA categories don't indicate any risks associated with lactation, he added.

Dr. Hom has aggregated information on topical medications commonly prescribed by optometrists, to aid in selecting an appropriate drug for pregnant or lactating patients. His guide:

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