Is (R)-Epinephrine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use (R)-Epinephrine? Is (R)-Epinephrine safe for nursing mother and child? Does (R)-Epinephrine extracts into breast milk? Does (R)-Epinephrine has any long term or short term side effects on infants? Can (R)-Epinephrine influence milk supply or can (R)-Epinephrine decrease milk supply in lactating mothers?

Used as a systemic drug for cardiac resuscitation and locally in topical anesthetic preparations, epidural anesthesia, eye drops (mydriatic), and nasal drops (vasoconstrictor). At last update no published data on excretion in breast milk were found.Its rapid metabolism (short Tmax and T½) makes it unlikely an excretion into milk in significant amounts. It is destroyed in the gastrointestinal tract. The low oral-bioavailability makes its levels into infant's plasma, that would be absorbed from ingested breast milk, be nil or negligible. Maintained high intravenous doses decrease milk production by interfering with the secretion of prolactin especially the early postpartum-weeks, because when breastfeeding is well established, prolactin levels do not correlate with milk production any longer. No problems related to lactation have been observed due to epidural anesthesia in which adrenaline is used.

No information is available on the use of (R)-Epinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any (R)-Epinephrine in milk is unlikely to affect the infant. High intravenous doses of (R)-Epinephrine might reduce milk production or milk letdown. Low-dose intramuscular (such as Epi-Pen), epidural, topical, inhaled or ophthalmic (R)-Epinephrine are unlikely to interfere with breastfeeding. To substantially diminish the effect of the drug 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.

Relevant published information in nursing mothers was not found as of the revision date. Intravenous (R)-Epinephrine infusion in nonnursing subjects and in women with hyperprolactinemia decreases serum prolactin concentrations.[1] Animal data indicate that intraarterial (R)-Epinephrine can decrease serum oxytocin and inhibit milk ejection.[2][3] However, low-dose infusion of (R)-Epinephrine as part of epidural analgesia does not impair breastfeeding in nursing mothers.[4][5] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. An Egyptian study compared lidocaine 2% (n = 75) to lidocaine 2% plus (R)-Epinephrine 1:200,000 (n = 70) as a wound infiltration following cesarean section. Patients who received (R)-Epinephrine in combination with lidocaine began breastfeeding at 89 minutes following surgery compared to 132 minutes for those receiving lidocaine alone. The difference was statistically significant.[6]