Is Timolol Safe in Breastfeeding

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

It is used as hypotensive drug, and, on topical treatment of glaucoma. Systemic absorption is minimal. There have not been problems except when a maternal overdose has been absorbed. Like most ophthalmologic compounds for topical use a low dose and poor absorption make it compatible with breastfeeding.

Because of the variability in excretion of timolol into breastmilk and minimal reported experience during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.Ophthalmic use of timolol by the mother should pose little risk to the breastfed infant. 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.

None reported, but beta-adrenergic blocking drugs with similar breastmilk excretion characteristics have caused adverse effects in breastfed newborns.[5][6] No side effects were reported in one case report of a 9-week-old breastfed infant whose mother was using 0.5% ophthalmic timolol drops twice daily in one eye.[2] A mother who was taking 2 drops of timolol 0.5% eye drops daily as well as using pilocarpine eye drops twice daily and acetazolamide 250 mg orally twice daily and delivered a preterm infant at 36 weeks of gestation. The infant began 5 months of exclusive breastfeeding at 6 hours after birth. On day 2, the infant developed electrolyte abnormalities consisting of hypocalcemia, hypomagnesemia, and metabolic acidosis. The infant was treated with oral calcium gluconate and a single dose of intramuscular magnesium sulfate. Despite continued breastfeeding and maternal drug therapy, the infant's mild metabolic acidosis disappeared on day 4 of life and the infant was gaining weight normally at 1, 3 and 8 months, but had mild hypotonicity. The authors considered the metabolic effects to be caused by transplacental passage of acetazolamide that resolved despite the infant being breastfed. The infant gained weight adequately during breastfeeding, but had some mild, residual hypertonicity of the lower limbs requiring physical therapy.[2] A mother used timolol gel-forming solution 0.5% in one eye with punctal occlusion immediately after nursing in the newborn period and a few months later. Her infant was breastfed (extent not stated) during these times and no adverse effects were noted.[7]

Relevant published information on the effects of beta-blockade or timolol during normal lactation was not found as of the revision date. A study in 6 patients with hyperprolactinemia and galactorrhea found no changes in serum prolactin levels following beta-adrenergic blockade with propranolol.[8]