Is Acetazolamide Safe in Breastfeeding

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

Carbonic anhydrase inhibitor diuretic that has been used in the treatment of glaucoma, intracraneal hypertension and some types of epilepsy. Small amonut presented in the breast milk does not have any effect on the nursing baby. American Academy of Pediatrics: Maternal Medication Usually Compatible With Breastfeeding.

Limited information indicates that maternal doses of acetazolamide up to 1000 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.

A breastfed (extent not stated) infant whose mother was taking sustained-release acetazolamide (Diamox Sequels) 500 mg twice daily exhibited no apparent adverse effects related to acetazolamide from day 6 to day 10 postpartum.[1] A mother who was taking acetazolamide 250 mg orally twice daily as well as using 2 drops of timolol 0.5% eye drops daily and pilocarpine eye drops twice daily 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]