毒理性
◉ 母乳喂养期间使用总结：由于噻吗洛尔进入母乳的排泄量变异性和在哺乳期间的最小报告经验，可能更倾向于使用其他药物，特别是在哺乳新生儿或早产儿时。
母亲使用噻吗洛尔眼药水对哺乳婴儿的风险很小，尽管一些指南指出，凝胶制剂比溶液更受欢迎。为了显著减少使用眼药水后到达母乳中的药物量，可以在眼角处对泪管施加压力1分钟或更长时间，然后用吸收性纸巾去除多余的溶液。
◉ 对哺乳婴儿的影响：未报告，但具有类似母乳排泄特征的β-肾上腺素能阻断药在哺乳新生儿中引起了不良影响。
在一例报告中，一名9周大的哺乳婴儿的母亲每天一只眼睛使用两次0.5%的噻吗洛尔眼药水，未报告副作用。
一名母亲在怀孕36周时早产，她每天使用两滴0.5%的噻吗洛尔眼药水，同时还使用两次毛果芸香碱眼药水和两次口服250毫克乙酰唑胺。婴儿出生后6小时开始进行为期5个月的纯母乳喂养。在第二天，婴儿出现了电解质异常，包括低钙血症、低镁血症和代谢性酸中毒。婴儿接受了口服葡萄糖酸钙和一次肌内注射硫酸镁的治疗。尽管继续哺乳和母亲药物治疗，婴儿在生命第4天轻度代谢性酸中毒消失，1、3和8个月时体重增长正常，但出现轻度肌张力减退。作者认为代谢效应是由乙酰唑胺的跨胎盘传递引起的，尽管婴儿继续哺乳，但这种效应得到了解决。婴儿在哺乳期间体重增长适当，但下肢有轻微的残余肌张力增高，需要物理治疗。
一名新生儿在母亲接受各种眼用噻吗洛尔、二匹弗林、多佐胺、溴莫尼定和多次乙酰唑胺治疗期间进行母乳喂养。最终，母亲使用0.5%的噻吗洛尔凝胶形成溶液和2%的多佐胺滴眼液。药物在哺乳后立即给予，并封堵泪点，婴儿未观察到呼吸暂停或心动过缓。
◉ 对泌乳和母乳的影响：截至修订日期，未找到关于β-阻断或噻吗洛尔在正常哺乳期间影响的相关已发布信息。在一项对6名高催乳素血症和乳汁过多患者的研究中，发现β-肾上腺素能阻断剂心得安（普萘洛尔）治疗后血清催乳素水平没有变化。
◉ Summary of Use during Lactation: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, although some guidelines state that gel formulations are preferred over solutions. 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.
◉ Effects in Breastfed Infants:None reported, but beta-adrenergic blocking drugs with similar breastmilk excretion characteristics have caused adverse effects in breastfed newborns.
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.
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.
A newborn infant was breastfed during maternal therapy with various combinations of ocular timolol, dipivifrin, dorzolamide, brimonidine and several doses of acetazolamide. Ultimately, the mother was treated with timolol gel-forming solution 0.5% and dorzolamide 2% drops. The drugs were given immediately following breastfeeding with punctal occlusion and no apnea or bradycardia was observed in the infant.
◉ Effects on Lactation and Breastmilk: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.
来源:Drugs and Lactation Database (LactMed)
