What allergy medicine is safe to take when pregnant
Corneal thickness, curvature, and sensitivity as well as tear composition can every change during pregnancy, said Elizabeth A. Davis, M.D., Bloomington, Minn., who co-authored a chapter on pregnancy and the eye for the book Principles and Practices of Ophthalmology. For this reason, pregnant patients who wear contact lenses may discover their contacts do not always fit properly, she said, or their contacts may feel greasier because of an increased level of lysozyme in the tear film, she said.
If these patients desire to opt for refractive surgery because their contacts are uncomfortable, they own to ponder again, Dr.
“We don’t do refractive surgery in pregnant women,” she said. “We recommend patients wait three months after giving birth and/or breastfeeding because of every sorts of hormonal changes that can change the refractive error.” Between the changes in refractive error that pregnancy can cause—which could lead surgeons to treat an inaccurate refractive error—and the unknown risks of any medications patients may take in conjunction with refractive surgery, waiting is a safer option, Dr.
Glaucoma medication risks
For glaucoma patients, one positive aspect is that IOP tends to decrease naturally during pregnancy, said Douglas J. Rhee, M.D., assistant professor of ophthalmology, Department of Ophthalmology, Glaucoma Section, Massachusetts Eye & Ear Infirmary, Boston.
He cites previous studies that own been done in this area. He also did some research regarding pregnancy and the eye for the Ophthalmic Drug Guide, a book he co-authored that was published this year.
Beyond the IOP advantage, he said that glaucoma specialists are especially cautious in their treatment of pregnant patients because of the unknown effects of glaucoma medications.
“All glaucoma medications own the potential to cause fetal and embryonic harm,” he said. “It’s not a well-studied area.” In fact, most glaucoma medications are classified in category C of the Food and Drug istration’s safety categories; this means the drugs own an uncertain safety profile, there own been no human studies, and animal studies may show an adverse effect.
Two exceptions to the risks from glaucoma medications: brimonidine is category B and reasonable to offer up to one month before delivery and oral acetazolaminde was reported safe in a case series for the treatment of intracranial hypertension, published in in the American Journal of Ophthalmology.
Still, the series only involved patients, Dr.
Rhee said. Plus, “acetazolamide during tardy pregnancy has been associated with renal tubular acidosis in the newborn and may own potential teratogenic effects if istered during the first 12 weeks of fetal development,” Dr. Rhee said, citing a study from Survey of Ophthalmology.
Amtimetabolites such as 5-fluorouracil (5-FU) and mitomycin C and prostaglandin analogues are medications to definitely avoid during pregnancy, he said.
Soft contact lens-related corneal infiltrate in a year-old lady.
Infiltrates such as this one may require additional care in a pregnant patient.
Source: Christopher J. Rapuano, M.D.
The best approach is avoidance of glaucoma medications during this period, he said.
“You see what happens to pressure when you take them off the medications, monitor the pressure, and see if the optic nerve can tolerate it,” Dr. Rhee said.
Selective or argon laser trabeculoplasty are potential surgical solutions for pregnant patients, he said. If those are not successful, some investigators own suggested cylcophotocoagulation as a excellent option, Dr. Rhee said. Trabeculect-omy without anti-metabolites or post-op anti-inflammatory medication is another procedure to attempt.
Still, the surgical methods own a lower success rate because of the young age of the patients.
“It’s a notoriously hard area,” he said. By the time the patient has delivered the baby and is nursing, glaucoma practitioners can once again consider how much the patient needs her medications. A switch to bottle feeding for the newborn may be the best option so the patient can resume their medicine, Dr. Rhee said. h
Editors’ note: Dr. Rapuano lectures for Alcon (Fort Worth, Texas) and Allergan (Irvine, Calif.).
Drs. Davis and Rhee own no financial interests related to their comments. Dr. Sheppard is a consultant for Alcon, Allergan, Bausch & Lomb (Rochester, N.Y.), and various other companies.
Davis: , [email protected]
Rapuano: , [email protected]
Rhee: , [email protected]
Sheppard: , [email protected]
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Dry eye and allergies
Dry eye can be an issue in pregnant patients who wear contact lenses and in those who experience nausea and vomiting, said John D.
Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk. The nausea and vomiting lead to dehydration, which can lead to drier eyes, he said. Certain medications that patients may take to inhibit nausea can also contribute to dry eye, he said. Practitioners seem to consent that artificial tear drops are a safe treatment option to lubricate the eyes.
Another simple solution is asking patients to reduce contact lens wear or not wear them at all.
Beyond those easier steps, everyone has diverse ideas.
Dr. Sheppard said he “leans more toward the natural route” to treat pregnant dry-eye patients. This includes supplements such as fish oil, flaxseed oil, and black currant seed oil. Preliminary research and anecdotal evidence shows that omega-3 acids found in these supplements can assist the ocular surface.
He uses silicone or plastic punctal plugs as well, an option that Dr.
Davis also thinks is reasonable. “Punctal plugs and lubricant drops would be the mainstay of my treatment,” she said.
Restasis (cyclosporine ophthalmic emulsion %, Allergan, Irvine, Calif.), which is frequently used now to treat dry eye, may or may not be a excellent option for pregnant patients, physicians said.
“The use of Restasis is not contraindicated,” Dr. Sheppard said. “I own no problems treating pregnant patients with Restasis.” He said Restasis has an added benefit: helping to control ocular allergies.
However, “I’d take the patient off the Restasis, not because I ponder it’s unsafe but because it is cyclosporine and as far as I know, it’s not been tested [with pregnant women],” Dr.
If the patient has severe dry eye, Dr. Sheppard is also comfortable using Lotemax (loteprednol etabonate ophthalmic suspension %, Bausch & Lomb, Rochester, N.Y.).
With seasonal allergies, Dr. Sheppard will use Restasis and drops such as Elestat (epinastine hydrocholoride %, Inspire Pharmaceuticals, Durham, N.C.) and Patanol (olopatadine hydrocholoride %, Alcon, Fort Worth, Texas). Still, he avoids oral antihistamines or antihistamines with a decongestant component. “With the systemic effects, we’re not percent certain they’re safe for the fetus,” he said.
Patients who wear contact lenses and own seasonal allergies may discover their symptoms more manageable if they avoid their contacts for awhile, Dr.
Using the lowest quantity of drops necessary and encouraging patients with allergies to use cool compresses are other possible approaches, Dr. Davis said. “If they’re miserable, I tell it’s OK” to use drops for ocular allergies, Dr. Rapuano said. Still, he tries to hold their use to a minimum during pregnancy.
Dr. Rapuano also teaches his patients to act out digital punctal occlusion before they ister a drop and at least 60 seconds after they put a drop in.
“This significantly decreases the quantity of the drop that gets into the nose and the bloodstream,” he said.
“It keeps the medication more localized.”
Generic Name:diphenhydramine (DYE fen HYE dra meen)
Medically reviewed by Sanjai Sinha, MD Final updated on Dec 18,
Dr. Rapuano said dilating drops are safe to occasionally use if it’s an urgent situation—a patient experiencing flashers and floaters, for example. If it is a routine examination, he advises the patient to wait until she has had the baby.
Even though practitioners generally prefer to avoid medications for pregnant patients, a corneal infection requires treatment, Dr. Davis said.
There are certain drops that are safer,” she said.
“Erythromycin and polymixin B appear to be the safest antibiotics,” she said. “They’re not as wide spectrum as the fourth-generation fluoroquinolones, but I’d start with those and see if they’ll treat the problem.”
A corneal infection is another excellent situation in which to consult the obstetrician about the treatment plan, Dr. Sheppard said.
Low-dose steroid drops are generally safe during pregnancy in patients such as those who’ve had a corneal transplant and are on anti-rejection steroids, Dr. Rapuano said.
However, he said he generally stops the use of antiviral medications such as Valtrex (valacylovir, GlaxoSmithKline, United Kingdom) in patients with herpes.
What is Benadryl?
Benadryl (diphenhydramine) is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.
Benadryl is used to treat sneezing, runny nose, watery eyes, hives, skin rash, itching, and other freezing or allergy symptoms.
Benadryl is also used to treat motion sickness, to induce sleep, and to treat certain symptoms of Parkinson’s disease.