Drugs List

Pregnancy and Lactation

Pregnancy

Lidocaine hydrochloride with fluorescein is considered safe for use in pregnancy.

This combination has been used for a number of years without apparent ill-consequence.

There is limited data regarding the safety of lidocaine administration during pregnancy. Animal studies also indicate no hazard.

Case studies of fluorescein in pregnant women have not revealed any unwanted foetal effects. Fluorescein crosses the placenta; passage to the foetus due to systemic circulation should be expected, but is unlikely to produce unwanted effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Lidocaine hydrochloride with fluorescein is considered safe for use in breastfeeding.

Lidocaine is excreted in human breast milk, however at therapeutic doses, the excreted amounts are not high enough to be of risk to the infant.

Following topical application to the eye, the levels of fluorescein in breast milk are small and hence the amounts ingested by the infant would not be expected to cause any adverse effects. Therefore no special precautions are required (LactMed). Due to the photosensitivity of fluorescein, there is a risk of phototoxicity, especially in neonates, but this is unlikely to be a problem within the normal therapeutic dose range.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Presentation

Eye drops containing lidocaine hydrochloride with fluorescein (preservative-free).

Drugs List

Dosage

Adults

Children

Pregnancy and Lactation

Pregnancy

Lidocaine hydrochloride with fluorescein is considered safe for use in pregnancy.

This combination has been used for a number of years without apparent ill-consequence.

There is limited data regarding the safety of lidocaine administration during pregnancy. Animal studies also indicate no hazard.

Case studies of fluorescein in pregnant women have not revealed any unwanted foetal effects. Fluorescein crosses the placenta; passage to the foetus due to systemic circulation should be expected, but is unlikely to produce unwanted effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Lidocaine hydrochloride with fluorescein is considered safe for use in breastfeeding.

Lidocaine is excreted in human breast milk, however at therapeutic doses, the excreted amounts are not high enough to be of risk to the infant.

Following topical application to the eye, the levels of fluorescein in breast milk are small and hence the amounts ingested by the infant would not be expected to cause any adverse effects. Therefore no special precautions are required (LactMed). Due to the photosensitivity of fluorescein, there is a risk of phototoxicity, especially in neonates, but this is unlikely to be a problem within the normal therapeutic dose range.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Minims Lidocaine & Fluorescein. Bausch & Lomb U.K. Limited. Revised January 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 17 August 2017

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 07 September 2015

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Lidocaine. Last revised: 08 July 2014
Last accessed: 07 September 2015