Plop, plop then blink, blink, blink?

Ahhh, today was the first day that I woke up with minimal sneezing and eyes that didn't itch or look bloodshot. It has been torture for the past couple of weeks, but I survived with over-the-counter (OTC) cetirizine (Zyrtec) 10 mg that I took by mouth once a day and OTC ketotifen (Zatitor) eye drops twice daily. They don't make me symptom-free, but they definitely dampen my misery. I even started breaking my dose in half and taking it twice a day; 5 mg in the morning and 5 mg in the evening, and it's been working out. Sometimes this is done with other medications to maintain a better drug level in the blood.

Since I'm still nursing my son, my first concern is his safety; how will these antihistamines affect him? Cetirizine is generally considered safe, but it is unknown how much of the medicine will distribute into the breast milk. I have been watching him for excessive irritability and drowsiness, and he's been fine. There is little information about ketotifen and breastfeeding. So, I make sure I practice good technique when applying eye drops. The amount of drug that drains into the tear duct into the nose, where much of the drug will get absorbed into the bloodstream, can be minimized. Good tip to remember: put in the drops, gently put pressure on the tear duct with eyes closed for at least 30 seconds (up to 2 minutes). Of note, applying more drops is not better; 1 drop is more than enough, even if some of it drips out of the corner of your eye. If your doctor tells you to put in 2 drops, avoid the plop, plop method; put in one drop at a time. Try not to blink right away because that will flush the eye drop out of the eye like a windshield wiper.

Kids suffer from seasonal allergies, too. Some kids who also have asthma may need higher doses of their controller medicines, or start additional ones, like montelukast (Singulair), to prevent the asthma attacks triggered by seasonal allergies. Check with the pediatrician or pharmacist first if your child has other conditions (and especially if they are younger than 2 years of age) before giving them OTC antihistamines, like diphenhydramine (Benadryl) or loratadine (Claritin). Make sure the proper measuring tool is used for syrups. If the medicine is to be taken once daily, give it at bedtime so the morning symptoms are covered. Try to use the proper technique for eye drops. One plop, but no blinking...just light pressure on the tear duct. Oh, and be sure to wash your hands before and after.

Other resources:
The FDA has good information about breastfeeding, but other sources may be more current regarding the transfer of medications into breastmilk. Kellymom.com provides evidence-based information on breastfeeding and parenting. The American Academy of Allergy, Asthma, and Immunology (AAAAI) has kid-friendly information about allergies and asthma.