Cyclosporine levels vary considerably in several case reports and series. This variability may be partially due to inconsistent sampling times among the reports and probably related to the fat content of the milk at the time of sampling. With typical maternal cyclosporine blood levels, a completely breastfed infant would usually receive no more than about 2% of the mother’s weight-adjusted dosage or pediatric transplantation maintenance dosage, and often less than 1%. In most breastfed infants, cyclosporine is not detectable in blood; however, occasionally infants have had detectable blood levels, even when milk levels and infant dosage were low. Numerous infants have been breastfed during maternal cyclosporine use, usually with a concurrent corticosteroid and sometimes with concurrent azathioprine. At least 2 mothers successfully breastfed a second infant after successfully breastfeeding the first infant. No reports of adverse effects on infants’ growth, development or kidney function have been reported, although thorough follow-up examinations have not always been performed or reported. Numerous experts and professional guidelines have stated that the drug is a low risk to nursing infants and acceptable to use during breastfeeding.[1–7] Breastfed infants should be monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.[8] Because absorption from the eye is limited, ophthalmic cyclosporine would not be expected to cause any adverse effects in breastfed infants. To decrease 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.
在多个病例报告和系列研究中，环孢素水平差异很大。这种变异性可能部分归因于各报告中采样时间不一致，并且可能与采样时母乳中的脂肪含量有关。对于典型的母亲环孢素血药水平，完全母乳喂养的婴儿通常接受的剂量不超过母亲体重调整剂量或儿科移植维持剂量的约2%，且通常低于1%。在大多数母乳喂养的婴儿中，血液中检测不到环孢素；然而，偶尔婴儿的血液水平可被检测到，即使母乳中环孢素水平和婴儿摄入量较低。许多婴儿在母亲使用环孢素期间接受母乳喂养，通常同时使用皮质类固醇，有时还同时使用硫唑嘌呤。至少有2名母亲在成功母乳喂养第一个婴儿后又成功母乳喂养了第二个婴儿。尽管并非总是进行或报告全面的随访检查，但尚未有关于对婴儿生长、发育或肾功能产生不良影响的报告。众多专家和专业指南指出，该药物对哺乳婴儿的风险较低，母乳喂养期间使用是可接受的。[1 - 7] 如果在哺乳期使用该药物，应对母乳喂养的婴儿进行监测，如有疑虑，可能需要检测血清水平以排除毒性。[8] 由于眼部吸收有限，预计眼部用环孢素不会对母乳喂养的婴儿造成任何不良影响。使用滴眼液后，为减少进入母乳的药量，可在眼角处按压泪道1分钟或更长时间，然后用吸水纸巾擦去多余溶液。
