DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI dari sumber URL : http://www.kellymom.com/health/meds/aap-approved-meds.html

Kelompok Analgetik, NSAIDS, Obat Batuk dan Pilek, Anti Alergi dan Asma, Anestesi

Obat untuk Penghilang Rasa Sakit (Pain Killer)Nama Obat AAP approved?* Kategori Risiko Kehamilan** Risiko Menyusui** NotesAcetaminophen (Tylenol) Approved B L1

Aspirin Caution C (1st, 2nd trim.)D (3rd trim.) L3 1

Azapropazone (Rheumox) Approved - L2Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne) NR D L3 2

Butorphanol (Stadol) Approved B (1st, 2nd trim.)D (3rd trim.) L3

Celecoxib (Celebrex)) NR C L2Codeine (in Tylenol #3, #4) Approved C L3 3Colchicine Approved D L4Diclofenac (Cataflam, Voltaren) NR B L2Fentanyl (Sublimaze) Approved B L2

Flurbiprofen (Ansaid, Froben, Ocufen) NR B (1st, 2nd trim.)C (3rd trim.) L2

Hydrocodone (Lortab, Vicodin) NR B L3 4Hydromorphone (Dilaudid) NR C L3 5

Ibuprofen (Advil, Nuprin, Motrin, Pediaprofen) Approved B (1st, 2nd trim.)D (3rd trim.) L1

Indomethacin (Indocin) Approved B (1st, 2nd trim.)D (3rd trim.) L3

Ketorolac (Toradol, Acular) Approved B (1st, 2nd trim.)D (3rd trim.) L2

Meperidine (Demerol) Approved B L2;L3 early postpartum 6

Methadone (Dolophine) Approved B L3 7Morphine (Duramorph, Infumorph, Epimorph, MS Contin) Approved B L3 8

Nalbuphine (Nubain) NR B L2Naproxen (Anaprox, Naprosyn, Naproxen, Aleve) Approved B L3;

L4 for chronic use 9

Nefopam (Acupan) Approved - NROxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet) NR B L3 10

Pentosan polysulfate (Elmiron) NR B L2Piroxicam (Feldene) Approved B L2Propoxyphene (Darvocet N, Propacet, Darvon) Approved C L2 11Rofecoxib (Vioxx) Withdrawn from the market 12Secobarbital (Seconal) Approved D L3 13Tolmetin (Tolectin) Approved C L3Tramadol HCL (Ultram, Ultracet) NR C L3 14Valdecoxib (Bextra) Withdrawn from the market more* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Approved: (Table 6) Maternal Medication Usually Compatible With Breastfeeding Caution: (Table 5) Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers

With Caution NR: Not Reviewed. This drug has not yet been reviewed by the AAP.

** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2004 edition).Lactation Risk Categories Pregnancy Risk Categories L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)

A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) D (positive evidence of risk) X (contraindicated in pregnancy)

NR: Not Reviewed. This drug has not yet been reviewed by Hale.

1. Aspirin use is discouraged in children and nursing mothers due to the risk of Reye’s syndrome and internal bleeding.2. Fioricet (Fiorinal, Bancap, Two-dyne) contains acetaminaphen or asprin, caffeine, and butalbital. Per Hale, baby should be observed for sedation.3. Hale suggests weakened or premature infants be observed for sedation and apnea.4. Hale suggests newborns be observed for sedation, apnea, constipation.

5. Per Hale, use of frequent, higher dose may result in infant sedation.6. Per Hale, Meperidine use during labor or early postpartum has been associated with sedation, poor sucking reflex, and neurobehavioral delay in infants.7. Per Hale, observe infant for sedation, respiratory depression, addiction, withdrawal syndrome.8. Per Hale, higher doses may result in infant sedation.9. Per Hale, should be used with caution due to its long half-life and its effect on baby’s cardiovascular system, kidneys and GI tract; short-term, infrequent

or occasional use is not necessarily incompatible with breastfeeding.10. Roxicet, Endocet, Roxiprin, Percocet also contain acetaminophen. Per Hale, observe infant for sedation.11. Per Hale, observe infant for sedation.12. Per Hale, observe infant for GI cramping, distress, diarrhea.13. Per Hale, observe infant for sedation.14. Per Hale, observe infant for sedation.

Non-steroidal anti-inflammatory analgesics (NSAIDs) [more]

Nama Generik Nama Dagang AAP approved?*Kategori Risiko

Kehamilan** Risiko Menyusui**Azapropazone (apazone) Rheumox Approved - L2Dipyrone (banned in the US & UK) - Approved - NR

Flufenamic acid - Approved - NR

Ibuprofen Advil, Nuprin, Motrin, Pediaprofin Approved B (1st, 2nd trim.)D (3rd trim.) L1

Indomethacin Indocin Approved B (1st, 2nd trim.)D (3rd trim.) L3

Ketorolac Toradol, Acular Approved B (1st, 2nd trim.)D (3rd trim.) L2

Mefenamic acid Ponstan, Ponstel Approved - NR

Naproxen Anaprox, Naprosyn, Naproxen, Aleve Approved B L3L4 (for chronic use)

Phenylbutazone Butazolidine Approved - NRPiroxicam Feldene Approved B L2Suprofen Profenal Approved - NRTolmetin Tolectin Approved C L3Steroid [contents]Methylprednisolone[ high dosage methylprednisolone] Solu-Medrol, Depo-Medrol, Medrol Approved C L2

Prednisolone - Approved C L2Prednisone Deltasone, Meticorten, Orasone Approved C L2

Obat Asma [contents]Dyphylline Dilor, Lufyllin, Dyphylline Approved C L3Terbutaline Bricanyl, Brethine Approved B L2Theophylline Aminophylline, Quibron, Theo-Dur Approved C L3

Analgetik Narkotik [more]

Butorphanol Stadol Approved B (1st, 2nd trim.)D (3rd trim.) L3

Codeine Tylenol #3, #4 Approved C L3Fentanyl Sublimaze Approved B L2

Meperidine Demerol Approved B L2L3 (if used early postpartum)

Methadone Dolophine Approved B L3Morphine Morphine Approved B L3Propoxyphene Darvocet N, Propacet, Darvon Approved C L2

Obat BatukNama Obat AAP approved?* Risiko Menyusui**Codeine yes L3 (moderately safe)Dextromethorphan not reviewed L1 (safest)Guaifenesin not reviewed L2 (safer)Dekongestan (Obat Pilek)Nama Obat AAP approved?* Risiko Menyusui**Phenylephrine not reviewed L3 (moderately safe)

Pseudoephedrine (Sudafed, Actifed) yes L3 (moderately safe) for acute useL4 (possibly hazardous) for chronic use due to potential for decreasing milk supply

* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2006 edition)Nasal Sprays (Spray Hidung)

Nama Obat AAPapproved?* Risiko Menyusui**

Beclomethasone (Vanceril, Beclovent, Beconase, Vancenase) not reviewed L2 (safer)

Cromlyn sodium (Nasalcrom) not reviewed L1 (safest)Fluticasone (Flonase) not reviewed L3 (moderately safe)Mometasone (Nasonex) not reviewed L3 (moderately safe)Phenylephrine (in some forms of Sinex and Neo-Synephrine) not reviewed L3 (moderately safe)

Triamcinolone Acetonide (Nasacort) not reviewed L3 (moderately safe)Antihistamin (Anti Alergi)

Nama Obat AAPapproved?* Risiko Menyusui**

Brompheniramine not reviewed L3 (moderately safe)Chlorpheniramine (Chlor-Trimeton) CTM not reviewed L3 (moderately safe)

Cetirizine (Zyrtec) not reviewed L2 (safer)Dexbrompheniramine maleatewith d-isoephedrine yes not reviewed

Diphenhydramine (Benadryl) not reviewed L2 (safer)Doxylamine not reviewed L4 (possibly hazardous)Fexofenadine (Allegra) yes L3 (moderately safe)Loratadine (Claritin) yes L2 (safer)Terfenadine (Seldane) yes not reviewedTriprolidine (Actidil, Actifed) yes L1 (safest)* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition)

Obat Anestesi

Nama Obat AAP approved?* Kategori Risiko Kehamilan** Risiko Menyusui** Notes

Local anesthetics Articaine (Septocaine) NR - NR moreBupivacaine (Marcaine) NR C L2Lidocaine (Xylocaine) Approved C L2Mepivacaine (Carbocaine, Polocaine) NR C L3 moreProcaine HCL (Novocaine) NR C L3General anestheticsHalothane (Fluothane) Approved C L2 moreIsoflurane (Forane) NR - NR 1Ketamine NR - NR moreMethohexital (Brevital) Approved B L3Nitrous oxide NR - L3Sevoflurane (Ultane) NR B L3Thiopental (Pentothal) Approved C L3Other medications often used during anesthesiaSedativesDiazepam (Valium) Concern D L3; L4 for

chronic useMidazolam (Versed) Concern D L3Propofol (Diprivan) NR B L2 moreTriazolam (Halcion) NR X L3Narcotic AnalgesicsAlfentanil (Alfenta) NR C L2Fentanyl (Sublimaze) Approved B L2Hydromorphone (Dilaudid) NR C L3Morphine Approved B L3Reversal Medication

Flumazenil (Romazicon) NR C NR 2Naloxone (Narcan) NR C NR 3SteroidsDecadron (Dexamethasone) NR C NR moreStimulantsEpinephrine (Adrenaline) NR C L1Anti-nauseaPromethazine (Phenergan) NR C L2* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Approved: (Table 6) Maternal Medication Usually Compatible With Breastfeeding Concern: (Table 4) Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern Caution: (Table 5) Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers

With Caution NR: Not Reviewed. This drug has not yet been reviewed by the AAP.

** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2004 edition).Lactation Risk Categories Pregnancy Risk Categories L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)

A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) D (positive evidence of risk) X (contraindicated in pregnancy)

NR: Not Reviewed. This drug has not yet been reviewed by Hale.

1. Isoflurane (Forane) is used for c-sections and directly in newborns. Induction of and recovery from isoflurane anesthesia are rapid, so the majority of the medication is out of the body (and milk) very quickly. More here.

2. Flumazenil (Romazicon) is used directly in children aged 12 months and up.3. Naloxone (Narcan) is used directly in newborns and children.4. Many forms of Robitussin, Delsym and Benylin are considered compatible with breastfeeding. Always check the active ingredients, as there are many

versions.Kelompok Antasida, Antibiotik, Antivirus, Antijamur, Kontrasepsi, Obat jantung & Hipertensi, Vitamin, dll

Nama Generik Nama Dagang AAP approved?*Kategori Risiko

Kehamilan** Risiko Menyusui**Antasida [contents]Cimetidine (Antacid) Tagamet Approved B L2Cisapride (GI tract stimulant) Propulsid Approved C L2Domperidone (used for nausea & vomiting, stimulates lactation) [more] Motilum Approved - L1

Antibiotika [contents]Amoxicillin Larotid, Amoxil Approved B L1Aztreonam Azactam Approved B L2Cefadroxil Ultracef, Duricef Approved B L1Cefazolin Ancef, Kefzol Approved B L1Cefotaxime Claforan Approved B L2Cefoxitin Mefoxin Approved B L1Cefprozil Cefzil Approved C L1

Ceftazidime Ceftazidime, Fortaz, Taxidime Approved B L1

Ceftriaxone Rocephin Approved B L2Ciprofloxacin [more] Cipro Approved C L3Clindamycin Cleocin Approved B L3

Erythromycin E-Mycin, Ery-tab, ERYC, Ilosone Approved B L1

L3 early postnatalFleroxacin - Approved - NRGentamicin Garamycin Approved C L2Kanamycin Kebecil, Kantrex Approved D L2Moxalactam Moxam Approved - NRNitrofurantoin Macrobid Approved B L2Ofloxacin Floxin Approved C L2Penicillin - Approved B L1Streptomycin Streptomycin Approved D L3Sulbactam - Approved - NRSulfisoxazole Gantrisin, Azo-Gantrisin Approved C L2Tetracycline Achromycin, Sumycin, Approved D L2

TerramycinTicarcillin Ticarcillin, Ticar, Timentin Approved B L1Trimethoprim/sulfamethoxazole Proloprim, Trimpex Approved C L3Antikoagulan [contents]Bishydroxycoumarin (dicumarol) - Approved - NRWarfarin Coumadin, Panwarfin Approved D L2Antikonvulsan (Anti kejang) [contents]Carbamazepine Tegretol, Epitol Approved C L2Ethosuximide Zarontin Approved C L4Magnesium sulfate Epsom salt Approved B L1Phenytoin Dilantin Approved D L2Valproic acid Depakene, Depakote Approved D L2Anti Jamur [contents]Fluconazole [more] Diflucan Approved C L2Ketoconazole Nizoral Shampoo, Nizoral Approved C L2Antivirus [contents]Acyclovir [more] Zovirax Approved C L2

Interferon-alpha [more] Alferon N, Interferon Alpha Approved C L2

Arthritis meds (see also: pain meds) [contents]

Gold salts Ridaura, Myochrysine, Solganal Approved C L5

Kontrasepsi, Hormon [contents]

Estradiol Estratab, Permarin, Menest Approved X L3 (may interfere with

milk production)Clogestone - Approved - NR

Contraceptive pill with estrogen/progesterone

Preven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra patch, etc.

Approved X L3 (may interfere with milk production)

Levonorgestrel Norplant, Mirena, Plan B Approved X L2

Medroxyprogesterone Provera, Depo-Provera, Cycrin Approved D

L1L4 (if used first 3 days

postpartum)Norethynodrel Enovid Approved X L2Progesterone Crinone, Prometrium Approved - L3Obat Diabetes [contents]Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1.Tolbutamide Oramide, Orinase Approved D L3Obat Diare [contents]

Loperamide

Imodium, Pepto Diarrhea Control, Maalox Antidiarrheal Caplets, Kaopectate II Caplets, Immodium Advanced

Approved B L2

** Note: Pepto-Bismol & Kaopectate (bismuth subsalicylate is the active ingredient in both) are not recommended for routine use by nursing moms, due to the association of salicylates with Reyes syndrome in children. [more]Diuretik (Peluruh Kencing) [contents]Acetazolamide Dazamide, Diamox Approved C L2

Bendroflumethiazide Naturetin Approved D L4 (may inhibit lactation)

Chlorothiazide Hydrodiuril Approved D L3Chlorthalidone Hygroton Approved D L3

Hydrochlorothiazide (HCT) Hydrodiuril, Esidrix, Oretic Approved D L2

Spironolactone Aldactone Approved D L2Anti Muntah [more] [contents]Domperidone Motilum Approved - L1Anti Hipertensi, Obat Jantung [contents]Anti aritmiaDisopyramide Norpace, Napamide Approved C L2

Flecainide Tambocor Approved C L3Mexiletine Mexitil Approved B L2Procainamide Pronestyl, Procan Approved C L3Quinidine Quinaglute, Quinidex Approved C L2Anti Hipertensi

Captopril Capoten Approved D L3 (if used after 30 days)

Diltiazem/Diltiazem HCL Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD Approved C L3

Enalapril/Enalapril Maleate Vasotec Approved C (1st trim.)D (2nd, 3rd trim.) L2

Hydralazine Apresoline Approved C L2Labetalol Trandate, Normodyne Approved C L2Methyldopa Aldomet Approved C L2Metoprolol Toprol XL, Lopressor Approved B L3

Minoxidil Loniten, Minodyl, Rogaine Approved C L2 (topically)

L3 (orally)Nadolol Corgard, Nadolol Approved C L4Nifedipine Adalat, Procardia Approved C L2

Oxprenolol Apsolox, Slow-Trasicor, Trasicor Approved - NR

Propranolol Inderol Approved C L2Sotalol Betapace Approved B L3Timolol Blocadren Approved C L2

Verapamil Calan, Isoptin, Covera-HS Approved C L2

Cardiac stimulantsDigoxin Lanoxin, Lanoxicaps Approved C L2Laksan (Pelancar BAB) [more] [contents]Cascara/Cascara Sagrada - Approved C L3Danthron - Approved - NRMagnesium sulfate Epsom salt Approved B L1Senna - Approved - L3Obat malaria [contents]Chloroquine Aralen, Novo-chloroquine Approved C L3Hydroxychloroquine Plaquenil Approved C L2Pyrimethamine Daraprim Approved C L4Quinine Quinamm Approved D L2Medical Testing [more] [contents]Diatrizoate - Approved - NRFluorescein - Approved C L3Gadopentetic (Gadolinium) - Approved C L2Iohexol Omnipaque Approved B L2Iopanoic acid Telepaque Approved D L2Metrizamide Amipaque Approved B L2Metrizoate Isopaque Approved B L2Obat Migren [more] [contents]Sumatriptan Imitrex Approved C L3Obat Sedativ [more] [contents]Chloral hydrate Aquachloral, Noctec Approved C L3Methyprylon (withdrawn from use in US & Canada) - Approved - NRBromide - Approved D L5Secobarbital Seconal Approved D L3Obat Tidur [contents]Zolpidem/Zolpidem Tartrate Ambien Approved B L3Obat Anti Tiroid [more] [contents]Carbimazole - Approved D L3Methimazole (active metabolite of carbimazole) Tapazole Approved D L3Propylthiouracil PTU Approved D L2Thiouracil - Approved - NR

Levothyroxine Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl Approved A L1

Obat TBC [contents]Cycloserine Seromycin Approved C L3Ethambutol Ethambutol, Myambutol Approved B L2Isoniazid INH, Laniazid Approved C L3Rifampin Rifadin, Rimactane Approved C L2VITAMIN [more] [contents]B-1 (thiamin) - Approved - NRB-12 (Cyanocobalamin) - Approved A L1

B-6 (pyridoxine) - Approved A L2; L4 in high doses (may inhibit lactation)

D, vitamin Calciferol, Delta-d Approved A L3 (do not overdose)

Folic acid - Approved A (1st, 2nd trim.)C (3rd trim.) L1

K-1, vitamin (Phytonadione) - Approved C L1Riboflavin/B2 - Approved A L1Lain-lain [contents]Acitretin (Anti-psoriasis) Soriatane Approved - NRAlcohol/Ethanol [more] - Approved D L3Allopurinol Zyloprim, Lopurin Approved C L2Antimony - Approved - NRAtropine (Anticholinergic, drying agent) Belladonna, Atropine Approved C L3Azapropazone/apazone (Antirheumatic) Rheumox Approved - L2Baclofen (muscle relaxant) Lioresal, Atrofen Approved C L2Barbiturate - Approved - NRCaffeine [more] Vivarin, NoDoz, Coffee Approved B L2Carbetocin (Antihemorrhagic) Duratocin Approved - NRChloroform - Approved - NRCisplatin (Anti-cancer) Platinol Approved D L4Dapsone (Antileprosy) Avlosulfon, DDS Approved C L4Hydroxychloroquine (Antirheumatic, lupus) Plaquenil Approved C L2Iodides - Approved - NRIodine - Approved - NRIodine (povidone-iodine, eg, in a vaginal douche) - Approved - NRIvermectin (Antiparasitic) Mectizan Approved C L3Nalidixic acid (Urinary Anti-infective) NegGram Approved B L4Norsteroids - Approved - NRPyridostigmine (Muscle stimulant) Mestinon, Regonol Approved C L2Scopolamine (Motion sickness) Transderm Scope Approved C L3Sulfapyridine Dagenan Approved - NRTimolol (glaucoma med) Blocadren Approved D L3* Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Approved: (Table 6) Maternal Medication Usually Compatible With Breastfeeding Caution: (Table 5) Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With

Caution NR: Not Reviewed. This drug has not yet been reviewed by the AAP.

** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2004 edition).Lactation Risk Categories Pregnancy Risk Categories L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)

A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) D (positive evidence of risk) X (contraindicated in pregnancy)

NR: Not Reviewed. This drug has not yet been reviewed by Hale

Pembagian kategori tingkat keamanan obat (termasuk antibiotik) untuk kehamilan Pembagian kategori tingkat keamanan obat (termasuk antibiotik) untuk kehamilanSebelumnya, perlu saya kemukakan pembagian kategori keamanan suatu obat untuk penggunaan pada ibu hamil :Kategori A :Obat-obat yang menurut studi terkontrol tidak menimbulkan resiko pada janin

Kategori B :Untuk obat-obat yang berdasarkan studi pada binatang dan manusia tidak menunjukkan resiko yang bermakna. Termasuk disini adalah :1. Dari studi pada binatang tidak menunjukkan resiko, tetapi belum ada studi pada manusia mengenai hal tersebut2. Dari studi pada binatang menunjukkan adanya resiko, tetapi dari hasil studi yang terkontrol baik pada manusia menunjukkan tidak adanya resiko.Kategori C :Untuk obat-obat yang belum didukung studi adekuat, baik pada binatang maupun pada manusia atau obat-obat yang menunjukkan efek yang merugikan pada studi binatang tetapi belum ada studi pada manusiaKategori D :Untuk obat-obat yang ada bukti resikonya pada janin tetapi manfaatnya jauh lebih besar

Kategori X :Untuk obat-obat yang terbukti mempunyai resiko terhadap janin dan resiko itu lebih berat daripada manfaatnyaAntibiotik tidak ada yang termasuk kategori X. Umumnya masuk kategori B, kecuali beberapa yang masuk kategori C atau D.