DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI

Kelompok Analgetik,  NSAIDS,  Obat Batuk dan Pilek,

Anti Alergi dan Asma, Anestesi

 

Obat untuk Penghilang Rasa Sakit (Pain Killer)

Nama ObatAAP

approved?*Kategori Risiko

Kehamilan**Risik

oMenyusui**Note

sAcetaminophen (Tylenol) Approved B L1

Aspirin CautionC (1st, 2nd trim.)

D (3rd trim.)L3 1

Azapropazone (Rheumox) Approved - L2Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne)

NR D L3 2

Butorphanol  (Stadol) ApprovedB (1st, 2nd trim.)

D (3rd trim.)L3

Celecoxib (Celebrex)) NR C L2Codeine (in Tylenol #3, #4)

Approved C L3 3

Colchicine Approved D L4Diclofenac (Cataflam, NR B L2

Voltaren)Fentanyl  (Sublimaze) Approved B L2Flurbiprofen (Ansaid, Froben, Ocufen)

NRB (1st, 2nd trim.)

C (3rd trim.)L2

Hydrocodone (Lortab, Vicodin)

NR B L3 4

Hydromorphone(Dilaudid)

NR C L3 5

Ibuprofen (Advil, Nuprin, Motrin, Pediaprofen)

ApprovedB (1st, 2nd trim.)

D (3rd trim.)L1

Indomethacin (Indocin) ApprovedB (1st, 2nd trim.)

D (3rd trim.)L3

Ketorolac (Toradol, Acular)

ApprovedB (1st, 2nd trim.)

D (3rd trim.)L2

Meperidine (Demerol) Approved BL2;

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 BL3;

L4 for chronic use9

Nefopam (Acupan) Approved - NROxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)

NR B L3 10

Pentosan polysulfate(Elmiron)

NR B L2

Piroxicam (Feldene) Approved B L2Propoxyphene(Darvocet N, Propacet, Darvon)

Approved C L2 11

Rofecoxib (Vioxx) Withdrawn from the market 12Secobarbital (Seconal) Approved D L3 13Tolmetin (Tolectin) Approved C L3Tramadol HCL(Ultram, Ultracet)

NR C L3 14

Valdecoxib  (Bextra) Withdrawn from the market more*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.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 DagangAAP

approved?*

Kategori Risiko

Kehamilan**

RisikoMenyusui**

Azapropazone (apazone) Rheumox Approved - L2Dipyrone (banned in the US & UK)

- Approved - NR

Flufenamic acid - Approved - NR

IbuprofenAdvil, Nuprin, Motrin, Pediaprofin

ApprovedB (1st, 2nd

trim.)D (3rd trim.)

L1

Indomethacin Indocin ApprovedB (1st, 2nd

trim.)D (3rd trim.)

L3

Ketorolac Toradol, Acular ApprovedB (1st, 2nd

trim.)D (3rd trim.)

L2

Mefenamic acid Ponstan, Ponstel Approved - NR

NaproxenAnaprox, Naprosyn, Naproxen, Aleve

Approved BL3

L4 (for chronic use)

Phenylbutazone Butazolidine Approved - NRPiroxicam Feldene Approved B L2Suprofen Profenal Approved - NRTolmetin Tolectin Approved C L3    Steroid [contents]Methylprednisolone[ high dosage methylprednisolone]

Solu-Medrol, Depo-Medrol, Medrol

Approved C L2

Prednisolone - Approved C L2

PrednisoneDeltasone, Meticorten, Orasone

Approved C L2

Obat Asma [contents]

DyphyllineDilor, Lufyllin, Dyphylline

Approved C L3

Terbutaline Bricanyl, Brethine Approved B L2

TheophyllineAminophylline, Quibron, Theo-Dur

Approved C L3

     Analgetik Narkotik  [more]

Butorphanol Stadol ApprovedB (1st, 2nd

trim.)D (3rd trim.)

L3

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

Meperidine Demerol Approved BL2

L3 (if used early postpartum)

Methadone Dolophine Approved B L3Morphine Morphine Approved B L3

PropoxypheneDarvocet N, Propacet, Darvon

Approved C L2

 

Obat Batuk

Nama ObatAAP

approved?*Risiko Menyusui**

Codeine yes L3 (moderately safe)Dextromethorphan not reviewed L1 (safest)Guaifenesin not reviewed L2 (safer)Dekongestan (Obat Pilek)

Nama ObatAAP

approved?*Risiko Menyusui**

Phenylephrine not reviewed L3 (moderately safe)

Pseudoephedrine (Sudafed, Actifed)

yesL3 (moderately safe) for acute use

L4 (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 ObatAAP

approved?*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 ObatAAP

approved?*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 reviewed

Triprolidine (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 ObatAAP

approved?*

Kategori Risiko Kehamilan**

RisikoMenyusui**

Notes

     Local anestheticsArticaine (Septocaine) NR - NR moreBupivacaine (Marcaine) NR C L2Lidocaine (Xylocaine) Approved C L2Mepivacaine (Carbocaine, Polocaine)

NR C L3 more

Procaine HCL (Novocaine) NR C L3     General 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 L3     Other medications often used during anesthesia

SedativesDiazepam (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 MedicationFlumazenil (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 GenerikNama

Dagang AAP approved?*

Kategori Risiko

Kehamilan**

RisikoMenyusui**

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]

AmoxicillinLarotid, Amoxil

Approved B L1

Aztreonam Azactam Approved B L2

CefadroxilUltracef, Duricef

Approved B L1

CefazolinAncef, Kefzol

Approved B L1

Cefotaxime Claforan Approved B L2Cefoxitin Mefoxin Approved B L1Cefprozil Cefzil Approved C L1

CeftazidimeCeftazidime, Fortaz, Taxidime

Approved B L1

Ceftriaxone Rocephin Approved B L2Ciprofloxacin [more] Cipro Approved C L3Clindamycin Cleocin Approved B L3Erythromycin E-Mycin,

Ery-tab, Approved B L1

L3 early postnatal

ERYC, Ilosone

Fleroxacin - Approved - NRGentamicin Garamycin Approved C L2

KanamycinKebecil, Kantrex

Approved D L2

Moxalactam Moxam Approved - NRNitrofurantoin Macrobid Approved B L2Ofloxacin Floxin Approved C L2Penicillin - Approved B L1Streptomycin Streptomycin Approved D L3Sulbactam - Approved - NR

SulfisoxazoleGantrisin, Azo-Gantrisin

Approved C L2

TetracyclineAchromycin, Sumycin, Terramycin

Approved D L2

TicarcillinTicarcillin, Ticar, Timentin

Approved B L1

Trimethoprim/sulfamethoxazole

Proloprim, Trimpex

Approved C L3

Antikoagulan [contents]Bishydroxycoumarin (dicumarol)

- Approved - NR

WarfarinCoumadin, Panwarfin

Approved D L2

Antikonvulsan (Anti kejang) [contents]

CarbamazepineTegretol, Epitol

Approved C L2

Ethosuximide Zarontin Approved C L4Magnesium sulfate Epsom salt Approved B L1Phenytoin Dilantin Approved D L2

Valproic acidDepakene, Depakote

Approved D L2

Anti Jamur [contents]Fluconazole [more] Diflucan Approved C L2

KetoconazoleNizoral Shampoo, Nizoral

Approved C L2

Antivirus [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 saltsRidaura, Myochrysine, Solganal

Approved C L5

Kontrasepsi, Hormon [contents]

EstradiolEstratab, Permarin, Menest

Approved XL3 (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 XL3 (may interfere

with milk production)

LevonorgestrelNorplant, Mirena, Plan B

Approved X L2

Medroxyprogesterone

Provera, Depo-Provera, Cycrin

Approved DL1

L4 (if used first 3 days postpartum)

Norethynodrel Enovid Approved X L2

ProgesteroneCrinone, Prometrium

Approved - L3

Obat Diabetes [contents]Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1.

TolbutamideOramide, Orinase

Approved D L3

Obat Diare [contents]Loperamide Imodium,

Pepto Diarrhea Control, Maalox Antidiarrheal

Approved B L2

Caplets, Kaopectate II Caplets, Immodium Advanced

** 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]

AcetazolamideDazamide, Diamox

Approved C L2

Bendroflumethiazide Naturetin Approved DL4 (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 aritmia

DisopyramideNorpace, Napamide

Approved C L2

Flecainide Tambocor Approved C L3Mexiletine Mexitil Approved B L2

ProcainamidePronestyl, Procan

Approved C L3

QuinidineQuinaglute, Quinidex

Approved C L2

   Anti Hipertensi

Captopril Capoten Approved DL3 (if used after 30

days)

Diltiazem/Diltiazem HCL

Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD

Approved C L3

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

trim.)L2

Hydralazine Apresoline Approved C L2Labetalol Trandate, Approved C L2

NormodyneMethyldopa Aldomet Approved C L2

MetoprololToprol XL, Lopressor

Approved B L3

MinoxidilLoniten, Minodyl, Rogaine

Approved CL2(topically)L3 (orally)

NadololCorgard, Nadolol

Approved C L4

NifedipineAdalat, Procardia

Approved C L2

Oxprenolol

Apsolox, Slow-Trasicor, Trasicor

Approved - NR

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

VerapamilCalan, Isoptin, Covera-HS

Approved C L2

     Cardiac stimulants

DigoxinLanoxin, Lanoxicaps

Approved C L2

Laksan (Pelancar BAB) [more] [contents]Cascara/Cascara Sagrada - Approved C L3Danthron - Approved - NRMagnesium sulfate Epsom salt Approved B L1Senna - Approved - L3Obat malaria [contents]

ChloroquineAralen, Novo-chloroquine

Approved C L3

Hydroxychloroquine 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 L2

Metrizoate Isopaque Approved B L2Obat Migren [more] [contents]Sumatriptan Imitrex Approved C L3Obat Sedativ [more] [contents]

Chloral hydrateAquachloral, Noctec

Approved C L3

Methyprylon (withdrawn from use in US & Canada)

- Approved - NR

Bromide - 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 L3

Propylthiouracil PTU Approved D L2Thiouracil - Approved - NR

Levothyroxine

Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl

Approved A L1

Obat TBC [contents]Cycloserine Seromycin Approved C L3

EthambutolEthambutol, Myambutol

Approved B L2

IsoniazidINH, Laniazid

Approved C L3

RifampinRifadin, Rimactane

Approved C L2

VITAMIN [more] [contents]B-1 (thiamin) - Approved - NRB-12 (Cyanocobalamin) - Approved A L1

B-6 (pyridoxine) - Approved AL2; L4 in high

doses (may inhibit lactation)

D, vitaminCalciferol, Delta-d

Approved AL3 (do not overdose)

Folic acid - ApprovedA (1st, 2nd

trim.)C (3rd trim.)

L1

K-1, vitamin (Phytonadione) - Approved C L1

Riboflavin/B2 - Approved A L1Lain-lain [contents]Acitretin (Anti-psoriasis) Soriatane Approved - NRAlcohol/Ethanol [more] - Approved D L3

AllopurinolZyloprim, Lopurin

Approved C L2

Antimony - Approved - NRAtropine (Anticholinergic, drying agent)

Belladonna, Atropine

Approved C L3

Azapropazone/apazone (Antirheumatic)

Rheumox Approved - L2

Baclofen (muscle relaxant)Lioresal, Atrofen

Approved C L2

Barbiturate - Approved - NR

Caffeine [more]Vivarin, NoDoz, Coffee

Approved B L2

Carbetocin (Antihemorrhagic) Duratocin Approved - NRChloroform - Approved - NRCisplatin (Anti-cancer) Platinol Approved D L4

Dapsone (Antileprosy)Avlosulfon, DDS

Approved C L4

Hydroxychloroquine (Antirheumatic, lupus)

Plaquenil Approved C L2

Iodides - Approved - NRIodine - Approved - NRIodine (povidone-iodine, eg, in a vaginal douche)

- Approved - NR

Ivermectin (Antiparasitic) Mectizan Approved C L3Nalidixic acid (Urinary Anti-infective)

NegGram Approved B L4

Norsteroids - Approved - NRPyridostigmine (Muscle stimulant)

Mestinon, Regonol

Approved C L2

Scopolamine (Motion sickness)Transderm Scope

Approved C L3

Sulfapyridine 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