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) AAP Kategori Risiko Nama Obat approved?* Kehamilan** Acetaminophen (Tylenol) Approved B C (1st, 2nd trim.) Aspirin Caution D (3rd trim.) Azapropazone (Rheumox) Approved Butalbital (Fioricet, Fiorinal, Bancap, TwoNR D dyne) B (1st, 2nd trim.) Butorphanol (Stadol) Approved D (3rd trim.) Celecoxib (Celebrex)) NR C Codeine (in Tylenol #3, #4) Approved C Colchicine Approved D Diclofenac (Cataflam, NR B Voltaren)

RisikoMenyusui** Notes L1 L3 L2 L3 L3 L2 L3 L4 L2 3 2 1

Fentanyl (Sublimaze) Approved Flurbiprofen (Ansaid, NR Froben, Ocufen) Hydrocodone (Lortab, NR Vicodin) Hydromorphone(Dilaudid) NR Ibuprofen (Advil, Nuprin, Approved Motrin, Pediaprofen) Indomethacin (Indocin) Ketorolac (Toradol, Acular) Meperidine (Demerol) Approved Approved Approved

B B (1st, 2nd trim.) C (3rd trim.) B C B (1st, 2nd trim.) D (3rd trim.) B (1st, 2nd trim.) D (3rd trim.) B (1st, 2nd trim.) D (3rd trim.) B

L2 L2 L3 L3 L1 L3 L2 L2; L3 early postpartum L3 6 4 5

Methadone (Dolophine) 7 Approved B Morphine (Duramorph, Infumorph, Epimorph, MS Approved 8 B L3 Contin) Nalbuphine (Nubain) NR B L2 Naproxen (Anaprox, L3; Naprosyn, Naproxen, 9 Approved B L4 for chronic use Aleve) Nefopam (Acupan) NR Approved Oxycodone (Tylox, Percodan,Oxycontin, NR 10 B L3 Roxicet, Endocet, Roxiprin, Percocet) Pentosan NR B L2 polysulfate(Elmiron) Piroxicam (Feldene) Approved B L2 Propoxyphene(Darvocet 11 Approved C L2 N, Propacet, Darvon) Rofecoxib (Vioxx) Withdrawn from the market 12 Secobarbital (Seconal) 13 Approved D L3 Tolmetin (Tolectin) Approved C L3 Tramadol HCL(Ultram, NR 14 C L3 Ultracet) Valdecoxib (Bextra) Withdrawn from the market more * Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.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 L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated) Pregnancy Risk Categories 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 Reyes 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 babys 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] Kategori Nama Generik Nama Dagang AAP Risiko approved?* Kehamilan** RisikoMenyusui** Azapropazone (apazone) Rheumox Approved L2 Dipyrone (banned in the NR Approved US & UK) Flufenamic acid NR Approved Ibuprofen Advil, Nuprin, Approved B (1st, 2nd L1

Motrin, Pediaprofin

Indomethacin

Indocin

Ketorolac Mefenamic acid Naproxen Phenylbutazone Piroxicam Suprofen Tolmetin Steroid Methylprednisolone [ high dosage methylprednisolone] Prednisolone Prednisone Obat Asma

Toradol, Acular Ponstan, Ponstel Anaprox, Naprosyn, Naproxen, Aleve Butazolidine Feldene Profenal Tolectin Solu-Medrol, DepoMedrol, Medrol Deltasone, Meticorten, Orasone

trim.) D (3rd trim.) B (1st, 2nd trim.) Approved D (3rd trim.) B (1st, 2nd trim.) Approved D (3rd trim.) Approved Approved Approved Approved Approved Approved B B C

L3

L2 NR L3 L4 (for chronic use) NR L2 NR L3 [contents] L2 L2 L2 [contents]

Approved Approved Approved

C C C

Dilor, Lufyllin, Dyphylline Terbutaline Bricanyl, Brethine Aminophylline, Theophylline Quibron, Theo-Dur Analgetik Narkotik [more] Dyphylline Butorphanol Codeine Fentanyl Meperidine Methadone Morphine Propoxyphene Stadol Tylenol #3, #4 Sublimaze Demerol

Approved Approved Approved

C B C

L3 L2 L3

B (1st, 2nd trim.) D (3rd trim.) Approved C Approved B Approved Approved B B B C

L3 L3 L2 L2 L3 (if used early postpartum) L3 L3 L2

Dolophine Approved Morphine Approved Darvocet N, Propacet, Approved Darvon

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

L3 (moderately safe) L3 (moderately safe) for acute use Pseudoephedrine yes L4 (possibly hazardous) for chronic use due to (Sudafed, Actifed) 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) AAP Nama Obat Risiko Menyusui** approved?* Beclomethasone (Vanceril, Beclovent, not reviewed L2 (safer) Beconase, Vancenase) Cromlyn sodium not reviewed L1 (safest) (Nasalcrom) Fluticasone (Flonase) not reviewed L3 (moderately safe) Mometasone not reviewed L3 (moderately safe) (Nasonex) Phenylephrine (in some forms of Sinex not reviewed L3 (moderately safe) and Neo-Synephrine) Triamcinolone not reviewed L3 (moderately safe) Acetonide (Nasacort) Antihistamin (Anti Alergi) AAP Nama Obat Risiko Menyusui** approved?* Brompheniramine not reviewed L3 (moderately safe) Chlorpheniramine (Chlor-Trimeton) not reviewed L3 (moderately safe) CTM Cetirizine (Zyrtec) not reviewed L2 (safer) Dexbrompheniramine yes not reviewed

maleate with d-isoephedrine Diphenhydramine not reviewed L2 (safer) (Benadryl) Doxylamine not reviewed L4 (possibly hazardous) Fexofenadine yes L3 (moderately safe) (Allegra) Loratadine (Claritin) yes L2 (safer) Terfenadine yes not reviewed (Seldane) Triprolidine (Actidil, yes L1 (safest) Actifed) * 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 Kategori Risiko RisikoMenyusui** Notes approved?* Kehamilan** C C C C C B B C NR L2 L2 L3 L3 L2 NR NR L3 L3 L3 L3 more 1 more more

Local anesthetics Articaine (Septocaine) NR Bupivacaine (Marcaine) NR Lidocaine (Xylocaine) Approved Mepivacaine (Carbocaine, NR Polocaine) Procaine HCL (Novocaine) NR General anesthetics Halothane (Fluothane) Approved Isoflurane (Forane) NR Ketamine NR Methohexital (Brevital) Approved Nitrous oxide NR Sevoflurane (Ultane) NR Thiopental (Pentothal) Approved Other medications often used during anesthesia Sedatives Diazepam (Valium) Concern Midazolam (Versed) Propofol (Diprivan) Triazolam (Halcion) Concern NR NR

more

D D B X

L3; L4 for chronic use L3 more L2 L3

Narcotic Analgesics Alfentanil (Alfenta) NR C L2 Fentanyl (Sublimaze) Approved B L2 Hydromorphone (Dilaudid) NR C L3 Morphine Approved B L3 Reversal Medication Flumazenil (Romazicon) NR NR 2 C Naloxone (Narcan) NR NR 3 C Steroids Decadron (Dexamethasone) NR NR more C Stimulants Epinephrine (Adrenaline) NR C L1 Anti-nausea Promethazine (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 L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated) Pregnancy Risk Categories 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

Antasida Cimetidine (Antacid) Tagamet Cisapride (GI tract stimulant) Propulsid Domperidone (used for nausea & vomiting, stimulates Motilum lactation) [more] Antibiotika Larotid, Amoxicillin Amoxil Aztreonam Azactam Ultracef, Cefadroxil Duricef Ancef, Cefazolin Kefzol Cefotaxime Claforan Cefoxitin Mefoxin Cefprozil Cefzil Ceftazidime, Ceftazidime Fortaz, Taxidime Ceftriaxone Rocephin Ciprofloxacin [more] Cipro Clindamycin Cleocin E-Mycin, Ery-tab, Erythromycin ERYC, Ilosone Fleroxacin Gentamicin Garamycin Kebecil, Kanamycin Kantrex Moxalactam Moxam Nitrofurantoin Macrobid Ofloxacin Floxin Penicillin -

Kategori AAP Risiko approved?* Kehamilan** RisikoMenyusui** [contents] Approved B L2 Approved C L2 Approved L1 [contents] Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved B B B B B B C B B C B B C D B C B L1 L2 L1 L1 L2 L1 L1 L1 L2 L3 L3 L1 L3 early postnatal NR L2 L2 NR L2 L2 L1

Streptomycin Sulbactam

Streptomycin Gantrisin, Sulfisoxazole AzoGantrisin Achromycin, Tetracycline Sumycin, Terramycin Ticarcillin, Ticarcillin Ticar, Timentin Proloprim, Trimethoprim/sulfamethoxazole Trimpex Antikoagulan Bishydroxycoumarin (dicumarol) Coumadin, Warfarin Panwarfin Antikonvulsan (Anti kejang) Tegretol, Carbamazepine Epitol Ethosuximide Zarontin Magnesium sulfate Epsom salt Phenytoin Dilantin Depakene, Valproic acid Depakote Anti Jamur Fluconazole [more] Diflucan Nizoral Ketoconazole Shampoo, Nizoral Antivirus Acyclovir [more] Zovirax Alferon N, Interferon-alpha [more] Interferon Alpha Arthritis meds (see also: pain meds) Ridaura, Gold salts Myochrysine, Solganal Kontrasepsi, Hormon Estratab, Estradiol Permarin, Menest

Approved Approved Approved

D C

L3 NR L2

Approved

L2

Approved Approved

B C

L1 L3 [contents]

Approved Approved

NR L2 [contents]

Approved Approved Approved Approved Approved Approved Approved

C C B D D C C

L2 L4 L1 L2 L2 [contents] L2 L2 [contents] L2 L2 [contents]

Approved Approved

C C

Approved

L5 [contents] L3 (may interfere with milk production)

Approved

Clogestone

Contraceptive pill with estrogen/progesterone

Levonorgestrel

Medroxyprogesterone Norethynodrel Progesterone

Preven, Seasonale, Norinyl, Norlestin, OrthoNovum, Ovral, Lunelle injection, Ortho-Evra patch, etc. Norplant, Mirena, Plan B Provera, DepoProvera, Cycrin Enovid Crinone, Prometrium

Approved

NR

Approved

L3 (may interfere with milk production)

Approved

L2 L1 L4 (if used first 3 days postpartum) L2 L3

Approved Approved Approved

D X -

[contents] Obat Diabetes Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1. Oramide, Tolbutamide Approved D L3 Orinase [contents] Obat Diare Imodium, Pepto Diarrhea Control, Maalox Loperamide 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] [contents] Diuretik (Peluruh Kencing) Dazamide, Acetazolamide Approved C L2 Diamox

Bendroflumethiazide Chlorothiazide Chlorthalidone Hydrochlorothiazide (HCT)

Naturetin Hydrodiuril Hygroton Hydrodiuril, Esidrix, Oretic Aldactone

Approved Approved Approved Approved Approved Approved

D D D D D -

L4 (may inhibit lactation) L3 L3 L2 L2 [contents] L1 [contents] L2 L3 L2 L3 L2 L3 (if used after 30 days) L3

Spironolactone Anti Muntah [more] Domperidone Motilum Anti Hipertensi, Obat Jantung Anti aritmia Norpace, Disopyramide Napamide Flecainide Tambocor Mexiletine Mexitil Pronestyl, Procainamide Procan Quinaglute, Quinidine Quinidex Anti Hipertensi Captopril Capoten

Approved Approved Approved Approved Approved

C C B C C

Approved

Diltiazem/Diltiazem HCL

Cardizem Sr, Dilacor-XR, Approved Diltiazem, Cardizem CD Vasotec Apresoline Trandate, Normodyne Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, Approved Approved Approved Approved Approved Approved Approved Approved Approved

C C (1st trim.) D (2nd, 3rd trim.) C C C B C C C -

Enalapril/Enalapril Maleate Hydralazine Labetalol Methyldopa Metoprolol Minoxidil Nadolol Nifedipine Oxprenolol

L2 L2 L2 L2 L3 L2(topically) L3 (orally) L4 L2 NR

Propranolol Sotalol Timolol Verapamil Cardiac stimulants

SlowTrasicor, Trasicor Inderol Betapace Blocadren Calan, Isoptin, Covera-HS

Approved Approved Approved Approved

C B C C

L2 L3 L2 L2

Lanoxin, Lanoxicaps Laksan (Pelancar BAB) [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Epsom salt Senna Obat malaria Aralen, Chloroquine Novochloroquine Hydroxychloroquine Plaquenil Pyrimethamine Daraprim Quinine Quinamm Medical Testing [more] Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Omnipaque Iopanoic acid Telepaque Metrizamide Amipaque Metrizoate Isopaque Obat Migren [more] Sumatriptan Imitrex Obat Sedativ [more] Aquachloral, Chloral hydrate Noctec Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Seconal Obat Tidur Zolpidem/Zolpidem Tartrate Ambien Digoxin

Approved Approved Approved Approved Approved

C C B -

L2 [contents] L3 NR L1 L3 [contents] L3 L2 L4 L2 [contents] NR L3 L2 L2 L2 L2 L2 [contents] L3 [contents] L3 NR L5 L3 [contents] L3

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

C C C D C C B D B B C C D D B

Obat Anti Tiroid [more] Carbimazole Methimazole (active metabolite of carbimazole) Propylthiouracil Thiouracil

Tapazole PTU Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Calciferol, Delta-d Soriatane Zyloprim, Lopurin Belladonna, Atropine Rheumox Lioresal,

Approved Approved Approved Approved

D D D -

[contents] L3 L3 L2 NR

Levothyroxine

Approved

L1

Obat TBC Cycloserine Ethambutol Isoniazid Rifampin VITAMIN [more] B-1 (thiamin) B-12 (Cyanocobalamin) B-6 (pyridoxine) D, vitamin Folic acid K-1, vitamin (Phytonadione) Riboflavin/B2 Lain-lain Acitretin (Anti-psoriasis) Alcohol/Ethanol [more] Allopurinol Antimony Atropine (Anticholinergic, drying agent) Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant)

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

C B C C A A A A (1st, 2nd trim.) C (3rd trim.) C A D C C C

[contents] L3 L2 L3 L2 [contents] NR L1 L2; L4 in high doses (may inhibit lactation) L3 (do not overdose) L1 L1 L1 [contents] NR L3 L2 NR L3 L2 L2

Atrofen NR Approved Vivarin, Caffeine [more] NoDoz, Approved B L2 Coffee Carbetocin (Antihemorrhagic) Duratocin NR Approved Chloroform NR Approved Cisplatin (Anti-cancer) Platinol Approved D L4 Avlosulfon, Dapsone (Antileprosy) Approved C L4 DDS Hydroxychloroquine Plaquenil Approved C L2 (Antirheumatic, lupus) Iodides NR Approved Iodine NR Approved Iodine (povidone-iodine, eg, in NR Approved a vaginal douche) Ivermectin (Antiparasitic) Mectizan Approved C L3 Nalidixic acid (Urinary AntiNegGram Approved B L4 infective) Norsteroids NR Approved Pyridostigmine (Muscle Mestinon, Approved C L2 stimulant) Regonol Transderm Scopolamine (Motion sickness) Approved C L3 Scope Sulfapyridine Dagenan NR Approved Timolol (glaucoma med) Blocadren Approved D L3 * Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001. Barbiturate

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 L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated) Pregnancy Risk Categories 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