materi


DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI

Disusun kembali oleh dr.Abu Hana
daftar obat
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**
RisikoMenyusui**
Notes
Acetaminophen (Tylenol)
Approved
B
L1

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

-
L2

Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne)
NR
D
L3
Butorphanol  (Stadol)
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3

Celecoxib (Celebrex))
NR
C
L2

Codeine (in Tylenol #3, #4)
Approved
C
L3
Colchicine
Approved
D
L4

Diclofenac (Cataflam, Voltaren)
NR
B
L2

Fentanyl  (Sublimaze)
Approved
B
L2

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

Hydrocodone (Lortab, Vicodin)
NR
B
L3
Hydromorphone(Dilaudid)
NR
C
L3
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
Methadone (Dolophine)
Approved
B
L3
Morphine (Duramorph, Infumorph, Epimorph, MS Contin)
Approved
B
L3
Nalbuphine (Nubain)
NR
B
L2

Naproxen (Anaprox, Naprosyn, Naproxen, Aleve)
Approved
B
L3;
L4 for chronic use
Nefopam (Acupan)
Approved
-
NR

Oxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)
NR
B
L3
Pentosan polysulfate(Elmiron)
NR
B
L2

Piroxicam (Feldene)
Approved
B
L2

Propoxyphene(Darvocet N, Propacet, Darvon)
Approved
C
L2
Rofecoxib (Vioxx)
Secobarbital (Seconal)
Approved
D
L3
Tolmetin (Tolectin)
Approved
C
L3

Tramadol HCL (Ultram, Ultracet)
NR
C
L3
Valdecoxib  (Bextra)
*  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 (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**
RisikoMenyusui**
Azapropazone (apazone)Rheumox
Approved
-
L2
Dipyrone (banned in the US & UK)-
Approved
-
NR
     
Flufenamic acid-
Approved
-
NR
IbuprofenAdvil, Nuprin, Motrin, Pediaprofin
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L1
IndomethacinIndocin
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3
KetorolacToradol, Acular
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L2
Mefenamic acidPonstan, Ponstel
Approved
-
NR
NaproxenAnaprox, Naprosyn, Naproxen, Aleve
Approved
B
L3
L4 (for chronic use)
PhenylbutazoneButazolidine
Approved
-
NR
PiroxicamFeldene
Approved
B
L2
SuprofenProfenal
Approved
-
NR
TolmetinTolectin
Approved
C
L3
    Steroid
Methylprednisolone
high dosage methylprednisolone]
Solu-Medrol, Depo-Medrol, Medrol
Approved
C
L2
Prednisolone-
Approved
C
L2
PrednisoneDeltasone, Meticorten, Orasone
Approved
C
L2
     
Obat Asma
DyphyllineDilor, Lufyllin, Dyphylline
Approved
C
L3
TerbutalineBricanyl, Brethine
Approved
B
L2
TheophyllineAminophylline, Quibron, Theo-Dur
Approved
C
L3
     
     Analgetik Narkotik  [more]
ButorphanolStadol
Approved
B (1st, 2nd trim.)
D (3rd trim.)
L3
CodeineTylenol #3, #4
Approved
C
L3
FentanylSublimaze
Approved
B
L2
MeperidineDemerol
Approved
B
L2
L3 (if used early postpartum)
MethadoneDolophine
Approved
B
L3
MorphineMorphine
Approved
B
L3
PropoxypheneDarvocet N, Propacet, Darvon
Approved
C
L2

Obat Batuk
Nama 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 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 Obat
AAP
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 Obat
AAP
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 maleate
with 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 Obat
AAP approved?*
Kategori Risiko Kehamilan**
RisikoMenyusui**
Notes
     Local anesthetics
Articaine (Septocaine)
NR
-
NR
Bupivacaine (Marcaine)
NR
C
L2

Lidocaine (Xylocaine)
Approved
C
L2

Mepivacaine (Carbocaine, Polocaine)
NR
C
L3
Procaine HCL (Novocaine)
NR
C
L3

     General anesthetics
Halothane (Fluothane)
Approved
C
L2
Isoflurane (Forane)
NR
-
NR
Ketamine
NR
-
NR
Methohexital (Brevital)
Approved
B
L3

Nitrous oxide
NR
-
L3

Sevoflurane (Ultane)
NR
B
L3

Thiopental (Pentothal)
Approved
C
L3

     Other medications often used during anesthesia
Sedatives
Diazepam (Valium)
Concern
D
L3L4 for chronic use

Midazolam (Versed)
Concern
D
L3

Propofol (Diprivan)
NR
B
L2
Triazolam (Halcion)
NR
X
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
C
NR
Naloxone (Narcan)
NR
C
NR
Steroids
Decadron (Dexamethasone)
NR
C
NR
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.
** 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**
RisikoMenyusui**
Antasida
Cimetidine (Antacid)Tagamet
Approved
B
L2
Cisapride (GI tract stimulant)Propulsid
Approved
C
L2
Domperidone (used for nausea & vomiting, stimulates lactation) [more]Motilum
Approved
-
L1
Antibiotika
AmoxicillinLarotid, Amoxil
Approved
B
L1
AztreonamAzactam
Approved
B
L2
CefadroxilUltracef, Duricef
Approved
B
L1
CefazolinAncef, Kefzol
Approved
B
L1
CefotaximeClaforan
Approved
B
L2
CefoxitinMefoxin
Approved
B
L1
CefprozilCefzil
Approved
C
L1
CeftazidimeCeftazidime, Fortaz, Taxidime
Approved
B
L1
CeftriaxoneRocephin
Approved
B
L2
Ciprofloxacin [more]Cipro
Approved
C
L3
ClindamycinCleocin
Approved
B
L3
ErythromycinE-Mycin, Ery-tab, ERYC, Ilosone
Approved
B
L1
L3 early postnatal
Fleroxacin-
Approved
-
NR
GentamicinGaramycin
Approved
C
L2
KanamycinKebecil, Kantrex
Approved
D
L2
MoxalactamMoxam
Approved
-
NR
NitrofurantoinMacrobid
Approved
B
L2
OfloxacinFloxin
Approved
C
L2
Penicillin-
Approved
B
L1
StreptomycinStreptomycin
Approved
D
L3
Sulbactam-
Approved
-
NR
SulfisoxazoleGantrisin, Azo-Gantrisin
Approved
C
L2
TetracyclineAchromycin, Sumycin, Terramycin
Approved
D
L2
TicarcillinTicarcillin, Ticar, Timentin
Approved
B
L1
Trimethoprim/sulfamethoxazoleProloprim, Trimpex
Approved
C
L3
Antikoagulan
Bishydroxycoumarin (dicumarol)-
Approved
-
NR
WarfarinCoumadin, Panwarfin
Approved
D
L2
Antikonvulsan (Anti kejang)
CarbamazepineTegretol, Epitol
Approved
C
L2
EthosuximideZarontin
Approved
C
L4
Magnesium sulfateEpsom salt
Approved
B
L1
PhenytoinDilantin
Approved
D
L2
Valproic acidDepakene, Depakote
Approved
D
L2
Anti Jamur
Fluconazole [more]Diflucan
Approved
C
L2
KetoconazoleNizoral Shampoo, Nizoral
Approved
C
L2
Antivirus
Acyclovir [more]Zovirax
Approved
C
L2
Interferon-alpha [more]Alferon N, Interferon Alpha
Approved
C
L2
Arthritis meds (see also: pain meds)
Gold saltsRidaura, Myochrysine, Solganal
Approved
C
L5
Kontrasepsi, Hormon
EstradiolEstratab, Permarin, Menest
Approved
X
L3 (may interfere with milk production)
Clogestone-
Approved
-
NR
Contraceptive pill with estrogen/progesteronePreven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra patch, etc.
Approved
X
L3 (may interfere with milk production)
LevonorgestrelNorplant, Mirena, Plan B
Approved
X
L2
MedroxyprogesteroneProvera, Depo-Provera, Cycrin
Approved
D
L1
L4 (if used first 3 days postpartum)
NorethynodrelEnovid
Approved
X
L2
ProgesteroneCrinone, Prometrium
Approved
-
L3
Obat Diabetes
Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1.
TolbutamideOramide, Orinase
Approved
D
L3
Obat Diare
LoperamideImodium, 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)
AcetazolamideDazamide, Diamox
Approved
C
L2
BendroflumethiazideNaturetin
Approved
D
L4 (may inhibit lactation)
ChlorothiazideHydrodiuril
Approved
D
L3
ChlorthalidoneHygroton
Approved
D
L3
Hydrochlorothiazide (HCT)Hydrodiuril, Esidrix, Oretic
Approved
D
L2
SpironolactoneAldactone
Approved
D
L2
Anti Muntah  [more]
DomperidoneMotilum
Approved
-
L1
Anti Hipertensi, Obat Jantung
     Anti aritmia
DisopyramideNorpace, Napamide
Approved
C
L2
FlecainideTambocor
Approved
C
L3
MexiletineMexitil
Approved
B
L2
ProcainamidePronestyl, Procan
Approved
C
L3
QuinidineQuinaglute, Quinidex
Approved
C
L2
   Anti Hipertensi
CaptoprilCapoten
Approved
D
L3 (if used after 30 days)
Diltiazem/Diltiazem HCLCardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD
Approved
C
L3
Enalapril/Enalapril MaleateVasotec
Approved
C (1st trim.)
D (2nd, 3rd trim.)
L2
HydralazineApresoline
Approved
C
L2
LabetalolTrandate, Normodyne
Approved
C
L2
MethyldopaAldomet
Approved
C
L2
MetoprololToprol XL, Lopressor
Approved
B
L3
MinoxidilLoniten, Minodyl, Rogaine
Approved
C
L2 (topically)
L3 (orally)
NadololCorgard, Nadolol
Approved
C
L4
NifedipineAdalat, Procardia
Approved
C
L2
OxprenololApsolox, Slow-Trasicor, Trasicor
Approved
-
NR
PropranololInderol
Approved
C
L2
SotalolBetapace
Approved
B
L3
TimololBlocadren
Approved
C
L2
VerapamilCalan, Isoptin, Covera-HS
Approved
C
L2
     Cardiac stimulants
DigoxinLanoxin, Lanoxicaps
Approved
C
L2
Laksan (Pelancar BAB) [more]
Cascara/Cascara Sagrada-
Approved
C
L3
Danthron-
Approved
-
NR
Magnesium sulfateEpsom salt
Approved
B
L1
Senna-
Approved
-
L3
Obat malaria
ChloroquineAralen, Novo-chloroquine
Approved
C
L3
HydroxychloroquinePlaquenil
Approved
C
L2
PyrimethamineDaraprim
Approved
C
L4
QuinineQuinamm
Approved
D
L2
Medical Testing [more]
Diatrizoate-
Approved
-
NR
Fluorescein-
Approved
C
L3
Gadopentetic (Gadolinium)-
Approved
C
L2
IohexolOmnipaque
Approved
B
L2
Iopanoic acidTelepaque
Approved
D
L2
MetrizamideAmipaque
Approved
B
L2
MetrizoateIsopaque
Approved
B
L2
Obat Migren [more]
SumatriptanImitrex
Approved
C
L3
Obat Sedativ [more]
Chloral hydrateAquachloral, Noctec
Approved
C
L3
Methyprylon (withdrawn from use in US & Canada)-
Approved
-
NR
Bromide-
Approved
D
L5
SecobarbitalSeconal
Approved
D
L3
Obat Tidur
Zolpidem/Zolpidem TartrateAmbien
Approved
B
L3
Obat Anti Tiroid  [more]
Carbimazole-
Approved
D
L3
Methimazole (active metabolite of carbimazole)Tapazole
Approved
D
L3
PropylthiouracilPTU
Approved
D
L2
Thiouracil-
Approved
-
NR
LevothyroxineSynthroid, Levothroid, Thyroid, Levo-T, Levoxyl
Approved
A
L1
Obat TBC
CycloserineSeromycin
Approved
C
L3
EthambutolEthambutol, Myambutol
Approved
B
L2
IsoniazidINH, Laniazid
Approved
C
L3
RifampinRifadin, Rimactane
Approved
C
L2
VITAMIN [more]
B-1 (thiamin)-
Approved
-
NR
B-12 (Cyanocobalamin)-
Approved
A
L1
B-6 (pyridoxine)-
Approved
A
L2L4 in high doses (may inhibit lactation)
D, vitaminCalciferol, 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
L1
Riboflavin/B2 -
Approved
A
L1
Lain-lain
Acitretin (Anti-psoriasis)Soriatane
Approved
-
NR
Alcohol/Ethanol [more]-
Approved
D
L3
AllopurinolZyloprim, Lopurin
Approved
C
L2
Antimony-
Approved
-
NR
Atropine (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
-
NR
Chloroform-
Approved
-
NR
Cisplatin (Anti-cancer)Platinol
Approved
D
L4
Dapsone (Antileprosy)Avlosulfon, DDS
Approved
C
L4
Hydroxychloroquine (Antirheumatic, lupus)Plaquenil
Approved
C
L2
Iodides-
Approved
-
NR
Iodine-
Approved
-
NR
Iodine (povidone-iodine, eg, in a vaginal douche)-
Approved
-
NR
Ivermectin (Antiparasitic)Mectizan
Approved
C
L3
Nalidixic acid (Urinary Anti-infective)NegGram
Approved
B
L4
Norsteroids-
Approved
-
NR
Pyridostigmine (Muscle stimulant)Mestinon, Regonol
Approved
C
L2
Scopolamine (Motion sickness)Transderm Scope
Approved
C
L3
SulfapyridineDagenan
Approved
-
NR
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.
** 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