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 Obat
AAP approved?*
Kategori Risiko Kehamilan**
Risiko Menyusui**
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.
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.
Aspirin use is discouraged in children and nursing mothers due to the risk of Reye’s syndrome and internal bleeding.
Fioricet (Fiorinal, Bancap, Two-dyne) contains acetaminaphen or asprin, caffeine, and butalbital. Per Hale, baby should be observed for sedation.
Hale suggests weakened or premature infants be observed for sedation and apnea.
Hale suggests newborns be observed for sedation, apnea, constipation.
Per Hale, use of frequent, higher dose may result in infant sedation.
Per Hale, Meperidine use during labor or early postpartum has been associated with sedation, poor sucking reflex, and neurobehavioral delay in infants.
Per Hale, observe infant for sedation, respiratory depression, addiction, withdrawal syndrome.
Per Hale, higher doses may result in infant sedation.
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.
Roxicet, Endocet, Roxiprin, Percocet also contain acetaminophen. Per Hale, observe infant for sedation.
Per Hale, observe infant for sedation.
Per Hale, observe infant for GI cramping, distress, diarrhea.
Per Hale, observe infant for sedation.
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
-
L2
-
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
L3
L4 (for chronic use)
Phenylbutazone
Butazolidine
Approved
-
NR
Piroxicam
Feldene
Approved
B
L2
Suprofen
Profenal
Approved
-
NR
Tolmetin
Tolectin
Approved
C
L3
    Steroid
Methylprednisolone
high dosage methylprednisolone]
Solu-Medrol, Depo-Medrol, Medrol
Approved
C
L2
Prednisolone
-
Approved
C
L2
Prednisone
Deltasone, Meticorten, Orasone
Approved
C
L2





Obat Asma
Dyphylline
Dilor, Lufyllin, Dyphylline
Approved
C
L3
Terbutaline
Bricanyl, Brethine
Approved
B
L2
Theophylline
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
L3
Fentanyl
Sublimaze
Approved
B
L2
Meperidine
Demerol
Approved
B
L2
L3 (if used early postpartum)
Methadone
Dolophine
Approved
B
L3
Morphine
Morphine
Approved
B
L3
Propoxyphene
Darvocet 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**
Risiko Menyusui**
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
L3; L4 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.
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.
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.
Flumazenil (Romazicon) is used directly in children aged 12 months and up.
Naloxone (Narcan) is used directly in newborns and children.
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
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
Amoxicillin
Larotid, Amoxil
Approved
B
L1
Aztreonam
Azactam
Approved
B
L2
Cefadroxil
Ultracef, Duricef
Approved
B
L1
Cefazolin
Ancef, Kefzol
Approved
B
L1
Cefotaxime
Claforan
Approved
B
L2
Cefoxitin
Mefoxin
Approved
B
L1
Cefprozil
Cefzil
Approved
C
L1
Ceftazidime
Ceftazidime, Fortaz, Taxidime
Approved
B
L1
Ceftriaxone
Rocephin
Approved
B
L2
Ciprofloxacin [more]
Cipro
Approved
C
L3
Clindamycin
Cleocin
Approved
B
L3
Erythromycin
E-Mycin, Ery-tab, ERYC, Ilosone
Approved
B
L1
L3 early postnatal
Fleroxacin
-
Approved
-
NR
Gentamicin
Garamycin
Approved
C
L2
Kanamycin
Kebecil, Kantrex
Approved
D
L2
Moxalactam
Moxam
Approved
-
NR
Nitrofurantoin
Macrobid
Approved
B
L2
Ofloxacin
Floxin
Approved
C
L2
Penicillin
-
Approved
B
L1
Streptomycin
Streptomycin
Approved
D
L3
Sulbactam
-
Approved
-
NR
Sulfisoxazole
Gantrisin, Azo-Gantrisin
Approved
C
L2
Tetracycline
Achromycin, Sumycin, Terramycin
Approved
D
L2
Ticarcillin
Ticarcillin, Ticar, Timentin
Approved
B
L1
Trimethoprim/sulfamethoxazole
Proloprim, Trimpex
Approved
C
L3
Antikoagulan
Bishydroxycoumarin (dicumarol)
-
Approved
-
NR
Warfarin
Coumadin, Panwarfin
Approved
D
L2
Antikonvulsan (Anti kejang)
Carbamazepine
Tegretol, Epitol
Approved
C
L2
Ethosuximide
Zarontin
Approved
C
L4
Magnesium sulfate
Epsom salt
Approved
B
L1
Phenytoin
Dilantin
Approved
D
L2
Valproic acid
Depakene, Depakote
Approved
D
L2
Anti Jamur
Fluconazole [more]
Diflucan
Approved
C
L2
Ketoconazole
Nizoral 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 salts
Ridaura, Myochrysine, Solganal
Approved
C
L5
Kontrasepsi, Hormon
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
L1
L4 (if used first 3 days postpartum)
Norethynodrel
Enovid
Approved
X
L2
Progesterone
Crinone, Prometrium
Approved
-
L3
Obat Diabetes
Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1.
Tolbutamide
Oramide, Orinase
Approved
D
L3
Obat Diare
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)
Acetazolamide
Dazamide, Diamox
Approved
C
L2
Bendroflumethiazide
Naturetin
Approved
D
L4 (may inhibit lactation)
Chlorothiazide
Hydrodiuril
Approved
D
L3
Chlorthalidone
Hygroton
Approved
D
L3
Hydrochlorothiazide (HCT)
Hydrodiuril, Esidrix, Oretic
Approved
D
L2
Spironolactone
Aldactone
Approved
D
L2
Anti Muntah  [more]
Domperidone
Motilum
Approved
-
L1
Anti Hipertensi, Obat Jantung
     Anti aritmia
Disopyramide
Norpace, Napamide
Approved
C
L2
Flecainide
Tambocor
Approved
C
L3
Mexiletine
Mexitil
Approved
B
L2
Procainamide
Pronestyl, Procan
Approved
C
L3
Quinidine
Quinaglute, Quinidex
Approved
C
L2
   Anti 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
L2
Labetalol
Trandate, Normodyne
Approved
C
L2
Methyldopa
Aldomet
Approved
C
L2
Metoprolol
Toprol XL, Lopressor
Approved
B
L3
Minoxidil
Loniten, Minodyl, Rogaine
Approved
C
L2 (topically)
L3 (orally)
Nadolol
Corgard, Nadolol
Approved
C
L4
Nifedipine
Adalat, Procardia
Approved
C
L2
Oxprenolol
Apsolox, Slow-Trasicor, Trasicor
Approved
-
NR
Propranolol
Inderol
Approved
C
L2
Sotalol
Betapace
Approved
B
L3
Timolol
Blocadren
Approved
C
L2
Verapamil
Calan, Isoptin, Covera-HS
Approved
C
L2
     Cardiac stimulants
Digoxin
Lanoxin, Lanoxicaps
Approved
C
L2
Laksan (Pelancar BAB) [more]
Cascara/Cascara Sagrada
-
Approved
C
L3
Danthron
-
Approved
-
NR
Magnesium sulfate
Epsom salt
Approved
B
L1
Senna
-
Approved
-
L3
Obat malaria
Chloroquine
Aralen, Novo-chloroquine
Approved
C
L3
Hydroxychloroquine
Plaquenil
Approved
C
L2
Pyrimethamine
Daraprim
Approved
C
L4
Quinine
Quinamm
Approved
D
L2
Medical Testing [more]
Diatrizoate
-
Approved
-
NR
Fluorescein
-
Approved
C
L3
Gadopentetic (Gadolinium)
-
Approved
C
L2
Iohexol
Omnipaque
Approved
B
L2
Iopanoic acid
Telepaque
Approved
D
L2
Metrizamide
Amipaque
Approved
B
L2
Metrizoate
Isopaque
Approved
B
L2
Obat Migren [more]
Sumatriptan
Imitrex
Approved
C
L3
Obat Sedativ [more]
Chloral hydrate
Aquachloral, Noctec
Approved
C
L3
Methyprylon (withdrawn from use in US & Canada)
-
Approved
-
NR
Bromide
-
Approved
D
L5
Secobarbital
Seconal
Approved
D
L3
Obat Tidur
Zolpidem/Zolpidem Tartrate
Ambien
Approved
B
L3
Obat Anti Tiroid  [more]
Carbimazole
-
Approved
D
L3
Methimazole (active metabolite of carbimazole)
Tapazole
Approved
D
L3
Propylthiouracil
PTU
Approved
D
L2
Thiouracil
-
Approved
-
NR
Levothyroxine
Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl
Approved
A
L1
Obat TBC
Cycloserine
Seromycin
Approved
C
L3
Ethambutol
Ethambutol, Myambutol
Approved
B
L2
Isoniazid
INH, Laniazid
Approved
C
L3
Rifampin
Rifadin, Rimactane
Approved
C
L2
VITAMIN [more]
B-1 (thiamin)
-
Approved
-
NR
B-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
L1
Riboflavin/B2 
-
Approved
A
L1
Lain-lain
Acitretin (Anti-psoriasis)
Soriatane
Approved
-
NR
Alcohol/Ethanol [more]
-
Approved
D
L3
Allopurinol
Zyloprim, 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
Sulfapyridine
Dagenan
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.
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

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