B.

DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI Obat Kategori A: Adalah golongan obat yang pada studi (terkontrol) pada kehamilan yang tidak menunjukkan risiko bagi janin pada trimester 1 dan trimester berikutnya. Obat dalam kategori ini amat kecil kemungkinannya bagi keselamatan janin. Obat Kategori B: Adalah golongan obat yang pada studi terhadap sistem reproduksi binatang percobaan yang tidak menunjukkan resiko bagi janin. Belum ada studi terkontrol pada wanita hamil yang menunjukkan adanya efek samping, kecuali adanya penurunan fertilitas pada kehamilan trimester pertama, sedangkan pada trimester berikutnya tidak didapatkan bukti adanya resiko. Obat Kategori C: Adalah golongan obat yang pada studi terhadap sistem reproduksi binatang percobaan menunjukkan adanya efek samping bagi janin. Sedangkan pada wanita hamil belum ada study terkontrol. Obat golongan ini hanya dapat dipergunakan jika manfaatnya lebih besar ketimbang resiko yang mungkin terjadi pada janin. Obat Kategoti D: Adalah golongan obat yang menunjukkan adanya resiko bagi janin.

Padakeadaan khusus obat ini digunakan jika manfaatnya kemungkinan lebih besar dibanding resikonya. Penggunaan obat golongan ini terutama untuk mengatasi keadaan yang mengancam jiwa atau jika tidak ada obat lain yang lebih aman. Obat Kategori X: Adalah golongan obat yang pada studi terhadap binatang percobaan maupun pada manusia menunjukkan bukti adanya resiko bagi janin. Obat golongan ini tidak boleh dipergunakan (kontra indikasi) untuk wanita hamil, atau kemungkinan dalam keadaan hamil

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.) Approved Azapropazone (Rheumox) Butalbital (Fioricet, Fiorinal, Bancap, Twodyne) Butorphanol (Stadol) Celecoxib (Celebrex)) Codeine (in Tylenol #3, #4) Colchicine Diclofenac (Cataflam, Voltaren) Fentanyl (Sublimaze) Flurbiprofen (Ansaid, Froben, Ocufen) Hydrocodone (Lortab, Vicodin) Hydromorphone(Dilaudid) Ibuprofen (Advil, Nuprin, Motrin, Pediaprofen) Indomethacin(Indocin) Ketorolac (Toradol, Acular) Meperidine (Demerol) Methadone (Dolophine) Morphine (Duramorph, Infumorph, Epimorph, MS Contin) Nalbuphine (Nubain) Naproxen (Anaprox, NR Approved NR Approved Approved NR Approved NR NR NR Approved Approved Approved Approved Approved Approved NR Approved D B (1st, 2nd trim.) D (3rd trim.) C C D B 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 B B B B

RisikoMenyusui** Notes L1 L3 L2 L3 L3 L2 L3 L4 L2 L2 L2 L3 L3 L1 L3 L2 L2; L3 early postpartum L3 L3 L2 L3; 6 7 8 4 5 3 2 1

Naprosyn, Naproxen, 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 Pregnancy Risk Categories L1 (safest) A (controlled studies show no risk) L2 (safer) B (no evidence of risk in humans) L3 (moderately safe) C (risk cannot be ruled out) L4 (possibly hazardous) D (positive evidence of risk) L5 (contraindicated) 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 Ibuprofen Advil, Nuprin, Motrin, Pediaprofin Indocin Approved Approved B (1st, 2nd trim.) D (3rd trim.) B (1st, 2nd trim.) D (3rd trim.) B (1st, 2nd trim.) D (3rd trim.) B B C NR L1

Indomethacin

Approved

L3

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

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

Approved Approved Approved Approved Approved Approved Approved

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

Approved Approved

C C

Prednisone Obat Asma Dyphylline Terbutaline Theophylline

Deltasone, Meticorten, Orasone

Approved

L2 [contents]

Dilor, Lufyllin, Dyphylline Bricanyl, Brethine Aminophylline, Quibron, Theo-Dur

Approved Approved Approved

C B C

L3 L2 L3

Analgetik Narkotik [more] Butorphanol Codeine Fentanyl Meperidine Methadone Morphine Propoxyphene Obat Batuk Nama Obat Codeine Dextromethorphan Guaifenesin AAP approved?* yes not reviewed not reviewed Risiko Menyusui** L3 (moderately safe) L1 (safest) L2 (safer) Stadol Tylenol #3, #4 Sublimaze Demerol B (1st, 2nd trim.) Approved D (3rd trim.) Approved C Approved B 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

Dekongestan (Obat Pilek) Nama Obat Phenylephrine AAP approved?* not reviewed 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 approved?* Beclomethasone (Vanceril, Beclovent, not reviewed Beconase, Vancenase) Cromlyn sodium not reviewed (Nasalcrom) Fluticasone (Flonase) not reviewed Mometasone not reviewed (Nasonex) Phenylephrine (in some forms of Sinex not reviewed and Neo-Synephrine) Triamcinolone not reviewed Acetonide (Nasacort)

Risiko Menyusui** L2 (safer) L1 (safest) L3 (moderately safe) L3 (moderately safe) L3 (moderately safe) L3 (moderately safe)

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 maleate yes not reviewed 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

more

Midazolam (Versed) Concern D Propofol (Diprivan) NR B Triazolam (Halcion) NR X 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.

L3; L4 for chronic use L3 more L2 L3

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) A (controlled studies show no risk) L2 (safer) B (no evidence of risk in humans) L3 (moderately safe) C (risk cannot be ruled out) L4 (possibly hazardous) D (positive evidence of risk) L5 (contraindicated) 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 Dagang Kategori AAP Risiko approved?* Kehamilan** RisikoMenyusui** [contents] Approved B L2 Approved C L2 Approved L1 [contents] Approved Approved Approved Approved B B B B L1 L2 L1 L1

Nama Generik

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 Cefoxitin Cefprozil

Claforan Mefoxin 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 Streptomycin Streptomycin Sulbactam Gantrisin, Sulfisoxazole AzoGantrisin Achromycin, Tetracycline Sumycin, Terramycin Ticarcillin, Ticarcillin Ticar, Timentin Proloprim, Trimethoprim/sulfamethoxazole Trimpex

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

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

L2 L1 L1 L1 L2 L3 L3 L1 L3 early postnatal NR L2 L2 NR L2 L2 L1 L3 NR L2

Approved

L2

Approved Approved

B C

L1 L3

Antikoagulan Bishydroxycoumarin (dicumarol) Warfarin

[contents] Coumadin, Panwarfin Approved Approved D NR L2

Antikonvulsan (Anti kejang) Carbamazepine Ethosuximide Magnesium sulfate Phenytoin Valproic acid Tegretol, Epitol Zarontin Epsom salt Dilantin Depakene, Depakote Approved Approved Approved Approved Approved C C B D D

[contents] L2 L4 L1 L2 L2

Anti Jamur Fluconazole [more] Ketoconazole

Diflucan Nizoral Shampoo, Nizoral

Approved Approved

C C

[contents] L2 L2

Antivirus Acyclovir [more] Interferon-alpha [more]

Zovirax Alferon N, Interferon Alpha

Approved Approved

C C

[contents] L2 L2

Arthritis meds (see also: pain meds) Ridaura, Gold salts Myochrysine, Approved Solganal

[contents] C L5

Kontrasepsi, Hormon Estradiol Clogestone Estratab, Permarin, Menest Preven, Seasonale, Norinyl, Norlestin, OrthoNovum, Ovral, Lunelle Approved Approved X -

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

Contraceptive pill with estrogen/progesterone

Approved

L3 (may interfere with milk production)

Levonorgestrel

Medroxyprogesterone Norethynodrel Progesterone

injection, Ortho-Evra patch, etc. Norplant, Mirena, Plan B Provera, DepoProvera, Cycrin Enovid Crinone, Prometrium

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

Obat Diare

[contents]

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]

Diuretik (Peluruh Kencing) Acetazolamide Bendroflumethiazide Chlorothiazide Chlorthalidone Hydrochlorothiazide (HCT) Spironolactone Dazamide, Diamox Naturetin Hydrodiuril Hygroton Hydrodiuril, Esidrix, Oretic Aldactone Approved Approved Approved Approved Approved Approved C D D D D D

[contents] L2 L4 (may inhibit lactation) L3 L3 L2 L2

Anti Muntah [more] Domperidone

Motilum

Approved

[contents] L1

Anti Hipertensi, Obat Jantung Anti aritmia Disopyramide Flecainide Mexiletine Procainamide Quinidine Norpace, Napamide Tambocor Mexitil Pronestyl, Procan Quinaglute, Quinidex Approved Approved Approved Approved Approved C C B C C

[contents] L2 L3 L2 L3 L2

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

Diltiazem/Diltiazem HCL

Cardizem Sr, Dilacor-XR, Approved Diltiazem, Cardizem CD Vasotec Apresoline Trandate, Normodyne Approved Approved Approved

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

Enalapril/Enalapril Maleate Hydralazine Labetalol

L2 L2 L2

Methyldopa Metoprolol Minoxidil Nadolol Nifedipine

Oxprenolol Propranolol Sotalol Timolol Verapamil

Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, SlowTrasicor, Trasicor Inderol Betapace Blocadren Calan, Isoptin, Covera-HS

Approved Approved Approved Approved Approved

C B C C C

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

Approved Approved Approved Approved Approved

C B C C

NR L2 L3 L2 L2

Cardiac stimulants Lanoxin, Lanoxicaps Laksan (Pelancar BAB) [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Epsom salt Senna Digoxin Approved Approved Approved Approved Approved C C B L2 [contents] L3 NR L1 L3

Obat malaria Chloroquine Hydroxychloroquine Pyrimethamine Quinine Aralen, Novochloroquine Plaquenil Daraprim Quinamm Approved Approved Approved Approved C C C D

[contents] L3 L2 L4 L2

Medical Testing [more] Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Iopanoic acid Metrizamide Metrizoate

Omnipaque Telepaque Amipaque Isopaque

Approved Approved Approved Approved Approved Approved Approved

C C B D B B

[contents] NR L3 L2 L2 L2 L2 L2

Obat Migren [more] Sumatriptan

Imitrex

Approved

[contents] L3

Obat Sedativ [more] Chloral hydrate Aquachloral, Noctec Approved Approved Approved Approved C D D

[contents] L3 NR L5 L3

Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Seconal

Obat Tidur Zolpidem/Zolpidem Tartrate

Ambien

Approved

[contents] L3

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

Tapazole PTU Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl

Approved Approved Approved Approved

D D D -

[contents] L3 L3 L2 NR

Levothyroxine

Approved

L1

Obat TBC Cycloserine Ethambutol Isoniazid Rifampin

Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane

Approved Approved Approved Approved

C B C C

[contents] L3 L2 L3 L2

VITAMIN [more] B-1 (thiamin) B-12 (Cyanocobalamin) B-6 (pyridoxine) D, vitamin Folic acid K-1, vitamin (Phytonadione) Riboflavin/B2

Calciferol, Delta-d -

Approved Approved Approved Approved Approved Approved Approved

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

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

Lain-lain Acitretin (Anti-psoriasis) Alcohol/Ethanol [more] Allopurinol Antimony Atropine (Anticholinergic, drying agent) Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant)

Soriatane Zyloprim, Lopurin Belladonna, Atropine Rheumox

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

D C C C B -

[contents] NR L3 L2 NR L3 L2 L2 NR L2 NR

Lioresal, Atrofen Barbiturate Vivarin, Caffeine [more] NoDoz, Coffee Carbetocin (Antihemorrhagic) Duratocin

Chloroform Cisplatin (Anti-cancer) Dapsone (Antileprosy) Hydroxychloroquine (Antirheumatic, lupus) Iodides Iodine Iodine (povidone-iodine, eg, in a vaginal douche) Ivermectin (Antiparasitic) Nalidixic acid (Urinary Antiinfective) Norsteroids Pyridostigmine (Muscle stimulant)

Platinol Avlosulfon, DDS Plaquenil Mectizan NegGram

Approved Approved Approved Approved Approved Approved Approved Approved Approved

D C C C B

NR L4 L4 L2 NR NR NR L3 L4

NR Approved Mestinon, Approved C L2 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. 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) A (controlled studies show no risk) L2 (safer) B (no evidence of risk in humans) L3 (moderately safe) C (risk cannot be ruled out) L4 (possibly hazardous) D (positive evidence of risk) L5 (contraindicated) X (contraindicated in pregnancy) NR: Not Reviewed. This drug has not yet been reviewed by Hale Disusun kembali oleh dr.Abu Hana dari sumber URL : http://www.kellymom.com/health/meds/aap-approved-meds.html