Sebagai dokter, kita kadang menerima pasien ibu hamil atau menyusui.

Pasien seperti ini membutuhkan terapi yang beda dari yang lainnya karena ditakutkan ada pengaruh obat terhadap bayi yang dikandung. Dan sudah terbukti dari sejarah pengobatan, bahwa begitu banyak obat yang memberikan efek negatif bagi bayi. Berikut ini adalah daftar obat-obat yang Aman untuk digunakan pada ibu hamil dan menyusui. Baris kuning menunjukkan obat-obatan yang paling sering dipakai di Indonesia. Sebagai keterangan, untuk kategori Pregnancy Risk Category :

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)

untuk kategori Lactation Risk Category :

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

(Perhatian : Karena tabelnya terpotong, disediakan tempat untuk melihat gambar tabel lebih jelas, bisa didownload di sini, File gambarnya tampak kecil, tapi bisa dizoom supaya tulisannya kelihatan) Pregnancy Lactation Risk Risk AAP Trade Name approved?* Category** Category** B D L1 L4 L2 L1

Generic name Analgesics (Pain-killers) [more] Acetaminophen (Parasetamol) Tylenol Approved Colchicine Colchicine Approved Non-steroidal anti-inflammatory analgesics (NSAIDs) [more] Azapropazone (apazone) Rheumox Approved Ibuprofen Advil, Nuprin, Motrin, Pediaprofin

Indomethacin

Indocin

Ketorolac

Toradol, Acular

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

L3

L2

trim.) Mefenamic acid Ponstan, Ponstel Anaprox, Naprosyn, Naproxen, Aleve Butazolidine Feldene Profenal Tolectin Approved NR L3 L4 (for chronic use) NR L2 NR L3

Naproxen Phenylbutazone Piroxicam Suprofen Tolmetin Narcotic analgesics [more] Butorphanol Codeine Fentanyl Meperidine Methadone Morphine Propoxyphene Anesthesia, Anesthetics [more] Halothane Lidocaine Methohexital Thiopental Antacids, GI meds Cimetidine (Antacid) Cisapride (GI tract stimulant) Domperidone (used for nausea & vomiting, stimulates lactation) [more] Antibiotics Amoxicillin Aztreonam Cefadroxil

Approved Approved Approved Approved Approved

B B C

Stadol Tylenol #3, #4 Sublimaze Demerol Dolophine Morphine Darvocet N, Propacet, Darvon Fluothane Xylocaine Brevital Pentothal Tagamet Propulsid Motilum

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

L3 L3 L2 L2 L3 (if used early postpartum) L3 L3 L2 [contents] L2 L2 L3 L3 [contents] L2 L2 L1 [contents]

Approved Approved Approved Approved Approved Approved Approved

C C B C B C -

Larotid, Amoxil Azactam Ultracef, Duricef

Approved Approved Approved

B B B

L1 L2 L1

Cefazolin Cefotaxime Cefoxitin Cefprozil

Ancef, Kefzol Claforan Mefoxin Cefzil Ceftazidime, Ceftazidime Fortaz, Taxidime Ceftriaxone Rocephin Ciprofloxacin [more] Cipro Clindamycin Cleocin E-Mycin, EryErythromycin tab, ERYC, Ilosone Fleroxacin Gentamicin Garamycin Kebecil, Kanamycin Kantrex Moxalactam Moxam Nitrofurantoin Macrobid Ofloxacin Floxin Penicillin Streptomycin Streptomycin Sulbactam Gantrisin, AzoSulfisoxazole Gantrisin Achromycin, Tetracycline Sumycin, Terramycin Ticarcillin, Ticarcillin Ticar, Timentin Proloprim, Trimethoprim/sulfamethoxazole Trimpex Anticoagulants Bishydroxycoumarin (dicumarol) Coumadin, Warfarin Panwarfin Anticonvulsants Tegretol, Carbamazepine Epitol Ethosuximide Zarontin Magnesium sulfate Epsom salt Phenytoin Dilantin

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

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

L1 L2 L1 L1 L1 L2 L3 L3 L1 L3 early postnatal NR L2 L2 NR L2 L2 L1 L3 NR L2 L2 L1 L3 [contents]

Approved Approved

NR L2 [contents]

Approved Approved Approved Approved

C C B D

L2 L4 L1 L2

Valproic acid Antifungals Fluconazole [more] Ketoconazole Antihistamines [more] Dexbrompheniramine maleate with d-isoephedrine Fexofenadine Loratadine Terfenadine Triprolidine Antivirals Acyclovir [more]

Depakene, Depakote Diflucan Nizoral Shampoo, Nizoral Allegra Claritin Seldane Actidil, Actifed

Approved Approved Approved

D C C

L2 [contents] L2 L2 [contents]

Approved Approved Approved Approved Approved Approved Approved

C B C C C

NR L2 L1 NR L1 [contents] L2 L2 [contents]

Zovirax Alferon N, Interferon-alpha [more] Interferon Alpha Arthritis meds (see also: pain meds) Ridaura, Gold salts Myochrysine, Solganal Asthma meds (see also: steroids) Dilor, Lufyllin, Dyphylline Dyphylline Bricanyl, Terbutaline Brethine Aminophylline, Theophylline Quibron, TheoDur Contraceptives, Hormones [more] Estradiol Clogestone Estratab, Permarin, Menest Preven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra

Approved

L5 [contents]

Approved Approved Approved

C B C

L3 L2 L3 [contents] L3 (may interfere with milk production) NR

Approved Approved

X -

Contraceptive pill with estrogen/progesterone

Approved

L3 (may interfere with milk production)

Levonorgestrel

patch, etc. Norplant, Approved Mirena, Plan B Provera, DepoProvera, Approved Cycrin Enovid Crinone, Prometrium Approved Approved

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

Medroxyprogesterone Norethynodrel Progesterone Cough meds [more] Codeine Noscapine Decongestants [more]

D X -

[contents] Tylenol #3, #4 Approved C L3 NR Approved [contents] L3 (for Sudafed, acute use) Halofed, Pseudoephedrine L4 (for Approved C Novafed, chronic Actifed use) Diabetes meds [contents] Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1. Oramide, Tolbutamide Approved D L3 Orinase Diarrhea meds [contents] Imodium, Pepto Diarrhea Control, Maalox Antidiarrheal Loperamide 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] Diuretics [contents] Dazamide, Acetazolamide Approved C L2 Diamox L4 (may Bendroflumethiazide Naturetin inhibit Approved D lactation) Chlorothiazide Hydrodiuril Approved D L3

Chlorthalidone

Hygroton Approved Hydrodiuril, Hydrochlorothiazide Approved Esidrix, Oretic Spironolactone Aldactone Approved Galactagogues (milk supply) [more] Domperidone Motilum Approved Heart, Blood Pressure meds (Antiarrhythmics, Antihypertensives, Cardiac stimulants) Antiarrhythmics Norpace, Disopyramide Approved Napamide Flecainide Tambocor Approved Mexiletine Mexitil Approved Pronestyl, Procainamide Approved Procan Quinaglute, Quinidine Approved Quinidex Antihypertensives Captopril Capoten Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD Vasotec Apresoline Trandate, Normodyne Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, SlowTrasicor, Trasicor Approved

D D D -

L3 L2 L2 [contents] L1 [contents]

C C B C C

L2 L3 L2 L3 L2 L3 (if used after 30 days) L3

Diltiazem/Diltiazem HCL

Approved

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

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

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

Propranolol Sotalol Timolol Verapamil Cardiac stimulants Digoxin Laxatives [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Senna Malaria meds Chloroquine

Inderol Betapace Blocadren Calan, Isoptin, Covera-HS Lanoxin, Lanoxicaps Epsom salt Aralen, Novochloroquine Plaquenil Daraprim Quinamm

Approved Approved Approved Approved

C B C C

L2 L3 L2 L2

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

C C B C C C D C C B D B B C C D D 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 [contents] L2

Hydroxychloroquine Pyrimethamine Quinine Medical Testing [more] Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Omnipaque Iopanoic acid Telepaque Metrizamide Amipaque Metrizoate Isopaque Migraine meds (see also: pain meds) [more] Sumatriptan Imitrex Sedatives [more] Aquachloral, Chloral hydrate Noctec Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Seconal Sleep Aids Zolpidem/Zolpidem Tartrate Ambien Steroids Methylprednisolone Solu-Medrol, [ high dosage Depo-Medrol, methylprednisolone] Medrol

Approved

Prednisolone Prednisone Thyroid meds [more] Carbimazole Methimazole (active metabolite of carbimazole) Propylthiouracil Thiouracil Levothyroxine Tuberculosis meds Cycloserine Ethambutol Isoniazid Rifampin Vitamins [more] B-1 (thiamin) B-12 (Cyanocobalamin)

Deltasone, Meticorten, Orasone Tapazole

Approved Approved

C C

L2 L2 [contents] L3 L3 L2 NR L1 [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

Approved Approved

D D D A

PTU Approved Approved Synthroid, Levothroid, Approved Thyroid, LevoT, Levoxyl Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Approved Approved Approved Approved Approved Approved

C B C C A

B-6 (pyridoxine)

Approved

D, vitamin

Calciferol, Delta-d Soriatane Zyloprim, Lopurin Belladonna,

Approved

Folic acid K-1, vitamin (Phytonadione) Riboflavin/B2 Miscellaneous Acitretin (Anti-psoriasis) Alcohol/Ethanol [more] Allopurinol Antimony Atropine (Anticholinergic,

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

drying agent) Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant) Barbiturate Caffeine [more] Carbetocin (Antihemorrhagic) 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)

Atropine Rheumox Lioresal, Atrofen Vivarin, NoDoz, Coffee Duratocin Platinol Avlosulfon, DDS Plaquenil Mectizan NegGram Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved C B D C C C B C C D L2 L2 NR L2 NR NR L4 L4 L2 NR NR NR L3 L4 NR L2 L3 NR L3

Mestinon, Regonol Transderm Scopolamine (Motion sickness) Scope Sulfapyridine Dagenan Timolol (glaucoma med) Blocadren

* 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) Pregnancy Risk Categories A (controlled studies show no risk) B (no evidence of risk in humans)

L3 (moderately safe) L4 (possibly hazardous) L5 (contraindicated)

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