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 menunjukkanrisikobagijaninpadatrimester1dantrimesterberikutnya.Obatdalam 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 adastudi terkontrol pada wanita hamil yang menunjukkan adanya efek samping, kecuali adanya penurunan fertilitas pada kehamilan trimesterpertama,sedangkanpadatrimesterberikutnyatidakdidapatkanbuktiadanya 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. Padakeadaankhususobatinidigunakanjikamanfaatnyakemungkinanlebihbesardibanding resikonya. Penggunaan obat golongan ini terutama untuk mengatasikeadaan yang mengancam jiwa atau jika tidak ada obat lain yanglebih 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 keadaanhamil
Kelompok Analgetik, NSAIDS, Obat Batuk dan Pilek,Anti Alergi dan Asma, AnestesiObat untuk Penghilang Rasa Sakit (Pain Killer)
Nama ObatAAP approved?*KategoriRisiko Kehamilan**RisikoMenyusui**Notes
Acetaminophen(Tylenol)ApprovedBL1
AspirinCautionC(1st, 2nd trim.)D(3rd trim.)L31
Azapropazone(Rheumox)Approved-L2
Butalbital(Fioricet, Fiorinal, Bancap, Two-dyne)NRDL32
Butorphanol(Stadol)ApprovedB(1st, 2nd trim.)D(3rd trim.)L3
Celecoxib(Celebrex))NRCL2
Codeine(in Tylenol #3, #4)ApprovedCL33
ColchicineApprovedDL4
Diclofenac(Cataflam, Voltaren)NRBL2
Fentanyl(Sublimaze)ApprovedBL2
Flurbiprofen(Ansaid, Froben, Ocufen)NRB(1st, 2nd trim.)C(3rd trim.)L2
Hydrocodone(Lortab, Vicodin)NRBL34
Hydromorphone(Dilaudid)NRCL35
Ibuprofen(Advil, Nuprin, Motrin, Pediaprofen)ApprovedB(1st, 2nd trim.)D(3rd trim.)L1
Indomethacin(Indocin)ApprovedB(1st, 2nd trim.)D(3rd trim.)L3
Ketorolac(Toradol, Acular)ApprovedB(1st, 2nd trim.)D(3rd trim.)L2
Meperidine(Demerol)ApprovedBL2;L3early postpartum6
Methadone(Dolophine)ApprovedBL37
Morphine(Duramorph, Infumorph, Epimorph, MS Contin)ApprovedBL38
Nalbuphine(Nubain)NRBL2
Naproxen(Anaprox, Naprosyn, Naproxen, Aleve)ApprovedBL3;L4for chronic use9
Nefopam(Acupan)Approved-NR
Oxycodone(Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)NRBL310
Pentosan polysulfate(Elmiron)NRBL2
Piroxicam(Feldene)ApprovedBL2
Propoxyphene(Darvocet N, Propacet, Darvon)ApprovedCL211
Rofecoxib(Vioxx)Withdrawn from the market12
Secobarbital(Seconal)ApprovedDL313
Tolmetin(Tolectin)ApprovedCL3
Tramadol HCL(Ultram, Ultracet)NRCL314
Valdecoxib(Bextra)Withdrawn from the marketmore
* Per the AAP Policy StatementThe 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.** PerMedications and Mothers Milkby Thomas Hale, PhD (2004 edition).Lactation Risk CategoriesPregnancy 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 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]
Nama GenerikNama DagangAAP approved?*Kategori Risiko Kehamilan**RisikoMenyusui**
Azapropazone (apazone)RheumoxApproved-L2
Dipyrone (banned in the US & UK)-Approved-NR
Flufenamic acid-Approved-NR
IbuprofenAdvil, Nuprin, Motrin, PediaprofinApprovedB(1st, 2nd trim.)D(3rd trim.)L1
IndomethacinIndocinApprovedB(1st, 2nd trim.)D(3rd trim.)L3
KetorolacToradol, AcularApprovedB(1st, 2nd trim.)D(3rd trim.)L2
Mefenamic acidPonstan, PonstelApproved-NR
NaproxenAnaprox, Naprosyn, Naproxen, AleveApprovedBL3L4(for chronic use)
PhenylbutazoneButazolidineApproved-NR
PiroxicamFeldeneApprovedBL2
SuprofenProfenalApproved-NR
TolmetinTolectinApprovedCL3
Steroid[contents]
Methylprednisolone[high dosage methylprednisolone]Solu-Medrol, Depo-Medrol, MedrolApprovedCL2
Prednisolone-ApprovedCL2
PrednisoneDeltasone, Meticorten, OrasoneApprovedCL2
Obat Asma[contents]
DyphyllineDilor, Lufyllin, DyphyllineApprovedCL3
TerbutalineBricanyl, BrethineApprovedBL2
TheophyllineAminophylline, Quibron, Theo-DurApprovedCL3
Analgetik Narkotik [more]
ButorphanolStadolApprovedB(1st, 2nd trim.)D(3rd trim.)L3
CodeineTylenol #3, #4ApprovedCL3
FentanylSublimazeApprovedBL2
MeperidineDemerolApprovedBL2L3(if used early postpartum)
MethadoneDolophineApprovedBL3
MorphineMorphineApprovedBL3
PropoxypheneDarvocet N, Propacet, DarvonApprovedCL2
Obat Batuk
Nama ObatAAP approved?*RisikoMenyusui**
CodeineyesL3 (moderately safe)
Dextromethorphannot reviewedL1 (safest)
Guaifenesinnot reviewedL2 (safer)
Dekongestan (Obat Pilek)
Nama ObatAAP approved?*RisikoMenyusui**
Phenylephrinenot reviewedL3 (moderately safe)
Pseudoephedrine (Sudafed, Actifed)yesL3 (moderately safe) for acute useL4 (possibly hazardous) for chronic use due to potential for decreasing milk supply
* Per the AAP Policy StatementThe Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.** PerMedications and Mothers Milkby Thomas Hale, PhD (2006 edition)
Nasal Sprays (Spray Hidung)
Nama ObatAAPapproved?*RisikoMenyusui**
Beclomethasone (Vanceril, Beclovent, Beconase, Vancenase)not reviewedL2 (safer)
Cromlyn sodium (Nasalcrom)not reviewedL1 (safest)
Fluticasone (Flonase)not reviewedL3 (moderately safe)
Mometasone (Nasonex)not reviewedL3 (moderately safe)
Phenylephrine (in some forms of Sinex and Neo-Synephrine)not reviewedL3 (moderately safe)
Triamcinolone Acetonide (Nasacort)not reviewedL3 (moderately safe)
Antihistamin (Anti Alergi)
Nama ObatAAPapproved?*RisikoMenyusui**
Brompheniraminenot reviewedL3 (moderately safe)
Chlorpheniramine (Chlor-Trimeton) CTMnot reviewedL3 (moderately safe)
Cetirizine (Zyrtec)not reviewedL2 (safer)
Dexbrompheniramine maleatewithd-isoephedrineyesnot reviewed
Diphenhydramine (Benadryl)not reviewedL2 (safer)
Doxylaminenot reviewedL4 (possibly hazardous)
Fexofenadine (Allegra)yesL3 (moderately safe)
Loratadine (Claritin)yesL2 (safer)
Terfenadine (Seldane)yesnot reviewed
Triprolidine (Actidil, Actifed)yesL1 (safest)
* Per the AAP Policy StatementThe Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.** PerMedications and Mothers Milkby Thomas Hale, PhD (2002 edition)
Obat Anestesi
Nama ObatAAP approved?*KategoriRisiko Kehamilan**RisikoMenyusui**Notes
Local anesthetics
Articaine (Septocaine)NR-NRmore
Bupivacaine (Marcaine)NRCL2
Lidocaine (Xylocaine)ApprovedCL2
Mepivacaine (Carbocaine, Polocaine)NRCL3more
Procaine HCL (Novocaine)NRCL3
General anesthetics
Halothane (Fluothane)ApprovedCL2more
Isoflurane (Forane)NR-NR1
KetamineNR-NRmore
Methohexital (Brevital)ApprovedBL3
Nitrous oxideNR-L3
Sevoflurane (Ultane)NRBL3
Thiopental (Pentothal)ApprovedCL3
Other medications often used during anesthesia
Sedatives
Diazepam (Valium)ConcernDL3;L4for chronic use
Midazolam (Versed)ConcernDL3
Propofol (Diprivan)NRBL2more
Triazolam (Halcion)NRXL3
Narcotic Analgesics
Alfentanil (Alfenta)NRCL2
Fentanyl (Sublimaze)ApprovedBL2
Hydromorphone (Dilaudid)NRCL3
MorphineApprovedBL3
Reversal Medication
Flumazenil (Romazicon)NRCNR2
Naloxone (Narcan)NRCNR3
Steroids
Decadron (Dexamethasone)NRCNRmore
Stimulants
Epinephrine (Adrenaline)NRCL1
Anti-nausea
Promethazine (Phenergan)NRCL2
* Per the AAP Policy StatementThe 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.** PerMedications and Mothers Milkby Thomas Hale, PhD (2004 edition).Lactation Risk CategoriesPregnancy 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, dllNama GenerikNama DagangAAP approved?*Kategori Risiko Kehamilan**RisikoMenyusui**
Antasida[contents]
Cimetidine (Antacid)TagametApprovedBL2
Cisapride (GI tract stimulant)PropulsidApprovedCL2
Domperidone (used for nausea & vomiting, stimulates lactation) [more]MotilumApproved-L1
Antibiotika[contents]
AmoxicillinLarotid, AmoxilApprovedBL1
AztreonamAzactamApprovedBL2
CefadroxilUltracef, DuricefApprovedBL1
CefazolinAncef, KefzolApprovedBL1
CefotaximeClaforanApprovedBL2
CefoxitinMefoxinApprovedBL1
CefprozilCefzilApprovedCL1
CeftazidimeCeftazidime, Fortaz, TaxidimeApprovedBL1
CeftriaxoneRocephinApprovedBL2
Ciprofloxacin [more]CiproApprovedCL3
ClindamycinCleocinApprovedBL3
ErythromycinE-Mycin, Ery-tab, ERYC, IlosoneApprovedBL1L3early postnatal
Fleroxacin-Approved-NR
GentamicinGaramycinApprovedCL2
KanamycinKebecil, KantrexApprovedDL2
MoxalactamMoxamApproved-NR
NitrofurantoinMacrobidApprovedBL2
OfloxacinFloxinApprovedCL2
Penicillin-ApprovedBL1
StreptomycinStreptomycinApprovedDL3
Sulbactam-Approved-NR
SulfisoxazoleGantrisin, Azo-GantrisinApprovedCL2
TetracyclineAchromycin, Sumycin, TerramycinApprovedDL2
TicarcillinTicarcillin, Ticar, TimentinApprovedBL1
Trimethoprim/sulfamethoxazoleProloprim, TrimpexApprovedCL3
Antikoagulan[contents]
Bishydroxycoumarin (dicumarol)-Approved-NR
WarfarinCoumadin, PanwarfinApprovedDL2
Antikonvulsan (Anti kejang)[contents]
CarbamazepineTegretol, EpitolApprovedCL2
EthosuximideZarontinApprovedCL4
Magnesium sulfateEpsom saltApprovedBL1
PhenytoinDilantinApprovedDL2
Valproic acidDepakene, DepakoteApprovedDL2
Anti Jamur[contents]
Fluconazole [more]DiflucanApprovedCL2
KetoconazoleNizoral Shampoo, NizoralApprovedCL2
Antivirus[contents]
Acyclovir [more]ZoviraxApprovedCL2
Interferon-alpha [more]Alferon N, Interferon AlphaApprovedCL2
Arthritis meds (see also:pain meds)[contents]
Gold saltsRidaura, Myochrysine, SolganalApprovedCL5
Kontrasepsi, Hormon[contents]
EstradiolEstratab, Permarin, MenestApprovedXL3(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.ApprovedXL3(may interfere with milk production)
LevonorgestrelNorplant, Mirena, Plan BApprovedXL2
MedroxyprogesteroneProvera, Depo-Provera, CycrinApprovedDL1L4(if used first 3 days postpartum)
NorethynodrelEnovidApprovedXL2
ProgesteroneCrinone, PrometriumApproved-L3
Obat Diabetes[contents]
Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1.
TolbutamideOramide, OrinaseApprovedDL3
Obat Diare[contents]
LoperamideImodium, Pepto Diarrhea Control, Maalox Antidiarrheal Caplets, Kaopectate II Caplets, Immodium AdvancedApprovedBL2
** 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)[contents]
AcetazolamideDazamide, DiamoxApprovedCL2
BendroflumethiazideNaturetinApprovedDL4(may inhibit lactation)
ChlorothiazideHydrodiurilApprovedDL3
ChlorthalidoneHygrotonApprovedDL3
Hydrochlorothiazide (HCT)Hydrodiuril, Esidrix, OreticApprovedDL2
SpironolactoneAldactoneApprovedDL2
Anti Muntah [more][contents]
DomperidoneMotilumApproved-L1
Anti Hipertensi, Obat Jantung[contents]
Anti aritmia
DisopyramideNorpace, NapamideApprovedCL2
FlecainideTambocorApprovedCL3
MexiletineMexitilApprovedBL2
ProcainamidePronestyl, ProcanApprovedCL3
QuinidineQuinaglute, QuinidexApprovedCL2
Anti Hipertensi
CaptoprilCapotenApprovedDL3(if used after 30 days)
Diltiazem/Diltiazem HCLCardizem Sr, Dilacor-XR, Diltiazem, Cardizem CDApprovedCL3
Enalapril/Enalapril MaleateVasotecApprovedC(1st trim.)D(2nd, 3rd trim.)L2
HydralazineApresolineApprovedCL2
LabetalolTrandate, NormodyneApprovedCL2
MethyldopaAldometApprovedCL2
MetoprololToprol XL, LopressorApprovedBL3
MinoxidilLoniten, Minodyl, RogaineApprovedCL2(topically)L3(orally)
NadololCorgard, NadololApprovedCL4
NifedipineAdalat, ProcardiaApprovedCL2
OxprenololApsolox, Slow-Trasicor, TrasicorApproved-NR
PropranololInderolApprovedCL2
SotalolBetapaceApprovedBL3
TimololBlocadrenApprovedCL2
VerapamilCalan, Isoptin, Covera-HSApprovedCL2
Cardiac stimulants
DigoxinLanoxin, LanoxicapsApprovedCL2
Laksan (Pelancar BAB) [more][contents]
Cascara/Cascara Sagrada-ApprovedCL3
Danthron-Approved-NR
Magnesium sulfateEpsom saltApprovedBL1
Senna-Approved-L3
Obat malaria[contents]
ChloroquineAralen, Novo-chloroquineApprovedCL3
HydroxychloroquinePlaquenilApprovedCL2
PyrimethamineDaraprimApprovedCL4
QuinineQuinammApprovedDL2
Medical Testing [more][contents]
Diatrizoate-Approved-NR
Fluorescein-ApprovedCL3
Gadopentetic (Gadolinium)-ApprovedCL2
IohexolOmnipaqueApprovedBL2
Iopanoic acidTelepaqueApprovedDL2
MetrizamideAmipaqueApprovedBL2
MetrizoateIsopaqueApprovedBL2
Obat Migren [more][contents]
SumatriptanImitrexApprovedCL3
Obat Sedativ [more][contents]
Chloral hydrateAquachloral, NoctecApprovedCL3
Methyprylon (withdrawn from use in US & Canada)-Approved-NR
Bromide-ApprovedDL5
SecobarbitalSeconalApprovedDL3
Obat Tidur[contents]
Zolpidem/Zolpidem TartrateAmbienApprovedBL3
Obat Anti Tiroid [more][contents]
Carbimazole-ApprovedDL3
Methimazole (active metabolite of carbimazole)TapazoleApprovedDL3
PropylthiouracilPTUApprovedDL2
Thiouracil-Approved-NR
LevothyroxineSynthroid, Levothroid, Thyroid, Levo-T, LevoxylApprovedAL1
Obat TBC[contents]
CycloserineSeromycinApprovedCL3
EthambutolEthambutol, MyambutolApprovedBL2
IsoniazidINH, LaniazidApprovedCL3
RifampinRifadin, RimactaneApprovedCL2
VITAMIN [more][contents]
B-1 (thiamin)-Approved-NR
B-12 (Cyanocobalamin)-ApprovedAL1
B-6 (pyridoxine)-ApprovedAL2;L4in high doses (may inhibit lactation)
D, vitaminCalciferol, Delta-dApprovedAL3(do not overdose)
Folic acid-ApprovedA(1st, 2nd trim.)C(3rd trim.)L1
K-1, vitamin (Phytonadione)-ApprovedCL1
Riboflavin/B2-ApprovedAL1
Lain-lain[contents]
Acitretin (Anti-psoriasis)SoriataneApproved-NR
Alcohol/Ethanol [more]-ApprovedDL3
AllopurinolZyloprim, LopurinApprovedCL2
Antimony-Approved-NR
Atropine (Anticholinergic, drying agent)Belladonna, AtropineApprovedCL3
Azapropazone/apazone (Antirheumatic)RheumoxApproved-L2
Baclofen (muscle relaxant)Lioresal, AtrofenApprovedCL2
Barbiturate-Approved-NR
Caffeine [more]Vivarin, NoDoz, CoffeeApprovedBL2
Carbetocin (Antihemorrhagic)DuratocinApproved-NR
Chloroform-Approved-NR
Cisplatin (Anti-cancer)PlatinolApprovedDL4
Dapsone (Antileprosy)Avlosulfon, DDSApprovedCL4
Hydroxychloroquine (Antirheumatic, lupus)PlaquenilApprovedCL2
Iodides-Approved-NR
Iodine-Approved-NR
Iodine (povidone-iodine, eg, in a vaginal douche)-Approved-NR
Ivermectin (Antiparasitic)MectizanApprovedCL3
Nalidixic acid (Urinary Anti-infective)NegGramApprovedBL4
Norsteroids-Approved-NR
Pyridostigmine (Muscle stimulant)Mestinon, RegonolApprovedCL2
Scopolamine (Motion sickness)Transderm ScopeApprovedCL3
SulfapyridineDagenanApproved-NR
Timolol (glaucoma med)BlocadrenApprovedDL3
* Per the AAP Policy StatementThe 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.** PerMedications and Mothers Milkby Thomas Hale, PhD (2004 edition).Lactation Risk CategoriesPregnancy 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
Disusun kembali oleh dr.Abu Hanadari sumber URL :http://www.kellymom.com/health/meds/aap-approved-meds.html
