Kelompok Analgetik, NSAIDS, Obat Batuk dan Pilek, Anti Alergi dan Asma, Anestesi

Obat untuk Penghilang Rasa Sakit (Pain Killer) Nama Obat Acetaminophen (Tylenol) Aspirin Azapropazone (Rheumox) Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne) 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) NR Approved NR Approved Approved NR Approved NR NR NR Approved Approved Approved Approved AAP approved?* Approved Caution 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 L2 L3 L3 L2 L3 L4 L2 L2 L2 L3 L3 L1 L3 L2 L2; L3 early postpartum L3 6 4 5 3 2 Kategori Risiko Kehamilan** B C (1st, 2nd trim.) D (3rd trim.) Risiko Menyusui** L1 L3 Notes

Methadone (Dolophine) Approved B 7 Morphine (Duramorph, Infumorph, Approved B L3 8 Epimorph, MS Contin) Nalbuphine (Nubain) NR B L2 Naproxen (Anaprox, Naprosyn, L3; Approved B 9 Naproxen, Aleve) L4 for chronic use Nefopam (Acupan) Approved NR Oxycodone (Tylox, Percodan,Oxycontin, Roxicet, NR B L3 10 Endocet, Roxiprin, Percocet) Pentosan polysulfate (Elmiron) NR B L2 Piroxicam (Feldene) Approved B L2 Propoxyphene (Darvocet N, Approved C L2 11 Propacet, Darvon) Rofecoxib (Vioxx) Withdrawn from the market 12 Secobarbital (Seconal) Approved D L3 13 Tolmetin (Tolectin) Approved C L3 Tramadol HCL (Ultram, Ultracet) NR C L3 14 Valdecoxib (Bextra) Withdrawn from the market more * Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised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 L1 (safest) L2 (safer) L3 (moderately safe) L4 (possibly hazardous)

Pregnancy Risk Categories A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) 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] AAP Kategori Risiko Nama Generik Nama Dagang approved?* Kehamilan** Risiko Menyusui** Azapropazone (apazone) Rheumox Approved L2 Dipyrone (banned in the US & Approved NR UK) Flufenamic acid Ibuprofen Indomethacin Ketorolac Mefenamic acid Naproxen Phenylbutazone Piroxicam Suprofen Tolmetin Steroid Advil, Nuprin, Motrin, Pediaprofin Indocin Toradol, Acular Ponstan, Ponstel Anaprox, Naprosyn, Naproxen, Aleve Butazolidine Feldene Profenal Tolectin Approved Approved Approved Approved Approved Approved Approved Approved 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 L3 L2 NR L3 L4 (for chronic use) NR L2 NR L3 [contents]

Methylprednisolone [ high dosage methylprednisolone] Prednisolone Prednisone Obat Asma Dyphylline Terbutaline Theophylline

Solu-Medrol, Depo-Medrol, Approved Medrol Deltasone, Meticorten, Orasone Approved Approved

C C C

L2 L2 L2 [contents] L3 L2 L3

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

Approved Approved Approved

C B C

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

L3 (moderately safe) L3 (moderately safe) for acute use Pseudoephedrine yes L4 (possibly hazardous) for chronic use due to potential for (Sudafed, Actifed) 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 Risiko Menyusui** approved?* Beclomethasone (Vanceril, Beclovent, not reviewed L2 (safer) Beconase, Vancenase) Cromlyn sodium not reviewed L1 (safest) (Nasalcrom) Fluticasone (Flonase) not reviewed L3 (moderately safe) Mometasone (Nasonex) not reviewed L3 (moderately safe) Phenylephrine (in some forms of Sinex and Neonot reviewed L3 (moderately safe) Synephrine) Triamcinolone Acetonide not reviewed L3 (moderately safe) (Nasacort)

Antihistamin (Anti Alergi) Nama Obat AAP approved?* not reviewed Risiko Menyusui**

Brompheniramine L3 (moderately safe) Chlorpheniramine not reviewed L3 (moderately safe) (Chlor-Trimeton) 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 (Allegra) yes L3 (moderately safe) Loratadine (Claritin) yes L2 (safer) Terfenadine (Seldane) yes not reviewed 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 approved?* Kategori Risiko Kehamilan** C C C C C B B C Risiko Notes Menyusui** NR L2 L2 L3 L3 L2 NR NR L3 L3 L3 L3 more

Local anesthetics Articaine (Septocaine) NR Bupivacaine (Marcaine) NR Lidocaine (Xylocaine) Approved Mepivacaine (Carbocaine, Polocaine) NR 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 Midazolam (Versed) Propofol (Diprivan) Triazolam (Halcion) Narcotic Analgesics Alfentanil (Alfenta) Fentanyl (Sublimaze) Hydromorphone (Dilaudid) Morphine Reversal Medication Flumazenil (Romazicon) Naloxone (Narcan) Steroids Concern NR NR NR Approved NR Approved NR NR

more

more 1 more

D D B X C B C B C C

L3; L4 for chronic use L3 L2 more L3 L2 L2 L3 L3 NR NR 2 3

Decadron (Dexamethasone) NR C NR more 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.

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

Pregnancy Risk Categories A (controlled studies show no risk) B (no evidence of risk in humans) C (risk cannot be ruled out) 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 Generik Antasida Cimetidine (Antacid) Cisapride (GI tract stimulant) Domperidone (used for nausea & vomiting, stimulates lactation) [more] Antibiotika Amoxicillin Aztreonam Cefadroxil Cefazolin Cefotaxime Cefoxitin Cefprozil Ceftazidime Ceftriaxone Ciprofloxacin [more] Clindamycin Nama Dagang Tagamet Propulsid Motilum Kategori Risiko Risiko Kehamilan** Menyusui** [contents] B L2 C L2 L1 [contents] L1 L2 L1 L1 L2 L1 L1 L1 L2 L3 L3

AAP approved?* Approved Approved Approved

Larotid, Amoxil Azactam Ultracef, Duricef Ancef, Kefzol Claforan Mefoxin Cefzil Ceftazidime, Fortaz, Taxidime Rocephin Cipro Cleocin

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

B B B B B B C B B C B

Erythromycin Fleroxacin Gentamicin Kanamycin Moxalactam Nitrofurantoin Ofloxacin Penicillin Streptomycin Sulbactam

E-Mycin, Ery-tab, ERYC, Ilosone

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

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

Garamycin Kebecil, Kantrex Moxam Macrobid Floxin Streptomycin Gantrisin, AzoSulfisoxazole Gantrisin Achromycin, Sumycin, Tetracycline Terramycin Ticarcillin, Ticar, Ticarcillin Timentin Trimethoprim/sulfamethoxazole Proloprim, Trimpex Antikoagulan Bishydroxycoumarin (dicumarol) Warfarin Coumadin, Panwarfin Antikonvulsan (Anti kejang) Carbamazepine Tegretol, Epitol Ethosuximide Zarontin Magnesium sulfate Epsom salt Phenytoin Dilantin Valproic acid Depakene, Depakote Anti Jamur Fluconazole [more] Diflucan Nizoral Shampoo, Ketoconazole Nizoral Antivirus Acyclovir [more] Zovirax Alferon N, Interferon Interferon-alpha [more] Alpha Arthritis meds (see also: pain meds) Ridaura, Myochrysine, Gold salts Solganal Kontrasepsi, Hormon Estratab, Permarin, Menest Estradiol Clogestone Contraceptive pill with estrogen/progesterone Preven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra patch, etc. Norplant, Mirena, Plan B Provera, Depo-Provera, Cycrin

L1 L3 early postnatal NR L2 L2 NR L2 L2 L1 L3 NR L2 L2 L1 L3 [contents] NR L2 [contents] L2 L4 L1 L2 L2 [contents] L2 L2 [contents] L2 L2 [contents]

Approved

L5 [contents] L3 (may interfere with milk production) NR L3 (may interfere with milk production) L2 L1 L4 (if used first 3 days

Approved Approved

X -

Approved

Levonorgestrel Medroxyprogesterone

Approved Approved

X D

postpartum) Norethynodrel Enovid Approved X L2 Progesterone Crinone, Prometrium Approved L3 Obat Diabetes [contents] 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 [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] Diuretik (Peluruh Kencing) [contents] Acetazolamide Dazamide, Diamox Approved C L2 L4 (may Bendroflumethiazide Naturetin Approved D inhibit lactation) Chlorothiazide Hydrodiuril Approved D L3 Chlorthalidone Hygroton Approved D L3 Hydrodiuril, Esidrix, Hydrochlorothiazide (HCT) Approved D L2 Oretic Spironolactone Aldactone Approved D L2 Anti Muntah [more] [contents] Domperidone Motilum Approved L1 Anti Hipertensi, Obat Jantung [contents] 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 L3 (if used Captopril Capoten Approved D after 30 days) Cardizem Sr, DilacorDiltiazem/Diltiazem HCL XR, Diltiazem, Approved C L3 Cardizem CD C (1st trim.) Enalapril/Enalapril Maleate Vasotec Approved L2 D (2nd, 3rd trim.) Hydralazine Apresoline Approved C L2 Labetalol Trandate, Normodyne Approved C L2 Methyldopa Aldomet Approved C L2 Metoprolol Toprol XL, Lopressor Approved B L3 Loniten, Minodyl, L2 (topically) Minoxidil Approved C Rogaine L3 (orally) Nadolol Corgard, Nadolol Approved C L4 Nifedipine Adalat, Procardia Approved C L2 Apsolox, SlowOxprenolol Approved NR Trasicor, Trasicor Propranolol Inderol Approved C L2 Sotalol Betapace Approved B L3

Timolol Verapamil

Blocadren Calan, Isoptin, CoveraHS

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

C C C C B C C C D C C B D B B C C D D B D D D A

L2 L2 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] L3 L3 L2 NR L1 [contents] L3 L2 L3 L2 [contents] NR L1 L2; L4 in high doses

Cardiac stimulants Digoxin Lanoxin, Lanoxicaps Laksan (Pelancar BAB) [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Epsom salt Senna Obat malaria Aralen, NovoChloroquine chloroquine Hydroxychloroquine Plaquenil Pyrimethamine Daraprim Quinine Quinamm Medical Testing [more] Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Omnipaque Iopanoic acid Telepaque Metrizamide Amipaque Metrizoate Isopaque Obat Migren [more] Sumatriptan Imitrex Obat Sedativ [more] Chloral hydrate Aquachloral, Noctec Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Seconal Obat Tidur Zolpidem/Zolpidem Tartrate Ambien Obat Anti Tiroid [more] Carbimazole Methimazole (active metabolite Tapazole of carbimazole) Propylthiouracil PTU Thiouracil Synthroid, Levothroid, Levothyroxine Thyroid, Levo-T, Levoxyl Obat TBC Cycloserine Seromycin Ethambutol, Ethambutol Myambutol Isoniazid INH, Laniazid Rifampin Rifadin, Rimactane VITAMIN [more] B-1 (thiamin) B-12 (Cyanocobalamin) B-6 (pyridoxine) -

Approved Approved Approved Approved Approved Approved Approved

C B C C A A

D, vitamin Folic acid K-1, vitamin (Phytonadione) Riboflavin/B2 Lain-lain Acitretin (Anti-psoriasis) Alcohol/Ethanol [more] Allopurinol Antimony Atropine (Anticholinergic, drying agent) Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant) Barbiturate

Calciferol, Delta-d Soriatane Zyloprim, Lopurin Belladonna, Atropine Rheumox

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

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

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

Lioresal, Atrofen Approved C Approved Vivarin, NoDoz, Caffeine [more] Approved B Coffee Carbetocin (Antihemorrhagic) Duratocin Approved Chloroform Approved Cisplatin (Anti-cancer) Platinol Approved D Dapsone (Antileprosy) Avlosulfon, DDS Approved C Hydroxychloroquine Plaquenil Approved C (Antirheumatic, lupus) Iodides Approved Iodine Approved Iodine (povidone-iodine, eg, in Approved a vaginal douche) Ivermectin (Antiparasitic) Mectizan Approved C Nalidixic acid (Urinary AntiNegGram Approved B infective) Norsteroids Approved Pyridostigmine (Muscle Mestinon, Regonol Approved C stimulant) Scopolamine (Motion sickness) Transderm Scope Approved C Sulfapyridine Dagenan Approved Timolol (glaucoma med) Blocadren Approved D * 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) L3 (moderately safe) L4 (possibly hazardous)

Pregnancy Risk Categories 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)

L5 (contraindicated)

NR: Not Reviewed. This drug has not yet been reviewed by Hale