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

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)

NR: Not Reviewed. This drug has not yet been reviewed by Hale. Yankowitz J. Use of medications in pregnancy : General principles, teratology, and current developments. In : Yankowitz J, Niebyl J, eds. Drug therapy in pregnancy. London : Lippincott Williams & Wilkins, 2001 ; 1-19

Antibiotika Amoxicillin Aztreonam Cefadroxil Cefazolin Cefotaxime Cefoxitin Cefprozil Ceftazidime Ceftriaxone Ciprofloxacin [more] Clindamycin Erythromycin Fleroxacin Gentamicin Kanamycin Moxalactam Nitrofurantoin Ofloxacin Penicillin Streptomycin Sulbactam Sulfisoxazole Tetracycline Larotid, Amoxil Azactam Ultracef, Duricef Ancef, Kefzol Claforan Mefoxin Cefzil Ceftazidime, Fortaz, Taxidime Rocephin Cipro Cleocin E-Mycin, Ery-tab, ERYC, Ilosone Garamycin Kebecil, Kantrex Moxam Macrobid Floxin Streptomycin Gantrisin, Azo-Gantrisin Achromycin, Sumycin, Terramycin Approved 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 B B B C B B C B B C D B C B D C D

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

Ticarcillin

Ticarcillin, Ticar, Timentin Approved

L1

Trimethoprim/sulfamethoxazole Proloprim, Trimpex

Approved

L3

Info on selected MEDICATIONS USED FOR PAIN RELIEF Pregnancy AAP approved?* Risk Category** Approved B C (1st, 2nd trim.) D (3rd trim.) Lactation Risk Category**

Name of medication

Notes

Acetaminophen (Tylenol)

L1

Aspirin

Caution

L3

Azapropazone (Rheumox)

Approved

L2

Butalbital (Fioricet, Fiorinal, Bancap, Two- NR dyne) Butorphanol (Stadol) Celecoxib (Celebrex) (FDA safety info) Codeine (in Tylenol #3, #4) Colchicine Diclofenac (Cataflam, Voltaren) Fentanyl (Sublimaze) Flurbiprofen (Ansaid, Froben, Ocufen)

L3

Approved

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

L3

NR

L2

Approved Approved NR

C D B

L3 L4 L2

Approved

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

L2

NR

L2

Hydrocodone (Lortab, Vicodin) Hydromorphone (Dilaudid) Ibuprofen (Advil, Nuprin, Motrin, Pediaprofen) Indomethacin (Indocin)

NR

L3

NR

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

L3

Approved

L1

Approved

L3

Ketorolac (Toradol, Acular) Meperidine (Demerol) Methadone (Dolophine) Morphine (Duramorph, Infumorph, Epimorph, MS Contin) Nalbuphine (Nubain)

Approved

L2

Approved

L2; L3 early postpartum L3

Approved

Approved

L3

NR

L2

Naproxen (Anaprox, Naprosyn, Naproxen, Approved Aleve) Nefopam (Acupan) Oxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet) Approved

L3; L4 for chronic use

NR

NR

L3

10

Pentosan polysulfate (Elmiron) Piroxicam (Feldene)

NR

L2

Approved

L2

Propoxyphene Approved (Darvocet N, Propacet, Darvon) Rofecoxib (Vioxx) Secobarbital (Seconal) Tolmetin (Tolectin) Tramadol HCL (Ultram, Ultracet) Valdecoxib (Bextra) (FDA safety info)

L2

11

Withdrawn from the market

12

Approved

L3

13

Approved

L3

NR

L3

14

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).

Non-steroidal anti-inflammatory analgesics (NSAIDs) [more] Kategori Nama Nama Generik AAP Risiko Dagang approved?* Kehamilan**RisikoMenyusui** Azapropazone Rheumox Approved L2 (apazone) Dipyrone (banned in Approved NR the US & UK) Flufenamic acid NR B (1st, 2nd Ibuprofen Approved trim.) L1 D (3rd trim.) B (1st, 2nd Indomethacin Indocin Approved trim.) L3 D (3rd trim.) B (1st, 2nd Ketorolac Toradol, Acular Approved trim.) L2 D (3rd trim.) Ponstan, Mefenamic acid Approved NR Ponstel Anaprox, Naprosyn, L3 Naproxen Approved B Naproxen, L4 (for chronic use) Aleve Phenylbutazone Butazolidine Approved NR Piroxicam Feldene Approved B L2 Suprofen Profenal Approved NR Tolmetin Tolectin Approved C L3 Steroid [contents] Methylprednisolone Solu-Medrol, [ high dosage Depo-Medrol, Approved C L2 methylprednisolone] Medrol Prednisolone Approved C L2 Deltasone, Prednisone Meticorten, Approved C L2 Orasone Advil, Nuprin, Motrin, Pediaprofin Approved

Obat Asma Dyphylline Terbutaline Theophylline Dilor, Lufyllin, Approved Dyphylline Bricanyl, Approved Brethine Aminophylline, Quibron, Theo- Approved Dur C B C

[contents] L3 L2 L3

Analgetik Narkotik [more] Butorphanol Codeine Fentanyl Meperidine Methadone Morphine Propoxyphene 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

Obat Batuk AAP approved?* Codeine yes Dextromethorphan not reviewed Guaifenesin not reviewed Dekongestan (Obat Pilek) AAP Nama Obat approved?* Phenylephrine not reviewed Nama Obat Pseudoephedrine (Sudafed, Actifed) yes Risiko Menyusui** L3 (moderately safe) L1 (safest) L2 (safer) Risiko Menyusui** L3 (moderately safe) L3 (moderately safe) for acute use L4 (possibly hazardous) for chronic use due to potential for decreasing milk supply

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) Antihistamin (Anti Alergi) AAP Nama Obat approved?* Brompheniramine not reviewed Chlorpheniramine (Chlor-Trimeton) not reviewed CTM Cetirizine (Zyrtec) not reviewed Dexbrompheniramine maleate yes with d-isoephedrine Diphenhydramine not reviewed (Benadryl) Doxylamine not reviewed Fexofenadine yes (Allegra) Loratadine (Claritin) yes Terfenadine (Seldane) yes

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

Risiko Menyusui** L3 (moderately safe) L3 (moderately safe) L2 (safer) not reviewed L2 (safer) L4 (possibly hazardous) L3 (moderately safe) L2 (safer) not reviewed

Triprolidine (Actidil, Actifed)

yes

L1 (safest)

Nama Generik

Nama Dagang

Antasida Cimetidine Tagamet (Antacid) Cisapride (GI tract Propulsid stimulant) Domperidone (used for nausea & vomiting, Motilum stimulates lactation) [more]

Kategori AAP Risiko approved?* Kehamilan** RisikoMenyusui** [contents] Approved Approved B C L2 L2

Approved

L1

Antikoagulan Bishydroxycoumarin (dicumarol) Warfarin Carbamazepine Ethosuximide Magnesium sulfate Phenytoin Valproic acid Anti Jamur Fluconazole [more] Ketoconazole Antivirus Acyclovir [more] Interferon-alpha [more] Gold salts Estradiol Zovirax Alferon N, Interferon Alpha Approved Approved C C Diflucan Nizoral Shampoo, Nizoral Approved Approved C C Coumadin, Panwarfin Tegretol, Epitol Zarontin Epsom salt Dilantin Depakene, Depakote Approved Approved Approved Approved Approved Approved Approved D C C B D D

[contents] NR L2 [contents] L2 L4 L1 L2 L2 [contents] L2 L2 [contents] L2 L2 [contents] Approved Approved C X L5 [contents] L3 (may interfere

Antikonvulsan (Anti kejang)

Arthritis meds (see also: pain meds) Ridaura, Myochrysine, Solganal Estratab, Permarin, Menest Kontrasepsi, Hormon

with milk production) Clogestone Approved NR L3 (may interfere with milk production) L2 L1 L4 (if used first 3 days postpartum) L2 L3 [contents] Preven, Seasonale, Norinyl, Contraceptive pill with Norlestin, Ortho-Novum, Ovral, estrogen/progesterone Lunelle injection, Ortho-Evra patch, etc. Levonorgestrel Norplant, Mirena, Plan B

Approved

Approved

Medroxyprogesterone Provera, Depo-Provera, Cycrin

Approved

Norethynodrel Progesterone Obat Diabetes

Enovid Crinone, Prometrium

Approved Approved

X -

Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk category = L1. Tolbutamide Obat Diare Imodium, Pepto Diarrhea Control, Maalox Antidiarrheal Caplets, Kaopectate II Caplets, Immodium Advanced Oramide, Orinase Approved D L3 [contents]

Loperamide

Approved

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]

Laksan (Pelancar BAB) [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Senna Epsom salt Approved Approved Approved Approved C B -

[contents] L3 NR L1 L3

Diuretik (Peluruh Kencing) Acetazolamide Bendroflumethiazide Dazamide, Diamox Naturetin Approved Approved C D

[contents] L2 L4 (may inhibit lactation)

Chlorothiazide Chlorthalidone Hydrochlorothiazide (HCT) Spironolactone Anti Muntah [more] Domperidone

Hydrodiuril Hygroton Hydrodiuril, Esidrix, Oretic Aldactone Motilum

Approved Approved Approved Approved Approved

D D D D -

L3 L3 L2 L2 [contents] L1

Obat malaria Chloroquine Hydroxychloroquine Pyrimethamine Quinine Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Iopanoic acid Metrizamide Metrizoate Obat Migren [more] Sumatriptan Obat Sedativ [more] Chloral hydrate Aquachloral, Noctec Approved Approved Approved Approved C D D Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Obat Tidur Zolpidem/Zolpidem Tartrate Carbimazole Methimazole (active Ambien Approved B Seconal Imitrex Approved C Aralen, Novochloroquine Plaquenil Daraprim Quinamm Omnipaque Telepaque Amipaque Isopaque Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved C C C D C C B D B B

[contents] L3 L2 L4 L2 [contents] NR L3 L2 L2 L2 L2 L2 [contents] L3 [contents] L3 NR L5 L3 [contents] L3 [contents] Approved Approved D D L3 L3

Medical Testing [more]

Obat Anti Tiroid [more] Tapazole

metabolite of carbimazole) Propylthiouracil Thiouracil Levothyroxine Obat TBC Cycloserine Ethambutol Isoniazid Rifampin VITAMIN [more] B-1 (thiamin) B-12 (Cyanocobalamin) Approved Approved A Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Approved Approved Approved Approved C B C C PTU Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl Approved Approved Approved D A L2 NR L1 [contents] L3 L2 L3 L2 [contents] NR L1 L2; L4 in high doses (may inhibit lactation) L3 (do not overdose) L1

B-6 (pyridoxine)

Approved

D, vitamin

Calciferol, Delta-d

Approved

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

Folic acid K-1, vitamin (Phytonadione) Riboflavin/B2 Lain-lain

Approved

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

L1 L1 [contents] NR L3 L2 NR L3 L2 L2 NR L2

Acitretin (Anti-psoriasis) Soriatane Alcohol/Ethanol [more] Allopurinol Antimony Zyloprim, Lopurin -

Atropine (Anticholinergic, Belladonna, Atropine drying agent) Azapropazone/apazone (Antirheumatic) Barbiturate Caffeine [more] Rheumox

Baclofen (muscle relaxant) Lioresal, Atrofen Vivarin, NoDoz, Coffee

Carbetocin (Antihemorrhagic) Chloroform Cisplatin (Anti-cancer) Dapsone (Antileprosy) Hydroxychloroquine (Antirheumatic, lupus) Iodides Iodine Iodine (povidone-iodine, eg, in a vaginal douche) Nalidixic acid (Urinary Anti-infective) Norsteroids Pyridostigmine (Muscle stimulant) Scopolamine (Motion sickness) Sulfapyridine Timolol (glaucoma med)

Duratocin Platinol Avlosulfon, DDS Plaquenil -

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

D C C C B C C D

NR NR L4 L4 L2 NR NR NR L3 L4 NR L2 L3 NR L3

Ivermectin (Antiparasitic) Mectizan NegGram Mestinon, Regonol Transderm Scope Dagenan Blocadren

Anti Hipertensi, Obat Jantung Anti aritmia Disopyramide Flecainide Mexiletine Procainamide Quinidine Anti Hipertensi Captopril Capoten Approved Approved D C C (1st trim.) D (2nd, 3rd trim.) C Norpace, Napamide Tambocor Mexitil Pronestyl, Procan Quinaglute, Quinidex Approved Approved Approved Approved Approved C C B C C

[contents] L2 L3 L2 L3 L2 L3 (if used after 30 days) L3

Diltiazem/Diltiazem Cardizem Sr, Dilacor-XR, HCL Diltiazem, Cardizem CD Enalapril/Enalapril Vasotec Maleate Hydralazine Apresoline

Approved Approved

L2 L2

Labetalol Methyldopa Metoprolol Minoxidil Nadolol Nifedipine Oxprenolol Propranolol Sotalol Timolol Verapamil Digoxin

Trandate, Normodyne Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, Slow-Trasicor, Trasicor Inderol Betapace Blocadren Calan, Isoptin, Covera-HS Lanoxin, Lanoxicaps

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

C C B C C C C B C C C

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

Cardiac stimulants