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, Naprosyn, Naproxen, Aleve) Nefopam (Acupan)

Risiko Notes Menyusui** L1 L3 L2 1

NR Approved NR Approved Approved NR Approved NR NR NR Approved Approved Approved Approved Approved Approved NR Approved 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 -

L3 L3 L2 L3 L4 L2 L2 L2 L3 L3 L1 L3 L2 L2; L3 early postpartum L3 L3 L2 L3; L4 for chronic use NR

4 5

6 7 8

Oxycodone (Tylox, Percodan,Oxycontin, NR B L3 10 Roxicet, Endocet, Roxiprin, Percocet) Pentosan polysulfate NR B L2 (Elmiron) Piroxicam (Feldene) Approved B L2 Propoxyphene (Darvocet Approved C L2 11 N, Propacet, Darvon) Rofecoxib (Vioxx) Withdrawn from the market 12 Secobarbital (Seconal) Approved D L3 13 Tolmetin (Tolectin) Approved C L3 Tramadol HCL (Ultram, NR C L3 14 Ultracet) Valdecoxib (Bextra) Withdrawn from the market more * Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
y y y

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

y y y y y

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 Risiko Nama Generik Nama Dagang AAP approved?* Kehamilan** Azapropazone (apazone) Rheumox Approved Dipyrone (banned in the Approved US & UK) Flufenamic acid Ibuprofen 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

Risiko Menyusui** L2 NR NR L1

Advil, Nuprin, Motrin, Approved Pediaprofin Indocin Approved

Indomethacin

L3

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

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 L2

Approved

C C C

Approved Deltasone, Meticorten, Approved Orasone

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

[contents] L3 L2 L3

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

Obat Batuk AAP approved?* Codeine yes Dextromethorphan not reviewed Guaifenesin not reviewed Dekongestan (Obat Pilek) AAP Nama Obat approved?* Phenylephrine not reviewed Nama Obat Risiko Menyusui** L3 (moderately safe) L1 (safest) L2 (safer) 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 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 not reviewed L3 (moderately safe) (Nasonex) Phenylephrine (in some forms of Sinex not reviewed L3 (moderately safe) and Neo-Synephrine) Triamcinolone not reviewed L3 (moderately safe) Acetonide (Nasacort) Antihistamin (Anti Alergi) AAP Nama Obat Risiko Menyusui** approved?* Brompheniramine not reviewed 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 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 approved?* Kategori Risiko Kehamilan** Risiko Notes Menyusui**

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

C C C C C B B C

NR L2 L2 L3 L3 L2 NR NR L3 L3 L3 L3

more

more

more 1 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 C NR 2 Naloxone (Narcan) NR C NR 3 Steroids 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.
y y y

L3; L4 for chronic use L3 L2 more 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 y L1 (safest) y L2 (safer) y L3 (moderately safe) y L4 (possibly hazardous) y 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)

y y y y y

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

Nama Dagang

AAP approved?* Approved Approved Approved

Tagamet Propulsid Motilum

Kategori Risiko Risiko Kehamilan** Menyusui** [contents] B L2 C L2 L1 [contents] L1 L2 L1 L1 L2 L1 L1

Larotid, Amoxil Azactam Ultracef, Duricef Ancef, Kefzol Claforan Mefoxin Cefzil

Approved Approved Approved Approved Approved Approved Approved

B B B B B B C

Ceftazidime, Fortaz, Taxidime Ceftriaxone Rocephin Ciprofloxacin [more] Cipro Clindamycin Cleocin E-Mycin, EryErythromycin tab, ERYC, Ilosone Fleroxacin Gentamicin Garamycin Kanamycin Kebecil, Kantrex Moxalactam Moxam Nitrofurantoin Macrobid Ofloxacin Floxin Penicillin Streptomycin Streptomycin Sulbactam Gantrisin, AzoSulfisoxazole Gantrisin Achromycin, Sumycin, Tetracycline Terramycin Ticarcillin, Ticarcillin Ticar, Timentin Proloprim, Trimethoprim/sulfamethoxazole Trimpex Antikoagulan Bishydroxycoumarin (dicumarol) Coumadin, Warfarin Panwarfin Antikonvulsan (Anti kejang) Carbamazepine Tegretol, Epitol Ethosuximide Zarontin Magnesium sulfate Epsom salt Phenytoin Dilantin Depakene, Valproic acid Depakote Anti Jamur Fluconazole [more] Diflucan Nizoral Ketoconazole Shampoo, Nizoral Ceftazidime

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

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

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

Approved Approved Approved Approved Approved Approved Approved Approved Approved

D C C B D D C C

NR L2 [contents] L2 L4 L1 L2 L2 [contents] L2 L2

Antivirus Acyclovir [more]

Zovirax Alferon N, Interferon-alpha [more] Interferon Alpha Arthritis meds (see also: pain meds) Ridaura, Gold salts Myochrysine, Solganal Kontrasepsi, Hormon Estradiol Clogestone Estratab, Permarin, Menest Preven, Seasonale, Norinyl, Norlestin, OrthoNovum, Ovral, Lunelle injection, OrthoEvra patch, etc. Norplant, Mirena, Plan B Provera, DepoProvera, Cycrin Enovid Crinone, Prometrium

Approved Approved

C C

[contents] L2 L2 [contents]

Approved

L5 [contents] L3 (may interfere with milk production) NR

Approved Approved

X -

Contraceptive pill with estrogen/progesterone

Approved

L3 (may interfere with milk production)

Levonorgestrel

Approved

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

Medroxyprogesterone Norethynodrel Progesterone

Approved Approved Approved

D X -

Obat Diabetes [contents] 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 Approved B L2 Antidiarrheal 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] Dazamide, Acetazolamide Approved C L2 Diamox L4 (may inhibit Bendroflumethiazide Naturetin Approved D lactation) Chlorothiazide Hydrodiuril Approved D L3 Chlorthalidone Hygroton Approved D L3 Hydrodiuril, Hydrochlorothiazide (HCT) Approved D L2 Esidrix, Oretic Spironolactone Aldactone Approved D L2 Anti Muntah [more] [contents] Domperidone Motilum Approved L1 Anti Hipertensi, Obat Jantung [contents] Anti aritmia Norpace, Disopyramide Approved C L2 Napamide Flecainide Tambocor Approved C L3 Mexiletine Mexitil Approved B L2 Pronestyl, Procainamide Approved C L3 Procan Quinaglute, Quinidine Approved C L2 Quinidex Anti Hipertensi L3 (if used after 30 Captopril Capoten Approved D days) Cardizem Sr, Dilacor-XR, Diltiazem/Diltiazem HCL Approved C L3 Diltiazem, Cardizem CD C (1st trim.) D (2nd, 3rd Enalapril/Enalapril Maleate Vasotec Approved L2 trim.) Hydralazine Apresoline Approved C L2 Trandate, Labetalol Approved C L2 Normodyne Methyldopa Aldomet Approved C L2 Metoprolol Toprol XL, Approved B L3

Minoxidil Nadolol Nifedipine Oxprenolol Propranolol Sotalol Timolol Verapamil Cardiac stimulants

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

Approved Approved Approved Approved Approved Approved Approved Approved

C C C C B C C

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

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] Aquachloral, Chloral hydrate Noctec Digoxin

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

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

Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Obat Tidur Zolpidem/Zolpidem Tartrate Obat Anti Tiroid [more] Carbimazole Methimazole (active metabolite of carbimazole) Propylthiouracil Thiouracil Levothyroxine Obat TBC Cycloserine Ethambutol Isoniazid Rifampin VITAMIN [more] B-1 (thiamin) B-12 (Cyanocobalamin) B-6 (pyridoxine)

Seconal Ambien Tapazole PTU Synthroid, Levothroid, Thyroid, LevoT, Levoxyl Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Calciferol, Delta-d Soriatane Zyloprim, Lopurin -

Approved Approved Approved Approved Approved Approved Approved Approved Approved

D D B D D D A

NR L5 L3 [contents] L3 [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

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

Approved Approved Approved Approved Approved Approved Approved Approved

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

Atropine (Anticholinergic, drying agent) Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant) Barbiturate

Belladonna, Atropine Rheumox

Approved Approved

C -

L3 L2

Lioresal, Atrofen Approved C L2 Approved NR Vivarin, NoDoz, Caffeine [more] Approved B L2 Coffee Carbetocin (Antihemorrhagic) Duratocin Approved NR Chloroform Approved NR Cisplatin (Anti-cancer) Platinol Approved D L4 Avlosulfon, Dapsone (Antileprosy) Approved C L4 DDS Hydroxychloroquine Plaquenil Approved C L2 (Antirheumatic, lupus) Iodides Approved NR Iodine Approved NR Iodine (povidone-iodine, eg, in Approved NR a vaginal douche) Ivermectin (Antiparasitic) Mectizan Approved C L3 Nalidixic acid (Urinary AntiNegGram Approved B L4 infective) Norsteroids Approved NR Pyridostigmine (Muscle Mestinon, Approved C L2 stimulant) Regonol Transderm Scopolamine (Motion sickness) Approved C L3 Scope Sulfapyridine Dagenan Approved NR 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.
y y y

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 y L1 (safest) y L2 (safer) y L3 (moderately safe) y 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)

y y y y

L5 (contraindicated)

X (contraindicated in pregnancy)

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