DAFTAR OBAT AMAN DAN BERBAHAYA

DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI
dari sumber URL : http://www.kellymom.com/health/meds/aap-approved-meds.html

Kelompok Analgetik, NSAIDS, Obat Batuk dan Pilek,

Anti Alergi dan Asma, Anestesi

Obat untuk Penghilang Rasa Sakit (Pain Killer)
Nama Obat	AAP approved?*	Kategori Risiko Kehamilan**	Risiko Menyusui**	Notes
Acetaminophen (Tylenol)	Approved	B	L1
Aspirin	Caution	C (1st, 2nd trim.) D (3rd trim.)	L3	1
Azapropazone (Rheumox)	Approved	-	L2
Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne)	NR	D	L3	2
Butorphanol (Stadol)	Approved	B (1st, 2nd trim.) D (3rd trim.)	L3
Celecoxib (Celebrex))	NR	C	L2
Codeine (in Tylenol #3, #4)	Approved	C	L3	3
Colchicine	Approved	D	L4
Diclofenac (Cataflam, Voltaren)	NR	B	L2
Fentanyl (Sublimaze)	Approved	B	L2
Flurbiprofen (Ansaid, Froben, Ocufen)	NR	B (1st, 2nd trim.) C (3rd trim.)	L2
Hydrocodone (Lortab, Vicodin)	NR	B	L3	4
Hydromorphone (Dilaudid)	NR	C	L3	5
Ibuprofen (Advil, Nuprin, Motrin, Pediaprofen)	Approved	B (1st, 2nd trim.) D (3rd trim.)	L1
Indomethacin (Indocin)	Approved	B (1st, 2nd trim.) D (3rd trim.)	L3
Ketorolac (Toradol, Acular)	Approved	B (1st, 2nd trim.) D (3rd trim.)	L2
Meperidine (Demerol)	Approved	B	L2; L3 early postpartum	6
Methadone (Dolophine)	Approved	B	L3	7
Morphine (Duramorph, Infumorph, Epimorph, MS Contin)	Approved	B	L3	8
Nalbuphine (Nubain)	NR	B	L2
Naproxen (Anaprox, Naprosyn, Naproxen, Aleve)	Approved	B	L3; L4 for chronic use	9
Nefopam (Acupan)	Approved	-	NR
Oxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)	NR	B	L3	10
Pentosan polysulfate (Elmiron)	NR	B	L2
Piroxicam (Feldene)	Approved	B	L2
Propoxyphene (Darvocet N, Propacet, Darvon)	Approved	C	L2	11
Rofecoxib (Vioxx)	Withdrawn from the market			12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Valdecoxib (Bextra)	Withdrawn from the market			more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 Pregnancy 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 Reye’s 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 baby’s 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 Generik	Nama Dagang	AAP approved?*	Kategori Risiko Kehamilan**	Risiko Menyusui**
Azapropazone (apazone)	Rheumox	Approved	-	L2
Dipyrone (banned in the US & UK)	-	Approved	-	NR
Flufenamic acid	-	Approved	-	NR
Ibuprofen	Advil, Nuprin, Motrin, Pediaprofin	Approved	B (1st, 2nd trim.) D (3rd trim.)	L1
Indomethacin	Indocin	Approved	B (1st, 2nd trim.) D (3rd trim.)	L3
Ketorolac	Toradol, Acular	Approved	B (1st, 2nd trim.) D (3rd trim.)	L2
Mefenamic acid	Ponstan, Ponstel	Approved	-	NR
Naproxen	Anaprox, Naprosyn, Naproxen, Aleve	Approved	B	L3 L4 (for chronic use)
Phenylbutazone	Butazolidine	Approved	-	NR
Piroxicam	Feldene	Approved	B	L2
Suprofen	Profenal	Approved	-	NR
Tolmetin	Tolectin	Approved	C	L3
Steroid				[contents]
Methylprednisolone [ high dosage methylprednisolone]	Solu-Medrol, Depo-Medrol, Medrol	Approved	C	L2
Prednisolone	-	Approved	C	L2
Prednisone	Deltasone, Meticorten, Orasone	Approved	C	L2
Obat Asma				[contents]
Dyphylline	Dilor, Lufyllin, Dyphylline	Approved	C	L3
Terbutaline	Bricanyl, Brethine	Approved	B	L2
Theophylline	Aminophylline, Quibron, Theo-Dur	Approved	C	L3
Analgetik Narkotik [more]
Butorphanol	Stadol	Approved	B (1st, 2nd trim.) D (3rd trim.)	L3
Codeine	Tylenol #3, #4	Approved	C	L3
Fentanyl	Sublimaze	Approved	B	L2
Meperidine	Demerol	Approved	B	L2 L3 (if used early postpartum)
Methadone	Dolophine	Approved	B	L3
Morphine	Morphine	Approved	B	L3
Propoxyphene	Darvocet N, Propacet, Darvon	Approved	C	L2

Obat Batuk
Nama Obat		AAP approved?*	Risiko Menyusui**
Codeine		yes	L3 (moderately safe)
Dextromethorphan		not reviewed	L1 (safest)
Guaifenesin		not reviewed	L2 (safer)
Dekongestan (Obat Pilek)
Nama Obat		AAP approved?*	Risiko Menyusui**
Phenylephrine		not reviewed	L3 (moderately safe)
Pseudoephedrine (Sudafed, Actifed)		yes	L3 (moderately safe) for acute use L4 (possibly hazardous) for chronic use due to 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)
Nama Obat		AAP approved?*	Risiko Menyusui**
Beclomethasone (Vanceril, Beclovent, Beconase, Vancenase)		not reviewed	L2 (safer)
Cromlyn sodium (Nasalcrom)		not reviewed	L1 (safest)
Fluticasone (Flonase)		not reviewed	L3 (moderately safe)
Mometasone (Nasonex)		not reviewed	L3 (moderately safe)
Phenylephrine (in some forms of Sinex and Neo-Synephrine)		not reviewed	L3 (moderately safe)
Triamcinolone Acetonide (Nasacort)		not reviewed	L3 (moderately safe)
Antihistamin (Anti Alergi)
	Nama Obat	AAP approved?*	Risiko Menyusui**
	Brompheniramine	not reviewed	L3 (moderately safe)
	Chlorpheniramine (Chlor-Trimeton) CTM	not reviewed	L3 (moderately safe)
	Cetirizine (Zyrtec)	not reviewed	L2 (safer)
	Dexbrompheniramine maleate with d-isoephedrine	yes	not reviewed
	Diphenhydramine (Benadryl)	not reviewed	L2 (safer)
	Doxylamine	not reviewed	L4 (possibly hazardous)
	Fexofenadine (Allegra)	yes	L3 (moderately safe)
	Loratadine (Claritin)	yes	L2 (safer)
	Terfenadine (Seldane)	yes	not reviewed
	Triprolidine (Actidil, Actifed)	yes	L1 (safest)
	* 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 Menyusui**	Notes
Local anesthetics
Articaine (Septocaine)	NR	-	NR	more
Bupivacaine (Marcaine)	NR	C	L2
Lidocaine (Xylocaine)	Approved	C	L2
Mepivacaine (Carbocaine, Polocaine)	NR	C	L3	more
Procaine HCL (Novocaine)	NR	C	L3
General anesthetics
Halothane (Fluothane)	Approved	C	L2	more
Isoflurane (Forane)	NR	-	NR	1
Ketamine	NR	-	NR	more
Methohexital (Brevital)	Approved	B	L3
Nitrous oxide	NR	-	L3
Sevoflurane (Ultane)	NR	B	L3
Thiopental (Pentothal)	Approved	C	L3
Other medications often used during anesthesia
Sedatives
Diazepam (Valium)	Concern	D	L3; L4 for chronic use
Midazolam (Versed)	Concern	D	L3
Propofol (Diprivan)	NR	B	L2	more
Triazolam (Halcion)	NR	X	L3
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. 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 Pregnancy 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, dll

Nama Generik	Nama Dagang	AAP approved?*	Kategori Risiko Kehamilan**	Risiko Menyusui**
Antasida				[contents]
Cimetidine (Antacid)	Tagamet	Approved	B	L2
Cisapride (GI tract stimulant)	Propulsid	Approved	C	L2
Domperidone (used for nausea & vomiting, stimulates lactation) [more]	Motilum	Approved	-	L1
Antibiotika				[contents]
Amoxicillin	Larotid, Amoxil	Approved	B	L1
Aztreonam	Azactam	Approved	B	L2
Cefadroxil	Ultracef, Duricef	Approved	B	L1
Cefazolin	Ancef, Kefzol	Approved	B	L1
Cefotaxime	Claforan	Approved	B	L2
Cefoxitin	Mefoxin	Approved	B	L1
Cefprozil	Cefzil	Approved	C	L1
Ceftazidime	Ceftazidime, Fortaz, Taxidime	Approved	B	L1
Ceftriaxone	Rocephin	Approved	B	L2
Ciprofloxacin [more]	Cipro	Approved	C	L3
Clindamycin	Cleocin	Approved	B	L3
Erythromycin	E-Mycin, Ery-tab, ERYC, Ilosone	Approved	B	L1 L3 early postnatal
Fleroxacin	-	Approved	-	NR
Gentamicin	Garamycin	Approved	C	L2
Kanamycin	Kebecil, Kantrex	Approved	D	L2
Moxalactam	Moxam	Approved	-	NR
Nitrofurantoin	Macrobid	Approved	B	L2
Ofloxacin	Floxin	Approved	C	L2
Penicillin	-	Approved	B	L1
Streptomycin	Streptomycin	Approved	D	L3
Sulbactam	-	Approved	-	NR
Sulfisoxazole	Gantrisin, Azo-Gantrisin	Approved	C	L2
Tetracycline	Achromycin, Sumycin, Terramycin	Approved	D	L2
Ticarcillin	Ticarcillin, Ticar, Timentin	Approved	B	L1
Trimethoprim/sulfamethoxazole	Proloprim, Trimpex	Approved	C	L3
Antikoagulan				[contents]
Bishydroxycoumarin (dicumarol)	-	Approved	-	NR
Warfarin	Coumadin, Panwarfin	Approved	D	L2
Antikonvulsan (Anti kejang)				[contents]
Carbamazepine	Tegretol, Epitol	Approved	C	L2
Ethosuximide	Zarontin	Approved	C	L4
Magnesium sulfate	Epsom salt	Approved	B	L1
Phenytoin	Dilantin	Approved	D	L2
Valproic acid	Depakene, Depakote	Approved	D	L2
Anti Jamur				[contents]
Fluconazole [more]	Diflucan	Approved	C	L2
Ketoconazole	Nizoral Shampoo, Nizoral	Approved	C	L2
Antivirus				[contents]
Acyclovir [more]	Zovirax	Approved	C	L2
Interferon-alpha [more]	Alferon N, Interferon Alpha	Approved	C	L2
Arthritis meds (see also: pain meds)				[contents]
Gold salts	Ridaura, Myochrysine, Solganal	Approved	C	L5
Kontrasepsi, Hormon				[contents]
Estradiol	Estratab, Permarin, Menest	Approved	X	L3 (may interfere with milk production)
Clogestone	-	Approved	-	NR
Contraceptive pill with estrogen/progesterone	Preven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra patch, etc.	Approved	X	L3 (may interfere with milk production)
Levonorgestrel	Norplant, Mirena, Plan B	Approved	X	L2
Medroxyprogesterone	Provera, Depo-Provera, Cycrin	Approved	D	L1 L4 (if used first 3 days 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]
Loperamide	Imodium, Pepto Diarrhea Control, Maalox Antidiarrheal Caplets, Kaopectate II Caplets, Immodium Advanced	Approved	B	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]
Diuretik (Peluruh Kencing)				[contents]
Acetazolamide	Dazamide, Diamox	Approved	C	L2
Bendroflumethiazide	Naturetin	Approved	D	L4 (may inhibit lactation)
Chlorothiazide	Hydrodiuril	Approved	D	L3
Chlorthalidone	Hygroton	Approved	D	L3
Hydrochlorothiazide (HCT)	Hydrodiuril, Esidrix, Oretic	Approved	D	L2
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
Captopril	Capoten	Approved	D	L3 (if used after 30 days)
Diltiazem/Diltiazem HCL	Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD	Approved	C	L3
Enalapril/Enalapril Maleate	Vasotec	Approved	C (1st trim.) D (2nd, 3rd trim.)	L2
Hydralazine	Apresoline	Approved	C	L2
Labetalol	Trandate, Normodyne	Approved	C	L2
Methyldopa	Aldomet	Approved	C	L2
Metoprolol	Toprol XL, Lopressor	Approved	B	L3
Minoxidil	Loniten, Minodyl, Rogaine	Approved	C	L2 (topically) L3 (orally)
Nadolol	Corgard, Nadolol	Approved	C	L4
Nifedipine	Adalat, Procardia	Approved	C	L2
Oxprenolol	Apsolox, Slow-Trasicor, Trasicor	Approved	-	NR
Propranolol	Inderol	Approved	C	L2
Sotalol	Betapace	Approved	B	L3
Timolol	Blocadren	Approved	C	L2
Verapamil	Calan, Isoptin, Covera-HS	Approved	C	L2
Cardiac stimulants
Digoxin	Lanoxin, Lanoxicaps	Approved	C	L2
Laksan (Pelancar BAB) [more]				[contents]
Cascara/Cascara Sagrada	-	Approved	C	L3
Danthron	-	Approved	-	NR
Magnesium sulfate	Epsom salt	Approved	B	L1
Senna	-	Approved	-	L3
Obat malaria				[contents]
Chloroquine	Aralen, Novo-chloroquine	Approved	C	L3
Hydroxychloroquine	Plaquenil	Approved	C	L2
Pyrimethamine	Daraprim	Approved	C	L4
Quinine	Quinamm	Approved	D	L2
Medical Testing [more]				[contents]
Diatrizoate	-	Approved	-	NR
Fluorescein	-	Approved	C	L3
Gadopentetic (Gadolinium)	-	Approved	C	L2
Iohexol	Omnipaque	Approved	B	L2
Iopanoic acid	Telepaque	Approved	D	L2
Metrizamide	Amipaque	Approved	B	L2
Metrizoate	Isopaque	Approved	B	L2
Obat Migren [more]				[contents]
Sumatriptan	Imitrex	Approved	C	L3
Obat Sedativ [more]				[contents]
Chloral hydrate	Aquachloral, Noctec	Approved	C	L3
Methyprylon (withdrawn from use in US & Canada)	-	Approved	-	NR
Bromide	-	Approved	D	L5
Secobarbital	Seconal	Approved	D	L3
Obat Tidur				[contents]
Zolpidem/Zolpidem Tartrate	Ambien	Approved	B	L3
Obat Anti Tiroid [more]				[contents]
Carbimazole	-	Approved	D	L3
Methimazole (active metabolite of carbimazole)	Tapazole	Approved	D	L3
Propylthiouracil	PTU	Approved	D	L2
Thiouracil	-	Approved	-	NR
Levothyroxine	Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl	Approved	A	L1
Obat TBC				[contents]
Cycloserine	Seromycin	Approved	C	L3
Ethambutol	Ethambutol, Myambutol	Approved	B	L2
Isoniazid	INH, Laniazid	Approved	C	L3
Rifampin	Rifadin, Rimactane	Approved	C	L2
VITAMIN [more]				[contents]
B-1 (thiamin)	-	Approved	-	NR
B-12 (Cyanocobalamin)	-	Approved	A	L1
B-6 (pyridoxine)	-	Approved	A	L2; L4 in high doses (may inhibit lactation)
D, vitamin	Calciferol, Delta-d	Approved	A	L3 (do not overdose)
Folic acid	-	Approved	A (1st, 2nd trim.) C (3rd trim.)	L1
K-1, vitamin (Phytonadione)	-	Approved	C	L1
Riboflavin/B2	-	Approved	A	L1
Lain-lain				[contents]
Acitretin (Anti-psoriasis)	Soriatane	Approved	-	NR
Alcohol/Ethanol [more]	-	Approved	D	L3
Allopurinol	Zyloprim, Lopurin	Approved	C	L2
Antimony	-	Approved	-	NR
Atropine (Anticholinergic, drying agent)	Belladonna, Atropine	Approved	C	L3
Azapropazone/apazone (Antirheumatic)	Rheumox	Approved	-	L2
Baclofen (muscle relaxant)	Lioresal, Atrofen	Approved	C	L2
Barbiturate	-	Approved	-	NR
Caffeine [more]	Vivarin, NoDoz, Coffee	Approved	B	L2
Carbetocin (Antihemorrhagic)	Duratocin	Approved	-	NR
Chloroform	-	Approved	-	NR
Cisplatin (Anti-cancer)	Platinol	Approved	D	L4
Dapsone (Antileprosy)	Avlosulfon, DDS	Approved	C	L4
Hydroxychloroquine (Antirheumatic, lupus)	Plaquenil	Approved	C	L2
Iodides	-	Approved	-	NR
Iodine	-	Approved	-	NR
Iodine (povidone-iodine, eg, in a vaginal douche)	-	Approved	-	NR
Ivermectin (Antiparasitic)	Mectizan	Approved	C	L3
Nalidixic acid (Urinary Anti-infective)	NegGram	Approved	B	L4
Norsteroids	-	Approved	-	NR
Pyridostigmine (Muscle stimulant)	Mestinon, Regonol	Approved	C	L2
Scopolamine (Motion sickness)	Transderm Scope	Approved	C	L3
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. 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 Pregnancy 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

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Lactation Risk

source: Medications and Mothers' Milk (2004) by Thomas W. Hale, PhD

L1 SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2 SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

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Obat Aman untuk Ibu hamil dan Menyusui

Bagi Anda yang sedang hamil atau menyusui sebaiknya hati-hati dalam mengkonsumsi obat-obatan yang mungkin dapat menghilangkan keluhan sakit Anda tapii, mungkin obat tersebut dapat berbahaya bagi janin maupun bayi Anda. Apapun yang anda makan akan mempengaruhi janin dan bayi Anda termasuk apapun yang anda oleskan diluar tubuh Anda.

Dalam sebuah seminar dikatakan sekitar 60% ibu hamil dan menyusui menggunkan obat-obatan atau suplemen, banyak yang mengkonsumsinya pada trimenster pertama kehamilan.

Hal ini sangat berbahaya karena pada periode tersebut terjadi proses pembentukan organ (organosenesis). Zat aktif obat dapat masuk ke peredaran darah janin dan mempengaruhi proses pembentukan organ tersebut yang akhirnya akan menyebkan terjadinya kecacatan karena terganggunya proses tersebut.

Penggunaan obat sembarang pun, termasuk obat yang dijual bebas sebaiknya dihindari oleh ibu menyusui, karena obat yang dikonsumsi ibu diseskresikan memlalui ASI yang diminum bayi sehingga menyebabkan kadar obar dalam tubuh ibu sama dengan kadar obat adlam tubuh bayi. Tentunya hal ini akan sangat membahayakan bagi si bayi.

Tidak semua obat berbahaya. Ada beberapa jenis obat yang terbukti cukup aman dikonsumsi baik selama hamil maupun selama menyusui. Diperlukan pemahaman mengenai obat yang relatif aman dan tidak aman agar Anda bisa menghundarinya selama periode kehamilan dan menyusui. Dengan demikian ibi hamil dan janin tidak dirugikan.

Hindari Antibiotik

Pemeberian antibiotik umumnya tidak diperbolehkan selama kehamilan dan menyusui. Jikan manfaat bagi ibu lebih besar daripada risiko yang ditimbulkan pada janin, antibiotik diperbolehkan untuk diberikan. Sebelumnya harus dipastikan bahwa ibu hamil benar-benar memerlukan antibiotik. Sebaiknya konsultasikan dengan dokter Anda sebelum mengkonsumsi obat antibiotik dan juga diperhatikan mengenai keamanan bagi janin itu sendiri.

Suplemen Untuk Ibu Hamil

Konsumsi suplemen juga perlu diperhatikan dan perlu pertimbangan matang. Konsumsi vitamin dan mineral tambahan yang berlebihan juga tidak bermanfaat dan berisiko terhadap ibu hamil dan bayi yang akan dilahirkan.

Hindari Aspirin

Aspirin terbukti menimbulkan gangguan proses tumbuh kembang janin. Selain itu, aspirin memicu komplikasi selama kehamilan. Bahkan, kandungan aspirin masih ditemukan dalam ASI. Tubuh bayi akan menerima 4-8% dosis aspirin yang dikonsumsi oleh ibu. Penelitina mengatakan bahwa bayi memilim ASI dari ibu yang mengkonsumsi aspirin berisiko untuk menderita Reye’s Syndrome yang merupakan suatu penyakit gangguan fungsi otak dan hati. Karenanya, hindari pemakaian aspirin, terutama selama trimester tiga, kecuali dianjurkan dokter.

Indeks Keamanan Obat pada kehamilan

Suatu pedoman berdasarkan kategori US FDA mengenai kemanan pemberian obat pada kehamilan. FDA mengkategori obat menjadi 5 kategori yaitu kategori A, B, C, D, X

Kategori A : Studi terkontrol pada wanita tidak memperlihatkan adanya risiko terhadap janin pada kehamilan trimester 1 (dan tidak ada bukti mengenai risiko pada trimester berikutnya), dan sangat kecil kemungkinan obat ini membahayakan janin.

Kategori B : Studi terhadap reproduksi binatang percobaan tidak memperlihatkan adanya risiko terhadap janin tetapi belum ada studi terkontrol yang diperoleh pada ibu hamil. Atau studi terhadap reproduksi binatang percobaan memperlihatkan efek samping (selain penurunan fertilitas) yang tidak didapati pada studi terkontrol pada wanita hamil trimester 1 (dan ditemukan bukti adanya risiko pada kehamilan berikutnya)

Kategori C : Studi pada binatang percobaan memperlihatkan sdanya efek samping terhadap nanin( teratogenok atau embriosidal), dan studi terkontrol pada wanita dan binatang percobaan tidak tersedia atau tidak dapat dilakukan. obat pada kategori in boleh diberikan jika besarnya manfaat terapeutik melebihi risiko yang terjadi pada janin.

Kategori D : Terdapat bukti adanya risiko pada janin( manusia), tetapi manfaat terapeutik yang diharapkan mungkin melebihi besarnya risiko ( misalnya jika obat diperlukan untuk mengatasi kondisi mengancam jiwa atau penyakit serius bilamanan obat yang lebih aman tidak dapat digunakan atau tidak efektif)

Kategori X : Studi pada manusia atau binatang percobaan memperlihatkan adanya abnormalitas pada janin, atau terdapat bukti adanya risiko pada janin. dan besarnya risiko obat ini digunkan pada ibu hamil jelas-jelas melebihi manfaat teraoeutiknya. Obat yang termasuk kategori ini dikontrindikasikan pada wanita yang sedang atau kemungkinan hamil.

Obat Bebas

Risiko penggunaan obat bebas sering kali dilupakan oleh ibu hamil dan menyusui. Padahal kandungan zat aktif di dalamnya juga mengalami absorbsi, metabolisme, dan ekskresi.

Obat Bebas (OTC) yang Aman

• Obat Alergi : Antihistamin seperti Benadryl dan Unisom. Obat. Obat hirup seperti nasalcrom
• Anti mual : Vitamin B6 (maksimum 100mg/hari diminum 1/2 jam sebelum makan)
• Pereda sembelit : Milk of magnesia. Amphogel, Metamucil dan Maalox
• Pereda nyeri uluhati (heartburn) : jenis Antasida
• Multivitamin : pilih multivitamin dengan rekomendasi disis tidak melebihi angka kecukupan gizi harian
• Pereda nyeri : Acetaminophen atau paracetamol
• Obat infeksi jamur : Myestatin/ nystastin
• Obat batuk apa saja tanpa tamahan lain

Obat Bebas Yang Kurang Aman

• Pereda Nyeri : Aspirin dosis lebih dari 81 mg, Ibuprofen, NSAID
• Pereda sembelit : Minyak mineral

Obat Terbatas

• Obat jerawat : Vitamin A oral dan Accutane
• Obat radang sendi : Arthrotec
• Pengencer darah : Warfarin yang dijual dengan merk Coumadin
• Obat tekanan darah tinggi : ACE inhibitor
• Misoprostol atau cytotec
• obat anti kanker

Sumber: dari sini

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