DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU

DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU
HAMIL DAN MENYUSUI
Disusun kembali oleh dr.Abu Hana
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)
AAP
Kategori Risiko
Nama Obat
approved?*
Kehamilan**
Acetaminophen (Tylenol)
Approved
B
C (1st, 2nd trim.)
Aspirin
Caution
D (3rd trim.)

Approved
Azapropazone (Rheumox)
-

Risiko
Notes
Menyusui**
L1
L3

1

L2

Butalbital (Fioricet,
Fiorinal, Bancap, Twodyne)

NR

D

L3

Butorphanol (Stadol)

Approved

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

L3

2

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)

NR
Approved
Approved

C
C
D

L2
L3
L4

NR

B

L2

Approved

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

L2

NR

B

L3

4

NR

C

L3

5

Indomethacin (Indocin)

Approved

Ketorolac (Toradol,
Acular)

Approved

Meperidine (Demerol)

Approved

B

Methadone (Dolophine)
Morphine (Duramorph,
Infumorph, Epimorph, MS
Contin)
Nalbuphine (Nubain)
Naproxen (Anaprox,
Naprosyn, Naproxen,
Aleve)
Nefopam (Acupan)
Oxycodone (Tylox,
Percodan,Oxycontin,
Roxicet, Endocet, Roxiprin,
Percocet)
Pentosan polysulfate

(Elmiron)
Piroxicam (Feldene)
Propoxyphene (Darvocet
N, Propacet, Darvon)
Rofecoxib (Vioxx)
Secobarbital (Seconal)
Tolmetin (Tolectin)
Tramadol HCL (Ultram,
Ultracet)

Approved

B

L2;
L3 early
postpartum
L3

Approved

B

L3

8

NR

B

Approved

B

9

Approved

-

L2
L3;
L4 for chronic
use
NR

NR

B

L3

10

NR

B

L2

Approved

B

L2

Approved

C

L2

NR

Approved

L2

B (1st, 2nd trim.)

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

L1
L3
L2

Withdrawn from the market
Approved
D
Approved
C
NR

C

3

L3
L3
L3

6
7

11
12
13
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Withdrawn from the market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)
 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.
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]
AAP
Kategori
Nama Generik
Nama Dagang
approved?*
Risiko

Risiko
Menyusui**

Azapropazone (apazone) Rheumox
Dipyrone (banned in the
US & UK)

Approved

Kehamilan**
-

L2

Approved

-

NR

Flufenamic acid

-

Approved

NR

Ibuprofen

Advil, Nuprin, Motrin,
Approved
Pediaprofin

Indomethacin

Indocin

Approved

Ketorolac

Toradol, Acular

Approved

Mefenamic acid

Ponstan, Ponstel

Approved

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

Naproxen

Anaprox, Naprosyn,
Naproxen, Aleve

Approved

B

Butazolidine
Feldene
Profenal
Tolectin

Approved
Approved
Approved
Approved

B
C

Solu-Medrol, DepoMedrol, Medrol

Approved

C

L2

Approved
Deltasone, Meticorten,
Approved
Orasone

C

L2

C

L2

Phenylbutazone
Piroxicam
Suprofen
Tolmetin
Steroid
Methylprednisolone
[ high dosage
methylprednisolone]
Prednisolone
Prednisone

Terbutaline
Theophylline

L3

L2
NR
L3
L4 (for chronic
use)
NR
L2
NR
L3
[contents]

[contents]

Obat Asma
Dyphylline

L1

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

Approved

C

L3

Approved

B

L2

Approved

C

L3

Analgetik Narkotik [more]
Butorphanol

Stadol

Codeine

Tylenol #3, #4

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

L3
L3

Fentanyl

Sublimaze

Approved

B

Meperidine

Demerol

Approved

B

Methadone
Morphine

Dolophine
Approved
Morphine
Approved
Darvocet N, Propacet,
Approved
Darvon

B
B

L2
L2
L3 (if used early
postpartum)
L3
L3

C

L2

Propoxyphene

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)

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
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
Local anesthetics
Articaine (Septocaine)
Bupivacaine (Marcaine)
Lidocaine (Xylocaine)
Mepivacaine (Carbocaine,
Polocaine)
Procaine HCL (Novocaine)
General anesthetics
Halothane (Fluothane)
Isoflurane (Forane)
Ketamine
Methohexital (Brevital)
Nitrous oxide

AAP
approved?*

Kategori Risiko
Kehamilan**

Risiko
Notes
Menyusui**

NR
NR
Approved

C
C

NR
L2
L2

more

NR

C

L3

more

NR

C

L3

Approved
NR
NR
Approved
NR

C
B
-

L2
NR
NR
L3
L3

more
1
more

Sevoflurane (Ultane)
NR
Thiopental (Pentothal)
Approved
Other medications often used during anesthesia
Sedatives
Diazepam (Valium)
Concern

B
C

D

L3
L3

L3; L4 for
chronic use
L3
more
L2
L3

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
NR
2
C
Naloxone (Narcan)
NR
NR
3
C
Steroids
Decadron (Dexamethasone)
NR
NR
more
C
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)
 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.

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
Erythromycin
Fleroxacin
Gentamicin
Kanamycin
Moxalactam

Nama Dagang

AAP
approved?*

Tagamet
Propulsid

Approved
Approved

Motilum

Approved

Larotid, Amoxil
Azactam
Ultracef, Duricef
Ancef, Kefzol
Claforan
Mefoxin
Cefzil
Ceftazidime,
Fortaz, Taxidime
Rocephin
Cipro
Cleocin
E-Mycin, Erytab, ERYC,
Ilosone
Garamycin
Kebecil, Kantrex
Moxam

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

L1

Approved
Approved
Approved
Approved
Approved
Approved
Approved

B
B
B
B
B
B
C

[contents]
L1
L2
L1
L1
L2
L1
L1

Approved

B

L1

Approved
Approved
Approved

B
C
B

Approved

B

Approved
Approved
Approved
Approved

C
D
-

L2
L3
L3
L1
L3 early
postnatal
NR
L2
L2
NR

Nitrofurantoin
Ofloxacin
Penicillin
Streptomycin
Sulbactam

Macrobid
Floxin
Streptomycin
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
Antivirus
Acyclovir [more]
Zovirax
Alferon N,
Interferon-alpha [more]
Interferon Alpha
Arthritis meds (see also: pain meds)
Ridaura,
Gold salts
Myochrysine,
Solganal
Kontrasepsi, Hormon
Estratab,
Estradiol
Permarin,
Menest

Approved
Approved
Approved
Approved
Approved

B
C
B
D
-

L2
L2
L1
L3
NR

Approved

C

L2

Approved

D

L2

Approved

B

L1

Approved

C

L3
[contents]

Approved

-

NR

Approved

D

L2

Approved
Approved
Approved
Approved

C
C
B
D

[contents]
L2
L4
L1
L2

Approved

D

L2

Approved

C

[contents]
L2

Approved

C

L2

Approved

C

[contents]
L2

Approved

C

L2
[contents]

Approved

Approved

C

X

L5
[contents]
L3 (may
interfere
with milk

Clogestone

Contraceptive pill with
estrogen/progesterone

Levonorgestrel

Medroxyprogesterone
Norethynodrel
Progesterone

Preven,
Seasonale,
Norinyl,
Norlestin, OrthoNovum, Ovral,
Lunelle
injection, OrthoEvra patch, etc.
Norplant,
Mirena, Plan B
Provera, DepoProvera, Cycrin
Enovid
Crinone,
Prometrium

Approved

-

production)
NR

Approved

X

L3 (may
interfere
with milk
production)

Approved

X

L2

Approved

D

Approved

X

L1
L4 (if used
first 3 days
postpartum)
L2

Approved

-

L3

[contents]
Obat Diabetes
Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk
category = L1.
Oramide,
Tolbutamide
Approved
D
L3
Orinase
[contents]
Obat Diare
Imodium, Pepto
Diarrhea
Control, Maalox
Antidiarrheal
Caplets,
Loperamide
Approved
B
L2
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]
[contents]
Diuretik (Peluruh Kencing)
Dazamide,
Acetazolamide
Approved
C
L2
Diamox
L4 (may
Bendroflumethiazide
Naturetin
inhibit
Approved
D
lactation)
Chlorothiazide
Hydrodiuril
Approved
D
L3

Chlorthalidone
Hydrochlorothiazide (HCT)

Hygroton
Hydrodiuril,
Esidrix, Oretic
Aldactone

Spironolactone
Anti Muntah [more]
Domperidone
Motilum
Anti Hipertensi, Obat Jantung
Anti aritmia
Norpace,
Disopyramide
Napamide
Flecainide
Tambocor
Mexiletine
Mexitil
Pronestyl,
Procainamide
Procan
Quinaglute,
Quinidine
Quinidex
Anti Hipertensi

Approved

D

L3

Approved

D

L2

Approved

D

Approved

-

L2
[contents]
L1
[contents]

Approved

C

L2

Approved
Approved

C
B

L3
L2

Approved

C

L3

Approved

C

L2

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

Hydralazine

Apresoline
Trandate,
Normodyne
Aldomet
Toprol XL,
Lopressor
Loniten,
Minodyl,
Rogaine
Corgard,
Nadolol
Adalat,
Procardia
Apsolox, SlowTrasicor,
Trasicor
Inderol

Approved

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

Approved

C

L2

Approved

C

L2

Approved

B

L3

Approved

C

L2
(topically)
L3 (orally)

Approved

C

L4

Approved

C

L2

Approved

-

NR

Approved

C

L2

Labetalol
Methyldopa
Metoprolol
Minoxidil
Nadolol
Nifedipine
Oxprenolol
Propranolol

L2
L2

Sotalol
Timolol
Verapamil

Betapace
Blocadren
Calan, Isoptin,
Covera-HS

Approved
Approved

B
C

L3
L2

Approved

C

L2

Approved

C

L2

Approved
Approved
Approved
Approved

C
B
-

[contents]
L3
NR
L1
L3
[contents]

Approved

C

L3

Approved
Approved
Approved

C
C
D

Approved
Approved
Approved
Approved
Approved
Approved
Approved

C
C
B
D
B
B

Approved

C

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

Approved

C

L3

Approved

-

NR

Approved
Approved

D
D

Approved

B

Approved

D

L5
L3
[contents]
L3
[contents]
L3

Approved

D

L3

Approved

D

L2

Cardiac stimulants

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
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
Digoxin

Thiouracil

Synthroid,
Levothroid,
Thyroid, LevoT, Levoxyl

Approved

-

NR

Approved

A

L1

Seromycin
Ethambutol,
Myambutol
INH, Laniazid
Rifadin,
Rimactane

Approved

C

[contents]
L3

Approved

B

L2

Approved

C

L3

Approved

C

L2

VITAMIN [more]
B-1 (thiamin)
B-12 (Cyanocobalamin)

-

Approved
Approved

A

B-6 (pyridoxine)

-

Approved

A

D, vitamin

Calciferol,
Delta-d

Approved

A

Folic acid

-

Approved

K-1, vitamin (Phytonadione)
Riboflavin/B2
Lain-lain
Acitretin (Anti-psoriasis)
Alcohol/Ethanol [more]

-

Approved
Approved

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

Soriatane
Zyloprim,
Lopurin
Belladonna,
Atropine

Approved
Approved

D

L1
L1
[contents]
NR
L3

Approved

C

L2

Approved

-

NR

Approved

C

L3

Rheumox

Approved

-

L2

Approved
Approved

C
-

L2
NR

Approved

B

L2

Approved
Approved
Approved

D

NR
NR
L4

Levothyroxine
Obat TBC
Cycloserine
Ethambutol
Isoniazid
Rifampin

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

Lioresal, Atrofen
Vivarin, NoDoz,
Caffeine [more]
Coffee
Carbetocin (Antihemorrhagic) Duratocin
Chloroform
Cisplatin (Anti-cancer)
Platinol

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

Dapsone (Antileprosy)
Hydroxychloroquine
(Antirheumatic, lupus)
Iodides
Iodine
Iodine (povidone-iodine, eg, in
a vaginal douche)
Ivermectin (Antiparasitic)
Nalidixic acid (Urinary Antiinfective)
Norsteroids
Pyridostigmine (Muscle
stimulant)

Avlosulfon,
DDS

Approved

C

L4

Plaquenil

Approved

C

L2

-

Approved
Approved

-

NR
NR

-

Approved

-

NR

Mectizan

Approved

C

L3

NegGram

Approved

B

L4

NR
Approved
Mestinon,
Approved
C
L2
Regonol
Transderm
Scopolamine (Motion sickness)
Approved
C
L3
Scope
Sulfapyridine
Dagenan
NR
Approved
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
 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

Keamanan obat pada kehamilan
Diterbitkan Juni 3, 2008 Artikel , Gaya Hidup , Health , Informasi , Kedokteran , Kesehatan , Reviews 42 Komentar
Tag:Artikel, Gaya Hidup, Hamil, Health, Informasi, Kedokteran, Kesehatan, Obat, Reviews, Wanita

Pada umumnya para ibu hamil akan memberitahu dokter saat berobat bahwa dirinya hamil
sekian bulan. Demikian pula jika berobat saat menyusui (ASI bayinya. Informasi
tersebut diberikan si ibu dengan harapan dokter akan memberikan obat yang aman
bagi janin yang dikandungnya. Itupun tak jarang si ibu masih mananyakan kepada
dokter apakah obat yang dgunakan benar-benar aman. Hal ini sangat wajar dan
kita patut menghargainya.
Di sisi lain, ketika seorang ibu hamil sakit adakalanya enggan ke dokter lantaran
takut menggunakan obat. Alhasil keluhannya makin bertambah dan akhirnya
datang juga ke dokter untuk berobat.
Seorang dokter tentu sangat paham bahwa saat memberikan(meresepkan) obat bagi wanita
hamil akan dipilihkan obat yang aman, baik dalam hal jenis obat (berdasarkan indeks keamanan
obat), dosis maupun lamanya penggunaan. Selain itu akan dipertimbangkan pula aspek-aspek
lain berdasarkan penyakitnya, misalnya: resiko penularan kepada anggota keluarga lain, dan
pertimbangan lain terkait kondisi janin maupun si ibu sendiri.
Pun manakala seorang dokter dihadapkan pada 2 pilihan sulit yang menyangkut life saving,
aspek manfaat akan dikedepankan dibanding resiko yang bakal dihadapi baik bagi janin maupun
ibunya.
Sebagai contoh, seorang ibu hamil yang kebetulan menderita asma, justru seyogyanya segera
berobat agar tidak mengalami sesak berkepanjangan yang justru tidak baik bagi janin karena
beresiko terjadinya hipoksia (kekurangan oksigen) yang akan mempengaruhi pasokan oksigen
bagi janin.
INDEKS KEAMANAN OBAT PADA KEHAMILAN
Hingga kini kita di Indonesia masih menggunakan kriteria keamanan obat bagi ibu hamil yang
dilansir oleh FDA (Food and Drug Administration) sebagai pedoman dalam memberikan obat
pada ibu hamil.
Pada posting ini penulis hanya menampilkan garis-garis besar batasan keamanan obat bagi ibu
hamil yang tersusun dalam 5 kategori (kategori A, B, C, D dan X) beserta contoh-contohnya
agar diketahui khalayak dengan harapan dapat memberikan informasi yang bermanfaat.
Kategori-kategori tersebut dibuat berdasarkan ada tidaknya (besar kecilnya) resiko terhadap
sistem reproduksi, efek samping dan manfaat yag diharapkan.
Obat Kategori A: adalah golongan obat yang pada studi (terkontrol) pada kehamilan tidak
menunjukkan resiko bagi janin pada trimester 1 dan trimester berikutnya. Obat dalam kategori
ini amat kecil kemungkinannya bagi keselamatan janin.
Obat Kategori B: adalah golongan obat yang pada studi terhadap sistem reproduksi binatang
percobaan tidak menunjukkan resiko bagi janin. Belum ada studi terkontrol pada wanita hamil

yang menunjukkan adanya efek samping, kecuali adanya penurunan fertilitas pada kehamilan
trimester pertama, sedangkan pada trimester berikutnya tidak didapatkan bukti adanya 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. Pada
keadaan khusus obat ini digunakan jika manfaatnya kemungkinan lebih besar dibanding
resikonya. Penggunaan obat golongan ini terutama untuk mengatasi keadaan yang mengancam
jiwa atau jika tidak ada obat lain yang lebih 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 keadaan hamil.
CONTOH OBAT KATEGORI A (nama generik): Ascorbic acid (vitamin C) *masuk kategori
C jika dosisnya melebihi US RDA*, Doxylamine, Ergocalciferol *masuk kategori D jika
dosisnya melebihi US RDA*, Folic acid *masuk kategori C jika dosisnya melebihi 0,8 mg per
hari*, Hydroxocobalamine *masuk kategori C jika dosisnya melebihi US RDA*, Liothyronine,
Nystatin vaginal sup *masuk kategori C jika digunakan per oral dan topikal*, Pantothenic acid
*masuk kategori C jika dosisnya melebihi US RDA*, Potassium chloride, Potassium citrate,
Potassium gluconate, Pyridoxine (vitamin B6), Riboflavin *masuk kategori C jika dosisnya
melebihi US RDA*, Thiamine (vitamin B1) *masuk kategori C jika dosisnya melebihi US
RDA*, Thyroglobulin, Thyroid hormones, Vitamin D *masuk kategori D jika dosisnya melebihi
US RDA*, Vitamin E *masuk kategori C jika dosisnya melebihi US RDA*.
CONTOH OBAT KATEGORI B (nama generik): Acetylcysteine, Acyclovir, Amiloride
*masuk kategori D jika digunakan untuk hipertensi yang diinduksi oleh kehamilan*, Ammonium
chloride, Ammonium lactate *topical*, Amoxicillin, Amphotericin B, Ampicillin, Atazanavir,
Azatadine, Azelaic acid, Benzylpenicillin, Bisacodyl, Budesonide *inhalasi, nasal*, Buspiron,
Caffeine, Carbenicillin, Camitine, Cefaclor, Cefadroxil, Cefalexin, Cefalotin, Cefamandole,
Cefapirin, Cefatrizine, Cefazolin, Cefdinir, Cefditoren, Cefepime, Cefixime, Cefmetazole,
Cefonicid, Cefoperazone, Ceforanide, Cefotaxime, Cefotetan disodium, Cefoxitin, Cefpodoxime,
Cefprozil, Cefradine, Ceftazidime, Ceftibuten, Ceftizoxime, Ceftriaxone, Cefuroxime, Cetirizine,
Chlorhexidine *mulut dan tenggorokan*, Chlorpenamine, Chlortalidone *masuk kategori D jika
digunakan untuk hipertensi yang diinduksi oleh kehamilan*, Ciclacillin, Ciclipirox, Cimetidine,

Clemastine, Clindamycin, Clotrimazole, Cloxacillin, Clozapine, Colestyramine, …. dll ….. dll

… buanyak
CONTOH OBAT KATEGORI C (nama generik): Acetazolamide, Acetylcholine chloride,
Adenosine, Albendazole, Albumin, Alclometasone, Allopurinol, Aluminium hydrochloride,
Aminophylline, Amitriptyline, Amlodipine, Antazoline, Astemizole, Atropin, Bacitracin,
Beclometasone, Belladonna, Benzatropine mesilate, Benzocaine, Buclizine, Butoconazole,
Calcitonin, Calcium acetate, Calcium ascorbate, Calcium carbonate, Calcium chloride, Calcium
citrate, Calcium folinate, Calcium glucoheptonade, Calcium gluconate, Calcium lactate, Calcium
phosphate, Calcium polystyrene sulfonate, Capreomycin, Captopril, Carbachol, Carbidopa,
Carbinoxamine, Chloral hydrate, Chloramphenicol, Chloroquine, Chlorothiazide,
Chlorpromazine, Choline theophyllinate, Cidofovir, Cilastatin, Cinnarizine, Cyprofloxacin,
Cisapride, Clarithromycin, Clinidium bromide, Clonidine, Co-trimoxazole, Codeine,
Cyanocobalamin, Deserpidine, Desonide, Desoximetasone, Dexamethasone, Dextromethorphan,
Digitoxin, Digoxin, Diltiazem, Dopamine, Ephedrine, Epinephrine, Fluconazole, Fluocinolone,
Fosinopril, Furosemide, Gemfibrozil, Gentamicin, Glibenclamide, Glimepiride, Glipizide,
Griseofulvin, Hydralazine, Hydrocortisone, Hyoscine, Hyoscyamine, Isoniazid, Isoprenaline,

Isosorbid dinitrate, Ketoconazole, Ketotifen fumarate, Magaldrate, Mefenamic acid, Methyl

prednisolone, …dll …dll …
CONTOH OBAT KATEGORI D (nama generik): Amikacin, Amobarbital, Atenolol,
Carbamazepine, Carbimazole, Chlordizepoxide, Cilazapril, Clonazepam, Diazepam,
Doxycycline, Imipramine, Kanamycin, Lorazepam, Lynestrenol, Meprobamate, Methimazole,
Minocycline, Oxazepam, Oxytetracycline, Tamoxifen, Tetracycline, Uracil, Voriconazole… dll
… dll.
CONTOH OBAT KATEGORI X (nama generik): Acitretin, Alprotadil *parenteral*,
Atorvastatin, Bicalutamide, Bosentan, Cerivastatin disodium, Cetrorelix, Chenodeoxycholic
acid, Chlorotrianisene, Chorionic gonadotrophin, Clomifen, Coumarin, Danazol, Desogestrel,
Dienestrol, Diethylstilbestrol, Dihydro ergotamin, Dutasteride, Ergometrin, Ergotamin,
Estazolam, Etradiol, Estramustine, Estriol succinate, Estrone, Estropipate, Ethinyl estradiol,
Etretinate, Finasteride, Fluorescein *parenteral*, Flurouracil, Fluoxymesterone, Flurazepam,
Fluvastatin, Floritropin, Ganirelix, Gestodene, Goserelin, Human menopausal gonadotrophin,
Iodinated glycerol, Isotretinoin, Leflunomide, Leuprorelin, Levonorgestrel, Lovastatin,
Medrogestrone, Medroxyprogesterone, Menotrophin, Mestranol, Methotrexate, Methyl
testosterone, Mifeprestone, Miglustat, Misoprostol, Nafarelin, nandrolone, Nicotine *po*,
Norethisterone, Noretynodrel, Norgestrel, Oxandrolone,Oxymetholone, Oxytocin, Pravastatin,
Quinine, Raloxifene, Ribavirin, Rosuvastatin, Simvastatin, Stanozolol, Tazarotene, Temazepam,
tetosterone, Thalidomide, Triazolam, Triproretin, Urofolitropin, Warfarin.

Ooopsss … banyak banget, mana namanya rumit pula. … hehehe, maaf

Obat-obat kategori A (yang paling aman pada kehamilan) dan obat kategori X (kontra indikasi
pada kehamilan) sengaja ditulis lengkap agar dapat diketahui oleh khalayak. *padahal alasan

sebenarnya karena itemnya ga banyak*
…sedangkan
obat kategori B, C dan D hanya ditulis sebagian kecil saja karena saking banyaknya item dan
jenisnya.
PESAN-PESAN:
Bagi khalayak, penggunaan obat menyangkut jenis, dosis dan lamanya pemakaian seyogyanya
atas petunjuk dokter.
Tawaran obat (dengan jargon apapun) disertai klaim-klaim aduhai (seolah paling aman dan
paling ampuh) tanpa diketahui dengan jelas kandungan yang ada di dalamnya, patut diwaspadai,

… apalagi jika tidak mencantumkan efek samping, peringatan hati-hati pada kondisi tertentu dan
kontra-indikasi.
Obat hanya akan bermanfaat jika digunakan dengan tepat sesuai indikasi, dosis dan lamanya
pengobatan berlandaskan pengetahuan yang dapat dipertanggung jawabkan.
Semoga bermanfaat.