DAFTAR OBAT AMAN DAN BERBAHAYA UNTUK IBU HAMIL DAN MENYUSUI

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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) Butalbital (Fioricet, Fiorinal, Bancap, Twodyne) Butorphanol (Stadol) NR Approved D B (1st, 2nd trim.)

Risiko Notes Menyusui** L1 L3 L2 L3 L3 2 1

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) Oxycodone (Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet) Pentosan polysulfate (Elmiron) Piroxicam (Feldene) Propoxyphene (Darvocet N, Propacet, Darvon) Rofecoxib (Vioxx) Secobarbital (Seconal)

NR Approved Approved NR Approved NR NR NR Approved Approved Approved Approved Approved Approved NR Approved Approved NR

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 B

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

4 5

6 7 8

10

NR Approved Approved

B B C

L2 L2 L2 L3 11 12 13

Withdrawn from the market Approved D

Tolmetin (Tolectin) Approved C L3 Tramadol HCL (Ultram, NR C L3 14 Ultracet) Valdecoxib (Bextra) Withdrawn from the market more * Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001. 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)

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)

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

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] Kategori Nama Generik Nama Dagang AAP Risiko 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 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

Toradol, Acular Ponstan, Ponstel Anaprox, Naprosyn, Naproxen, Aleve Butazolidine Feldene Profenal Tolectin Solu-Medrol, DepoMedrol, Medrol

Approved Approved Approved Approved Approved Approved Approved Approved

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

methylprednisolone] Prednisolone Prednisone Obat Asma Dyphylline Terbutaline Theophylline

Approved Deltasone, Meticorten, Approved Orasone

C C

L2 L2 [contents]

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

Approved Approved Approved

C B C

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 Approved trim.) D (3rd trim.) Approved C Approved B 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 Pseudoephedrine yes (Sudafed, Actifed) Nama Obat 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 * 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 (Chlor-Trimeton) not reviewed L3 (moderately safe) 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** C C C C C B B C Risiko Notes Menyusui** NR L2 L2 L3 L3 L2 NR NR L3 L3 L3 L3 more 1 more more

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 Midazolam (Versed) Propofol (Diprivan) Triazolam (Halcion) Narcotic Analgesics Alfentanil (Alfenta) Fentanyl (Sublimaze) Hydromorphone (Dilaudid) Morphine Reversal Medication Flumazenil (Romazicon) Concern NR NR NR Approved NR Approved NR

more

D D B X C B C B C

L3; L4 for chronic use L3 L2 more L3 L2 L2 L3 L3 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 L1 (safest)

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)

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

L5 (contraindicated) X (contraindicated in pregnancy) NR: Not Reviewed. This drug has not yet been reviewed by Hale. recovery from isoflurane anesthesia are rapid, so the majority of the medication is out of the body (and milk) very quickly. More here.

1. Isoflurane (Forane) is used for c-sections and directly in newborns. Induction of and

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 Nitrofurantoin Ofloxacin Penicillin Streptomycin Sulbactam Sulfisoxazole

Kategori Nama Dagang AAP approved? Risiko Risiko * Kehamilan** Menyusui** [contents] Tagamet Approved B L2 Propulsid Approved C L2 Motilum Approved L1 [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

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 Macrobid Floxin Streptomycin Gantrisin, Azo-

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

Gantrisin Achromycin, Tetracycline Sumycin, Terramycin Ticarcillin, Ticar, Ticarcillin 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 Estradiol Clogestone Contraceptive pill with Estratab, Permarin, Menest Preven,

Approved Approved Approved

D B C

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 [contents] L2 L2 [contents]

Approved Approved

C C

Approved

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

Approved Approved Approved

X X

estrogen/progesterone

Levonorgestrel

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

interfere with milk production)

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 Antidiarrheal Loperamide Caplets, 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] Diuretik (Peluruh Kencing) [contents] Dazamide, Acetazolamide Approved C L2 Diamox L4 (may Bendroflumethiazide Naturetin Approved D inhibit lactation) Chlorothiazide Hydrodiuril Approved D L3 Chlorthalidone Hygroton Approved D L3

Hydrochlorothiazide (HCT)

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 Captopril Capoten

Hydrodiuril, Esidrix, Oretic Aldactone

Approved Approved Approved

D D -

L2 L2 [contents] L1 [contents] L2 L3 L2 L3 L2 L3 (if used after 30 days) L3

Approved Approved Approved Approved Approved

C C B C C

Approved

Diltiazem/Diltiazem HCL

Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD Vasotec Apresoline Trandate, Normodyne Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, SlowTrasicor, Trasicor Inderol

Approved

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

Enalapril/Enalapril Maleate Hydralazine Labetalol Methyldopa Metoprolol Minoxidil Nadolol Nifedipine Oxprenolol Propranolol

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

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

Sotalol Timolol Verapamil Cardiac stimulants

Betapace Blocadren Calan, Isoptin, Covera-HS

Approved Approved Approved

B C C

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 Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital Seconal Obat Tidur Zolpidem/Zolpidem Tartrate Ambien Obat Anti Tiroid [more] Digoxin

Approved Approved Approved Approved 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 D D B

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]

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)

Tapazole PTU Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Calciferol, Deltad Soriatane Zyloprim, Lopurin Belladonna, Atropine Rheumox

Approved Approved Approved Approved Approved

D D D A

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 L3 L2

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)

Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved

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

Baclofen (muscle relaxant) Barbiturate

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 Dapsone (Antileprosy) Avlosulfon, DDS Approved C L4 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 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 L1 (safest)

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)

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

L5 (contraindicated) X (contraindicated in pregnancy) NR: Not Reviewed. This drug has not yet been reviewed by Hale

9999999999999999999999999

Generic name Analgesics (Pain-killers) [more] Acetaminophen Colchicine Nefopam Azapropazone (apazone) Dipyrone (banned in the US & UK) Flufenamic acid Ibuprofen

Trade Name Tylenol Colchicine Acupan Rheumox -

Pregnancy Lactation AAP Risk Risk approved?* Category** Category** Approved Approved Approved Approved Approved Approved B D B (1st, 2nd trim.) D (3rd trim.) L1 L4 NR L2 NR NR L1

Non-steroidal anti-inflammatory analgesics (NSAIDs) [more]

Advil, Nuprin, Approved Motrin, Pediaprofin

Indomethacin

Indocin

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

L3

Ketorolac Mefenamic acid Naproxen

Toradol, Acular Ponstan, Ponstel

L2 NR L3 L4 (for

Anaprox, Naprosyn, Approved Naproxen, Aleve

chronic use) Phenylbutazone Piroxicam Suprofen Tolmetin Narcotic analgesics [more] Butorphanol Codeine Fentanyl Meperidine Methadone Morphine Propoxyphene Anesthesia, Anesthetics [more] Halothane Lidocaine Methohexital Thiopental Antacids, GI meds Cimetidine (Antacid) Cisapride (GI tract stimulant) Tagamet Propulsid Approved Approved Approved B C Fluothane Xylocaine Brevital Pentothal Approved Approved Approved Approved C C B C Stadol Tylenol #3, #4 Sublimaze Demerol Dolophine Morphine Darvocet N, Propacet, Darvon B (1st, 2nd trim.) Approved D (3rd trim.) Approved Approved Approved Approved Approved Approved C B B B B C L3 L3 L2 L2 L3 (if used early postpartum) L3 L3 L2 [contents] L2 L2 L3 L3 [contents] L2 L2 L1 [contents] Larotid, Amoxil Azactam Ultracef, Duricef Ancef, Kefzol Claforan Approved Approved Approved Approved Approved B B B B B L1 L2 L1 L1 L2 Butazolidine Feldene Profenal Tolectin Approved Approved Approved Approved B C NR L2 NR L3

Domperidone (used for nausea & vomiting, stimulates lactation) Motilum [more] Antibiotics Amoxicillin Aztreonam Cefadroxil Cefazolin Cefotaxime

Cefoxitin Cefprozil Ceftazidime Ceftriaxone Ciprofloxacin [more] Clindamycin Erythromycin Fleroxacin Gentamicin Kanamycin Moxalactam Nitrofurantoin Ofloxacin Penicillin Streptomycin Sulbactam Sulfisoxazole Tetracycline Ticarcillin

Mefoxin Cefzil Ceftazidime, Fortaz, Taxidime Rocephin Cipro Cleocin E-Mycin, Ery-tab, ERYC, Ilosone Garamycin Kebecil, Kantrex Moxam Macrobid Floxin Streptomycin Gantrisin, AzoGantrisin Achromycin, Sumycin, Terramycin Ticarcillin, Ticar, Timentin

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

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

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

Trimethoprim/sulfamethoxazole Proloprim, Trimpex Approved Anticoagulants Bishydroxycoumarin (dicumarol) Warfarin Anticonvulsants Carbamazepine Ethosuximide Magnesium sulfate Phenytoin Tegretol, Epitol Zarontin Epsom salt Dilantin Approved Approved Approved Approved Coumadin, Panwarfin Approved Approved

C C B D

L2 L4 L1 L2

Valproic acid Antifungals Fluconazole [more] Ketoconazole Antihistamines [more] Dexbrompheniramine maleate with d-isoephedrine Fexofenadine Loratadine Terfenadine Triprolidine Antivirals Acyclovir [more] Interferon-alpha [more]

Depakene, Depakote Diflucan Nizoral Shampoo, Nizoral

Approved

L2 [contents]

Approved Approved

C C

L2 L2 [contents]

Allegra Claritin Seldane Actidil, Actifed Zovirax Alferon N, Interferon Alpha Ridaura, Myochrysine, Solganal Dilor, Lufyllin, Dyphylline Bricanyl, Brethine Aminophylline, Quibron, Theo-Dur

Approved Approved Approved Approved Approved Approved Approved

C B C C C

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

Arthritis meds (see also: pain meds) Gold salts Asthma meds (see also: steroids) Dyphylline Terbutaline Theophylline Contraceptives, Hormones [more] Estradiol Clogestone Contraceptive pill with estrogen/progesterone Estratab, Permarin, Menest Preven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, OrthoApproved Approved Approved X X Approved Approved Approved C B C Approved C

L5 [contents] L3 L2 L3 [contents] L3 (may interfere with milk production) NR L3 (may interfere with milk production)

Evra patch, etc. Levonorgestrel Norplant, Mirena, Plan B Provera, DepoProvera, Cycrin Enovid Crinone, Prometrium Tylenol #3, #4 Approved X L2 L1 L4 (if used first 3 days postpartum) L2 L3 [contents] Approved Approved C L3 NR [contents] Sudafed, Halofed, Novafed, Actifed Approved C L3 (for acute use) L4 (for chronic use) [contents]

Medroxyprogesterone Norethynodrel Progesterone Cough meds [more] Codeine Noscapine Decongestants [more] Pseudoephedrine Diabetes meds

Approved Approved Approved

D X -

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

Loperamide

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] Diuretics Acetazolamide Bendroflumethiazide Dazamide, Diamox Naturetin Approved Approved C D [contents] L2 L4 (may inhibit lactation)

Chlorothiazide Chlorthalidone Hydrochlorothiazide Spironolactone Domperidone

Hydrodiuril Hygroton Hydrodiuril, Esidrix, Oretic Aldactone Motilum

Approved Approved Approved Approved Approved

D D D D -

L3 L3 L2 L2 [contents] L1 [contents]

Galactagogues (milk supply) [more] Heart, Blood Pressure meds (Antiarrhythmics, Antihypertensives, Cardiac stimulants) Antiarrhythmics Disopyramide Flecainide Mexiletine Procainamide Quinidine Antihypertensives Captopril Capoten Cardizem Sr, Dilacor-XR, Diltiazem, Cardizem CD Vasotec Apresoline Trandate, Normodyne Aldomet Toprol XL, Lopressor Loniten, Minodyl, Rogaine Corgard, Nadolol Adalat, Procardia Apsolox, SlowTrasicor, Trasicor Approved D Norpace, Napamide Approved Tambocor Mexitil Pronestyl, Procan Quinaglute, Quinidex Approved Approved Approved Approved C C B C C

L2 L3 L2 L3 L2

L3 (if used after 30 days) L3

Diltiazem/Diltiazem HCL

Approved

Enalapril/Enalapril Maleate Hydralazine Labetalol Methyldopa Metoprolol Minoxidil Nadolol Nifedipine Oxprenolol

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

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

Propranolol Sotalol Timolol Verapamil Cardiac stimulants Digoxin Laxatives [more] Cascara/Cascara Sagrada Danthron Magnesium sulfate Senna Malaria meds Chloroquine Hydroxychloroquine Pyrimethamine Quinine Medical Testing [more] Diatrizoate Fluorescein Gadopentetic (Gadolinium) Iohexol Iopanoic acid Metrizamide Metrizoate Sumatriptan Sedatives [more] Chloral hydrate Methyprylon (withdrawn from use in US & Canada) Bromide Secobarbital

Inderol Betapace Blocadren Calan, Isoptin, Covera-HS Lanoxin, Lanoxicaps Epsom salt Aralen, Novochloroquine Plaquenil Daraprim Quinamm Omnipaque Telepaque Amipaque Isopaque Imitrex Aquachloral, Noctec Seconal

Approved Approved Approved Approved

C B C C

L2 L3 L2 L2

Approved

L2 [contents]

Approved Approved Approved Approved

C B -

L3 NR L1 L3 [contents]

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

C C C D C C B D B B C

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

Migraine meds (see also: pain meds) [more]

Approved Approved Approved Approved

C D D

L3 NR L5 L3

Sleep Aids Zolpidem/Zolpidem Tartrate Steroids Methylprednisolone [ high dosage methylprednisolone] Prednisolone Prednisone Thyroid meds [more] Carbimazole Methimazole (active metabolite of carbimazole) Propylthiouracil Thiouracil Levothyroxine Tuberculosis meds Cycloserine Ethambutol Isoniazid Rifampin Vitamins [more] B-1 (thiamin) B-12 (Cyanocobalamin) B-6 (pyridoxine) Approved Approved Approved A A Seromycin Ethambutol, Myambutol INH, Laniazid Rifadin, Rimactane Approved Approved Approved Approved C B C C Tapazole PTU Synthroid, Levothroid, Thyroid, Levo-T, Levoxyl Approved Approved Approved Approved Approved D D D A Solu-Medrol, DepoApproved Medrol, Medrol Deltasone, Meticorten, Orasone Approved Approved C C C Ambien Approved B

[contents] L3 [contents] L2 L2 L2 [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

D, vitamin Folic acid

Calciferol, Delta-d -

Approved

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

trim.) K-1, vitamin (Phytonadione) Riboflavin/B2 Miscellaneous Acitretin (Anti-psoriasis) Alcohol/Ethanol [more] Allopurinol Antimony Soriatane Zyloprim, Lopurin Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved Approved D C C C B D C C C B C C D Approved Approved C A 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

Atropine (Anticholinergic, drying Belladonna, agent) Atropine Azapropazone/apazone (Antirheumatic) Baclofen (muscle relaxant) Barbiturate Caffeine [more] Carbetocin (Antihemorrhagic) Chloroform Cisplatin (Anti-cancer) Dapsone (Antileprosy) Hydroxychloroquine (Antirheumatic, lupus) Iodides Iodine Rheumox Lioresal, Atrofen Vivarin, NoDoz, Coffee Duratocin Platinol Avlosulfon, DDS Plaquenil -

Iodine (povidone-iodine, eg, in a vaginal douche) Ivermectin (Antiparasitic) Nalidixic acid (Urinary Antiinfective) Norsteroids Pyridostigmine (Muscle stimulant) Scopolamine (Motion sickness) Sulfapyridine Timolol (glaucoma med) Mectizan NegGram Mestinon, Regonol Transderm Scope Dagenan Blocadren

* 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.