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Lactation Risk Categories


L1
L2
L3
L4

(Paling Aman)
(Aman)
(Cukup Aman)
(Kemungkinan

A (studi terkontrol menunjukkan tanpa


resiko)
B (tidak ada bukti risiko pada manusia)
C (risiko tidak dapat dikesampingkan)
D (bukti positif resiko)
X (dikontraindikasikan untuk Ibu Hamil)

Barbahaya)
L5 (Kontra Indikasi)

Generic name

Pregnancy Risk Categories

Trade Name

AAP approved?*

Pregnanc Lactation
y Risk
Risk
Category Category
**
**

Analgesics (Pain-killers) [more]


Approved/diseu
jui

L1

Colchicine

Approved

L4

Acupan

Approved

NR

Acetaminophen

Tylenol

Colchicine
Nefopam

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


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

L3

trim.)

Ketorolac

Toradol,
Acular

Approved

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

Mefenamic acid

Ponstan,
Ponstel

Approved

NR

Naproxen

Anaprox,
Naprosyn,
Naproxen,
Aleve

Approved

L3
L4 (for
chronic
use)

Phenylbutazone

Butazolidin
e

Approved

NR

Piroxicam

Feldene

Approved

L2

Suprofen

Profenal

Approved

NR

Tolmetin

Tolectin

Approved

L3

L3

L2

Narcotic analgesics [more]

Butorphanol

Stadol

Approved

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

Codeine

Tylenol #3,
#4

Approved

L3

Fentanyl

Sublimaze

Approved

L2

Meperidine

Demerol

Approved

L2
L3 (if
used early
postpartu
m)

Methadone

Dolophine

Approved

L3

Morphine

Morphine

Approved

L3

Propoxyphene

Darvocet N,
Propacet,

Approved

L2

Darvon
[contents
]

Anesthesia, Anesthetics [more]

Halothane

Fluothane

Approved

L2

Lidocaine

Xylocaine

Approved

L2

Methohexital

Brevital

Approved

L3

Thiopental

Pentothal

Approved

L3
[contents
]

Antacids, GI meds
Cimetidine (Antacid)

Tagamet

Approved

L2

Cisapride (GI tract


stimulant)

Propulsid

Approved

L2

Domperidone (used for


nausea & vomiting,
stimulates lactation)
[more]

Motilum

Approved

L1 ??

[contents
]

Antibiotics
Amoxicillin

Larotid,
Amoxil

Approved

L1

Aztreonam

Azactam

Approved

L2

Cefadroxil

Ultracef,
Duricef

Approved

L1

Cefazolin

Ancef,
Kefzol

Approved

L1

Cefotaxime

Claforan

Approved

L2

Cefoxitin

Mefoxin

Approved

L1

Cefprozil

Cefzil

Approved

L1

Ceftazidime

Ceftazidime
, Fortaz,
Taxidime

Approved

L1

Ceftriaxone

Rocephin

Approved

L2

Ciprofloxacin [more]

Cipro

Approved

L3

Clindamycin

Cleocin

Approved

L3

Erythromycin

E-Mycin,
Ery-tab,
ERYC,
Ilosone

Approved

L1
L3 early
postnatal

Fleroxacin

Approved

NR

Gentamicin

Garamycin

Approved

L2

Kanamycin

Kebecil,
Kantrex

Approved

L2

Moxalactam

Moxam

Approved

NR

Nitrofurantoin

Macrobid

Approved

L2

Ofloxacin

Floxin

Approved

L2

Penicillin

Approved

L1

Streptomycin

Streptomyci
n

Approved

L3

Sulbactam

Approved

NR

Sulfisoxazole

Gantrisin,
AzoGantrisin

Approved

L2

Tetracycline

Achromycin
, Sumycin,
Terramycin

Approved

L2

Ticarcillin

Ticarcillin,
Ticar,
Timentin

Approved

L1

Trimethoprim/sulfametho Proloprim,
xazole
Trimpex

Approved

L3
[contents
]

Anticoagulants
Bishydroxycoumarin
(dicumarol)

Approved

NR

Warfarin

Coumadin,

Approved

L2

Panwarfin
[contents
]

Anticonvulsants
Carbamazepine

Tegretol,
Epitol

Approved

L2

Ethosuximide

Zarontin

Approved

L4

Magnesium sulfate

Epsom salt

Approved

L1

Phenytoin

Dilantin

Approved

L2

Valproic acid

Depakene,
Depakote

Approved

L2
[contents
]

Antifungals
Fluconazole [more]

Diflucan

Approved

L2

Ketoconazole

Nizoral
Shampoo,
Nizoral

Approved

L2
[contents
]

Antihistamines [more]
Dexbrompheniramine
maleate with disoephedrine

Approved

NR

Fexofenadine

Allegra

Approved

L2

Loratadine

Claritin

Approved

L1

Terfenadine

Seldane

Approved

NR

Triprolidine

Actidil,
Actifed

Approved

L1
[contents
]

Antivirals
Acyclovir [more]

Zovirax

Approved

L2

Interferon-alpha [more]

Alferon N,
Interferon
Alpha

Approved

L2

[contents
]

Arthritis meds (see also: pain meds)

Gold salts

Ridaura,
Myochrysin
e, Solganal

Approved

L5
[contents
]

Asthma meds (see also: steroids)

Dyphylline

Dilor,
Lufyllin,
Dyphylline

Approved

L3

Terbutaline

Bricanyl,
Brethine

Approved

L2

Theophylline

Aminophylli
ne,
Quibron,
Theo-Dur

Approved

L3

[contents
]

Contraceptives, Hormones [more]

Estradiol

Estratab,
Permarin,
Menest

Approved

L3 (may
interfere
with milk
production
)

Clogestone

Approved

NR

Contraceptive pill with


estrogen/progesterone

Preven,
Seasonale,
Norinyl,
Norlestin,
OrthoNovum,
Ovral,
Lunelle
injection,
Ortho-Evra

Approved

L3 (may
interfere
with milk
production
)

patch, etc.
Levonorgestrel

Norplant,
Mirena,
Plan B

Approved

L2

Medroxyprogesterone

Provera,
DepoProvera,
Cycrin

Approved

L1
L4 (if
used first
3 days
postpartu
m)

Norethynodrel

Enovid

Approved

L2

Progesterone

Crinone,
Prometrium

Approved

L3
[contents
]

Cough meds [more]


Codeine

Tylenol #3,
#4

Approved

L3

Noscapine

Approved

NR
[contents
]

Decongestants [more]

Pseudoephedrine

Sudafed,
Halofed,
Novafed,
Actifed

Approved

L3 (for
acute use)
L4 (for
chronic
use)
[contents
]

Diabetes meds

Note: Insulin has not been reviewed by the AAP. Pregnancy risk category =
B; Lactation risk category = L1.
Tolbutamide
Diarrhea meds

Oramide,
Orinase

Approved

L3
[contents
]

Loperamide

Imodium,
Pepto
Diarrhea
Control,
Maalox
Antidiarrhe
al Caplets,
Kaopectate
II Caplets,
Immodium
Advanced

Approved

L2

** Note: Pepto-Bismol & Kaopectate (bismuth subsalicylate is the active


ingredient in both) are not recommended for routine use by nursing moms,
due to the association of salicylates with Reyes syndrome in children. [more]
[contents
]

Diuretics
Acetazolamide

Dazamide,
Diamox

Approved

L2

Bendroflumethiazide

Naturetin

Approved

L4 (may
inhibit
lactation)

Chlorothiazide

Hydrodiuril

Approved

L3

Chlorthalidone

Hygroton

Approved

L3

Hydrochlorothiazide

Hydrodiuril,
Esidrix,
Oretic

Approved

L2

Spironolactone

Aldactone

Approved

L2
[contents
]

Galactagogues (milk supply) [more]


Domperidone

Motilum

Approved

Heart, Blood Pressure meds


(Antiarrhythmics, Antihypertensives, Cardiac stimulants)
Antiarrhythmics

L1
[contents
]

Disopyramide

Norpace,
Napamide

Approved

L2

Flecainide

Tambocor

Approved

L3

Mexiletine

Mexitil

Approved

L2

Procainamide

Pronestyl,
Procan

Approved

L3

Quinidine

Quinaglute,
Quinidex

Approved

L2

Antihypertensives
Captopril

Capoten

Approved

L3 (if
used after
30 days)

Diltiazem/Diltiazem HCL

Cardizem
Sr, DilacorXR,
Diltiazem,
Cardizem
CD

Approved

L3

L2

Enalapril/Enalapril
Maleate

Vasotec

Approved

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

Hydralazine

Apresoline

Approved

L2

Labetalol

Trandate,
Normodyne

Approved

L2

Methyldopa

Aldomet

Approved

L2

Metoprolol

Toprol XL,
Lopressor

Approved

L3

Minoxidil

Loniten,
Minodyl,
Rogaine

Approved

L2(topicall
y)
L3 (orally)

Nadolol

Corgard,
Nadolol

Approved

L4

Nifedipine

Adalat,
Procardia

Approved

L2

Oxprenolol

Apsolox,
SlowTrasicor,
Trasicor

Approved

NR

Propranolol

Inderol

Approved

L2

Sotalol

Betapace

Approved

L3

Timolol

Blocadren

Approved

L2

Verapamil

Calan,
Isoptin,
Covera-HS

Approved

L2

Lanoxin,
Lanoxicaps

Approved

L2

Cardiac stimulants
Digoxin

[contents
]

Laxatives [more]
Cascara/Cascara Sagrada -

Approved

L3

Danthron

Approved

NR

Magnesium sulfate

Epsom salt

Approved

L1

Senna

Approved

L3
[contents
]

Malaria meds

Chloroquine

Aralen,
Novochloroquine

Approved

L3

Hydroxychloroquine

Plaquenil

Approved

L2

Pyrimethamine

Daraprim

Approved

L4

Quinine

Quinamm

Approved

L2
[contents
]

Medical Testing [more]


Diatrizoate

Approved

NR

Fluorescein

Approved

L3

Gadopentetic
(Gadolinium)

Approved

L2

Iohexol

Omnipaque

Approved

L2

Iopanoic acid

Telepaque

Approved

L2

Metrizamide

Amipaque

Approved

L2

Metrizoate

Isopaque

Approved

L2
[contents
]

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


Sumatriptan

Imitrex

Approved

[contents
]

Sedatives [more]
Chloral hydrate

L3

Aquachloral
, Noctec

Approved

L3

Methyprylon (withdrawn
from use in US & Canada)

Approved

NR

Bromide

Approved

L5

Secobarbital

Seconal

Approved

L3
[contents
]

Sleep Aids
Zolpidem/Zolpidem
Tartrate

Ambien

Approved

L3
[contents
]

Steroids

Methylprednisolone
[
high dosage
methylprednisolone]

SoluMedrol,
DepoMedrol,
Medrol

Approved

L2

Prednisolone

Approved

L2

Prednisone

Deltasone,
Meticorten,
Orasone

Approved

L2

[contents
]

Thyroid meds [more]


Carbimazole

Approved

L3

Methimazole (active
metabolite of
carbimazole)

Tapazole

Approved

L3

Propylthiouracil

PTU

Approved

L2

Thiouracil

Approved

NR

Levothyroxine

Synthroid,
Levothroid,
Thyroid,
Levo-T,
Levoxyl

Approved

L1

[contents
]

Tuberculosis meds
Cycloserine

Seromycin

Approved

L3

Ethambutol

Ethambutol,
Myambutol

Approved

L2

Isoniazid

INH,
Laniazid

Approved

L3

Rifampin

Rifadin,
Rimactane

Approved

L2
[contents
]

Vitamins [more]
B-1 (thiamin)

Approved

NR

B-12 (Cyanocobalamin)

Approved

L1

B-6 (pyridoxine)

Approved

L2; L4 in
high
doses
(may
inhibit
lactation)

D, vitamin

Calciferol,

Approved

L3 (do not

Delta-d

overdose)

Folic acid

Approved

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

K-1, vitamin
(Phytonadione)

Approved

L1

Riboflavin/B2

Disetujui

L1

L1

[contents
]

Miscellaneous
Acitretin (Anti-psoriasis)

Soriatane

Disetujui

NR

Alcohol/Ethanol [more]

Disetujui

L3

Allopurinol

Zyloprim,
Lopurin

L2

Antimony

NR

L3

L2

L2

NR

L2

NR

NR

L4

Disetujui
Disetujui

Atropine (Anticholinergic, Belladonna,


drying agent)
Atropine

Disetujui

Azapropazone/apazone
(Antirheumatic)

Rheumox

Disetujui

Baclofen (muscle
relaxant)

Lioresal,
Atrofen

Barbiturate

Caffeine [more]

Vivarin,
NoDoz,
Coffee

Carbetocin
(Antihemorrhagic)

Duratocin

Chloroform

Cisplatin (Anti-cancer)

Platinol

Disetujui
Disetujui

Disetujui

Disetujui
Disetujui

Disetujui
Dapsone (Antileprosy)

Avlosulfon,
DDS

Hydroxychloroquine
(Antirheumatic, lupus)

Plaquenil

Iodides

Iodine

Iodine (povidone-iodine,
eg, in a vaginal douche)

Ivermectin (Antiparasitic) Mectizan

Disetujui
Disetujui
Disetujui
Disetujui
Disetujui
Disetujui

Nalidixic acid (Urinary


Anti-infective)

NegGram

Norsteroids

Pyridostigmine (Muscle
stimulant)

Mestinon,
Regonol

Disetujui

Scopolamine (Motion
sickness)

Transderm
Scope

Disetujui

Sulfapyridine

Dagenan

Timolol (glaucoma med)

Blocadren

Disetujui
Disetujui

Disetujui
Disetujui

L4

L2

NR

NR

NR

L3

L4

NR

L2

L3

NR

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 (Paling Aman)
A (studi terkontrol menunjukkan tanpa resiko)
L2 (Aman)
B (tidak ada bukti risiko pada manusia)
L3 (Cukup Aman)
C (risiko tidak dapat dikesampingkan)
L4 (Kemungkinan Barbahaya)
D (bukti positif resiko)
L5 (Kontra Indikasi)
X (dikontraindikasikan untuk Ibu Hamil)
NR: Not Reviewed. This drug has