Lactation Risk CategoriesPregnancy 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.

Yankowitz J. Use of medications in pregnancy : General principles, teratology, and current developments. In : Yankowitz J, Niebyl J, eds. Drug therapy in pregnancy. London : Lippincott Williams & Wilkins, 2001 ; 1-19

Antibiotika[contents]

AmoxicillinLarotid, AmoxilApprovedBL1

AztreonamAzactamApprovedBL2

CefadroxilUltracef, DuricefApprovedBL1

CefazolinAncef, KefzolApprovedBL1

CefotaximeClaforanApprovedBL2

CefoxitinMefoxinApprovedBL1

CefprozilCefzilApprovedCL1

CeftazidimeCeftazidime, Fortaz, TaxidimeApprovedBL1

CeftriaxoneRocephinApprovedBL2

Ciprofloxacin [more]CiproApprovedCL3

ClindamycinCleocinApprovedBL3

ErythromycinE-Mycin, Ery-tab, ERYC, IlosoneApprovedBL1L3early postnatal

Fleroxacin-Approved-NR

GentamicinGaramycinApprovedCL2

KanamycinKebecil, KantrexApprovedDL2

MoxalactamMoxamApproved-NR

NitrofurantoinMacrobidApprovedBL2

OfloxacinFloxinApprovedCL2

Penicillin-ApprovedBL1

StreptomycinStreptomycinApprovedDL3

Sulbactam-Approved-NR

SulfisoxazoleGantrisin, Azo-GantrisinApprovedCL2

TetracyclineAchromycin, Sumycin, TerramycinApprovedDL2

TicarcillinTicarcillin, Ticar, TimentinApprovedBL1

Trimethoprim/sulfamethoxazoleProloprim, TrimpexApprovedCL3

Info on selected MEDICATIONS USED FOR PAIN RELIEF

Name of medicationAAP approved?*Pregnancy Risk Category**Lactation Risk Category**Notes

Acetaminophen(Tylenol)ApprovedBL1

AspirinCautionC(1st, 2nd trim.)D(3rd trim.)L31

Azapropazone(Rheumox)Approved-L2

Butalbital(Fioricet, Fiorinal, Bancap, Two-dyne)NRDL32

Butorphanol(Stadol)ApprovedB(1st, 2nd trim.)D(3rd trim.)L3

Celecoxib(Celebrex) (FDA safety info)NRCL2

Codeine(in Tylenol #3, #4)ApprovedCL33

ColchicineApprovedDL4

Diclofenac(Cataflam, Voltaren)NRBL2

Fentanyl(Sublimaze)ApprovedBL2

Flurbiprofen(Ansaid, Froben, Ocufen)NRB(1st, 2nd trim.)C(3rd trim.)L2

Hydrocodone(Lortab, Vicodin)NRBL34

Hydromorphone(Dilaudid)NRCL35

Ibuprofen(Advil, Nuprin, Motrin, Pediaprofen)ApprovedB(1st, 2nd trim.)D(3rd trim.)L1

Indomethacin(Indocin)ApprovedB(1st, 2nd trim.)D(3rd trim.)L3

Ketorolac(Toradol, Acular)ApprovedB(1st, 2nd trim.)D(3rd trim.)L2

Meperidine(Demerol)ApprovedBL2;L3early postpartum6

Methadone(Dolophine)ApprovedBL37

Morphine(Duramorph, Infumorph, Epimorph, MS Contin)ApprovedBL38

Nalbuphine(Nubain)NRBL2

Naproxen(Anaprox, Naprosyn, Naproxen, Aleve)ApprovedBL3;L4for chronic use9

Nefopam(Acupan)Approved-NR

Oxycodone(Tylox, Percodan,Oxycontin, Roxicet, Endocet, Roxiprin, Percocet)NRBL310

Pentosan polysulfate(Elmiron)NRBL2

Piroxicam(Feldene)ApprovedBL2

Propoxyphene(Darvocet N, Propacet, Darvon)ApprovedCL211

Rofecoxib(Vioxx)Withdrawn from the market12

Secobarbital(Seconal)ApprovedDL313

Tolmetin(Tolectin)ApprovedCL3

Tramadol HCL(Ultram, Ultracet)NRCL314

Valdecoxib(Bextra) (FDA safety info)Withdrawn from the marketmore

* Per the AAP Policy StatementThe 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.

** PerMedications and Mothers Milkby Thomas Hale, PhD (2004 edition).

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

Nama GenerikNama DagangAAP approved?*Kategori Risiko Kehamilan**RisikoMenyusui**

Azapropazone (apazone)RheumoxApproved-L2

Dipyrone (banned in the US & UK)-Approved-NR

Flufenamic acid-Approved-NR

IbuprofenAdvil, Nuprin, Motrin, PediaprofinApprovedB(1st, 2nd trim.)D(3rd trim.)L1

IndomethacinIndocinApprovedB(1st, 2nd trim.)D(3rd trim.)L3

KetorolacToradol, AcularApprovedB(1st, 2nd trim.)D(3rd trim.)L2

Mefenamic acidPonstan, PonstelApproved-NR

NaproxenAnaprox, Naprosyn, Naproxen, AleveApprovedBL3L4(for chronic use)

PhenylbutazoneButazolidineApproved-NR

PiroxicamFeldeneApprovedBL2

SuprofenProfenalApproved-NR

TolmetinTolectinApprovedCL3

Steroid[contents]

Methylprednisolone[high dosage methylprednisolone]Solu-Medrol, Depo-Medrol, MedrolApprovedCL2

Prednisolone-ApprovedCL2

PrednisoneDeltasone, Meticorten, OrasoneApprovedCL2

Obat Asma[contents]

DyphyllineDilor, Lufyllin, DyphyllineApprovedCL3

TerbutalineBricanyl, BrethineApprovedBL2

TheophyllineAminophylline, Quibron, Theo-DurApprovedCL3

Analgetik Narkotik [more]

ButorphanolStadolApprovedB(1st, 2nd trim.)D(3rd trim.)L3

CodeineTylenol #3, #4ApprovedCL3

FentanylSublimazeApprovedBL2

MeperidineDemerolApprovedBL2L3(if used early postpartum)

MethadoneDolophineApprovedBL3

MorphineMorphineApprovedBL3

PropoxypheneDarvocet N, Propacet, DarvonApprovedCL2

Obat Batuk

Nama ObatAAP approved?*RisikoMenyusui**

CodeineyesL3 (moderately safe)

Dextromethorphannot reviewedL1 (safest)

Guaifenesinnot reviewedL2 (safer)

Dekongestan (Obat Pilek)

Nama ObatAAP approved?*RisikoMenyusui**

Phenylephrinenot reviewedL3 (moderately safe)

Pseudoephedrine (Sudafed, Actifed)yesL3 (moderately safe) for acute useL4 (possibly hazardous) for chronic use due to potential for decreasing milk supply

Nasal Sprays (Spray Hidung)

Nama ObatAAPapproved?*RisikoMenyusui**

Beclomethasone (Vanceril, Beclovent, Beconase, Vancenase)not reviewedL2 (safer)

Cromlyn sodium (Nasalcrom)not reviewedL1 (safest)

Fluticasone (Flonase)not reviewedL3 (moderately safe)

Mometasone (Nasonex)not reviewedL3 (moderately safe)

Phenylephrine (in some forms of Sinex and Neo-Synephrine)not reviewedL3 (moderately safe)

Triamcinolone Acetonide (Nasacort)not reviewedL3 (moderately safe)

Antihistamin (Anti Alergi)

Nama ObatAAPapproved?*RisikoMenyusui**

Brompheniraminenot reviewedL3 (moderately safe)

Chlorpheniramine (Chlor-Trimeton) CTMnot reviewedL3 (moderately safe)

Cetirizine (Zyrtec)not reviewedL2 (safer)

Dexbrompheniramine maleatewithd-isoephedrineyesnot reviewed

Diphenhydramine (Benadryl)not reviewedL2 (safer)

Doxylaminenot reviewedL4 (possibly hazardous)

Fexofenadine (Allegra)yesL3 (moderately safe)

Loratadine (Claritin)yesL2 (safer)

Terfenadine (Seldane)yesnot reviewed

Triprolidine (Actidil, Actifed)yesL1 (safest)

Nama GenerikNama DagangAAP approved?*Kategori Risiko Kehamilan**RisikoMenyusui**

Antasida[contents]

Cimetidine (Antacid)TagametApprovedBL2

Cisapride (GI tract stimulant)PropulsidApprovedCL2

Domperidone (used for nausea & vomiting, stimulates lactation) [more]MotilumApproved-L1

Antikoagulan[contents]

Bishydroxycoumarin (dicumarol)-Approved-NR

WarfarinCoumadin, PanwarfinApprovedDL2

Antikonvulsan (Anti kejang)[contents]

CarbamazepineTegretol, EpitolApprovedCL2

EthosuximideZarontinApprovedCL4

Magnesium sulfateEpsom saltApprovedBL1

PhenytoinDilantinApprovedDL2

Valproic acidDepakene, DepakoteApprovedDL2

Anti Jamur[contents]

Fluconazole [more]DiflucanApprovedCL2

KetoconazoleNizoral Shampoo, NizoralApprovedCL2

Antivirus[contents]

Acyclovir [more]ZoviraxApprovedCL2

Interferon-alpha [more]Alferon N, Interferon AlphaApprovedCL2

Arthritis meds (see also:pain meds)[contents]

Gold saltsRidaura, Myochrysine, SolganalApprovedCL5

Kontrasepsi, Hormon[contents]

EstradiolEstratab, Permarin, MenestApprovedXL3(may interfere with milk production)

Clogestone-Approved-NR

Contraceptive pill with estrogen/progesteronePreven, Seasonale, Norinyl, Norlestin, Ortho-Novum, Ovral, Lunelle injection, Ortho-Evra patch, etc.ApprovedXL3(may interfere with milk production)

LevonorgestrelNorplant, Mirena, Plan BApprovedXL2

MedroxyprogesteroneProvera, Depo-Provera, CycrinApprovedDL1L4(if used first 3 days postpartum)

NorethynodrelEnovidApprovedXL2

ProgesteroneCrinone, PrometriumApproved-L3

Obat Diabetes[contents]

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

TolbutamideOramide, OrinaseApprovedDL3

Obat Diare[contents]

LoperamideImodium, Pepto Diarrhea Control, Maalox Antidiarrheal Caplets, Kaopectate II Caplets, Immodium AdvancedApprovedBL2

** 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]

Laksan (Pelancar BAB) [more][contents]

Cascara/Cascara Sagrada-ApprovedCL3

Danthron-Approved-NR

Magnesium sulfateEpsom saltApprovedBL1

Senna-Approved-L3

Diuretik (Peluruh Kencing)[contents]

AcetazolamideDazamide, DiamoxApprovedCL2

BendroflumethiazideNaturetinApprovedDL4(may inhibit lactation)

ChlorothiazideHydrodiurilApprovedDL3

ChlorthalidoneHygrotonApprovedDL3

Hydrochlorothiazide (HCT)Hydrodiuril, Esidrix, OreticApprovedDL2

SpironolactoneAldactoneApprovedDL2

Anti Muntah [more][contents]

DomperidoneMotilumApproved-L1

Obat malaria[contents]

ChloroquineAralen, Novo-chloroquineApprovedCL3

HydroxychloroquinePlaquenilApprovedCL2

PyrimethamineDaraprimApprovedCL4

QuinineQuinammApprovedDL2

Medical Testing [more][contents]

Diatrizoate-Approved-NR

Fluorescein-ApprovedCL3

Gadopentetic (Gadolinium)-ApprovedCL2

IohexolOmnipaqueApprovedBL2

Iopanoic acidTelepaqueApprovedDL2

MetrizamideAmipaqueApprovedBL2

MetrizoateIsopaqueApprovedBL2

Obat Migren [more][contents]

SumatriptanImitrexApprovedCL3

Obat Sedativ [more][contents]

Chloral hydrateAquachloral, NoctecApprovedCL3

Methyprylon (withdrawn from use in US & Canada)-Approved-NR

Bromide-ApprovedDL5

SecobarbitalSeconalApprovedDL3

Obat Tidur[contents]

Zolpidem/Zolpidem TartrateAmbienApprovedBL3

Obat Anti Tiroid [more][contents]

Carbimazole-ApprovedDL3

Methimazole (active metabolite of carbimazole)TapazoleApprovedDL3

PropylthiouracilPTUApprovedDL2

Thiouracil-Approved-NR

LevothyroxineSynthroid, Levothroid, Thyroid, Levo-T, LevoxylApprovedAL1

Obat TBC[contents]

CycloserineSeromycinApprovedCL3

EthambutolEthambutol, MyambutolApprovedBL2

IsoniazidINH, LaniazidApprovedCL3

RifampinRifadin, RimactaneApprovedCL2

VITAMIN [more][contents]

B-1 (thiamin)-Approved-NR

B-12 (Cyanocobalamin)-ApprovedAL1

B-6 (pyridoxine)-ApprovedAL2;L4in high doses (may inhibit lactation)

D, vitaminCalciferol, Delta-dApprovedAL3(do not overdose)

Folic acid-ApprovedA(1st, 2nd trim.)C(3rd trim.)L1

K-1, vitamin (Phytonadione)-ApprovedCL1

Riboflavin/B2-ApprovedAL1

Lain-lain[contents]

Acitretin (Anti-psoriasis)SoriataneApproved-NR

Alcohol/Ethanol [more]-ApprovedDL3

AllopurinolZyloprim, LopurinApprovedCL2

Antimony-Approved-NR

Atropine (Anticholinergic, drying agent)Belladonna, AtropineApprovedCL3

Azapropazone/apazone (Antirheumatic)RheumoxApproved-L2

Baclofen (muscle relaxant)Lioresal, AtrofenApprovedCL2

Barbiturate-Approved-NR

Caffeine [more]Vivarin, NoDoz, CoffeeApprovedBL2

Carbetocin (Antihemorrhagic)DuratocinApproved-NR

Chloroform-Approved-NR

Cisplatin (Anti-cancer)PlatinolApprovedDL4

Dapsone (Antileprosy)Avlosulfon, DDSApprovedCL4

Hydroxychloroquine (Antirheumatic, lupus)PlaquenilApprovedCL2

Iodides-Approved-NR

Iodine-Approved-NR

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

Ivermectin (Antiparasitic)MectizanApprovedCL3

Nalidixic acid (Urinary Anti-infective)NegGramApprovedBL4

Norsteroids-Approved-NR

Pyridostigmine (Muscle stimulant)Mestinon, RegonolApprovedCL2

Scopolamine (Motion sickness)Transderm ScopeApprovedCL3

SulfapyridineDagenanApproved-NR

Timolol (glaucoma med)BlocadrenApprovedDL3

Anti Hipertensi, Obat Jantung[contents]

Anti aritmia

DisopyramideNorpace, NapamideApprovedCL2

FlecainideTambocorApprovedCL3

MexiletineMexitilApprovedBL2

ProcainamidePronestyl, ProcanApprovedCL3

QuinidineQuinaglute, QuinidexApprovedCL2

Anti Hipertensi

CaptoprilCapotenApprovedDL3(if used after 30 days)

Diltiazem/Diltiazem HCLCardizem Sr, Dilacor-XR, Diltiazem, Cardizem CDApprovedCL3

Enalapril/Enalapril MaleateVasotecApprovedC(1st trim.)D(2nd, 3rd trim.)L2

HydralazineApresolineApprovedCL2

LabetalolTrandate, NormodyneApprovedCL2

MethyldopaAldometApprovedCL2

MetoprololToprol XL, LopressorApprovedBL3

MinoxidilLoniten, Minodyl, RogaineApprovedCL2(topically)L3(orally)

NadololCorgard, NadololApprovedCL4

NifedipineAdalat, ProcardiaApprovedCL2

OxprenololApsolox, Slow-Trasicor, TrasicorApproved-NR

PropranololInderolApprovedCL2

SotalolBetapaceApprovedBL3

TimololBlocadrenApprovedCL2

VerapamilCalan, Isoptin, Covera-HSApprovedCL2

Cardiac stimulants

DigoxinLanoxin, LanoxicapsApprovedCL2