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)

Trade Name/
nama dagang

Generic name

AAP approved?

Pregnancy Lactation
Risk
Risk
Category Category

Analgesics (Pain-killers)
Approved/diseuju
i

L1

Colchicine

Approved

L4

Acupan

Approved

NR

Acetaminophen/PCT

Tylenol

Colchicine
Nefopam

Non-steroidal anti-inflammatory analgesics (NSAIDs)

Azapropazone (apazone)

Rheumox

Approved

L2

Dipyrone (dilarang di AS &

Inggris)

Approved

NR

Flufenamic acid

Approved

NR

Ibuprofen

Advil, Nuprin,
Motrin,
Pediaprofin

Approved

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

L1

Approved

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

L3

Approved

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

L2

Indomethacin

Ketorolac

Indocin

Toradol, Acular

Mefenamic acid

Ponstan, Ponstel

Approved

NR

Naproxen

Anaprox,
Naprosyn,
Naproxen, Aleve

Approved

L3
L4 (for
chronic use)

Phenylbutazone

Butazolidine

Approved

NR

Piroxicam

Feldene

Approved

L2

Suprofen

Profenal

Approved

NR

Tolmetin

Tolectin

Approved

L3

L3

Narcotic analgesics
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
postpartum)

Methadone

Dolophine

Approved

L3

Morphine

Morphine

Approved

L3

Propoxyphene

Darvocet N,
Propacet, Darvon

Approved

L2

Halothane

Fluothane

Approved

L2

Lidocaine

Xylocaine

Approved

L2

Methohexital

Brevital

Approved

L3

Thiopental

Pentothal

Approved

L3

Anesthesia, Anesthetics /Anastesi

Antacids, GI meds (Antasida, obat-obatan GI)

Cimetidine (Antacid)

Tagamet

Approved

L2

Cisapride (GI tract stimulant)

Propulsid

Approved

L2

Domperidone (used for nausea

& vomiting, stimulates
lactation)

Motilum

Approved

L1

Amoxicillin

Larotid, Amoxil

Approved

L1

Aztreonam

Azactam

Approved

L2

Antibiotics

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

Cipro

Approved

L3

Clindamycin

Cleocin

Approved

L3

Erythromycin

E-Mycin, Erytab, 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

Streptomycin

Approved

L3

Sulbactam

Approved

NR

Sulfisoxazole

Gantrisin, AzoGantrisin

Approved

L2

Tetracycline

Achromycin,
Sumycin,
Terramycin

Approved

L2

Ticarcillin

Ticarcillin, Ticar,
Timentin

Approved

L1

Trimethoprim/sulfamethoxazole

Proloprim,
Trimpex

Approved

L3

Bishydroxycoumarin
(dicumarol)

Approved

NR

Warfarin

Coumadin,
Panwarfin

Approved

L2

Anticoagulants/Antikoagulan

Anticonvulsants/Antikonvulsan

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

Fluconazole

Diflucan

Approved

L2

Ketoconazole

Nizoral
Shampoo,
Nizoral

Approved

L2

Dexbrompheniramine maleate
with d-isoephedrine

Approved

NR

Fexofenadine

Allegra

Approved

L2

Loratadine

Claritin

Approved

L1

Terfenadine

Seldane

Approved

NR

Triprolidine

Actidil, Actifed

Approved

L1

Acyclovir

Zovirax

Approved

L2

Interferon-alpha

Alferon N,
Interferon Alpha

Approved

L2

Approved

L5

Antifungals/ antijamur

Antihistamines/Antihistamin

Antivirals/ antivirus

Arthritis meds (see also: pain meds) =obat artritis

Gold salts

Ridaura,
Myochrysine,
Solganal

Asthma meds (see also: steroids) = Obat asma

Dyphylline

Dilor, Lufyllin,
Dyphylline

Approved

L3

Terbutaline

Bricanyl,
Brethine

Approved

L2

Theophylline

Aminophylline,
Quibron, TheoDur

Approved

L3

Approved

L3 (may
interfere
with milk

Contraceptives, Hormones = Kontrasepsi, Hormon

Estradiol

Estratab,
Permarin, Menest

production)
Clogestone

Contraceptive pill with

estrogen/progesterone

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

Levonorgestrel

Norplant, Mirena,
Plan B

Approved

NR

Approved

L3 (may
interfere
with milk
production)

Approved

L2

Medroxyprogesterone

Provera, DepoProvera, Cycrin

Approved

L1
L4 (if used
first 3 days
postpartum)

Norethynodrel

Enovid

Approved

L2

Progesterone

Crinone,
Prometrium

Approved

L3

Cough meds / obat batuk =antitusif=batuk kering

Codeine

Tylenol #3, #4

Approved

L3

Noscapine

Approved

NR

L3 (for
acute use)
L4 (for
chronic use)

Decongestants/ untuk batuk berdahak =ekspektoran

Pseudoephedrine

Sudafed,
Halofed,
Novafed, Actifed

Approved

Diabetes meds/ obat diabetes

Note: Insulin has not been reviewed by the AAP. Pregnancy risk category = B; Lactation risk
category = L1.
Catatan: Insulin belum dikaji oleh AAP. Kategori risiko kehamilan = B; Risiko laktasi kategori
L1.
Tolbutamide

Oramide, Orinase

Approved

L3

Imodium, Pepto
Diarrhea Control,
Maalox
Antidiarrheal
Caplets,
Kaopectate II
Caplets,

Approved

L2

Diarrhea meds/ obat diare

Loperamide

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.
Catatan: Pepto-Bismol & Kaopectate (bismuth subsalicylate adalah bahan aktif dalam kedua)
tidak direkomendasikan untuk penggunaan rutin oleh ibu menyusui, karena asosiasi salisilat
dengan sindrom Reyes pada anak-anak.
Diuretics/ diuretik
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

Motilum

Approved

L1

L2

Galactagogues (milk supply)

Domperidone

Heart, Blood Pressure meds

(Antiarrhythmics, Antihypertensives, Cardiac stimulants)
Antiarrhythmics/anti aritmia
Disopyramide

Norpace,
Napamide

Approved

L2

Flecainide

Tambocor

Approved

L3

Mexiletine

Mexitil

Approved

L2

Procainamide

Pronestyl, Procan

Approved

L3

Quinidine

Quinaglute,
Quinidex

Approved

L2

Antihypertensives/ anti hipertensi

Captopril

Capoten

Approved

L3 (if used
after 30
days)

Diltiazem/Diltiazem HCL

Cardizem Sr,
Dilacor-XR,
Diltiazem,

Approved

L3

Cardizem CD
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
(topically)
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

Cascara/Cascara Sagrada

Approved

L3

Danthron

Approved

NR

Magnesium sulfate

Epsom salt

Approved

L1

Senna

Approved

L3

Chloroquine

Aralen, Novochloroquine

Approved

L3

Hydroxychloroquine

Plaquenil

Approved

L2

Pyrimethamine

Daraprim

Approved

L4

Quinine

Quinamm

Approved

L2

L2

Cardiac stimulants/ stimulasi jantung

Digoxin
Laxatives/ obat pencahar

Malaria meds/ obat malaria

Medical Testing / pengujian medis

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

Approved

L3

Migraine meds/ obat migran (see also: pain meds)

Sumatriptan

Imitrex

Sedatives/ sediatif/ obat penenang

Chloral hydrate

Aquachloral,
Noctec

Approved

L3

Methyprylon (withdrawn from

use in US & Canada)

Approved

NR

Bromide

Approved

L5

Secobarbital

Seconal

Approved

L3

Ambien

Approved

L3

Solu-Medrol,
Depo-Medrol,
Medrol

Approved

L2

Prednisolone

Approved

L2

Prednisone

Deltasone,
Meticorten,
Orasone

Approved

L2

Approved

L3

Methimazole (active metabolite

Tapazole
of carbimazole)

Approved

L3

Propylthiouracil

PTU

Approved

L2

Thiouracil

Approved

NR

Levothyroxine

Synthroid,
Levothroid,
Thyroid, Levo-T,
Levoxyl

Approved

L1

Sleep Aids/ obat tidur

Zolpidem/Zolpidem Tartrate
Steroids
Methylprednisolone

Thyroid meds / obat tiroid

Carbimazole

Tuberculosis meds/ obat tuberkulosis

Cycloserine

Seromycin

Approved

L3

Ethambutol

Ethambutol,
Myambutol

Approved

L2

Isoniazid

INH, Laniazid

Approved

L3

Rifampin

Rifadin,
Rimactane

Approved

L2

B-1 (thiamin)

Approved

NR

B-12 (Cyanocobalamin)

Approved

L1

Vitamins

B-6 (pyridoxine)

Approved

L2; L4 in
high doses
(may inhibit
lactation)

D, vitamin

Calciferol, Deltad

Approved

L3 (do not
overdose)
L1

Folic acid

Approved

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

K-1, vitamin (Phytonadione)

Approved

L1

Riboflavin/B2

Disetujui

L1

Miscellaneous/ macam-macam/ lain-lain

Acitretin (Anti-psoriasis)

Soriatane

Disetujui

NR

Alcohol/Ethanol

Disetujui

L3

Allopurinol

Zyloprim,
Lopurin

Disetujui

L2

Antimony

NR

Atropine (Anticholinergic,
drying agent)

Belladonna,
Atropine

L3

Azapropazone/apazone
(Antirheumatic)

Rheumox

L2

Baclofen (muscle relaxant)

Lioresal, Atrofen

L2

Disetujui

Disetujui

Disetujui

Disetujui

Barbiturate

Caffeine

Vivarin, NoDoz,
Coffee

Carbetocin (Antihemorrhagic)

Duratocin

Chloroform

Cisplatin (Anti-cancer)

Platinol

Dapsone (Antileprosy)

Avlosulfon, DDS

Hydroxychloroquine
(Antirheumatic, lupus)

Plaquenil

Iodides

Iodine

Iodine (povidone-iodine, eg, in a

vaginal douche)
Ivermectin (Antiparasitic)

Mectizan

Nalidixic acid (Urinary Antiinfective)

NegGram

Norsteroids

Pyridostigmine (Muscle
stimulant)

Mestinon,
Regonol

Scopolamine (Motion sickness) Transderm Scope

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

Disetujui

NR

L2

NR

NR

L4

L4

L2

NR

NR

NR

L3

L4

NR

L2

L3

Disetujui
Sulfapyridine

Dagenan

Disetujui

NR

L3

Timolol (glaucoma med)

Blocadren

Disetujui

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 / belum ditinjau atau diteliti