MEDIKASI SELAMA KEHAMILAN

MEDIKASI SELAMA KEHAMILAN

Selama kehamilan sejumlah obat aman dan sejumlah obat lain tidak aman untuk dikonsumsi. Sejumlah obat memerlukan dosis yang lebih tinggi dan perubahan dosis ini sesuai dengan bertambahnya usia kehamilan.

Dokter yang bertanggung jawab atas kesehatan pasien harus waspada dengan berbagai obat dan pembatasan penggunaannya.

US Food and Drug Administration memberikan sistem penggolongan obat-obatan yang digunakan selama kehamilan. Golongan tersebut adalah golongan A,B,C,D dan golongan X seperti terlihat pada tabel dibawah :

	Definitions	Clinical Application
A	"Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of a risk in later trimester), and the possibility of fetal harm appears remote."	For all practical purposes, there are no Category A drugs.
B	"Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters)."	Category B drugs include prenatal vitamins, acetaminophen and several other medications used routinely and safely during pregnancy. If there is a clinical need for a Category B drug, it is considered safe to use it.
C	"Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus."	Category C drugs have not been shown to be harmful to fetuses (if they had been, they wouldn't be Category C drugs). However, there are some reasons to be more concerned about these drugs than Category B drugs. If the pregnant patient will benefit from a Category C drug, it is generally used, although most obstetricians would prefer a Category B drug if it will give equivalently good results.
D	"There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective.)"	Category D drugs have some significant risks. They should be used during pregnancy only when the alternatives are worse.
X	"Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant."	Category X drugs should not be used during pregnancy.

Penggunaan sejumlah obat selama kehamilan :

• Acetaminophen aman
• Pseudoephedrine aman
• Guaifenesin aman
• Diphenhydramine aman
• Anaesthesi lokal (Xylocaine) dapat digunakan dengan aman, namun penambahan epinephrine merupakan masalah. Epinephrine dapat menimbulkja efek terhadap sistem kardiovaskulaer ibu yang tidak dapat diramalkan sebelumnya (dan aliran darah pada janin), sehingga penggunaan epinephrine secara uimum harus dihindari
• Aspirin dapat menyebabkan perdarahan janin
• Codeine, Demerol, Morphine dan jenis narcotika lain dapat digunakan sesuai usia kehamilan dengan memperhatikan efek adiksi. Selain resiko sindroma putus obat, sebagian besar pereda rasa sakit aman digunakan selama kehamilan.
• Penicillins aman
• Cephalosporins aman
• Erythromycin aman
• Azithromycin aman
• Metronidazole aman setelah minggu ke 14. Keamanan sebelum minggu ke 14 belum diketahui.
• Tetracyclines tidak aman
• Aminoglycosides pada dasarnya aman , namun masalah ototoksisitas dan gangguan ginjal merupakan masalah yang potensial bila diberikan dalam dosis tinggi dan berkepanjangan.
• Clindamycin aman
• Chloramphenicol mungkin aman bila diberikan sebelum kehamilan minggu ke 28
• Sulfa drugs aman bila diberikan sebelum kehamilan minggu ke 34 . setelah minggu ke 34, kemungkinan dapat terjadi ikterus neonaturum
• Quinine hanya digunakan bila terjadi keadaan yang bersifat “life-threatening” pada kasus infeksi P falciparum yang resisten terhadap chloroquin.
• Miconazole aman
• Clotrimazole aman
• Quinacrine mungkin aman selama kehamilan
• Chloroquine mungkin menyebabkan cacat kongenital bila digunakan dengan dosis tinggi dan jangka lama
• Pyrimethamine aman setelah trimester pertama.Tambahkan suplemen asam folat
• Trimethoprim aman setelah trimester pertama.Tambahkan suplemen asam folat
• Primaquine dapat menyebabkan anemia hemolitik pada kasus G6PD . Dapat diberikan bila sangat diperlukan .