Formularium 2016

FORMULARIUM
RS.
TAHUN 2015

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 Formularium 2016

KATA PENGANTAR
Formularium RS. Stella Maris tahun 2014 ini merupakan edisi IV yang tentunya masih terdapat kekurangan disana sini.
Pada dasarnya formularium ini merupakan perangkat kebijakan dalam pemilihan obat dan penggunaanya. olah karena itu
hanya obat obat yang disepakati yang masuk dalam Formularium yang disediakan. Obat obat yang tidak tercantum tetapi sangat
diperlukan dimungkinkan pengadaannya melalui prosedur yang ditentukan.
Formularium RS. Stella Maris yang disediakan mengacu pada DOEN ditambah dengan obat obat yang terbukti secara ilmiah
dibutuhkan untuk pelayanan RS. Stella Maris dan mempertimbangkan syarat CPOB, kountiunitas ketersediaan obat, kecepatan dan
ketepatan pengiriman obat serta harga obat.
Akhirnya mengingat pentingnya keberadaan Formularium yang baik dan aktual bagi Rumah Sakit maka Formularium ini akan
dievaluasi setiap enam bulan dan revisinya dilaksanakan minimal satu tahun sekali. Oleh karena itu partisipasi aktif berupa kritik dan
saran sangat kami harapkan.
Kepada semua pihak yang telah membantu hingga terbitnya buku Formularium edisi IV ini kami sampaikan terimakasih.

Makassar, Oktober 2015 2015

Ketua Panitia Farmasi & Terapi

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1. ANALGESIK, ANTIPIRETIK, ANTIREMATIK, ANTIPIRAI

1.1. ANALGESIK NARKOTIK
1 Codein
Tablet 10 mg Codein KF 688
2 Fentanyl
Injeksi 50mcg/ml Fentanyl Janssen 53.415
3 Morfin HCl
Tablet 10 mg Morphine KF 13.124
Injeksi
4 Petidin HCl
Inj Petidin KF 16.489
1.2. ANALGESIK NON NARKOTIK

1. Asam Mefenamat

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Caplet : 500mg Asam Mefenamat Generik 463

Mefinal Sanbe 1.650
2. Metampiron + Diazepam
Tablet : 500mg + 2mg Analsik Sanbe 1.499
3. Na Metamizole
inj 500mg/ml Antrain Interbat 11.825

Paracetamol
Tablet : 500mg Paracetamol Generik 131
Sanmol Sanbe 344

Tiap 5ml syrup : 125mg Paracetamol Generik 4.367

Tiap 5ml syrup : 120mg Sanmol Sanbe 14.369
Tiap ml drops : 100mg Paracetamol Generik 6.593
Sanmol Sanbe 19.388
Tiap 5ml syrup : 160mg Tempra Bristol-M 43.725
Tiap 5ml syrup : 250mg Tempra Forte 48.331
Rectal tube : 125mg/2,5ml Dumin Actavis 16.033
Rectal tube : 250mg/4ml Dumin 22.385
Infus Paracetamol Generik 61.875
Farmadol Fahrenheit 78.375
Sanmol Sanbe 75.900
4. Paracetamol + Tramadol
Tablet Tramset Fahrenheit 8.250
5. Paracetamol + N asetilsistein
Kaplet : 500mg + 200mg Sistenol DexaM 2.063
6. Parecoxib Na
Injeksi Dynastat Pfzer

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7. Tinoridine HCl
Capsul Nonflamin Takeda
8. Tramadol HCl
Capsul : 50mg Tradosik Sanbe
Trasik Fahrenheit
Capsul : 100 mg Tramal Pharos
Suppo : 100 mg Tramal Pharos
Injeksi : 50 mg Tramadol Generik 7.865
Kamadol KF 5.666

1.3. ANTIREMATIK, ANTIPIRAI

1 Allopurinol
Tablet : 100mg Allopurinol Generik 228
Tablet : 300mg Allopurinol Generik 386
Puricemia Sanbe 3.506
2 Colchinine
Tablet : 0,3mg Recolfar Fahrenheit 6.149

3 Glucosamine + Chondroitin SO4 + Vit C + Mg + Zn + Mn + MSM

Tablet : 250mg + 200mg + 15 mg + 5 mg Vostem F Sanbe 7.563
+ 2,5 mg + 0,5 mg + Se 3,5 mcg

4 Ibuprofen
Tablet : 400mg Ibuprofen Generik 293
Tablet : 200mg Ibuprofen Generik 270
Buffect Sanbe 825
Tiap 5ml suspensi : 100mg Bufect Sanbe 18.012

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5 K-Diklofenak
Tablet : 50mg Eflagen Sanbe 2.434

6 Ketoprofen
Tab 100 mg Kaltropen Kalbe 17.394
Suppo : 100mg Protofen KF 13.045
Kaltropen Kalbe 15.813
7 Ketorolak Tromethamine
Tablet : 30 mg Farpain Fahrenheit 6.875
Injeksi : 30mg/ml Ketorolak Generik 6.250
Rativol Sanbe 45.513
8 Meloxicam
Tablet : 7,5mg Meloxicam Generik 533
Ostelox Sanbe 7.013
Tablet : 15mg Meloxicam Generik 600

9 Na Diklofenak
Tablet : 25mg Natrium Generik 252
Diklofenak
Flamar Sanbe 1.031
Tablet : 50mg Natrium Generik 340
Diklofenak
Flamar Sanbe 2.269
10 Sulfasalazine
Tablet : 50mg Sulfasalazine Generik 1.320
Sulcolon Fahrenheit 5.335
1.4. NOOTROPIK DAN NEUROTROPIK
1 B1 + B6 + B12
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Tablet : 100mg + 100mg + 200mcg Neurosanbe Sanbe 1.375

2 B1 + B6 + B12
Tablet : 100mg +100mg +5000mcg Neurosanbe 5000 Sanbe 2.956
Rebal Plus Fahrenheit 2.723
Injeksi : 100mg + 100mg + 5000mcg Neurosanbe Sanbe 6.325
Farbion 5000 Fahrenheit 7.109
3 B1 + B6 + B12 + Na Metamizole
Tablet : 50mg + 100mg + 100mcg + Neurosanbe Plus Sanbe 1.306
+ 500 mg
4 Citicoline
Tablet : 500mg Citicoline Generik 8.250
Brainact Kalbe 15.308
Injeksi : 12.5% Citicoline Generik 24.970
Brainact Kalbe 59.125
5 Mecobalamine
Tablet : 500mg Megabal Sanbe 2.145
6 Piracetam
Capsul : 400mg Piracetam Generik
Kaplet : 800mg Piracetam Generik 1.452
Ciclobrain coronet 3.781
Injeksi : 3 g/15ml Piracetam Generik 14.300
Neurotam Kalbe 75.625
1.5. CNS STIMULAN
1. Citicoline
Tablet : 500mg Citicoline Generik 8.250
Brainact Kalbe 15.308
injeksi : 220mg
2. Piracetam
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Capsul : 400mg Piracetam Piracetam Generik

Kaplet : 800mg Piracetam Piracetam Generik 1.452
Ciclobrain Coronet 3.781
Injeksi : 3 g/15ml Piracetam Generik 14.300
Neurotam Kalbe 75.625
2. ANESTETIK
2.1. ANESTETIK LOKAL
1 Bupivacaine HCl
Injeksi : 0,5% amp Bunascan Fahrenheit 82.940
Marcain Phapros
2 Lidocain HCl
Injeksi : 2% Lidocain Generik 1.506
2.2. ANESTETIK UMUM
1 Ketamin HCl
Injeksi : 100mg/ml KTM Guardian 250.250
2 Midazolam
Injeksi Anesfar Fahrenheit 51.250
Sedacum Dexa 27.500
3 Propofol
Injeksi Proanes Sanbe 101.959
Recofol Dexa 116.875
4 Sevoflurane
liquid Sojourn Fahrenheit
Sevoflurane Generik
3. ANTIALERGI DAN OBAT UNTUK ANAFILAKSIS
3.1. ANTIHISTAMIN DAN ANTIALERGI
1 Cetirizine

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Tablet : 10mg Cetirizine Generik 413

Cerini Sanbe 4.263
Tiap 5ml syrup 5mg Cetirizine Generik 10.522
Cerini Sanbe 49.362

2 Chlorpheniramine Maleat (generik)

Tablet 4 mg CTM Generik 72
3 Dexamethazone
Tablet : 0,5mg Dexamethazone Generik 108.75
Cortidex Sanbe 344
Injeksi : 5mg/ml Dexamethazone Generik 2.988
Cortidex Sanbe 7.769
4 Pseudoefedrine + Tripolidin
Tablet : 60 mg + 120 mg Tremenza Sanbe 1.444

5 Loratadine
Tablet : 10mg Alloris Sanbe 5.707
Syrup Alloris Sanbe 67.032
6 Loratadine + Pseudoephedrine HCl
Tablet : 120mg + 5mg Alco drops Interbat 68.750
7 Pseudoefedrin + CTM
Syrup 15 mg + 1 mg Rhinos Junior DexaM
8 Mebhidroline Napadisilat
Tablet : 50 mg Histapan Sanbe 825
Interhistin Interbat 791
9 Methylprednisolon
Tablet : 4mg Methylprednisolon Generik 606
Sanexon Sanbe 2.750
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Tablet : 8mg Methylprednisolon Generik 879

Sanexon Sanbe 4.263

Tablet : 16 mg Methylprednisolon Generik 1.423

Sanexon
Injeksi : 125mg/ml Sanexon Sanbe 113.850

10 Triamcinolone
Tablet : 4 mg Triamcort Interbat

a. VAKSIN
1 TT
Injeksi : 0.5 ml Toxoid Biofarma
3. ANTIEPILEPSI
1 Carbamazepine
Tab 200 mg Carbamazepine Generik 300
Bamgetol Mersi
2 Clonazepam
Tablet 2 mg Riklona Mersi 9.158

3 Diazepam
Tablet : 2mg Diazepam Generik 40
Valisanbe Sanbe 220
Tablet : 5mg Valisanbe Sanbe 344
Injeksi : 10mg/ml Valisanbe Sanbe 18.012
Rectal tube 5 mg.2,5ml Stesolid Actavis 32.670
Rectal tube 10mg .2,5ml Stesolid Actavis 44 550

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4 Gabapentin
Capsul : 300mg Galepsi Guardian 12.788

5 Magnesium Sulfat (generik)

Injeksi 40% Magnesium Sulfat Otsuka
Injeksi 20% Magnesium Sulfat Otsuka
6 Midazolam
Injeksi Anesfar Fahrenheit
Sedacum Dexa Medica27.500
7 Na Phenobarbital (generik)
Tablet 30 mg Phenobarbital Kimia Farma
Injeksi Sibital Mersifarma
8 Oxcarbazepine
Tablet : 300 mg Trileptal Novartis
9 Pregabalin
Capsul : 50 mg Lyrica Pfzer
Capsul : 75 mg Lyrica Pfzer
Capsul : 150 mg Lyrica Pfzer CEK OBAT PSIKO
10 Valproic Acid
Tiap 5ml syrup Depakene Abbott
Falpro Fahrenheit
4. ANTIMIKROBA
a. ANTELMINTIK
1 Pyrantel Pamoate
Tablet 125 mg Pyrantel Generik 400
Tiap 5ml syrup 125mg Combantrin Pfzer 17.797

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b. ANTIBAKTERI
i. GOLONGAN PENISILIN
1 Amoxycillin
Tablet : 500mg Amoxycillin Generik 463
Amoxsan Sanbe 4.153
Tiap ml drops 100mg Amoxsan Sanbe 28.476
Tiap 5ml syrup 125 mg Amoxycillin Generik 6.875
Amoxsan Sanbe 28.476
Tiap 5ml syrup Forte 250mg Amoxsan Sanbe 40.611
2 Amoxycillin + Clavulanic Acid
Tablet : 500mg + 125mg Claneksi Sanbe 14.637
Tiap 5ml syrup 125mg+31,25mg Claneksi Sanbe 65.450
Tiap 5ml syrup 250mg + 62,5mg Claneksi F Sanbe 89.540

ii. GOLONGAN - LACTAM

1 Imipenem + Cilastatin
Infus 500 mg + 500 mg Pelastin Sanbe 406.986
2 Meropenem
Injeksi : 1g Meropenem Generik 137.500

iii. GOLONGAN AMINOGLIKOSIDA

1 Gentamycin sulfate
Injeksi Gentamycin Generik 4.674
Sagestam Sanbe 12.100
Cream Sagestam Sanbe 15.193
iv. GOLONGAN KLORAMFENIKOL
1 Chloramphenicol

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Capsul : 250mg Colsancetine Sanbe

2 Thiamphenicol
Capsul : 500mg Biothicol Sanbe 4.538
Tiap 5ml syrup: 125 mg Biothicol Sanbe 27.225
Tiap 5ml syrup: 250 mg Biothicol Sanbe 75.240
v. GOLONGAN KUINOLON
1 Ciprofloxacin
Tablet : 500mg Ciprofloxacin Generik 760
Baquinor Sanbe 17.325
infus 2mg/ml Ciprofloxacin Generik 35.750

2 Levofloxacin
Tablet : 500mg Levofloxacin Generik 1.442
Levocin Sanbe 47.091
Infus : 0,5 gram Levofloxacin Generik

3 Ofloxacin
Tablet : 200mg Ofloxacin Generik 892
Tablet : 400mg Ofloxacin Generik 1.656
Akilen Sanbe 19.869

vi. GOLONGAN MAKROLID

1 Azythromycin dihydrate
Capsul : 250mg Mezantrin Sanbe 16.707

2 Clarithromycin
Tablet : 500mg Bicrolid Sanbe 29.810

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3 Erythromycin
Tablet : 500mg Erysanbe Sanbe

vii. GOLONGAN SEFALOSFORIN

1 Cefadroxil
Capsul : 500mg Cefadroxil Generik 1.513
Cefat Sanbe 13.269
Tiap 5ml syrup 125mg Cefadroxil Generik 11.000
Cefat Sanbe 54.588
Tiap 5ml syrup 250mg Cefat Forte Sanbe 93.913

2 Cefixime
Capsul : 100mg Cefixime Generik 2.250
Sporetik Sanbe 24.613
Tiap 5ml syrup 100mg Cefixime Generik 41.594
Sporetik Sanbe 103.813
Cefspan Kalbe 126.500
3 Cefotaxime
Injeksi : 1g Cefotaxime Generik 13.764
Taxegram Sanbe 177.650
4 Cefpirome
Injeksi : 1g Bactirom Sanbe 369.256

5 Ceftazidime
Injeksi : 1g Zidifec Sanbe 324.363

6 Ceftriaxone
Injeksi : 1g Ceftriaxone Generik 26.125
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Elpicef Fahrenheit 247.500

Terfacef Sanbe 262.625

7 Cefuroxime
Tablet : 500mg Anbacim Sanbe 25.245

viii. GOLONGAN TETRASIKLIN

1 Oxytetracyclin HCl
Salep : 1 % Oxytetracyclin Generik 2.835
Salep : 3 % Oxytetracyclin Generik 2.835

2 Doxycycline HCl
Capsul : 100mg Doxyciclone Generik 348
Siclidon Sanbe 6.531

ix. GOLONGAN LAIN LAIN

1 Clindamycin
Tablet : 300mg Clindamycin Generik 1.621
Prolic Sanbe 8.938
2 Cotrimoxazole (Sulfamethoxazole + Trimethoprim)
Tablet : 400mg + 80mg Cotrimoxazole Generik 317
Sanprima Sanbe 1.100
Tablet : 800mg + 160mg Sanprima Forte Sanbe 2.475
Tiap 5ml syrup: 200mg+40mg Cotrimoxazole Generik 4.945
Sanprima Sanbe 31.625
3 Metronidazole
Tablet : 500mg Metronidazole Generik 330
Trichodazol Sanbe 2.063
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Suppo 0,5g Trichodazol Sanbe

Infus Metronidazole Generik 33.000
Trichodazol Sanbe 110.963
c. ANTITUBERKULOSIS
1 Ethambutol
Tablet 500 mg Ethambutol Generik 718

2 Ethambutol + INH + B6
Tablet : 250mg + 100mg + 6mg Santibi Plus Sanbe
Tablet : 500mg + 200mg + 10mg
3 INH
Tablet 100 mg INH Generik 55
Tablet 300 mg INH Generik 145
4 Pyrazinamide
Tablet : 500mg Pyrazinamide Generik 454
Sanazet Sanbe 1581
5 Rifampisin
Tablet : 450mg Rifampisin Generik 1.002
Rifamtibi Sanbe 5.363
Tablet : 600mg Rifampisin Generik 1.995
Rifamtibi Sanbe

d. ANTIFUNGI

1 Griseofulvin
Tablet : 125 mg Griseofulvin Generik 300
2 Ketoconazole

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Tablet : 200mg Ketoconazole Generik 620

Formyco Sanbe 6.325

Salep Ketoconazole Generik

Formyco Sanbe 22.275
3 Nystatin
Tiap drops 100.000iu Nymico Sanbe 40.907

e. ANTIVIRUS
1 Acyclovir
Tablet : 400mg Acyclovir Generik 868
2 Echinaceae + Black Eldeberry Extr. + Zn picolinate
Tablet Formuno Sanbe 7.824

5. ANTIVERTIGO
a. ANTIVERTIGO
1. Betahistine
Tablet 6mg Betahistine Generik 1.269
Vesitab Fahrenheit 3.437
2. Flunarizine
Tablet 5mg Unalium Fahrenheit 6.738
Tablet 10 mg Unalium Fahrenheit 9.075

6. ANTIPARKINSON
1 Donezepil HCl
Tablet 5 mg Aldomer Mersi

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2 Trihexylphenidyl HCl
Tablet : 2 mg Trihexylphenidil Generik
Heximer Mersi
7. OBAT YANG MEMPENGARUHI DARAH
a. ANTIANEMIA
1 Asam Folat
Tablet : 400mcg Folavit Sanbe

2 A + B1 + B2 + B6 + B12 + C + D + E + Nicotinamide + Ca fosfat + Ca Lactate + Fe Fumarate + KI + Mn + Zn + DHA + Asam folat

Tablet : 5000iu + 3mg + 3mg + Prenatin DF Soho
2,5mg + 6mcg + 75mg + 400iu + 30mg
+ 20mg + 200mg + 5mg + 90mg + 200mcg
+ 1mg + 0,5mg + 1,5mg + 95mg + 1mg
3 Fe Fumarat + Asam folat + B12 + C + D3 + Ca karbonat
Tablet : 360mg + 1,5mg + 15mg Prenamia Sanbe 1,.244
+ 75mg + 400iu + 200mg
4 Fe Gluconate + MnSO4 + Copper Sulfat + C + Asam folat + B12
Capsul : 250mg + 200mcg + 200mcg Biosanbe Sanbe 1.238
+ 50mg + 1mg +7,5mcg

5 Sulfas Ferrosus (generik)

Tablet Ferrosi Sulfat Generik 91

b. ANTI KOAGULAN, ANTI THROMBOTIC DAN FIBRILYTIC

1 Asam Asetil Salisilat
Tablet : 80mg Aspilets UAP

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Miniaspi Mersi 537

2 Cilostazol
Tablet 100mg Fibrozol Sanbe
3 Clopidogrel
Tablet : 75mg Clopidogrel Generik 9.584
Pladogrel Fahrenheit 16.500
4 Na Enoksaparin
Injeksi 0,6 Lovenox Aventis 146.875

c. HAEMOSTATIK
1 Asam Traneksamat
Tablet : 500mg Asam Traneksamat Generik 1.925
Plasminex Sanbe 3.369
Injeksi : 500mg Asam Traneksamat Generik 18.906
Plasminex Sanbe 15.469
2 Carbazochrome Na
Tablet : 10 mg Adona Tanabe 4.049
Tablet : 30 mg Adona Tanabe 4.100
Injeksi : 50 mg Chrome Ferron 27.500
Adona Tanabe 28.600
3 Vitamin K
Injeksi Vitamin K Generik 5.368

8. PRODUK DARAH DAN PENGGANTI PLASMA

1 HES + NaCl
Infus Wida HES Widatra
9. DIAGNOSTIK
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a. OBAT KONTRAS
1 Iopamidol
Larutan 370/30 Iopamiro Bracco
Xolmetras Fahrenheit
Larutan 370/50 Iopamiro Bracco
10. ANTISEPTIK DAN DESINFEKTAN
a. ANTISEPTIK
1 Iodine Povidone
Larutan Betadine Mahakam
Gargarisma Betadine Mahakam
2 Polikresulen
Ovula 90 mg Albothyl Ovula Pharos
Vaginal gel Albothyl Gel Pharos
Topical Sol Conc Albothyl conc. Pharos
b. DESINFEKTAN
-
11. OBAT UNTUK GIGI DAN MULUT
a. OBAT TOPIKAL UNTUK GIGI DAN MULUT
1 Acid. Hyaluronic
Solution 0,025% Hexadol
Solution 0,1% Albotil

12. DIURETIK
a. DIURETIK
1 Furosemide
Tablet : 40mg Furosemide Generik

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Uresix Sanbe
Lasix Aventis
Injeksi : 10mg/ml Furosemide Generik
Lasix Aventis
Farsix Fahrenheit
2 Hydrochlortiazid (generic)
Tablet HCT Generik
3 Indapamide
Tablet : 1,5mg Natrilix SR Servier
4 Mannitol
Infus 20% Mannitol Otsuka
M-20 Sanbe
5 Phenazopyridine HCl
Tablet 100 mg Urogetix Transfarma
6 Spironolakton
Tablet : 25mg Spironolakton Generik
Carpiaton Fahrenheit
Tablet : 100mg Spironolakton Generik
Carpiaton Fahrenheit
b. LAIN LAIN
1 Doxazocin Mesylate
Tablet 2 mg Cardura Pfizer
2 Esential Ketoacid
Tablet : 630 mg Ketosteril Fresenius
3 Dutasteride
Tablet : 0,5 mg Avodart Glaxo

4 Solifenaum Succinate
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Tablet : 5 mg Vesicare Astellas

5 Tamsulosin HCl
Tablet : 0,4 mg Harnal Ocas Astellas
Tablet dispersible 0,2 mg Harnal Astellas

13. HORMON, ENDOKRIN LAIN DAN KONTRASEPSI

a. ANTIDIABETIK
i. ANTIDIABETIK ORAL
1 Glibenclamide (generik)
Tablet Glibenclamide Generik
2 Glimepiride
Tablet : 2mg Glimepiride Generik
Anpiride Sanbe

3 Glimepiride + Metformin
Tablet : 1mg + 250mg Amaryl M Sanofi
Tablet : 2mg + 500mg Amaryl M Sanofi
4 Gliclazide
Tablet Diamicron MR Prafa
5 Gliquidone
Tablet Glurenorm Boehringer
6 Linagliptin
Tablet Trajenta Boehringer
7 Metformin HCl
Tablet : 500mg Metformin Generik
Glucophage Merck

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Glucophage XR Merck
Forbetes Sanbe
Tablet : 850mg Forbetes Sanbe
8 Metformin + Glibenclamide
Tablet : 250mg + 1,25mg Glucovance Merck
Tablet : 250mg + 2,5mg Glucovance Merck
Tablet : 500mg + 2,5mg Glucovance Merck
Tablet : 500mg + 5mg Glucovance Merck
9 Pioglitazone
Tablet : 15mg Prabetic Fahrenheit
Actos Takeda
10 Pioglitazone + Metformin
Tablet 15 mg + 850 mg Pionix Kalbe
11 Saxagliptin
Tablet Ongliza AstraZ
12 Sitagliptin
Tablet 50 mg Januvia Merck
13 Sitagliptin + Metformin
Tablet 50 mg + 500 mg Janumet Merck
14 Vildagliptin
Tablet : 50mg Galvus Novartis
15 Vildagliptin + Metformin
Tablet : 50mg + 500mg Galvusmet Novartis
16 Bioaktif Extr. Lagerstroemia spesiosa + Extr. Cinnamommum burmanii
Tablet : 100 mg Inlacin DexaM
17 Extr. Touchi
Tablet Glusafe Promed
ii. ANTIDIABETIK PARENTERAL
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1 Insulin Aspart
Injeksi NovoRapid NovoN
2 Insulin Aspart + Insulin Aspart Protamine
Injeksi Novomix NovoN
3 Insulin Deternir
Injeksi Levemir NovoN
4 Insulin Glulisine
Injeksi Apidra NovoN
5 Insulin Glargine
Injeksi Lantus Aventis
6 Insulin Lispro + Insulin Lispro Protamine
Injeksi Humalog mix Eli lily
b. HORMON KELAMIN DAN OBAT YANG MEMPENGARUHI FERTILITAS
i. ESTROGEN
1 Allylestrenol
Tablet : 5mg Preabor Sanbe
Pregtenol Fahrenheit
2 Calcitriol
Tablet : 0,25mg Ostriol Fahrenheit
Kolkatriol Phapros
Tablet : 0,5 mg Kolkatriol Phapros

3 Estradiol + Drosperinone
Tablet 1 mg + 2 mg Angeliq Bayer
4 Methylestrenolone + Methylestradiol
Tablet : 5mg + 0,3mg Mediol Meprofarm
ii. PROGESTERON

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1 Dydrogesterone
Tablet : 10mg Duphaston Solvay
2 Medroxyprogesterone acetate
Tablet : 10 mg Prothyra Sunthi
3 Medroxyprogesterone acetate + Estradiol Cypionate
Injeksi Cyclofem Tunggal Idaman
4 Medroxyprogesterone
Injeksi Triclofem Tunggal Idaman
5 Nosethisterone
Tablet : 5mg Primolut N Schering
6 Progesteron
Suppo Cygest Actavis
iii. OKSITOKSIK
1 Methylergometrin Maleat
Tablet : 0,125mg Methergin Novartis
Bledstop Capri
Injeksi Methergin Novartis
2 Synthetic Oxytocin
Injeksi : 10mg/ml Oxytocin Generik
Syntocinon Sandoz
c. HORMON TIROID DAN ANTITIROID
i. HORMON TIROID
1 Propilthiouracil (PTU)
ii. HORMON ANTI TIROID
1 Propilthiouracil (PTU)
Tablet Propilthiouracil Generik
2 Thiamazole

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Tablet : 5 mg Thyrozol Merck

Tablet : 10 mg Thyrozol Merck
d. KORTIKOSTEROID DAN KORTIKOTROPIN
1 Dexamethazone
Tablet : 0,5mg Dexamethazone Generik
Cortidex Sanbe
Injeksi : 5mg/ml Dexamethazone Generik
Cortidex Sanbe
2 Methylprednisolone
Tablet : 4mg Methylprednisolon Generik
Sanexon Sanbe
Tablet : 8mg Sanexon Sanbe
Tablet : 16 mg Methylprednisolon Generik
Sanexon Sanbe
Injeksi : 125mg/ml Methylprednisolon Generik
Sanexon Sanbe
Injeksi : 500 mg/ml Sanexon Sanbe
3 Prednison
Tablet Prednison Generik
4 Triamcinolone
Injeksi : 40 mg IM Flamicort DexaM
Injeksi IA ID Flamicort DexaM
e. OBAT METABOLISME TULANG DAN OTOT
1 Calcitriol
Tablet : 0,25mg Ostriol Fahrenheit
Kolkatriol Phapros
Tablet : 0,5 mg Kolkatriol Phapros

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2 Glucosamine + Chondroitin SO4 + Vit C + Mg + Zn + Mn + MSM

Tablet : 500mg + 400mg + 50mg Vostem Forte Sanbe
+ 10mg + 5mg + 0,5mg Oste Forte Soho
Tablet : 250mg + 200mg + 15mg Vostem Sanbe
+ 5mg + 2,5mg + 0,5mg + Se 3,5mcg
Tablet effervescent Vostem Sanbe
3 Glucosamine + Chondroitin SO4 + Omega - 3 Fatty Acids + MSM + Boswellia serrata extr. + E + Mn + Zn
Sachet : 250mg + 200 mg + 100 mg Osmetin zuper Novell
+ 500 mg + 800 mg + 200 UI + 5 mg + 30 mg
4 Glucosamine SO4 + Chondroitin SO4 + Capsaicin Extr. + Camphore + Methylsalisilat
Cream 60 gram Osteor C Pyridam
Flexamine Novell
5 Hylan G-F 20
Injeksi Synvisc Sanofi
6 Ibandronic Acid Na
Tablet Bonviva Roche
Injeksi 3 mg Bonviva Roche
7 Na Alendronate
Tablet : 10mg Allovell Novell
Tablet : 70mg Allovell Novell
8 Na Risedronate
Tablet : 35mg Actonel Sanofi
Tablet Once Month Actonel Sanofi
9 Syntetic Salmon Calcitonin
Injeksi : 50mg/ml Miacalcic Novartis
Injeksi : 100 mg/ml Miacalcic Novartis
10 Zolendronic Acid
Sol 5 mg/ 100 ml Aclasta Novartis
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 Formularium 2016

14. OBAT KARDIOVASKULER

a. ANTIANGINA
1 Asam Asetil Salisilat
Tablet : 80mg Thrombo Aspilets UAP
Tablet : 100mg Farmasal Fahrenheit
2 Diltiazem HCl
Tablet 30 mg Diltiazem Generik
Dilmen Sanbe
Herbesser Tanabe
Tablet 180 mg Cordila SR DexaM
Tablet CD 100 Herbesser Tanabe
Tablet CD 200 Herbesser Tanabe
Injeksi Farmabes Fahrenheit
Herbesser Tanabe
3 Dipyridamol
Tablet : 25 mg Persantin Otto
4 Isosorbid Dinitrat
Tablet : 5mg Cedocard DaryaVaria
Tablet : 10mg Cedocard DaryaVaria
Injeksi Farsorbid Fahrenheit
5 Isosorbit Mononitrat
Tablet : 60 mg Imdur AstraZ
6 Trimetazidine HCl
Tablet : 35mg TrizedonMR Servier
Miozidine Fahrenheit

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 Formularium 2016

b. ANTIDISTRIMIA
1 Amiodarone HCl
Tablet : 200mg Cordarone Sanofi
Injeksi Cordarone Sanofi
Tiaryt Fahrenheit
2 Epinefrin
Injeksi : 1mg/ml Epinefrin Ethica
3 Lidocain HCl
Injeksi : 2% Lidocain Generik
c. ANTIHIPERTENSI
i. GOLONGAN ACE INHIBITOR
1. Amlodipine
Tablet 5mg Amlodipine Generik
Norvask Pfizer
Cardisan Sanbe
Calsivas Fahrenheit
Tablet 10mg Amlodipine Generik
Norvask Pfizer
Cardisan Sanbe Calsivas
Fahrenheit
2. Amlodipine + Perindopril
Tablet 10 mg + 10 mg Coveram Servier
3. Captopril
Tablet 12,5mg Tensicap Sanbe
Tablet 25mg Captopril Generik
Tensicap Sanbe
4. Imidapril

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 Formularium 2016

Tablet 5 mg Tanapress Tanabe

Tablet 10 mg Tanapress Tanabe
5. Lisinopril
Tablet 5mg Tensinop Sanbe
Tablet 10mg Lisinopril Generik
Tensinop Sanbe
6. Perindopril
Tablet 5 mg Bioprexum Servier
Tablet 10 mg Bioprexum Servier
7. Ramipril
Tablet 5mg Triatec Sanofi

ii. GOLONGAN BETA BLOKER

1 Bisoprolol
Tablet 2,5 mg Concor Merck
Tablet 5mg Bisoprolol Generik
Bipro Fahrenheit
Concor Merck
Maintate Tanabe
2 Losartan
Tablet 50mg Santesar Sanbe
Angioten Kalbe
Acetensa Fahrenheit
3 Metoprolol
Injeksi Fapresor Fahrenheit
4 Olmesartan
Tablet 20mg Olmetec Pfzer
Tablet 40mg Olmetec Pfzer
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 Formularium 2016

5 Olmesartan + HCT
Tablet 40mg + 12,5mg Olmetec plus Pfzer
6 Propanolol
Tablet 10mg Farmadral Fahrenheit
Tablet 40 mg Propranolol Generik
7 Telmisartan
Tablet 80mg Micardis Boehringer
iii. GOLONGAN PENGHAMBAT KANAL KALSIUM
1 Amlodipine
Tablet 5mg Amlodipine Generik
Norvask Pfizer
Cardisan Sanbe
Calsivas Fahrenheit
Tablet 10mg Amlodipine Generik
Norvask Pfizer
Cardisan Sanbe Calsivas
Fahrenheit
2 Diltiazem HCl
Tablet 30 mg Diltiazem Generik
Dilmen Sanbe
Herbesser Tanabe
Tablet 180 mg Cordila SR DexaM
Tablet CD 100 Herbesser Tanabe
Tablet CD 200 Herbesser Tanabe
Injeksi Farmabes Fahrenheit
Herbesser Tanabe
3 Nicardipine
Injeksi Perdipine Astellas
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 Formularium 2016

Tensilo Fahrenheit
4 Nimodipine
Tablet Nimotop Bayer
Infus Ceremax Kalbe
5 Nifedipine
Tablet 10mg Nifedipine Generik
Nifedin Sanbe
Tablet 30mg Adalat Oros Bayer
iv. GOLONGAN ANTAGONIS ANGIOTENSIN II
1 Amlodipine + Valsartan
Tablet 5mg + 80mg Exforge Novartis
Tablet 10mg + 160mg Exforge Novartis
Tablet 5mg + 160mg Exforge Novartis
2 Candesartan Cilexetil
Tablet 8mg Candesartan Generik
Blopress Takeda
Tablet 16mg Candesartan Generik
Blopress Takeda
3 Candesartan + HCT
Tablet 16mg + 12,5mg Blopress plus Takeda
4 Irbesartan
Tablet 150mg Irbesartan Generik
Iretensa Fahrenheit
Tablet 300 mg Iretensa Fahrenheit
5 Irbesartan + HCT
Tablet 150mg + 12,5mg Co Aprovel Sanofi
6 Losartan
Tablet 50mg Santesar Sanbe
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 Formularium 2016

Acetensa Fahrenheit
7 Pitavastatin Cal
Tablet Livalo Tanabe

8 Telmisartan + Amlodipine
Tablet 40 mg + 5 mg Twynsta Boehringer
Tablet 80 mg + 5 mg Twynsta Boehringer
Tablet 80 mg + 10 mg Twynsta Boehringer
9 Valsartan
Tablet 80 mg Valsartan Generik
Tablet 160 mg Valsartan Generik
v. GOLONGAN LAIN LAIN
1. Clonidin HCl
Tablet 150 mcg Clonidine Generik
Catapress Boehringer
Injeksi 0,15mg/ml Catapress Boehringer
d. GLIKOSIDA JANTUNG
1 Digoxin
Tablet 0,25mg Digoksin Novartis
Fargoxin Fahrenheit
Injeksi Fargoxin Fahrenheit
e. OBAT UNTUK SYOK
i. INOTROPIK
1 Adrenalin / Efinefrin
Injeksi 1mg/ml Efinefrin Ethica
2 Dobutamine HCl
Injeksi 25mg/ml Dobutamine Generik

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 Formularium 2016

Inotrop Fahrenheit
3 Dopamin
Injeksi 200 mg Dopamin
4 Na Bikarbonat
5 Sulfas Atropin
Injeksi Atropin Sulfas Generik
ii. VASOKONSTRIKSI
1 Norephineprine
Injeksi Vascon Fahrenheit
f. PERIPHERAL VASODILATOR DAN CEREBRAL ACTIV
1 Betahistine
Tablet 6mg Vertigosan Sanbe
Tablet 12 mg Merislon Eisai
Tablet 24mg Betaserc Solvay

2 Cilostazol
Tablet 50mg Pletaal Otsuka
Tablet 100mg Pletaal Otsuka
3 Citicoline
Tablet : 500mg Citicoline Generik
Neurolin Fahrenheit
Tablet : 1000mg Neulin PS Ferron
Injeksi : 100mg Nicholin Takeda
Injeksi : 12,5 % Brainact Kalbe
Beclov Sanbe
Neurolin Fahrenheit
Nicholin Takeda

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 Formularium 2016

Injeksi : 500mg Citicoline Generik

Neurolin Fahrenheit
Injeksi : 1000 mg Neulin Ferron
4 Co-Dergocrine Mesylate
Tablet : 4,5mg Cirloid Fahrenheit
5 Dipyradamol
Tablet Persantin Boehringer
6 Efinefrin
Injeksi 1mg/ml Efinefrin Ethica
7 Flunarizine
Tablet 5mg Flunarizine Generik
Gratizin Sanbe
8 Nicergoline
Tablet 10 mg Serolin Kalbe
9 Pentoxifylline
Tablet 400mg Tioxad Fahrenheit
Injeksi 20mg/ml Tioxad Fahrenheit
10 Piracetam
Capsul : 400mg Pratropil Fahrenheit
Revolan Sanbe
Kaplet : 800mg Piracetam Generik
Pratropil Fahrenheit
Revolan Sanbe
Tablet : 1200mg Revolan Sanbe
Syrup 10% Pratropil Fahrenheit
Injeksi : 1 g/5ml Pratropil Fahrenheit Revolan Sanbe
Injeksi : 3 g/15ml Piracetam Generik
Revolan Sanbe
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 Formularium 2016

Infus 12 g/60ml Pratropil Fahrenheit

g. PENURUN KOLESTEROL
1 Atorvastatin
Tablet 10mg Lipitor Pfzer
Atofar Fahrenheit
Tablet 20mg Atorvastatin Generik
Lipitor Pfzer
Atofar Fahrenheit
Tablet 40mg Lipitor Pfzer
Atofar Fahrenheit
2 Amlodipine + Atorvastatin
Tablet 5mg + 10mg Caduet Pfzer
Tablet 5mg + 20mg Caduet Pfzer
Tablet 10mg + 10mg Caduet Pfzer
3 Bezafibrate
Tablet 200 mg Decrilip Sanbe
4 Fenofibrate
Tablet 200 mg Micronised Hyperchol M Ikapharmindo
Tablet 300mg Fibramed Promed
Trolip DexaM
Tablet 145 mg Lipanthyl Penta Solvay
5 Gemfibrozil
Tablet 300mg Gemfibrozil Generik
Renabrazin Fahrenheit
6 Simvastatin
Tablet 5 mg Valemia Sanbe
Tablet 10mg Simvastatin Generik
Valemia Sanbe
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 Formularium 2016

Detrovel Fahrenheit
Tablet 20 mg Simvastatin Generik
7 Rosuvastatin
Tablet 10mg Crestor AstraZ
Tablet 20mg Crestor AstraZ
h. LAIN LAIN
1 Co Enzym
Softcaps 100mg Liproqy Sanbe
Ubi Q Eisai
Softcaps 30mg Ubi Q Eisai
2 D-ribose + L-carnitine fumarate + Co Enzym Q 10 + Mg
Sachet : 5000mg + 500mg + 50mg + 200mg Enercore Soho
3 K-l-aspartate + Mg l-aspartate + Bispentiamine + B6
Tablet : 100mg + 100mg +10mg + 5mg Aspar K Tanabe
4 Methionil + Glutamil + Histidil + Phenylalanil + Prolil + Glycil + Proline
Oral tetes Semax Semax
15. OBAT TOPIKAL UNTUK KULIT
a. ANTIBAKTERI
1 Fucidic Acid
Cream Afucid Ferron
2 Gentamycin Sulfat
Cream Gentamycin Generik Garamycin
Schering
Sagestam Sanbe
3 Mupirocin
Salep 2% Pibaksin Sanbe
Bactroban Glaxo

36
 Formularium 2016

4 Neomycin sulfat + Placenta extr.

Gel : 0,5% + 100mg Burnazin DaryaVaria
5 Neomycin sulfat + Bacitracin
Powder Nebacetin Pharos
6 Oxytetracycline HCl
Salep Kulit Oxytetracyclin Generik
7 Triamcinolone Acetonide
Salep Kenalog Squibb
Cream Kenacort-A Bristol
b. ANTIFUNGI
1 Ketoconazole
Tablet : 200mg Ketoconazole Generik
Formyco Sanbe
Salep Ketoconazole Generik
Formyco Sanbe
2 Miconazole Nitrat
Cream 2% Miconazole Generik
Oral gel Daktarin Janssen
serbuk Daktarin Janssen
3 Miconazole Nitrat + ZnO
Ointment Daktarin Diaper Janssen
4 Nystatin + ZnO
Ointment : 100.000iu + 200mg Myco-Z Bristol
5 Tioconazole
Cream Trosyd Pfizer
c. ANTIVIRUS
1 Acyclovir

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 Formularium 2016

Cream Acyclovir Generik

2 Tromantadine HCl
Gel Viru-Merz Combiphar
d. ANTIINFLAMASI DAN ANTIPRURITIK
1 Betametason valerate
Cream Betopic Armoxindo
2 Betamethazone Dipropionate + Asam Salisilat
Cream 10 gram Diprosalic Schering
3 Betametason + Gentamycin Sulfat
Tiap gram cream : 0,5mg+1mg Digenta Interbat
4 Betametazone Dipropionate + Gentamisin
Cream : 0,64mg + 1mg Diprogenta Schering
5 Desoximethazone
Cream 0,25% Desoximethazone Generik
Esperson Schering
Topcort Sanbe
6 Doxepin HCl
Cream Sagalon SDM
7 Fluocinolone acetonide
Cream Cinolon Sanbe
8 Fluocinolone acetonide + Neomisin Sulfat
Cream : 0,25mg + 5mg Cinolon N Sanbe
9 Fluticazone propionate
Cream Medicort SDM
10 Mometazone furoate
Cream Mefurosan Sanbe
Elocon Schering
11 Na Diklofenak
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 Formularium 2016

Gel 10 gram Flamar Sanbe

Voltaren Novartis
Gel 20 gram Voltaren Novartis
12 Piroxicam
Gel Pirofel Sanbe
Feldene Pfizer
e. ANTISKABIES
1 Permethrin
Cream Scabimite Galenium
f. PERANGSANG JARINGAN GRANULASI
1 Feracrylum
Solution 1% Hemolok DexaM
2 Hydrocortisone 17 butirate
Salep Hydrocortizone Generik
Lotion Locoid Combiphar
3 Tetrachlorodera-oxygen anion complex
Larutan Oxoferin Pharos
g. LAIN LAIN
1 CMC Polymer + Propylenglikol + Water
Gel Intrasite Kalbe
2 Clobetazol propionate
Cream Forderm Ferron
3 Desonide
Cream 0,5mg Apolar Alpharm
4 Desonide + Neomycin sulfat
Cream : 0,5mg + 5mg Apolar N Alpharm
5 Dexpanthenol

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 Formularium 2016

Ointment 5% Bepanthen Bayer

6 Eco Honey + Glycerin + PPG + PEG 4000
Gel 20 gram Sanoskin Melladerm Interbat
7 Extr. Cepalin + Allantoin
Gel 10% + 1% Mederma Combiphar
8 Heparin
Gel Thrombophob Tunggal
9 Hydroquinone
Cream Melanox SDM
10 Lanolin anhidrat + Isopropil miristat + Setil alkohol + Sorbiton monostearat + Polisorbat + Gliserol + Dimetikon + Asam
sorbet
Salep Decubal Alpharm

11 Mentol + Eugenol + Methlsalisilat

Salep Lafalos Sanbe
Gel Counterpain Bristol
Painkila
12 O2 + Olive Oil
Gel 30 gram Sanoskin Oxy Interbat
13 Polysiloxane, Silicon dioxide
Gel Kelo-Cote AxeliaH
14 Radix scutellariae + Phellodendri cortex + Rhizome coptidis
Ointment Mebo Combiphar
15 Urea
Cream 10% Carmed SDM
Cream 20% Carmed SDM
16. LARUTAN ELEKTROLIT, NUTRISI, DLL
a. NUTRISI
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 Formularium 2016

1 Amino Acids
Infus Pan Amin G Otsuka
Valamin Sanbe
2 Amino Acid + Vitamin + Elektrolit
Infus Benutrion Ve Sanbe
Comafusin Kalbe
3 Asam Amino + Elektrolit
Infus Renosan Sanbe
Livamin Sanbe
4 Asam Amino + Nitrogen
Infus Nephrosteril Fresenius
5 Asam Amino + Rendah (Methionine + Phenylalanine + Tryptofan)
Infus Aminofusin Hepar Kalbe
6 Asam Amino + Glucose + Elektrolit
Infus Clinimix Kalbe
Aminofluid Otsuka
7 Asam Amino + Glucose + Elektrolit + Fat Emulsion
Infus Kabiven 1440ml Fresenius
8 Dextrose Monohidrat
Infus Dextrose 5% Otsuka
Dextrose 40% Otsuka
9 Fat Emulsion
Infus 20% Intralipid Fresenius
10 Hydroxyethyl strach 200/0,5 + NaCl
Infus Wida HES Widatra
11 Maltosa
Infus Martos Otsuka
Infumal 10% Sanbe

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 Formularium 2016

12 Na + Cl + K + Lactate + Glucose
Infus Ka EN 3 B Otsuka
Ka EN Mg3 Otsuka
13 Refined Olive Oil + Refined Soya Bean Oil
Infus 20% 100 ml Clinoleic Kalbe
Infus 20% 250 ml Clinoleic Kalbe
14 Soybean Oil + Phosphatide Egg + Gliserol + Na Oleat
Infus 100 ml Ivelip 20% Kalbe
b. KESEIMBANGAN CAIRAN ELEKTROLIT
1 Dextrose
Infus 500 ml Dextrose 5% Otsuka
Dextrose 10% Otsuka
Infusan D5% Sanbe
Infus 100 ml Piggy D5 Otsuka
2 Dextran + CaCl2 + NaCl + KCl + Na Lactate + Mineral
Infus Dextran L Otsuka
3 Fruktosa + Glukosa + Xylitol
Infus 1000 ml Triofusin Pfrimmer
Infus 500 ml Triofusin Pfrimmer
4 Gelatine + Na Acetatetrihydrate + NaCl + KCl + CaCl + MgCl + NaOH
Infus Gelafusal DexaM
5 KCl
Tablet 600 mg KSR Merck
Injeksi 7,46% KCl Otsuka
6 Manitol
Infus Manitol Otsuka
Infusan M-20 Sanbe
7 Na + Cl + K + Lactate + Glucose
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 Formularium 2016

Infus Tridex 100 Sanbe

KaEN 3 B Otsuka
Tridex 27B Sanbe
8 Na + Cl + K + Lactate + Glucose
Infus KaEN Mg 3 Otsuka

9 Na + Cl + K + Ca + Mg + Acetate +
Infus Futrolit Sanbe
10 Na + K + Cl + Ca + Asetate
Infus Asering Otsuka
Infusan Ring-As Sanbe
11 NaCl
Infus 0,9% 500 ml NaCl Otsuka
Infusan NS Sanbe
Infus 0,9% 100 ml Piggy NS Otsuka
Infusan NS Sanbe
Infus 3% NaCl Otsuka
12 Na Lactate + NaCl + KCl + CaCl2
Infus Ringer lactat Otsuka
Infusan RL Sanbe
13 Na + Cl + Glukosa
Infus KaEN 1B Otsuka
14 Na + K + Ca + Mg + Cl + Acetate + Sorbitol
Infus Tutofusin OPS Kalbe
15 Oralit
Liquid Pedialyte Abbott
Renalyte Fahrenheit
17. OBAT UNTUK MATA
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 Formularium 2016

a. SISTEMIK
1 Dibekacin
Tetes mata : 3mg/ml Dibekacin Meiji
2 Fenilefrin HCl + Neomycin sulfat + polimiksin B sulfat
Tetes mata Polifrisin Sanbe
3 Gentamicin Sulfat
Tetes mata : 3mg/ml Gentamycin Cendo
Salep Mata Gentamycin Cendo
4 Polimyxin B Sulfate + Neomycin + Dexamethazone
Tiap ml tetes mata : 10.000iu + 3,5mg + 1mg Xitrol Cendo
Polidemisin Sanbe
Polidex Cendo
Salep mata Xitrol Cendo

b. TOPIKAL
i. ANTIMIKROBA
1 Chloramphenicol
Tetes mata 0,5% Fenicol Cendo
2 Ciprofloxacin
Tetes mata Baquinor Sanbe
3 Dibekacin
Tetes mata 3mg/ml Dibekacin Meiji
4 Fluorometholone + Neomycin Sulfate
Tiap ml tetes mata : 1mg+3,5mg Polynel Cendo
5 Gentamicyn Sulfat

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 Formularium 2016

Tetes mata 3mg/ml Sagestam Sanbe

Genta Cendo
Salep mata Genta Cendo
6 Idoxuridine
Tetes mata 1mg/ml Cendrid Cendo
7 Levofloxacin
Tetes mata LFX Cendo
Levocin Sanbe
8 Ofloxacin
Tetes mata 3mg/ml Floxa Cendo
Tarivid Kalbe
9 Oxytetracyclin HCl
Salep mata Oxytetracyclin Generik
Terramycin Pfizer
10 Polimyxin B Sulfate + Neomycin
Tiap ml tetes mata :5000iu + 2,5mg Polygran Cendo
11 Polimyxin B Sulfate + Neomycin + Phenylephrine HCl
Tiap ml tetes mata : 16.250iu + 3,5mg Polifrisin Sanbe
+ 1,2mg
12 Polimyxin B Sulfate + Neomycin + Dexamethazone
Tiap ml tetes mata : 10.000iu + 3,5mg Xitrol Cendo
+ 1mg Polidemisin Sanbe
Polidex Cendo
Salep mata Xitrol Cendo
13 Tobramycin + Dexamethazone
Tetes mata : 3mg + 1mg Tobroson Cendo

ii. ANAESTETIK LOKAL

45
 Formularium 2016

1. Tetracain
Tetes mata 0,5% Pantocain Cendo
Tetes mata 1% Pantocain Cendo
iii. MIDRIATIK
1 Tropicamide
Tetes mata 0,5% Mydriatyl Cendo
iv. MIOTIK DAN ANTIGLAUKOMA
1 Atropin Sulfat
Tetes mata 1% Cendo Carpine Cendo
v. KORTIKOSTEROID
1. Fluorometholone
Tetes mata 0,1% Ocuflam Sanbe
vi. LAIN LAIN
1 Na Diklofenak
Tetes mata 1mg/ml Flamar Sanbe
2 Aesculinum + Quinidine sulfas + ZnSO4 + Vit A
Tiap ml tetes mata : 0,9mg+ 1mg Augentonic Cendo
+ 20mg + 0,1mg
3 CaCl2 anhidrat + KI + Na Thiosulfat + Fenil Merkuri Nitrat
Tetes mata Catarlent Cendo
4 HPMC
Tetes mata 2mg Lubricent Cendo
5 HPMC + Dextran
Tetes mata : 3mg + 1mg Eyefresh Cendo
6 HPMC + Dextran + Gliserin
Tetes mata : 5mg + 1mg + 2mg Eyefresh Plus Cendo
7 KI + NaCI

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 Formularium 2016

Tetes mata : 5mg + 10mg Vitrolenta Cendo

8 NaCl + KCl
Tetes mata : 4,40mg + 0,8mg Lyteers Cendo
9 Na Carboxymethylcellulose
Tetes mata 5mg/ml Cenfresh Cendo
10 Na Hyaluronate
Tetes mata 1% Cendo Hyalub Cendo
Hialid Ferron Hyaloph Sanbe

11 Pemirolast
Tetes mata 0,1% Alegysal Ferron
12 Pirenoxine Na
Tiap 15ml 0,85mg Kary Uni Ferron
13 Polyvinyilpyrolidone + Vit A
Tetes mata : 20mg + Vit A ProtagentA Cendo
14 Vitamin A + Oxymethazoline HCl + Hydroxypropylmethylcellulose (HPMC)
Tetes mata : 1000iu +0,25mg + 5mg Asthenof Cendo
15 Vit A + B1 + Ca Phanthothenate
Tetes mata : 1000iu +0,5mg + 5mg Rephitel Cendo
16 Betacaroten + A + E
Tablet 5 mg + 1820ui + 40mg Cendovital Cendo
17 Billberry extr. + Lutein + -carotene + A + B2 + E
Tablet : 80mg + 1600iu + 40iu + 5mg Berry Vision Sanbe
18 Billberry extr. + Retinol + -carotene + E + Lutein + Zeaxanthin + Se + Zn
Tablet Eyevit Lapi
19 -carotene + C + E + Zn + Copper + Se + Lutein + Lycopene + Zeaxanthin
tablet : 5mg + 100mg + 60mg + 10mg Retivit Plus Sanbe
+ 1,5mg + 50mcg +30mg + 2mg + 0,67mg

47
 Formularium 2016

20 Vaccimum myrtillus fructus extr.

Tablet 80 mg Cendo Berry Cendo
18. PSIKOFARMAKA
a. ANTANSIETAS DAN ANTIINSOMNIA
1 Alprazolam
Tablet 0,5mg Alprazolam Generik
Xanax Pfzer
Tablet 1mg Alprazolam Generik
2 Bromazepam
Tablet 3 mg Lexotan Roche
3 Chlordiazepoxide + Clinidrium Br
Tablet 5mg + 2,5mg Braxidin Sanbe
Renagas Fahrenheit
4 Clobazam
Tablet 10mg Frisium Aventis
5 Diazepam
Tablet : 2mg Diazepam Generik
Valisanbe Sanbe
Tablet : 5mg Valisanbe Sanbe
Injeksi : 10mg/ml Valisanbe Sanbe
Valium Roche
Rectal tube5mg.2,5ml Stesolid Alpharm
Rectal tube5mg.2,5ml Stesolid Alpharm
Syrup Stesolid Alpharm
6 Lorazepam
Tablet 1mg Renaquil Fahrenheit
Tablet 2mg Merlopam Mersi
7 Sulpiride
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 Formularium 2016

Tablet Dogmatil Soho

b. ANTIDEPRESI DAN ANTIMANIA
1 Fluoxetine
Tablet 10mg Kalxetin Kalbe
Tablet 20mg Kalxetin Kalbe
2 Lithium carbonate
Tablet Frimania Mersifarma
3 Maprotiline HCl
Tablet 25mg Ludiomil Novartis
4 Sertraline HCl
Tablet 50mg Zoloft Pfzer
Fatral Fahrenheit
c. HIPNOTIK DAN SEDATIF
1 Diazepam
Tablet : 2mg Diazepam Generik
Valisanbe Sanbe
Tablet : 5mg Valisanbe Sanbe
Injeksi : 10mg/ml Valisanbe Sanbe
Valium Roche
Rectal tube5mg.2,5ml Stesolid Alpharm
Rectal tube5mg.2,5ml Stesolid Alpharm
Syrup Stesolid Alpharm
2 Estazolam
Tablet 1 mg Esilgan Takeda
Tablet 2 mg Esilgan Takeda
Estalin Novell
3 Lorazepam

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 Formularium 2016

Tablet 1mg Renaquil Fahrenheit

Tablet 2mg Merlopam Mersi
4 Midazolam
Injeksi Anesfar Fahrenheit
5 Nitrazepam
Tablet 5 mg Dumolid Actavis
6 Zolpidem tartrate
Tablet 10mg Zolmia Fahrenheit
Stilnox Sanofi
d. ANTIPSIKOSIS
1 Chlorpromazine (generik)
Tablet Chlorpromazine Generik
Injeksi Cepezet Mersi
2 Clozapine
Tablet 25mg Sizoril Meprofarm
3 Donepezil
Tablet 5 mg Aricept Eisai
Alzim Fahrenheit
4 Haloperidol
Tablet 0,5 mg Haloperidol Generik
Tablet 5mg Haloperidol Generik
Lodomer Mersi
Injeksi Lodomer Mersi
5 Quetiapine
Tablet XR 300 mg Seroquel AstraZ
6 Risperidone
Tablet 2 mg Risperidone Generik
Tablet 3mg Zofredal Kalbe
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 Formularium 2016

7 Rivastigmine
Patch 5 Exelon Novartis
Patch 10 Exelon Novartis
19. RELAKSAN OTOT PERIFER DAN PENGHAMBAT KOLINESTERASE
a. PENGHAMBAT NEUROMUSKULAR
1 Atracurium besylate
Injeksi 25mg Farelax Fahrenheit
2 Citicoline
Tablet : 500mg Citicoline Generik
Neurolin Fahrenheit
Tablet : 1000mg Neulin PS Ferron
Injeksi : 100mg Nicholin Takeda
Injeksi : 12,5 % Beclov Sanbe
Neurolin Fahrenheit
Nicholin Takeda
Injeksi : 500mg Citicoline Generik
Neurolin Fahrenheit
Injeksi : 1000 mg Neulin Ferron
3 Diazepam
Tablet : 2mg Diazepam Generik
Valisanbe Sanbe
Tablet : 5mg Valisanbe Sanbe
Injeksi : 10mg/ml Valisanbe Sanbe
Valium Roche
Rectal tube5mg.2,5ml Stesolid Alpharm
Rectal tube5mg.2,5ml Stesolid Alpharm
Syrup Stesolid Alpharm

51
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4 Eperisone
Tablet 10mg Eperisone Generik
Eprinoc Sanbe
Myonal Eisai
5 Neostigmine Methylsulfat
Injeksi 0,5mg/ml Neostigmin Combiphar
Prostigmin Transfarma
6 Pyridostigmine Br
Tablet Mestinon Transfarma
7 Rocuronium Br
Ampul 50 mg Roculax Kalbe
8 Tizanidine HCl
Tablet 2mg Myores Meprofarm
b. ENZIM ANTI INFLAMASI
1 Serratiopeptidase + Pancreatin + Lecithin
Kaplet 5 mg + 25 mg + 100 mg Nutriflam Tropica
c. OBAT UNTUK MISTENIA GRAVIS
1 ATP
Tablet ATP Dankos
2 Neostigmine Methylsulfate
Injeksi 0,5mg/ml Neostigmin Combiphar
Prostigmin Transfarma

20. OBAT UNTUK SALURAN CERNA

a. ANTASIDA DAN GIT REGULATOR
1 Chlordiazepoxide + Clinidrium Br
Tablet 5mg + 2,5mg Braxidin Sanbe

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Renagas Fahrenheit
2 Famotidin
Tablet 40 mg Famotidine Generik
3 Granisetron
Injeksi 1 mg Degrani Fahrenheit
Injeksi 3 mg Degrani Fahrenheit
4 Lansoprazole
Capsul 30mg Lansoprazole Generik
Lapraz Sanbe
Prazotec Fahrenheit
Injeksi Prosogan Takeda
5 Metochlopramide HCl
Tablet 10mg Metochlopramide Generik
Damaben Sanbe
Tiap ml drops 4mg Damaben Sanbe
Tiap 5ml syrup Damaben Sanbe
Injeksi 5mg/ml Damaben Sanbe
6 Mg trisilikat + Al(OH)3 coloidal + Papaverin + Chlordiazepoxide HCl + B1 + B6 + B12 + Niasinamide + Ca Panthotenate
Tablet 325mg + 250mg + 5mg + 2mg Sanmag Sanbe
+ 500mcg +1mcg + 5mg+ 1mg
7 Mg trisilikat + Al(OH)3 coloidal + Simethicone
Tiap 5ml syrup : 325mg +325mg + 25mg Sanmag Sanbe
8 Misoprostol
Tablet 20 mcg Gastrul Fahrenheit
9 Na Esomeprazole
Tablet 20mg Nexium AstraZ
Tablet 40mg Nexium AstraZ
Injeksi 40mg Nexium AstraZ

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10 Na Raberazole
Tablet 20 mg Pariet Eisai
11 Omeprazole
Capsul 20mg Omeprazole Generik
Pumpitor Sanbe
Rindopump Yarindo
Injeksi 40mg/ml Omeprazole Generik
Pumpitor Sanbe
Rindopump Yarindo
12 Ondansetron
Tablet 4mg Ondansetron Generik
Trovensis Sanbe
Onetic Fahrenheit
Tablet 8mg Trovensis Sanbe
Onetic Fahrenheit
Injeksi 2mg/ml Ondansetron Generik
Onetic Fahrenheit
Trovensis Sanbe
Injeksi 4mg/ml Trovensis Sanbe
Onetic Fahrenheit
13 Pantoprazole
Tablet 20mg Pariet Eisai
Tablet 40mg Pantozol Pharos
Injeksi Pantoprazole Generik
Pumpisel Sanbe
14 Ramosetron
Injeksi 0,3 mg Nasea Astellas
15 Ranitidine HCl
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Tablet 150mg Ranitidine Generik

Acran Sanbe
Renatac Fahrenheit
Tablet 300 mg Acran Sanbe
Syrup Ranivell Novell
Injeksi 25mg/ml Ranitidine Generik
Acran Sanbe
Renatac Fahrenheit
16 Rebamipide
Tablet 100 mg Rebamipide Generik
Sysmeco Fahrenheit
17 Simethicone + Mg(OH)2 + Al(OH)3
Tablet 20mg + 200mg + 200mg Acitral Interbat
Syrup Acitral Interbat
18 Simethicone + Mg(OH)2 + Al(OH)3 Mg carbonat dried gel
Tablet forte : 125mg + 100mg+ 275mg Farmacrol Fahrenheit
19 Simethicone + Mg(OH)2 + Al(OH)3
Tiap 5ml susp forte : 125mg +100mg Farmacrol Fahrenheit
+ 200mg
Tiap ml susp : 50mg + 250mg + 250 mg
Tiap ml susp forte : 80 mg +400mg Farmacrol Fahrenheit
+ 400 mg
20 Sucralfate
Tiap 5ml susp 500mg Inpepsa Fahrenheit
Episan Sanbe
b. TUKAK PEPTIK
1 Chlordiazepoxide + Clinidium Br
Tablet 5mg + 2,5mg Braxidin Sanbe
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Renagas Fahrenheit
2 Lansoprazole
Capsul 30mg Lansoprazole Generik
Lapraz Sanbe
Prazotec Fahrenheit
Injeksi Prosogan Takeda
3 Na Esomeprazole
Tablet 20mg Nexium AstraZ
Tablet 40mg Nexium AstraZ
Injeksi 40mg Nexium AstraZ
4 Omeprazole
Capsul 20mg Omeprazole Generik
Pumpitor Sanbe
Rindopump Yarindo
Injeksi 40mg/ml Omeprazole Generik
Pumpitor Sanbe
Rindopump Yarindo
5 Ondansetron
Tablet 4mg Ondansetron Generik
Trovensis Sanbe
Onetic Fahrenheit
Tablet 8mg Trovensis Sanbe
Onetic Fahrenheit
Injeksi 2mg/ml Ondansetron Generik
Onetic Fahrenheit
Trovensis Sanbe
Injeksi 4mg/ml Trovensis Sanbe
Onetic Fahrenheit
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6 Pantoprazole
Tablet 20mg Pariet Eisai
Tablet 40mg Pantozol Pharos
Injeksi Pantoprazole Generik
Pumpisel Sanbe
7 Ranitidine HCl
Tablet 150mg Ranitidine Generik
Acran Sanbe
Renatac Fahrenheit
Tablet 300 mg Acran Sanbe
Syrup Ranivell Novell
Injeksi 25mg/ml Ranitidine Generik
Acran Sanbe
Renatac Fahrenheit
8 Simethicone + Mg(OH)2 + Al(OH)3 Mg carbonat dried gel
Tablet forte : 125mg + 100mg+ 275mg Farmacrol Fahrenheit
9 Simethicone + Mg(OH)2 + Al(OH)3
Tiap 5ml susp forte : 125mg +100mg Farmacrol Fahrenheit
+ 200mg
Tiap ml susp : 50mg + 250mg + 250 mg Magtral Otto
Tiap ml susp forte : 80 mg +400mg Farmacrol Fahrenheit
+ 400 mg
10 Sucralfate
Tiap 5ml susp 500mg Inpepsa Fahrenheit
Episan Sanbe
c. ANTIFLATULEN DAN GIT REGULATOR
1 Lactobacillus rhamnosus + Lact.acidophillus
Sachet Probiokid Sanbe
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Capsul Lacidofil DexaM

L-Bio Lapi
2 Lactobacillus reuterii
Tablet Rillus Kalbe
Drops Interlac Probiotic Interbat
3 Lactobacillus + C + B1 + B2 +B6 +niasin +protein
Lactobacillu +10mg+0,5mg+0,5mg Lacto B Novell
+0,5mg+2 mg
4 Lanzoprazole
Capsul 30mg Lansoprazole Generik
Lapraz Sanbe
Prazotec Fahrenheit
Injeksi Prosogan Takeda
5 Metochlorpropamid
Tablet 10mg Metochlopramide Generik
Damaben Sanbe
Tiap ml drops 4mg Damaben Sanbe
Tiap 5ml syrup Damaben Sanbe
Injeksi 5mg/ml Damaben Sanbe
6 Mezalasine
Tablet 250 mg Salofalk DaryaVaria
7 Pancreatin + Dimethylpolysiloxane
Caplet 170mg+80mg Tripanzym Sanbe
Gasflat Fahrenheit
8 Sulfazalazine
Tablet Sulcolon Bernofarm
d. ANTIEMETIK
1. Dimenhydrinate
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2. Domperidone
Tablet 10mg Domperidone Generik
Vosedon Sanbe
Tiap 5ml syrup Domperidone Generik
Vosedon Sanbe
Tiap ml drops Dominal Actavis
Vometa DexaM
3. Granisetron
Injeksi 1 mg Degrani Fahrenheit
Injeksi 3 mg Degrani Fahrenheit
4. Metochlopramide HCl
Tablet 10mg Metochlopramide Generik Damaben Sanbe
Tiap ml drops 4mg Damaben Sanbe
Tiap 5ml syrup Damaben Sanbe
Injeksi 5mg/ml Damaben Sanbe
5. Ondansetron HCl
Tablet 4mg Ondansetron Generik
Trovensis Sanbe
Onetic Fahrenheit
Tablet 8mg Trovensis Sanbe
Onetic Fahrenheit
Injeksi 2mg/ml Ondansetron Generik
Onetic Fahrenheit
Trovensis Sanbe
Injeksi 4mg/ml Trovensis Sanbe
Onetic Fahrenheit
6. Pyrathiazine theoclate + B6
Tablet 40mg + 37,5mg Mediamer B6 DaryaV

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7. Ramosetron
Injeksi 0,3 mg Nasea Astellas
e. ANTIHAEMORRHOID
1 Diosmin + Hesperidin
Tablet 450 mg + 50 mg Rhodium Fahrenheit
Ardium Servier
2 Extr. Citrus Bioflavonoids + Diosmin + Hesperidin
Kaplet 500 mg + 450 mg + 50 mg Ciflon Lapi
3 Fluorocortolone privalate + Lidocain
Cream Ultraproct N Transfarma
4 Lithospermi radix extr. + Etilaminobenzoat + Diphenhydramine HCl + Cetrimide + Dibucaine HCl
Suppo Borraginol N Takeda
Ointment Borraginol N Takeda
5 Lithospermi radix extr. + Prednisolon + Lidocaine + Benzocaine + Cetrimide
Suppo Borraginol S Takeda
Ointment Borraginol S Takeda
6 Metokresol sulfonat dan Metanol + Sikokaina
Suppo : 100mg + 2,5mg Faktu Pharos
f. ANTISPASMODIK
1 Chlordiazepoxide + Clinidium Br
Tablet 5mg + 2,5mg Braxidin Sanbe
Renagas Fahrenheit
2 Hyosine N butyl Bromide
Tablet 10mg Buscopan Inglheim
Injeksi 20mg/ml Hyoscine Generik
Buscopan Inglheim
3 Hyosine N butyl Bromide + PCT
Tablet 10mg + 500mg Buscopan Plus Inglheim
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4 Loperamide HCl
Tablet 2mg Lodia Sanbe
5 Otilonium Br
Tablet 40mg Spasmomen DexaM
6 Mebeverine HCl
Tablet Irbosyd Fahrenheit
7 Papaverin (generik)
Tablet Papaverin Generik
g. OBAT UNTUK DIARE
1 Attapulgite + Pectin
Kaplet : 600mg + 50mg Neo Diastop Conmed
Tablet 650 mg + 50 mg Neo Enterostop Kalbe
2 Attapulgite active
Tablet 600mg New Diatabs UAP
3 Kaolin + Pectin
Tiap 5ml susp : 700mg + 66mg Neo Kaolana Sanbe
4 Loperamide HCl
Tablet 2mg Lodia Sanbe
5 Nifuroxazide
Tiap 5ml susp : 250mg Sanfuro Sanbe
6 Zn Sulfate
Syrup Darya Zinc DaryaVaria
Zincpro Combiphar
Zirea Actavis
Drops Darya Zinc DaryaVaria
Zincpro Combiphar

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h. LAKSATIF
1 Bisacodyl
Tablet 5mg Dulcolax Inglheim
Suppo 10mg Dulcolax Inglheim
Stolax Sanbe
2 Fenolftalein + Parafin Cair + Glycerin
Tiap 5ml syrup : 55mg + 1,2mg + 378mg Laxadine Galenium
3 Lactulosa
Tiap 15ml syrup : 10g Pralax Fahrenheit
Dulcolactol Boehringer
4 Monobasic Na Phospate + Dibasic Na Phospate
Liquid oral Fleet Phosposoda Combiphar
5 Na laurel Sulfoasetat + Na sitrat + asam sorbet + PEG
Suppo Microlax Inglheim
6 Na Phosphat
Liquid Fleet enema Combiphar
Fosen enema Fahrenheit
7 Sodium Picosulfate
Tiap ml drops 7,5mg Laxoberon Inglheim
i. KOLAGOGUM, KOLELITOLITIS DAN HEPATIC PROTECTOR
1 Curcuminoid + Silymarin phytosome + Extr.Echinacea + Choline bitartrat +B 6
Tablet : 20mg+70mg+150mg +150mg+2mg Hepatin Lapi
2 Esential phospholipid + B1 + B2 + B6 + B12 + nicotinamide + ginseng + curcuma
Softcaps : 300mg+7mg+7mg+7mg+ 7mcg+ Procur Plus Guardian
30mg+ 7mg+30mg
3 Extr. Curcuma+ Silymarin physotome + Extr.Schizandrae + Liquiritae Radix Choline bitartrat + B6
Kaplet : 150mg+35mg+135mg+135mg BioCurliv Soho
+150mg+2mg
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4 Kleinhovia hospital + Curcuma xanthorrhiza + NIgella sativa + Arcangelisa flava + Ophiocephalus striatus
Capsul Heparmin RoyalMed
5 L-ornithine-L-aspartate
Sachet 3 gram Hepa-Merz Combiphar
Ampul 5g/10ml Hepa-merz Combiphar
Forhepa Kalbe
6 PPC + Silymarin phytosome + extr. Schizandra + d tocopherol
Softcaps Hepamax Kalbe
7 Pure lecithin + B1 + B6 + B12 + Nicotinamide + E
Tablet 600mg Lesichol Landson
Tablet 300mg Lesichol Landson
8 Schizandrae fructus
Tablet 7,5mg HP Pro Biolife
9 Ursodeoxycholic acid
Capsul : 250mg Estazor Fahrenheit
21. OBAT UNTUK SALURAN NAFAS
a. ANTIASMA
1 Aminophylline
Tablet 200mg Aminophylline Generik
Injeksi 24mg/ml Aminophylline Ethica
2 Acefylline Piperazine
Tablet 250 mg Etaphylline Corsa
3 Dexamethazone
Tablet : 0,5mg Dexamethazone Generik
Cortidex Sanbe
Injeksi : 5mg/ml Dexamethazone Generik
Cortidex Sanbe

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4 Indacaterol maleate
Inhal powder Onbrez Breez Novartis
5 Ipratropium Br + Fenoterol
Inhaler 0,02 mg + 0,05 mg Berodual Boehringer
6 Ipratropium Br + Salbutamol
Nebulizer 0,5 mg + 2,5 mg Combivent Boehringer
Farbivent Fahrenheit
7 Ketotifen Hydrogen Fumarat
Tablet 1mg Intifen Interbat
Syrup 0,2 mg/ml Profilas Kalbe
8 Procaterol HCl Hemihydrate
Tablet 0,025mg Meptin Mini Otsuka
Syrup Meptin Otsuka
Inhalation Solution 50 Meptin Otsuka
9 Salbutamol
Tablet 2mg Salbutamol Generik
Astharol Sanbe
Ventolin Glaxo
Fartolin Fahrenheit
Tablet 4mg Salbutamol Generik
Astharol Sanbe
Tiap 5ml syrup Ventolin Glaxo
Astharol Sanbe
Per dosis inhaler 100mcg Ventolin Glaxo
Nebulizer Ventolin Glaxo
Fartolin Fahrenheit
10 Salbutamol + Guaiafenesin
Syrup 2 mg + 75 mg Fartolin exp Fahrenheit
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11 Terbutaline sulfat
Tablet 2,5 mg Bricasma AstraZ
Turbuhaler Bricasma AstraZ
Injeksi Bricasma AstraZ
12 Tiotropium Br
Inhaler Spiriva Respimat Boehringer
13 Theophylline
Capsul 130mg Theobron Interbat
Tablet 125 mg Euphyllin RM Pharos
Tablet 250 mg Euphyllin R Pharos
b. ANTITUSIF
1 Codein HCl
Tablet 10 mg Codein KF
Tablet 20 mg Codein KF
2 Diphenhydramin + NH4Cl + DMP
Tiap 5ml syrup : 12,5mg + 100mg + 10mg Sanadryl DMP Sanbe
3 GG + DMP + NH4Cl + Diphenhydramine + PPA
Tiap 5ml syrup : 75mg +7,5mg + 100mg + Lapisiv Lapi
12,5mg +6mg
4 Noscapine
Capsul 50mg Longatin Alpharm
5 Tipepidine Hibenzale
Tablet 33,21mg Asvex Tanabe
c. MUKOLITIK DAN BRONKHODILATOR
1 Aminophylline
Tablet 200mg Aminophylline Ethica
Injeksi 24mg/ml Aminophylline Ethica

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2 Bromhexine HCl
Tablet 8mg Bisolvon Inglheim
Mucohexin Sanbe
Tiap 5ml syrup : 15mg Bisolvon Inglheim
Mucohexin Sanbe
Drops Bisolvon Inglheim
Injeksi Bisolvon Inglheim
Farmavon Fahrenheit
3 Budesonide
Tiap dosis inhaler Obucort Otsuka
Pulmicort Resuples Astraz
4 Budesonide + Formoterol Fumarat
Per dosis turbuhaler : 160mcg + 4,5mcg Symbicort AstraZ
5 Fluticasone propionate + Salmeterol
Per dosis inhaler : 50mcg + 25mcg Seretide 50 Glaxo
Per dosis inhaler : 125mcg + 25mcg Seretide 125 Glaxo
Per dosis inhaler : 100mcg + 50mcg Seretide diskus 100 Glaxo
Per dosis inhaler : 250mcg + 50mcg Seretide diskus 250 Glaxo
6 Fluticasone Propionate
Per dosis nebulizer : 50mcg Flixotide Glaxo
7 Salbutamol
Tablet 2mg Salbutamol Generik
Astharol Sanbe
Ventolin Glaxo
Fartolin Fahrenheit
Tablet 4mg Salbutamol Generik
Astharol Sanbe
Tiap 5ml syrup Ventolin Glaxo
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Astharol Sanbe
Per dosis inhaler 100mcg Ventolin Glaxo
Nebulizer Ventolin Glaxo
Fartolin Fahrenheit
8 Terbutaline Sulfat
Tablet 2,5 mg Bricasma AstraZ
Turbuhaler Bricasma AstraZ
Injeksi Bricasma AstraZ
9 Theophylline
Capsul 130mg Theobron Interbat
Tablet 125 mg Euphyllin RM Pharos
Tablet 250 mg Euphyllin R Pharos
10 Trimetoquinol HCl
Tablet 3mg Inolin Tanabe
d. EKSPECTORAN
1 Ambroxol HCl
Tablet 30mg Ambroxol Generik
Epexol Sanbe
Mucopect Inglheim
Tablet 75mg Mucopect Inglheim
Tiap 5ml syrup : 15mg Ambroxol Generik
Epexol Sanbe
Mucopect Inglheim
Syrup Forte Epexol Sanbe
Drops Mucopect Inglheim

2 Bromhexine HCl
Tablet 8mg Bisolvon Inglheim
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Mucohexin Sanbe
Tiap 5ml syrup : 15mg Bisolvon Inglheim
Mucohexin Sanbe
Drops Bisolvon Inglheim
Injeksi Bisolvon Inglheim
Farmavon Fahrenheit
3 Diphenhydramine + NH4Cl + K guaicol sulfonate
Tiap 5ml syrup : 12,5mg + 100mg + 30mg Sanadryl Exp Sanbe
4 DMP + Promethazine HCl + Bromhexine HCl
Tiap 5ml syrup : 7,5mg + 5mg + 4mg Halmezin Coronet
5 Endosterine
Tablet 300mg Vectrine DexaM
Vestein Kalbe
Edotin Ferron
Tiap 5ml syrup 175mg Vectrine DexaM
Vestein Kalbe
6 Oxomemazin + Guaiafenesin
Tiap 5ml : 1,65mg + 33,3mg Toplexil Sanofi
7 Pipezetate
Tablet 20mg Selvigon Transfarma
Syrup 10 mg/ 5ml Selvigon Transfarma
e. ANTIINFLUENZA DAN PREPARAT BATUK
1 Betamethazone + Dexchlorpheniramine Maleate
Tablet : 0,25mg + 2mg Ocuson Sanbe
Tiap 5ml syrup : 0,25mg + 2mg Celestamine Schering
2 Dex CTM + Pseudoephedrine sulfate + GG
Tablet 2mg + 20mg + 100 mg Polaramine Schering
3 DMP + GG + CTM
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Tablet 15 mg + 100 mg + 1 mg Promedex Interbat

4 Promethazine + DMP + Ipecac tintur + Guaiafenesin + Na Citrat + Mentol
Syrup Promedex Interbat
5 Levodropropizine
Syrup Levopront Combiphar
6 N Acetylcysteine
Tablet 200 mg Acetylcysteine Generik
Acetin Sanbe
Fluimucil Zambon
N ace Fahrenheit
Tablet effervescent 600 mg Acetin Sanbe
Fluimucil Zambon
Syrup Fluimucil Zambon
Injeksi 100 mg N ace Fahrenheit
Fluimucil Zambon
7 Paracetamol + PPA
Tablet 500 mg + 15 mg Sanaflu Sanbe
8 PCT + DMP + PPA + CTM
Tablet 500mg + 10mg + 15mg + 1mg Tuzalos Sanbe
9 PPA + CTM
Tablet 15 mg + 2 mg Nalgestan UAP
10 Promethazine + DMP + Tingtur Ipeka + Guaiafenesin + Na. Sitrat + Menthol
Syrup 5 mg + 5mg + 0,1 ml + 50 mg Promedex Interbat
+ 197 mg + 1 mg
11 Pseudoephedrine + Terfenadine HCl
Tablet 30mg + 40mg Rhinofed DexaM

12 Pseudoephedrine HCl + Loratadine

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Tablet : 120mg + 5mg Aldisa SR Sanbe

Rhinos SR DexaM
13 Pseudoephedrine HCl + Triprolidine HCl
Tablet 60mg + 25mg Tremenza Sanbe
Tiap 5ml syrup : 30mg + 1,25mg Tremenza Sanbe
14 Triamcinolone Acetonide
Nasal Spray Nasacort AQ Sanofi
15 Triprolidine HCl + Pseudoephedrine HCl
Syrup 2,5mg + 60mg Lapifed Lapi
f. LAIN LAIN
1 Guaiafenesin + Extr. Thymi + Extr. Primulae + Extr. Althaea + Extr. Droserae + Extr. Serpylli + Oil Eucalyptus + Anise Oil
Syrup Silex DaryaV
22. OBAT YANG MEMPENGARUHI SISTEM IMUN
a. SERUM DAN IMUNOGLOBULIN
1 Fraksi Protein Plasma
Infus 5% Plasmanate DipaP
2 Human Albumin
Infus 20% Albapure DexaM
Alburaas Combiphar
Infus 25% Albuminaar DexaMF
b. VAKSIN
1 Human Tetanus
Injeksi Tetagam DexaM
c. IMUNOSUPRESAN
1 Tocilizumab
Injeksi Actemra Roche
2 Mycophenolate mofetil
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Tablet 500 mg Cellcept Roche

3 Methotrexate
Tablet Texorate Fahrenheit
Methotrexate Ferron
Injeksi Methotrexate Ferron
23. OBAT UNTUK TELINGA, HIDUNG DAN TENGGOROKAN
a. ANTIBAKTERI TOPIKAL
1 Ofloxacin
Tetes telinga Tarivid Kalbe
Akilen Sanbe
b. ANTISEPTIK DAN KORTIKOSTEROID
1 Polimyxin B Sulfat + Neomycin Sulfat + Fludrocortisone acetate + Lidocaine
Tetes Telinga Otopain Interbat
c. LAIN LAIN
1 Fluticazole
Tiap dosis nasal spray 50mcg Avamys Glaxo
2 Mometason Furoate
Tiap dosis nasal spray 50mcg Nasonex Schering
3 Na Docusate
Ear drops 5mg Forumen Sanbe
4 NaCl
Spray 30 ml Breathy Nasal Novell
Drops 30 ml Breathy Nasal Novell
24. VITAMIN DAN MINERAL
a. VITAMIN A,D,E
1 Vitamin E
Tablet : 400 mg Santa E Sanbe
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b. VITAMIN B DENGAN C
1 Asam Askorbat
Tablet 50 mg Vitamin C Generik
Biferce Sanbe
Injeksi Vitamin C Generik
Injeksi 1000mg Sankorbin Sanbe
2 B1 + B6 + B12
Tablet : 100mg + 100mg + 200mcg Neurosanbe Sanbe
Tablet : 100mg + 200mg + 200mcg Neurobion Merck
Farbion Fahrenheit
3 B1 + B6 + B12
Tablet : 100mg +100mg +5000mcg Neurobion 5000 Merck
Neurosanbe 5000 Sanbe
Rebal Plus Fahrenheit
Injeksi : 100mg + 100mg + 5000mcg Farbion 5000 Fahrenheit
Neurobion 5000 Merck
Neurosanbe Sanbe
4 B1 + B6 + B12
Tablet : 50mg + 100mg + 500mcg Nevramin Takeda
5 B1 + B6 + B12 + Na-Metamizole
Tablet : 50mg + 100mg + 100mcg + 500mg Neurosanbe Plus Sanbe
6 B1 + B2 +B6 + B12 + Nicotinamide
Tiap 5ml syrup : 5mg + 2mg + 2,5mg + 3mcg Becombion Merck
+ 20mg + d(+)panthotenol 3mg Sanvita B Sanbe
7 B1 + B2 +B6 + B12 + Vit C + Niacinamide + Ca Panthotenate
Tablet : 50mg + 25mg + 10mg + 5mcg Enervon C UnitedA
+ 500mg + 50mg + 20mg
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8 B6 + C + D + Ca Carbonate
Tablet effervescent Caldece Sanbe
9 Co-Enzyme B12
Kaplet 1000 mcg Cobazim Interbat
Kaplet 3000 mcg Cobazim Interbat
10 C + Citrus Bioflavonoid
Tablet Cester Ethica
Prove C Kalbe
11. Fursultiamine
Tablet Alinamin F Takeda
Injeksi Alinamin F Takeda
c. MULTIVITAMIN / DENGAN MINERAL
1 A + B1 + B2 + B6 + B12 + C + D + Ca Pantotenate + KI + Fe + Mg + Mn + Cu + Zn
Tablet Theragram M Bristol
2 A + B1 + B2 + B6 + B12 + C + D + Nicotinamide + Ca Panthotenate + Choline + Inositol + Ca Gluconate + Ca Hypophosphite +
Na Hypophosphite + Lysine
Syrup Elkana Sanbe
3 A + D + E + C + B1 + B2 + B6 + B12 + folic acid + biotin + as. panthotenate + nicotinamid
Injeksi 5ml Cernevit Kalbe
4 A + D + B1 + B2 + C + Niasinamide + Mn + Mg + Zn + Ca + I + Ca Panthotenate + Fe + Cu
Tablet Ultravita Sanbe
5 Asam folat + B1 + B6 + B12
Kaplet: 400mcg + 100mg + 200mg + 200mcg Nerva Plus Gracia
6 B1 + B2 + B6 + B12 + as.pantotenat + as.folat + Zn + Niacin
Kaplet: 15mg + 15mg + 20mg + 12mg + 20mg Becom Zet Sanbe
+ 400mg + 22,5mg + 100mg
7 B1 + B2 + B6 + B12 + Vit C + Nicotinamide + Ca Pantotenate
Kaplet : 50mg + 25mg + 10mg + 5mg Becom C Sanbe
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+ 500mg + 100mg + 20mg

8 B1 + B6 + B12 + E + As. Folat
Capsul Forneuro Dankos
9 -carotene + C + E + Zn + Se
Tablet : 10000iu + 250mg +200iu + Bevizil Sanbe
20mg + 30mg Seloxy Ferron
10 Ca phosphate + Ca Lactate + B6 + C + D
Tablet Elkana Sanbe
11 Ca Citrate + D3 + K1 + Mg + Zn
Tablet: 500mg + 200 iu + 20mcg Day Cal Sanbe
+ 100mg + 5mg Ossovit Interbat
12 Ca Elemental + D3
Tube : 600mg + 400 iu CDR Bayer
13 Ca Hydrogen Phosphate + Cholecalciferol
Tablet : 500mg + 133 iu Cavit D3 Merck
14 Coral Calcium + Natural Soy Isoflavone + D3 + KI + Mg + Zn + Boron
Kaplet Cal-95 Lapi
15 Fe Gluconate + MnSO4 + Copper Sulfat + C + Asam folat + B12
Capsul : 250mg + 200mcg + 200mcg + 50mg Biosanbe Sanbe
+ 1mg +7,5mcg Sangobion Merck
Syrup Sangobion Merck
16 Ginseng Extr. + A + B1 + B2 + Nicotinamide + B6 + B12 + C + D3 + E + Biotin + Asam Folat + Inositol + Lysine + Glutamic Acid +
Ca + Cu + Mg + K + Mn + Fe + Zn + P + Iodium Lesitin
Softcaps Provital Plus Landson
d. PAEDIATRIC VITAMIN DAN MINERAL
1 A + B1 + B2 + B6 + B12 + C + D + Nicotinamide + Lysin HCl + d-panthotenal
Syrup Sanbe Plex Sanbe
Drops Sanbe Plex Sanbe
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2 A + D + Minyak Ikan + DHA + Arachidonic Acid + Extr. Curcuma + + B1 + B2 + B6 + B12 + Nicotinamide + Choline + Inositol +
Lysin + Ca + Na + GOS
Syrup Elkana CL Sanbe
3 A + B1 + B2 + B6 + B12 + Nicotinamide + as. Folat + Inositol + Biotin + Fe + Zn + Mg + Cu + Se + Cr + Lysin + L glutamine
Syrup Zamel Novell
Drops Zamel Novell
4 A + B1 + B2 + B6 + Ca Pantotenate + Biotin + B12 + C + D3 + E + Asam Folat + Ca + P + Fe + Mg + Mn + K + Se + F + Cu + Zn +
Mb
Kaplet Pervita Sanbe
5 Cod Liver Oil + Curcuma + AA + DHA + FOS + Ca + Multivitamin
Emulsion Sanbe Kids Sanbe
Curvit CL Soho
6 DHA + Extr. Curcuma + A + D3 + C + B1 + B2 + B6 + B12 + Nicotinamide + Ca Panthotenate + Choline + Inositol + Ca
Gluconate + Ca + Na + Lysine
Syrup Asedas Pyridam
7 Fe + B1 + B6 + B12 + Asam Folat
Syrup Ferlin Medifarma
Drops Ferlin Medifarma
e. ELEKTROLIT DAN MINERAL
1 K-L-Aspartate
Tablet : 300mg Aspar K Tanabe
2 Zink
Syrup Zinkid Indofarma
f. PRE AND POST NATAL (VITAMIN DAN MINERAL), MENOPAUSE
1 -Carotene + Calk + Ca. Pantothenate + CuSO4 + Asam Folat + Ferronyl Iron + Nicotinamide + KI + Na Fluoride + B 1 + B12 +
B6 + E + D
tablet Ironyl Guardian

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2 Ferronyl + C + Asam Folat + B1 + B2 + B6 + B12 + Niacinamide + Ca Pantopthenate + Lysine + Zn

Tablet Ferofort Kalbe
3 Fe + Mn + Cu + C + Asam Folat + B12
Tablet Ferospat Pyridam
g. LAIN LAIN
1 Asam Amino + Minyak Kacang Kedelai
Soft caps Binapro Puspa
2 Coenzyme Q 10 + Lycopene + E + Extr. Green Tea
Capsul Liproqy Capri

3 Co Enzym Q 10 + L Carnitine + E
Softcaps Bioquinone Puspa
4 Curcuminoid + -carotene + B1 + B2 + B6 + B12 + D + Dexpanthenol + Ca Pidolate + Fructo Oligosacharida
Syrup Vitacur Lapi
5 Extr. Daun Jambu
Capsul Psidii DexaM
Syrup Psidii DexaM
6 Echinaceae dry extr. + Zn picolinate
Tablet : 250mg + 10mg Im Boost Force Soho
7 Echinaceae + Phyllanthus + Black Eldeberry + Zn picolinate
Tablet Formuno Capri
8 Echinaceae purpurea + Phylanthis niruri + Black Eldeberry + Zn picolinate + C + Se
Tablet Imunogard Puspa
9 Eldeberry extr. + Echinaceae extr. Zn + C + Garlic
Tablet: 125mg + 60mg + 7,5mg Imox Gracia
+ 250mg + 50mg
10 Echinaceae + Black Elderberry + Zn Picolinate
Kaplet Golmun plus Actavis
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11 Echinaceae Extr. + Propolis Bee + Zn licolinate

Kaplet Opinaceae Otto
12 Extr. Ophiocephalus Striatus
Soft capsul VipAlbumin RoyalMedica
Pujimin
Sachet VipAlbumin RoyalMedica

13 Ginseng extr G115 + dimethyl aminoethanol bitartrate + A + B1 + B2 + B6 + B12 + C + D + E + Nicotinamide + Ca

Panthotenate + Rotin + FeSO4 dihydrate + dibasic CaPO3 + CaF2 + K sulfate + copper sulfat monohydrate + MnSO 4
monohydrate +MgSO4 trihydrate + ZnO + Lecithin
Soft Caps Pharmaton F Boehringer
14 Ginseng extr G115 + -carotene + D3 + E + B1 + B2 + B6 + B12 + Biotin + Nicotinamide + C + Asam Folat + Cu + Se + Mn + Mg
+ Zn + Fe + Ca
Kaplet Pharmaton Vit Boehringer
15 Keto isoleucine + Ketoleucine + Ketophenylalanine + Hydroxymethionine + Keto valine + Tryptophan + Threonine +
Histidine + Tyrosine + Lysine
Tablet Aminoral Soho
16 Lumbrokinase
Capsul Disolf DexaM
17 Lutein + Lycopene + E + C + Zn + -carotene + Se
Tablet : 3mg + 6mg + 50mg Lycoxy DexaM
+ 250mg + 20mg + 10000iu +30mcg
18 Minyak Ikan
Soft caps BigFish SamcoF
19 Mono Amonium + Glycyrrhizinase + Asam Amino Asetic + L Systeine
Injeksi SNMC DexaM
20 Natural fish + Pepermint oil + Primrose oil + E + as. Folat + Soybean oil

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Tablet Fetavita Escolab

21 Natural astaxanthine
Softgel Asthin Force Soho
22 Radix Et Rhizoma Notoginseng + Borneolum Syntheticum + Rhizoma Diocoreae Nipponicae + Rhizoma Dioscoreae +
Herba Geranii Herba Erodii + Rhizoma Menispermi
Capsul Stobled Ethica
23 Schisandra + Lecithin + Silybium mariarum + Curcuminoid + B6
Tablet Hepa Balance Escolab
24 Sericocalyx Folium + Orthosiphonis Herba + Sonchus arvensis folium + Plantago Mayor Folium
Capsul Renax Interbat
25 Ubidecarenone + Levocarnitine fumarat
Tablet : 30mg + 500mg Corsel Fahrenheit
26 Ubidecarenone + L Carnitine + E + as. folat
Tablet Tonicard Escolab
27 Ubidecarenone + Soyabean oil
Soft caps Ubesco Escol

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 Formularium 2016

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