DAFTAR OBAT FORMULARIUM BERDASARKAN KELAS TERAPI

NO
NO
URU
KELAS BENTUK
T NAMA GENERIK KEKUATAN NAMA DAGANG KETR.
TERAP SEDIAAN
OBA
I
T
1   ANALGESIK, ANTIPIRETIK, ANTI- REMATIK, ANTIPIRAI
1.1   ANALGESIK NARKOTIK        
  1 Fentanil inj; inj 0,05 mg/ml; Fentanyl (inj.);  
Generik
  2 Kodein HCl tablet 10 mg, 15 mg, 20 Codein KF  
mg
  3 Morfin HCl inj 10 mg/ml Morphine HCl KF  
  4 Morfin sulfat tab short tab short acting    
acting; tab 10 mg; tab SR 10
SR mg, 15 mg, 30 mg,
60 mg
  5 Petidin HCl inj 50 mg/ml Pethidine HCl KF  
1.2   ANALGESIK NON NARKOTIK        
  1 Antalgin tablet; inj. tab 500 mg; inj. Antalgin Inj.,  
250 mg/ml tablet 500 mg
(generik)
  2 Asam Mefenamat kapsul; kapsul 250 mg; Asam Mefenamat  
tablet; tab 500 mg; susp tablet 500 mg
suspensi 50 mg/5 ml (generik)

1
  3 Asetosal tablet 500 mg Aspirin  
  4 Diklofenak tab; tab 25 mg, 50 mg; Natrium  
emulgel tetes; Diklofenak tablet
50 mg; 25 mg
(generik); Kalium
Diklofenak tablet
25

  mg; 50 mg
(generik)
  5 Ibuprofen tab tab kunyah 100 Ibuprofen tablet  
kunyah; mg; tab 200 mg; 400 mg
tab; sirup; 200 mg, 400mg; (generik)
suppos sirup
100 mg/5 ml, 200
mg/ml;
supp 125 mg
  6 Ketoprofen tab; tab 50 mg, 100 Ketoprofen tablet  
suppos; mg; supp 100 mg; 50 mg; 100 mg;
inj. inj.50 mg/ ml,100 inj. 50 mg/ml
mg/ml (generik)
  7 Ketorolak trometamin tab; inj tab 10 mg; inj10 ; Ketorolak inj. 10  
mg/ml, mg/ml; 30 mg/ml;
30 mg/ml tab 10 mg
(generik)
  8 Meloksikam tab; tab 7,5 mg, 15 Meloxicam tablet  
suppos; mg; supp 7,5 mg; 15

2
 inj. 15 mg mg; supp 15 mg;
inj
    (generik)
    Mitamizol Tab, Inj 500 mg, 150 mg/ Novalgin,  
santagesik
          Anthera  
  9 Parasetamol tab; tab 500 mg, susp Sanmol Infus;  
suspensi; 120 mg/5 ml; Paracetamol tablet
drops supp 125 mg, 500 mg; drops;
suppos; 250 mg; infus 10 syrup (generik)
infus mg/ml, drops 100
mg/ml
  10 Piroksikam kapsul; kaps 10 mg, 20 Piroxicam kapsul  
tab; mg; tab 10 mg; 20 mg
gel 10 mg, 20 mg; gel (generik)
5% 15 g, 25 g
  11 Tramadol HCl kapsul; kaps 50 mg; tab Tramadol HCl  
tab; 100 mg; inj 50 kapsul 50
inj; mg/ml; 100 mg/ mg; inj 50 mg/ml
suppos amp 2ml, 200
  mg/amp 2 ml; (generik)
supp 100mg

1.3   ANTIREMATIK, ANTIPIRAI        

  1 Allopurinol tablet 100 mg , 300 mg Allopurinol tablet  
100 mg; 300 mg
(generik)
  2 Kolkisin tablet 0,5 mg Kolkisin  

3
 (generik)
  3 Probenesid tablet 500 mg Probenid;  
Probenesid
(generik)
  4 Siklofosfamid tab; inj tab 50 mg; inj 200    
mg, 500 MG 1000
mg
  5 Sulfasalazin kaplet 500 mg Sulfasalazin  
(generik)
2   ANESTETIK
2.1   ANESTETIK LOKAL        
  1 Bupivakain HCl inj 0,5% duofit 0,5%; Bupivakain  
polyamp 20 ml; inj
0,5% spinal heavy
4 ml; 0,5% spinal  
4 ml;
0,5% heavy 4 ml 5 mg (generik)
2 Etilklorida semprot   Ethyl Chloride  
  (generik)

  3 Lidokain 2% + Adrenalin inj 20 mg + 0,0125 Pehacain  

mg
  4 Lidokain HCl inj; gel; inj 1%, 2%, 4%, Lidocaine inj 2%  
5%; gel (generik)
10%l
2.2   ANESTETIK UMUM        
  1 Isofluran inhalasi 250 ml Isoflurane  
cair (generik)

4
   3 Ketamin HCl inj 10 mg/ml Ketamin HCl  
(generik)
  4 Midazolam inj 5 mg/5 ml amp, Midazolam  
15 mg/
3 ml
  5 Propofol inj 1% dlm 20 ml    
  6 Sevofluran cairan 250 ml    
  7 Sodalime pro anestesi serbuk Gallon 4,5 liter Sodalime;  
3   ANTIALERGI DAN OBAT UNTUK ANAFILAKSIS
  1 Difenhidramin HCl inj, tab 10 mg/ml Diphenhydramine  
inj (generik)

  2 Klorfeniramin maleat tab; inj tab 4 mg, inj 5 Chlorpheniramine  

mg/ml HCl tablet
(generik)

  3 Loratadin tab; sirup tab 10mg; sirup 5 Loratadine tablet  

mg/ 5 ml botol 60 10 mg (generik)
ml
  4 Setirizin tab; sirup; tab 10 mg; sir 5 Cetirizine kapsul  
drop mg/ml, drop 10 10 mg (generik)
mg/ml
4   ANTIDOT DAN OBAT LAIN UNTUK KERACUNAN
4.1   KHUSUS        
  1 Atropin Sulfat tab; inj tab 0,5 mg; inj 1 Atropine Sulfate  
mg/ml tablet 0,5 mg; inj 1
mg/ml(generik)
  10 Kalsium glukonat inj 100 mg/ml Calcium Gluconate  

5
 10%
  13 N-asetil sistein inj.      
  14 Nalokson HCl inj 0,4 mg/ml Nokoba  
  15 Natrium Bikarbonat tab; inj tab 500 mg; inj Meylon 8,4%;  
8,4% Natrium
Bikarbonat tablet
500 mg (generik)
4.2   UMUM        
  1 Karbo Adsorben tablet 500 mg Norit; Bekarbon  
5   ANTIEPILEPSI
  1 Diazepam tab; inj; tab 2 mg, 5 mg; Stesolid; Diazepam  
lar rektal inj 10 mg/2ml; lar tablet 5 mg
rektal 5 mg tube (generik)
2,5 ml; lar rektal
10 mg tube 2,5 ml
  2 Fenitoin natrium tablet; kap 100 mg; inj Phenytoin kapsul  
kapsul; inj 100 mg/2 ml, 250 100 mg; inj.
mg/5 ml (generik)
  3 Fenobarbital tab; inj tab 30 mg, 50 mg, Sibital; Phental;  
100 mg; inj 50 Phenobarbital
mg/ml. i.m /i.v tablet
30 mg; 100 mg
(generik)
  4 Gabapentin kapsul 100 mg, 300 mg    
  5 Karbamazepin tablet 200 mg , Bamgetol,  
Carbamazepine
tablet 200 mg
(generik)

6
7
  6 Klonazepam tablet 2 mg    
  7 Magnesium sulfat inj 20%, 40% Magnesium  
Sulphate
Otsuka
  8 Valproat (dlm btk asam/Natrium) tab; sirup tab 250 mg, 500 Asam Valproat  
mg; sir tablet
250 mg/5 ml 150 mg; 250 mg
  (generik)
6   ANTIMIKROBA
6.1   ANTELMINTIK        
6.1.1   Antelmintik Intestinal        
  1 Levamisol tablet 25 mg    
  2 Mebendazol tablet 500 mg Mebendazol sirup  
(generik)
  3 Pirantel pamoat tab; tab 125mg, Pirantel  
250mg;
suspensi susp 10ml Pamoat tab 125
(125mg/ mg; 250 mg; sirup
(generik)
  5ml,250mg/5ml)  
6.2   ANTIBAKTERI        
6.2.1   Golongan Penisilin        
  1 Amoksisilin kapsul; Kaps 250 mg; kapl    
kaplet; 500 mg; sirup 125 Amoxicillin tablet
sirup mg/5 ml; inj 1 125 mg; kapsul
kering; inj g/vial 250 mg; kaplet
500 mg; sirup
kering 125 mg/

7
 5 ml (generik)
  3 Ampisilin tab; sirup tab 250 mg, 500 Ampicillin inj. 1 g  
kering; inj mg;
sirup 125 mg/5 (generik)
ml; inj
250 mg/vial, 500  
mg/vial,
1g/vial  
  4 Ampisilin-Sulbaktam inj 750 mg, 1,5 g    
  5 Benzatin Benzil inj 1,2 juta IU, 2,4 Benzatin Benzil  
Penisilin juta IU Penisilin 1,2 juta
UI;
  2,4 juta UI
(generik)
  6 Prokain Penisilin G inj 3 juta IU Procaine Penicillin-  
G-Meiji
6.2.2   Golongan        
Aminoglikosida
  1 Amikasin inj 250 mg, 500 mg Amikin; Mikasin  
2 Gentamisin inj 20 mg/2ml, 60 Gentamycin inj. 80  
  mg/1,5 ml, 80 mg (generik)
mg/2 ml

  3 Kanamisin sulfat kapsul, 250 mg,1 g vial Kanamycin inj. 1 g  

inj.

(generik)

8
6.2.3   Golongan        
Kloramfenikol
  1 Kloramfenikol kapsul; kap 250 mg; susp Chloramphenicol  
suspensi; 125mg/ 5ml; inj 1 kapsul 250 mg;
inj g/ml suspensi (generik)
  2 Tiamfenikol kapsul 250 mg, 500 mg Thiamphenicol  
tablet 500 mg; 250
mg (generik)
6.2.4   Golongan Kuinolon        
  1 Levofloksasin tab; infus 500 mg, 5 mg/ml ; Levofloxacin drip;  
tablet 500 mg
(generik)
  3 Ofloksasin tablet 200 mg, 400 mg Ofloxacin tablet  
200 mg; 400 mg
(generik)
  4 Siprofloksasin tab; infus tab 250 mg, 500 Ciprofloxacin  
mg; tab tablet
XR 500 mg, 1 g; 250 mg; 500 mg;
infus
2%, 4% dlm botol infus (generik)
100 ml
6.2.5   Golongan Makrolid        
  1 Azitromisin kapsul 250 mg, 500 mg Azithromycine  
tablet 500 mg
(generik)

9
   2 Eritromisin stearat kapsul; kap 250 mg; tab Erythromycin  
tab; tab 200 mg, 500 mg; tablet
kunyah; tab kunyah
sirup 200 mg; sir botol 250 mg; 500 mg;
kering; 60 ml (200 mg/5
drop ml); drop 100
mg/2,5 ml
  sirup (generik)
  3 Klaritromisin tablet 250 mg, 500mg Abbotic; Bicrolid  
  4 Roksitromisin kapsul 150 mg, 300 mg Rulid  
  5 Spiramisin tab; sirup tab 500 mg, 1,5 ; Spiramycin tablet  
MIU, 3 500 mg; 250 mg
MIU; sir 125 mg/5 (generik)
ml
6.2.6   Golongan Sefalosporin        
  1 Sefadroksil kapsul; kap 250, 500 mg; Cefadroxil kapsul  
sirup sirup kering 125 250 mg; 500 mg;
kering mg/5 ml, 250 sirup kering 125
mg/5 ml mg/ 5 ml(generik)
  2 Sefaklor tablet 250 mg, 500 mg Ceclor; Cloracef;  
Cefaclor (generik)
  3 Sefazolin inj 1g ; Cefazolin inj 1 g  
(generik)
  4 Sefiksim kapsul, kapsul 50 mg; 100 Cefixime kapsul  
sirup mg; 100 mg; kaplet
kering 200 mg; sirup 200 mg; sirup
kering 100 mg/ 5 kering 100 mg/ 5
ml ml(generik)

10
   5 Sefoperazon ; Sefoporazon inj 1g Cefoperazone inj.  
sulbaktam 1 g (generik)
  6 Sefotaksim inj 0,5 g; 1 g Cefotaxime inj  
500 mg; 1 g
(generik)
  7 Sefpirom inj 1g Cefpirome inj. 1 g  
(generik)
  8 Seftazidim inj 500 mg, 1 g Ceftazidime 1 g  
(generik)
  9 Seftizoksim injeksi 0,5 g, 1 g Ceftizoxime inj. 1  
g (generik)
  10 Seftriakson inj 1g Ecotrixon; Bioxon;  
Ceftriaxone

1 g (generik)
  11 Sefuroksim (kapsul: Axetil; inj. Na) kap; inj kap 250 mg, 500 Cefuroxime inj 750  
mg; inj mg (generik)
750 mg
6.2.7   Golongan Tetrasiklin        
  1 Doksisiklin kapsul 50 mg, 100 mg Doxicycline tablet  
100 mg (generik)
  3 Oksitetrasiklin kapsul; kaps 250 mg; inj Oxytetracycline  
inj; salep 500 mg/ ml; salep inj.
kulit; kulit 1%; salep 500 mg/ml
salep mata mata 0,5 %, 1% (generik)
  4 Tetrasiklin kapsul 250 mg, 500 mg Tetracycline HCl  
kapsul 250 mg;
500 mg (generik)

11
6.2.8   Golongan Lain-lain        
  1 Klindamisin kapsul 150 mg, 300 mg Clindamycine  
kapsul
150 mg; 300 mg
(generik)
  2 Kolistin tablet 250.000 IU; Colistine  
1.500.000 IU
  3 Kotrikmosazol tab; tab 80 mg + 400 Cotrimoxazole  
mg, 160 mg+ 800 tablet
mg; suspensi
(TMP+SMZ) suspensi 40 mg + 200 mg 480 mg; suspensi
per 5 ml
      240 mg/ 5 ml
      (generik)
  4 Meropenem inj 500 mg, 1 g Meropenem inj  
500 mg; 1 g
(generik)
  5 Metronidazol tab; infus; tab 250 mg, 500 Metronidazole  
suspensi; mg; tablet 500 mg; drip
ovula infus 500 mg/kolf; (generik)
susp
125 mg/5 ml;
ovula 500 mg, 1 g
  6 Vankomisin inj 500 mg Vancomycin HCl  
inj 500 mg
(generik)
6.3   ANTITUBERKULOSIS        
  1 Etambutol tablet 250 mg, 500 mg Ethambutol tablet  

12
 250 mg; 500 mg
(generik)
  2 Isoniazid tablet 100 mg, 300 mg Isoniazid tablet  
100 mg; 300 mg
(generik)
  3 Isoniazid + vit B6 tablet 100 mg, 300 mg INH Ciba;  
Pehadoxin
Forte
  4 Pirazinamid tablet 500 mg Pyrazinamide  
tablet
500 mg (generik)
  5 Rifampisin kaplet 300 mg, 450 mg, Rifampicin tablet  
600 mg 300 mg; 450 mg;
600 mg (generik)
  6 Rifampisin + INH tablet 450 mg + 300 mg; Rimactazid  
salut Paed 450/300;
selaput : 75 mg + 50 mg Rimactazid Paed
  7 Rifampisin + INH + Pirazinamid kaplet 150 mg + 75 mg + Rimcure 3 FDC;  
400 mg; Paed : 75 Rimcure Paed
mg + 50 mg + 150
mg
  8 Rifampisin +INH tablet 150 mg + 75 mg + Rimstar 4 FDC  
+ Pirazinamid + Ethambutol 400 mg + 275 mg
  9 Streptomisin sulfat inj. 1 g, 5 g Streptomycin  
Sulphate Meiji
6.4   ANTILEPROTIK        
6.5   ANTIFUNGI        
  1 Flukonazol kapsul; inj kaps 50 mg,150 Flukonazol tablet  
17

13
 mg, 150 mg;
200 mg; inj 2 Flukonazol drip
mg/ml 100 ml vial (generik)
  2 Griseofulvin tablet 125 mg, 500 mg Grivin; Griseofulvin  
tablet 125 mg; 500
mg (generik)

  3 Itrakonazol kapsul 100 mg Itraconazole  

kapsul
100 mg (generik)
  4 Ketokonazol tablet 200 mg Ketoconazole  
tablet
200 mg (generik)
  5 Metronidazol + Nistatin ovula 500 mg + 10.000    
IU
  6 Nistatin tab tab vagina Nystatin tablet  
vagina; 100.000 IU;
susp susp 100.000 500.000 IU
IU/ml (generik)
6.6   ANTIMALARIA        
  1 Artemether + Lumefantrin tablet 20 mg + 120 mg    
  2 Klorokuin fosfat/difosfat tablet 250 mg    
Chloroquine tablet

250 mg (generik)
  3 Kuinin diHCl tab; inj tab 222 mg; inj Quinine HCl  
300 mg/
ml amp (generik)

14
   4 Pirimetamin tablet 25 mg Pyrimethamine  
tablet 25 mg
(generik)
  5 Primakuin tablet 15 mg Primakuin  
(generik)
  6 Sulfadoksin + Pirimetamin tablet 500 mg + 25 mg Fansidar;  
Sulfadoxine-
Pyrimethamine
(generik)
6.7   ANTIVIRUS        
  1 Asiklovir tab; inj tab 200 mg, 400 Zovirax; Zoter;  
mg; inj Poviral; Acyclovir
tablet 200 mg;
250 mg 400mg (generik)
7   ANTIMIGRAIN / VERTIGO
7.1.   ANTIMIGRAIN        
  1 Ergotamin + Belladona alk + dragee 0,3 mg + 0,1 mg + Bellaphen  
Fenobarbital 20 mg
  2 Flunarizin tablet 5 mg, 10 mg Flunarizine tablet  
5 mg (generik)

7.2.   ANTIVERTIGO        
  1 Betahistin mesilat tablet 6 mg Betahistine  
mesilat tablet 6
mg (generik)
  2 Tamoksifen sitrat tablet 10 mg, 20 mg    
8   ANTIPARKINSON / DEMENTIA      
8.1   ANTIPARKINSON      

15
   1 Levodopa tablet 100 mg Levoben  
  2 Triheksifenidil HCl tablet 2 mg Trihexyphenidyl  
tablet 2 mg
(generik)
9   OBAT YANG MEMPENGARUHI DARAH
9.1   ANTIANEMIA        
  1 Asam Folat tab 1 mg, 5 mg Folic Acid tablet 1  
mg; 5 mg (generik)

  2 Besi Sukrosa ( Iron tab 100 mg/5ml    

Sucrose )
  3 Besi (II) dlm bentuk garam sulfat, tablet, Tab 15 mg, 300 Ferro sulfat  
fumarat) syrup mg; (generik)
drops; kombinasi,
150 mg/5 ml
  4 Kompleks Besi (III) hidroksida tab 357 mg + 350 mcg    
polimaltose (IPC) + Asam Folat kunyah
  5 Sianokobalamin tab; inj tab 50 mcg,100    
mcg; inj 500
mcg/ml, 1000
mcg/ml
9.2   OBAT YANG MEMPENGARUHI        
DARAH
  1 Asetosal tablet 80 mg, 100 mg, Aspirin (100 mg)  
160 mg
  2 Heparin dialisat gel; salep gel 20 g; salep 15 Thrombophob  
g
  3 Heparin natrium inj 25.000 IU/5ml Inviclot  

16
   10 Klopidogrel tablet 75 mg Clopidogrel tablet  
75 mg (generik)
9.3   Hemostatik        
  1 Asam Traneksamat kapsul; kaps 250 mg; tab    
tab; 500 mg; inj 250
inj mg/ 5ml amp, 500  
  mg/ 5ml amp    

  2 Vitamin K1 tab; inj tab 10 mg; inj 2 Kavita; Neo-K;  

mg/ml Phytomenadione
(generik)
10   PRODUK DARAH DAN PENGGANTI PLASMA
10.1   FRAKSI PLASMA UNTUK    
PEMAKAIAN KHUSUS
  1 Albumin (Human inj 20% 50 ml, 20% Octalbin;  
100 ml, Plasbumin
Albumin) 25% 20 ml, 25%
50 ml,
  25% 100 ml
10.2   PENGGANTI PLASMA        
  1 Dekstran 40 infus 10% dlm NaCl Otsutran L  
  2 Hidroksietil pati 6% (HES) infus 6%, 10% Voluven; Widahes;  
Tetraspan
  3 Poligelin infus 3,5% dlm 500 ml, Haemaccel;  
4% Gelofusin
dlm 500 ml
11   DIAGNOSTIK
11.1   OBAT KONTRAS        

17
   1 Barium enema tablet 5 mg Barium enema  
  2 Barium sulfat suspensi 998% w/w nett Liquid Polybar Plus  
340 g,
105% w/v nett
1900 ml
  3 EZ Gas II     EZ Gas II  
  4 Gadodiamida larutan   Omniscan;  
Magnevist;
Dotarem; Primovist;
Gadovist
  5 Gadobenat dimeglumin inj. 529 mg/ml,10 ml Multihance  
  6 Iodine larutan 320 mg/ml dalam Omnipaque;  
vial Iopamiro; Ultravist;
100 ml Optiray 320;
Visipaque
  7 Natrium/ Meglumin amidotrizoat inj 76% Urografin  
12   ANTISEPTIK DAN DESINFEKTAN
12.1   ANTISEPTIK        
  1 Alkohol cairan; 70%    
swab
  2 Etakridin Laktat larutan 0,10%    
(Rivanol)
  3 Ferakrilum larutan 1%    
  4 Hidrogen Peroksida cairan 3%    
  5 Iodin Povidon larutan; 10% Betadine;  
salep

18
   6 Kalium Permanganat larutan; 0,1%; 0,2%; 1%;    
2% (sediaan
segar); serbuk
serbuk 1:5.000, 1: 10.000
12.2   DESINFEKTAN        
  3 Formalin larutan 10% Formalin  
  5 Klorheksidin 7,5% + Setrimid 1,5% larutan   Savlon; Hibicet HC;  
First Aid
  6 Klorheksidin diglukonat larutan 4%, 5% Handscrub:  
Hibiscrub; Cutisoft;
Microshield;
Handrub:
Microshield: Viorex

  7 Lisol cairan 50% Lisol  

13   OBAT UNTUK GIGI DAN MULUT
13.1   14.1        
  1 Benzidamin HCl larutan 7,5 mg/5 ml Tantum Verde Oral  
Rinse
  2 Boraks Gliserin cairan      
  3 Gargarisma Khan larutan      
  4 Iodin Povidon larutan; 1% Betadine  
salep; obat
kumur
14   DIURETIK        
  1 Amilorid HCl + Hidroklortiazid tablet 2.5 mg + 25 mg, 5 Lorinid-Mite  
mg

19
 + 50 mg
  2 Furosemid tab; inj tab 40 mg; inj 20 Farsix;  
mg/2 ml Furosemide tablet
40 mg; inj.
(generik)
  4 Hidroklorotiazid tablet 25 mg, 50 mg Hydrochlorothizide  
(generik)
  7 Manitol Inj 20% Manitol; Infusan-  
M20
  8 Spironolakton tablet 25 mg, 100 mg Spironolactone  
tablet 25 mg; 100
mg (generik)
15   HORMON, ENDOKRIN LAIN DAN KONTRASEPSI

15.1   ANTIDIABETIK        
15.1.1   Antidiabetik oral        
  1 Akarbose tablet 50 mg, 100 mg    
  2 Glibenklamid tablet 5 mg Glibenclamide 5  
mg (generik)
  3 Gliklazid tablet 30 mg, 80 mg    
  4 Glikuidon tablet 30 mg Lodem  
  5 Glimepirid tablet 1 mg, 2 mg, 3 mg, Glimepiride  
4 mg 1 mg; 2 mg; 3 mg;
4 mg (generik)
  6 Glipizid tablet 5 mg, 10 mg ; Glucotrol XL  
  7 Metformin HCl tablet 500 mg, 850 mg Metformin  
500 mg; 850 mg
(generik)

20
   8 Metformin HCl + Glibenklamid tablet 250 mg + 1,25 mg, Glucovance  
500 mg + 2,5 mg,
500 mg
+ 5 mg
15.1.2   Antidiabetik parenteral        
  1 Insulin Analog Aspart inj 100 IU/ml 3 cc Novorapid flexpen  
  2 Insulin Analog Campur inj 100 IU/ml 3 cc Novomix flexpen  
(Aspart + NPH)
  3 Insulin Analog Glargine inj; penfill inj 100 IU/ml 10 Lantus  
ml;
penfill 100 IU/ml
3 ml
  4 Insulin Campur (Insulin inj; penfill inj 100 IU/ml 10 Mixtard 30 HM/  
ml; Mixtard HM Penfill;
Regular + NPH) penfill 100 IU/ml Mixtard Novolet
3 ml
  5 Insulin Kerja inj; penfill inj 100 IU/ml 10 Insulatard HM/  
ml; Insulatard HM
Menengah (NPH) penfill 100 IU/ml Penfill; Humulin N;
3 ml Insulatard Novolet
  6 Insulin Regular inj; penfill inj 100 IU/ml 10 Actrapid  
ml; HM/Actrapid HM
penfill 100 IU/ml Penfill; Humulin R;
3 ml Actrapid Novolet
15.2   HORMON KELAMIN DAN OBAT YANG MEMPENGARUHI FERTILITAS
15.2.2   Estrogen        
  1 Estradiol tab salut tab salut film 1 Ovestin; Progynova  
film; krim mg, 2 mg;

21
 krim 15 g
  2 Estradiol hemihidrat gel 0,1% 100 g Estreva  
  3 Estradiol valerat tablet 2 mg Cyclo-Progynova  
  4 Etinilestradiol tablet 50 mcg Lynoral  
  5 Estradiol + Drospirenon tablet 1 mg + 2 mg Angeliq  
15.2.3   Progestogen        
  1 Didrogesteron tablet 10 mg Duphaston  
  2 Medroksiprogesteron tablet 5 mg Prothyra  
  3 Noretisteron tablet 5 mg Primolut-N; Norelut  
  4 Nomegestrol asetat kaplet 5 mg Lutenyl  
  5 Progesteron pessari 200 mg, 400 mg Cygest  
  3 Levonorgestrel + Etinilestradiol tablet 150 mcg + 30 mcg Microgynon  
  4 Levonorgestrel tablet 30 mcg Mirena; Microlut  
  5 Medroksi Progesteron asetat tab; inj. tab 10 mg, 500 Triclofem; Veraplex  
depot mg; inj
150 mg/ml (tab 500 mg)
  6 Medroksi Progesteron asetat + inj. depot 0,5 ml Cyclofem  
Estradiol sipinoat
15.2.5   Induktor ovulasi        
  1 HCG inj 1500 IU, 5000 IU Pregnyl  
  2 Follitropin ß inj 50 IU, 100 IU Puregon  
  3 Klomifen sitrat tablet 50 mg Clomifen; Provula;  
Profertil
  4 Lutropin α inj 75 IU Luveris  
(Rekombinan LH)
15.3   HORMON TIROID DAN ANTITIROID
  1 Karbimazol tablet 5 mg Neo-Mercazol  

22
   2 Lugol cairan 30 ml    
 
  3 Methimazol tablet 5 mg, 10 mg Thyrozol  
  4 Propiltiourasil tablet 50 mg; 100 mg Propylthiouracil  
tablet 100 mg
(generik)
  5 L-Tiroksin natrium tablet 0,1 mg Levothyroxine  
tablet (generik)
15.4   KORTIKOSTEROID DAN KORTIKOTROPIN
  1 Budesonid kapsul 3 mg Budenofalk  
  2 Betametason + tab; sirup 60 ml Colergis  
desklofeniramin maleat
  3 Deksametason tab; inj tab 0,5 mg; inj 4 Dexamethasone  
mg/ ampul, 5 tablet 0,5 mg; 4
mg/amp, 20 mg; inj. (generik)
mg/vial
  4 Metil Prednisolon asetat tab; inj 4 mg, 8 mg, 16 Methylprednisolon  
mg; inj e tablet 4 mg; 8
mg;
125 mg/ 2ml, 500 16 mg (generik).
mg/8 ml Injeksi;
Methylprednisolon
e
  inj. 125 mg
(generik)
  5 Prednison tablet 5 mg Prednison tablet 5  
mg (generik)
  6 Triamsinolon asetonid tab; inj; tab 4 mg; inj Triamcort (tab);  

23
 IA/ID 10 mg/ml Flamicort Inj;
vial 5 ml, IM 40 Flamicort (inj IA/
mg/ml vial 1 ml; IB/ID/IM); Kenalog
salep in orabase (salep);
salep 0,1% 5 g Ketricin (tab, salep)
15.5   HORMON LAIN        
  1 Bromokriptin tablet 2,5 mg Parlodel; Elkrip  
15.7   OBAT METABOLISME TULANG        
DAN OTOT
  1 Alendronat tablet 10 mg Nichospor; Alovell  
  2 Alfakalsidol tablet 0,25 mcg, 0,5 Bone-One  
mcg, 1 mcg
  3 Ibandronat (asam) inj; tab inj: 6 mg ; tab 150 Bondronat (inj);  
mg Bonviva (tab)
  4 Kalsitonin inj 50 IU/ml, 100 Miacalcic  
IU/ml
  5 Klodronat dinatrium kapsul; kaps 400 mg; tab Bonefos  
tab; 800 mg; inf 60
infus mg/ml

  6 Risedronat tablet 5 mg, 35 mg Actonel; Osteonate  

OD; Retonel
  7 Stronsium ranelat granul 2g Protos  
  8 Zolendronat inj 5 mg/5 ml Zometa; Aclasta  
16   OBAT KARDIOVASKULER        
16.1   ANTIANGINA        
  1 Atenolol tablet 50 mg, 100 mg    
2 Bisoprolol tablet 2,5 mg, 5 mg Bisoprolol tablet  
2,5 mg; 5 mg

24
   (generik)

  3 Diltiazem tab; inj tab 30 mg, 60 mg; Herbesser; Cordila;  

inj Diltiazem tablet 30
50 mg mg (generik)
  4 Isosorbid dinitrat tab; tab 5 mg, 10 mg, 20 Isosorbide  
SL; mg; inj Dinitrate tablet 5
mg (generik)
tab SR; inj 10 mg/10 ml
  5 Isosorbid mononitrat tab; tab 20 mg, 60 mg (SR)    
SR
  7 Nitrogliserin inj; tablet 10 mg/10 ml Nitrocine;  
Glyceryltrinitrat
DBL (inj); Nitrokaf
retard (tablet)
16.2   ANTIDISRITMIA        
  2 Amiodaron tab; inj tab 200 mg; inj    
150 mg/3ml
  3 Diltiazem tab; inj tab 30 mg, 60 mg;    
inj
50 mg
  6 Lidokain HCl inj 2% Lidokain inj  
(generik)
  8 Propanolol HCl tab salut 10 mg, 40 mg Propanolol HCl  
selaput tablet 10 mg; 40
mg (generik)
  9 Verapamil tab; inj tab 80 mg, 240 Verapamil tablet  
mg; inj 80 mg; inj.

25
 2.5 mg/ml (generik)
16.3   ANTIHIPERTENSI        
16.3.1   Golongan ACE Inhibitor        
  1 Enalapril tablet 5 mg    
  2 Imidapril tablet 5 mg; 10 mg    
  3 Kaptopril tablet 12,5 mg, 25 mg, Captopril tablet  
50 mg 12,5 mg; 25 mg ,
50 mg (generik)
  4 Kaptopril + HCT tablet 25 mg + 12,5 mg    
  5 Lisinopril tablet 5 mg, 10 mg, 20    
mg
  7 Ramipril tablet 2,5 mg, 5 mg, 10 Triatec; Hyperil;  
mg Ramixal
16.3.2   Golongan Beta Blocker        
  1 Atenolol tablet 50 mg; 100 mg    
  2 Bisoprolol tablet 2,5 mg, 5 mg Bisoprolol tablet 5  
mg (generik)
  3 Bisoprolol + HCT tablet 2.5 mg, 5mg Lodoz  
  4 Karvedilol tablet 6,25 mg, 25 mg Dilbloc, V-bloc  
  5 Labetalol tab; inj tab 50 mg; inj 100 Trandete  
mg
  6 Metoprolol tartrat tablet 50 mg; 100 mg Seloken; Lopresor;  
Cardiosel
  7 Propranolol HCl tablet 10 mg; 40 mg Blocard; Farmadral;  
Propanolol HCl
tablet 10 mg; 40
mg (generik)

26
16.3.3   Golongan Calcium Channel        
Blocker
  1 Amlodipin besilat tablet 5 mg; 10 mg Norvask; Lovask;  
Amlogrix;
Amlodipine tablet
5 mg; 10 mg
(generik)

  2 Amlodipin + Atorvastatin tablet 5 mg + 10 mg, 10 Caduet  

mg +
10 mg, 5 mg + 20
mg, 10 mg + 20
mg
  3 Diltiazem tab; tab 30 mg, 60 mg; Herbesser;  
kapsul; kaps Carditen; Diltiazem
inj 90 mg, 100 mg, (generik)
180 mg,
  200 mg; inj 50 mg
  4 Felodipin tablet 5 mg Plendil; Nirmadil  
  6 Nifedipin tablet 5 mg, 10 mg, 20 Adalat/ Adalat oros;  
mg (oros/retard), Farmalat;
30 mg (oros), 60 Coronipin;
mg (oros) Nifedipine tablet
10 mg (generik)
  7 Nikardipin inj; tab; inj 2 mg/2 ml, 10 Perdipine (inj);  
kap mg/10 ml; tab 20 Loxen
mg; kap 40 mg (tablet; kapsul);
Blistra
16.3.4   Golongan Alpha Blocker        

27
   1 Doksazosin tablet 1 mg, 2 mg Cardura; Kaltensif  
  2 Terazosin HCl tablet 1 mg, 2 mg Hytrin  
16.3.5   Golongan Angiotensin        
II Antagonist
  1 Irbesartan tablet 150 mg, 300 mg Aprovel; Irvask;  
Irbedox; Irbesartan
(generik)

  2 Irbesartan + HCT tablet 300 mg + 12,5 mg Coaprovel; Irtan  

Plus; Co-Irverbal
  3 Kandesartan tablet 8 mg, 16 mg Blopress  
  4 Kandesartan + HCT tablet 16 mg + 12,5 mg Blopress plus  
  5 Losartan tablet 50 mg Cozaar; Angioten  
  6 Telmisartan tablet 40 mg, 80 mg Micardis  
  7 Valsartan tab salut 80 mg, 160 mg Diovan; Valsartan  
selaput tab
80 mg (generik)
16.3.6   Golongan Lain-lain        
  1 Klonidin HCl tab; inj tab 0,075 mg, Catapres; Clonidine  
0,15 mg; HCl tablet 0,15 mg
inj 0,15 mg/ml (generik)
  2 Metildopa anhidrat tab salut 250 mg Dopamet  
selaput
16.5   GLIKOSIDA JANTUNG        
  1 Digoksin tab; inj tab 0,25 mg; inj Lanoxin; Fargoxin  
0.25mg/

28
 ml (inj.); Digoxin tablet

  0,25 mg (generik)
16.6   OBAT UNTUK SYOK        
16..6.1   Inotropik        

  1 Dobutamin inj 250 mg/20 ml, Dobutamine Giulini  

250 mg/
vial 5 ml
  2 Dopamin HCl inj 10 mg/ml; 40 Dopamin Giulini;  
mg/ml
16.6.2.   Vasokonstriktor        

  1 Deksametason natrium fosfat inj. tab 0,5 mg; inj 4 Oradexon;  

mg/ ampul, 5
mg/amp, 20 Kalmethason
mg/vial
  2 Efedrin HCl tab; inj tab 25 mg; inj 50 Ephedrine HCl inj.  
mg/ml
50 mg/ml (generik)

  3 Epinefrin HCl inj. 1 mg/ml Ephinephrine inj  

(generik)
  6 Norepinefrin bitartrat inj. 4 mg/ 4 ml    
16.7   PENURUN KOLESTEROL        
  1 Atorvastatin tab salut 10 mg, 20 mg, 40    
selaput mg

29
   2 Fenofibrat kapsul 100 mg, 200 mg,    
300 mg
  3 Gemfibrozil kapsul 300 mg, 450 mg, Gemfibrozil tablet  
600 mg, 900 mg 300 mg (generik)
  6 Simvastatin tablet 10 mg, 20 mg    
Simvastatin tablet
10 mg; 20 mg
(generik)
16.8   VASODILATOR        
  1 Flunarizin tablet 5 mg, 10 mg Sibelium;  
Flunarizin tab 5
mg (generik)
  6 Sitikolin tab; inj tab 500 mg, 1000 Nicholin; Brainact;  
mg; inj Takelin; Citicholine
250 mg/2 ml, 500 inj 250 mg
mg/4 ml, 1 g/8 ml (generik)
  7 Tadalafil tablet 10 mg, 20 mg Cialis  
  8 Vardenafil tablet 5 mg, 10 mg, 20 Levitra  
mg
16.9   LAIN-LAIN        
  1 Ginko Biloba tablet 40 mg, 80 mg Tebokan; Tanakan  
  2 Magnesium klorida inj amp 20 ml Cardioplegia DBL  
+ Kalium klorida + Prokain HCl

30
   3 Pirasetam kaplet; kaplet 400 mg, Nootropil; Neurotam;  
sirup; 800 mg, Mersitropil;
Piracetam tablet
400 mg; 800 mg;
1200 mg; inj. 1

inj 1200 mg; sirup g; 3 g; 12 g

10%; inj (generik)
  1 g/ 5 ml, 3 g/ 5  
ml, 12 g/ 60 ml
17   OBAT TOPIKAL UNTUK KULIT
17.1   ANTIAKNE        
  1 Adapalen gel 0,10% Evalen  
  2 Asam Azeleat krim 20% Zelface  
  3 Belerang sabun 5% x 100 g, 10% x GF Sulfur  
batang 100 g
  4 Benzoil Peroksid gel 2,5%, 5% Benzolac  
  5 Isotretinoin kapsul; kapsul 10 mg, 20 Roaccutane  
tablet mg
  6 Lotio Kummerfeldi lotion - Lotio Kummerfeldi  
RSCM
  7 Sulphonated sabun - Acne Aid Bar  
Surfactant Blend batang
  8 Tretinoin larutan; Lar 0,05%; gel Vitacid; Retin A;  
gel; 0,025%; Reticor
krim krim 0,025%,
0,05%,
  0,10%

31
   9 Triklosan emulsi 2% Phisohex  
17.2   ANTIBAKTERI        
  1 Eritromisin krim; gel; 2% Erymed  
larutan
  2 Framisetin sulfat kasa steril 1% Sofratulle;  
Daryantulle
  3 Fusidat krim 2% Foban; Fucidin;  
(asam); Futaderm
salep
(Natrium)
  4 Fusidat (asam) + Betametason krim 2% + 0,1% Fucicort  
valerat
  5 Klindamisin gel; gel 1%, 1,2%; lar Comdacin;  
larutan 1,2% Mediklin; Clinium
  6 Kloramfenikol salep; 2% Kemicetine;  
gauze Chloramphenicol
salep (generik);
Chloramphenicol
Produksi RSCM
  7 Kloramfenikol + Hidrokortison krim   Chloramphecort  
asetat
  8 Mupirosin krim; 2% Bactroban;  
salep Bactoderm
  9 Nadifloksasin krim 10 g Acuatim  
  10 Perak Sulfadiazin krim 1% Dermazin; Burnazin  

17.3   ANTIFUNGI        

32
   1 Ketokonazol gel; krim; 2% Ketoconazole  
cream
shampoo 2 % (generik)
  2 Klotrimazol krim; 1%    
larutan
  3 Ketokonazol + Tar shampoo      
  4 Mikonazol Nitrat krim; 2%    
bubuk Miconazole cream
2
% (generik)
  5 Mikonazol Nitrat + Hidrokortison krim 2% + 1%    
  7 Nisatin + Seng Oksida salep 100.000 IU + 200    
mcg
  10 Tiokonazol krim      
  11 Flukonazole Kaps, Kapsul 150 mg,    
Injeksi Injeksi 2 mg/ml
17.4   ANTIVIRUS        
  1 Asiklovir krim 5% Acyclovir cream  
(generik)
17.5   ANTIINFLAMASI DAN        
ANTIPRURITIK
  1 Betametason dipropionat krim; krim 0,05%; salep Beprosone;  
salep 0,05% Diprosone
OV
  2 Betametason valerat krim 0,10% Benoson;  
Betamethasone
cream 0,1%
(generik)

33
   3 Boorschudmixture bedak   Boorschudmixture  
kocok Produksi RSCM
  4 Desoksimetason krim; 2,5 mg Esperson; Inerson  
salep
  5 Desonid krim; 0,05% Apolar; Dermades;  
salep; Desolex
lotio
  6 Diflukortolon valerat krim; 0,10% Nerisona; Nerisona  
salep FO
  7 Doksepin krim 5% Sagalon  
  8 Flusinolon asetonid krim; 0,03% Dermasolon;  
salep Cinolon
  9 Flutikason propionat krim 0,05% Medicort  
  10 Hidrokortison asetat krim 1%; 2,5% Hydrocortisone  
cream (generik)
  11 Hidrokortison butirat krim; krim 1.00% Locoid  
lemak;
scalp
lotion
  12 Kalamin krim; lotio; krim 10%; lotio    
15%;
bedak bedak 10%
  13 Mometason furoat krim; 0,10% Mofacort; Dermovel;  
salep;
lotio Elocon
17.6   ANTISKABIES        
  1 Asam Salisilat + Belerang endap salep 2% + 4%    
RSCM
  2 Lindane + Asam Usnat krim 1% Scabicid  

34
   3 Permetrin krim 5% Scabimite  
17.7   LAIN-LAIN        
  1 5-Fluorourasil krim      
  6 Asam Alfa Hidroksi peel larutan 20%, 35%, 50%,    
75%
  7 Asam Salisilat larutan; larutan 1%; salep Asam Salisilat  
2%,
salep 5%, 20%, 40%
  8 Bedak Salisilat serbuk 2%    
  34 Vaselin salep      
 
18   LARUTAN ELEKTROLIT, NUTRISI, DLL
18.1   ORAL        
  1 Asam Amino + Vitamin serbuk sachet @ 53 g, @    
+ Mineral 25 g
  2 Kalium klorida tablet siap tab siap larut 600 KSR; KCl puyer  
larut; mg, puyer 500 mg (Generik)
puyer
  3 Oralit serbuk 100 g/sachet Renalyte;  
Dehidralyte;
Oralit (Generik)
  4 Lemak,protein,karbo hidrat larutan 500 ml Fresubin  
18.2   PARENTERAL        
  1 Aqua pro injeksi larutan 20 ml, 25 ml; 500 WFI Otsuka; WIDA  
ml; 1000 ml WI (1000 ml)
  2 Asam amino infus berbagai Aminosteril 5%,  
komposisi 10%; Aminosteril
8% N Hepa;

35
 Aminosteril infant
6%, Pan Amin G;
Kidmin; Kalbamin;
Primene 10%;
Aminoplasmal 5%E,
10%E
  3 Asam amino + Karbohidrat infus   Nutrisol DBL  
  4 Asam amino + vitamin infus   Aminofusin L 600;  
+ elektrolit Aminofusin Paed
  5 Asam amino 50 g infus   Aminovel 600;  
+ sorbitol 100 g + Nutrisol-S
elektrolit + vitamin
  6 Asam amino bebas infus 250 ml; 500 ml Amiparen  
100 g + nitrogen 15,7 g + Na 2 mek
+ asetat
120 mek
  7 Asam amino rantai cabang (BCAA) infus   Aminoleban;  
infus Aminofusin Hepar;
Comafusin Hepar
  8 Glukosa infus 5%, 10%, 40% Otsuka; Widatra;  
B.Braun
  9 Kalium klorida inj 25 meq/vial Kalium Chloride  
  10 Kalsium glukonat inj 10% Calcii Gluconas  
  11 L-alanin + L-glutamin infus 50 ml, 100 ml Dipeptiven; Glutiven  

  12 Larutan elektrolit infus 500 ml Tutofusin OPS  

  13 Larutan kombinasi (dlm 1 liter): infus 250 ml Eas Pfrimmer  
asam amino esensial,histidin

36
  14 Larutan kombinasi (dlm 1 infus 500 ml Triofusin 500  
liter):fruktosa 60 g,glukosa 33 g,
xylitol
30 g
  15 Larutan kombinasi infus 500 ml Triofusin E 1000  
(dlm 1 liter): Fruktosa
120 g, glukosa 66 g, xylitol 60 g,
elektrolit, vitamin
  16 Larutan kombinasi infus 500 ml Triofusin 1600  
(dlm 1 liter): Fruktosa
200 g, glukosa 110 g, xylitol 100 g
  18 Larutan kombinasi infus 500 ml KA-EN Mg3; Tridex  
(dlm 1 liter): Natrium 100
50 mek, K 20 mek, Cl  
50 mek, laktat 20 mek, glukosa  
100 g
  19 Larutan kombinasi infus 500 ml KA-EN 3B; Tridex  
(dlm 1 liter): Natrium 27B
50 mek, K 20 mek, Cl
50 mek, laktat 20 mek, glukosa 27
g
  20 Larutan kombinasi infus 500 ml KA-EN 3A  
(dlm 1 liter): Natrium
60 mek, K 10 mek, Cl
50 mek, laktat 20 mek, glukosa 27
g
  21 Larutan kombinasi: Glukosa 10% infus 500 ml OTSU D10-0,18 NS  
& Natrium klorida 0,9%=

37
 4:1 (N5)
  22 Larutan kombinasi: Glukosa 2,5% infus 500 ml OTSU D2,5-1/2 NS  
& Natrium klorida 0,45%
  23 Larutan kombinasi: Glukosa 5% & infus 500 ml OTSU D5-1/4 NS;  
Natrium klorida 0,225% WIDA D5-1/4NS
  24 Larutan kombinasi: Glukosa 5% & infus 500 ml OTSU D5-1/2 NS;  
Natrium klorida 0,45% WIDA D5-1/2NS
  25 Larutan kombinasi: Glukosa 5% & infus 500 ml OTSU D5 NS; WIDA  
Natrium klorida 0,9% = 4:1(N4) D5-NS

  26 Larutan nutrisi + Infus berbagai Triparen 1; Triparen  

komposisi 2; Clinimix;
Combiflex; Kabiven;
Aminofluid;
elektrolit Nutriflex Lipid

  27 Lipid infus 20% Ivelip; Lipofundin  

MCT/LCT; Clinoleic

  28 Maltose infus 10% 500 ml,1000 Martos 10  

ml
  29 Multivitamin parenteral serbuk vial @166 mg Soluvit N  
infus
  30 Multivitamin parenteral inj 10 ml Vitalipid N Adult;  
MVI
  31 Natrium bikarbonat inj 8.4% vial 25 ml Meylon  

38
   32 Natrium klorida inj; infus inj 0.9% 25 ml; NaCl Otsuka; NaCl  
infus 100 ml, 500
ml, 1000 ml; 3%
500 ml Widatra; Ecosol
  33 Natrium laktat hipertonik infus 250 ml Totilac  
  34 Ringer Asetat infus   Asering; Infusan  
Ring- As;
Ringerfundin
  35 Ringer Asetat + infus 500 ml Asering-5  
glukosa 50 g
  36 Ringer Laktat infus 500 ml, 1000 ml ; Wida RL  
19   OBAT UNTUK MATA        
19.1   SISTEMIK        
  1 Asetazolamid tab 250 mg Glaucon  
  2 Gliserin larutan 50% Glycerine  
  3 Manitol inj 20% Manitol; Manitol  
Fima
Internasional
19.2   TOPIKAL        
19.2.1   Antimikroba        
  1 Amfoterisin salep mata 1% Fungicid  
  2 Asam Fusidat tetes mata 1% Fucithalmic  
  3 Asiklovir salep mata 3% Cendo Hervis  
  4 Dibekasin tetes mata 0,30% Dibekacine  
(generik)

39
  5 Gentamisin salep 0,30% Cendo Gentamycin;  
mata; Gentamycin ED;
Gentamycin salep

tetes mata 0,1% 5 g (generik)

  6 Idoksuridin tetes mata 0,10% Cendrid; Isotic  
Ixodine
  7 Kloramfenikol salep salep mata 1%; Cendo Fenicol (ED);  
mata; tetes mata 0,25%, Cendomycetin EO;
tetes mata 5%, 1% Ikamicetin 1% EO
  8 Kloramfenikol + Hidrokortison tetes mata 1% + 0,5% Cendomycos  
asetat
  9 Kloramfenikol + Polimiksin B salep salep mata 10 Cendo Mycetine  
Sulfat mata; mg/g;
tetes mata tetes mata (10 mg
+
  10000 UI)/ ml
  10 Levofloksasin tetes mata 0,50% Cravit; Cendo LFX  
  11 Natamisin tetes   Cendo Natacen  
mata;
salep mata
  12 Neomisin + Basitrasin salep mata 5 mg + 250 IU Nebacetin  
  13 Neomisin + Polimiksin tetes tetes mata 3,5 Cendo Xitrol  
mata; mg+
+ Deksametason salep mata 20.000 IU + 1,2
mg;
    salep mata 5 mg+
6.000

40
 9
5
    IU+1,3 mg; tetes
mata
    3,5 mg+ 6.000
IU+1 mg
  14 Neomisin Sulfat + Polimiksin B salep salep mata 3,5 g; Cendo Stratol  
sulfat + Tetrahidrozolin mata, tetes mata: MD
tetes mata 0,6 ml, 5 ml
  15 Ofloksasin tetes mata 0,30% Cendo Floxa;  
Tarivid
  16 Oksitetrasiklin salep mata 1% Terramycin Ophth  
  17 Polimiksin tetes mata 10000 IU/ml Cendo Polygran  
  18 Sulfasetamid salep 10%, 15% Cendo Cetamide;  
mata; Albuvit
tetes mata
  19 Tobramisin vial 80 mg/ml Cendo Tobro  
  20 Tobramisin + Deksametason tetes mata (3 mg + 1 mg)/ml Cendo Tobroson  
MD 0,6 ml, 5 ml,
viscous 5 ml
19.2.2   Antiinflamasi        
  1 Betametason tetes mata 0,10% Cendo Vosama  
  2 Diklofenak natrium tetes mata 1 mg/ml Cendo Noncort;  
Flamar ED
  3 Fluorometolon + Neomisin sulfat tetes mata (1 mg + 3,5 Cendo Polynel;  
mg) /ml 0,6 ml; 5 Flumetholone 0,1
ml
  4 Kromoglikat natrium larutan 2%, 4% Cendo Conver;  
Crom
Opthal

41
   5 Prednisolon asetat tetes mata 10 mg/ml P-Pred  
19.2.3   Midriatik        
  1 Atropin Sulfat tetes mata 0,5% ; 1% btl 5 ml Cendo Tropin  
  2 Fenilefrin HCl tetes mata 10% Cendo Efrisel  
  3 Homatropin hidrobromid tetes mata 2% Cendo Homatro  
  4 Tropikamid tetes mata 1% Cendomydriatyl  
19.2.4   Miotik dan antiglaukoma        
  1 Adrenalin HCl tetes mata 0.25% Cendo Adrenal  
  2 Betaksolol HCl tetes mata 0,50% Optibet  
  3 Brinzolamid tetes mata 1% Azopt  
  4 Dorzolamid tetes mata 1% - 2% Trusopt  
  5 Karteolol tetes mata 2% Arteopic  
  6 Latanoprost tetes mata 0.005% Xalatan  
  7 Pilokarpin HCl tetes mata 2% Cendo Carpin;  
Triacarpin
  8 Timolol tetes mata 0,25%, 0,5% Tim Opthal; Isotic  
Adretor; Timol
  9 Travoprost tetes mata 0.004% Travatan  
19.2.5   Lain-lain        
  1 Aneurin HCl + Ca tetes mata 0,5 mg + 5 mg + Rephitel  
Pantotenat + Vitamin A 1000 UI
  2 Dinatrium Edetat tetes mata 0.35% btl 15 ml EDTA  
  3 Fluorescein natrium tetes mata 2% dlm botol 5 ml Cendo Flurescein  
  4 Hidroksi Propil Metil tetes mata 0,30% Tears Naturalle II  
Selulosa
  5 Hidroksi Propil Metil tetes mata (3 mg + 1 mg)/ml Cendo Eyefresh  
Selulosa + Dekstran 70

42
  6 Hidroksi Propil Metil Selulosa + tetes mata 2 mg/ml Cendo Lubricen  
Natrium Hyaluronat
  7 Hidroksi Propil Metil Selulosa + tetes mata (5 mg + 0,25 mg + Augentonic  
Oksimetazolin + Vitamin A 1000
UI)/ml
  8 Hyaluronat natrium tetes mata 0,1%, 1,5%, 1,6% Hialid; BBTVISC  
1,5%; Occulon HV
1,6%; Cendo Hyalub

  9 Kalium klorida + Kalium Iodida + tetes mata   Cendo Catarlent  

Natrium tiosulfat
  10 Karboksimetil selulosa tetes mata   Cendo Cenfresh  
  11 Mitomisin tetes mata 0,4 mg/ml Mytocin  
  12 Nafazolin tetes mata 0,25 mg/ml Cendo  
Vasacon
  13 Natrium klorida + Kalium klorida tetes mata 8,664 mg+ 1,32 Cendolyteers  
mg
  14 Natrium klorida + Natrium asetat + tetes mata   Balanced Salt  
Natrium sitrat + Kalsium klorida +
Magnesium klorida + Kalium Solution (BSS)
klorida
  15 Pemirolast kalium tetes mata 0,10% Alegysal  
  16 Polivinil pirolidon + vit A + Na- tetes mata   Cendo Protagent A  
Hialuronat + NaCl + Na hidrogen
fosfat + Na dihidrogen fosfat
  17 Tetrahidrozolin HCl tetes mata 0,05% btl 5&10 ml Visine  
  18 Tetrakain HCl tetes mata 0,50% Pantocain  
  19 Vaccinium Myrtilllus tetes mata 80 mg/ml Cendo Berry  

43
 Extract
  20 Vitamin A palmitat salep mata 10 mg/ml Cendo Oculenta  
  21 Vit A palmitat + gel utk 1.000 IU + 3,5 mg Oculotect  
karbomer 980 mata
20   UTEROTONIK DAN RELAKSAN UTERUS
20.1   Uterotonik        
  1 Metilergometrin maleat tab; inj. 0,125 mg, 0,2 Methergin;  
mg/ml Pospargin
  2 Misoprostol tablet 200 mcg Cytotec; Gastrul  
  3 Oksitosin inj 10 IU/ml Synthocinon;  
Induxin
20.2   RELAKSAN UTERUS        
  1 Isoksuprin HCl tab; inj. tab 20 mg; inj. 10    
mg/2 ml amp
  2 Magnesium sulfat inj 20%, 40% Magnesium  
Sulphate
  3 Nifedipin tablet 5 mg, 10 mg Nifedipin tablet 10  
mg (generik)
  4 Terbutalin sulfat tab; inj; tab 2,5 mg; inj 0,5    
respules; mg/
turbuler ml; resp 2,5
mg/ml; turb
0,25 mg, 0,5 mg
21   PSIKOFARMAKA
21.1   ANTIANSIETAS DAN        
ANTIINSOMNIA

44
   1 Alprazolam tablet 0,25 mg, 0,5 mg, Xanax; Alganax;  
1 mg Zypraz; Alprazolam

0,5 mg; 1 mg
(generik)
  2 Bromazepam tablet 1,5 mg, 3 mg, 6 Lexotan; Lexzepam  
mg
  3 Diazepam tab; inj; tab 2 mg, 5 mg; Stesolid; Diazepam  
lar rektal inj 10 mg/2ml; lar tablet 5 mg
rektal 5 mg tube (generik)
2,5 ml; lar rektal
10 mg tube 2,5 ml
  4 Estazolam kapsul 1 mg, 2 mg    
  5 Klobazam tablet 10 mg Clobazam tablet  
10 mg (generik)
  6 Lorazepam tablet 0,5 mg; 1 mg; 2    
mg
21.2   ANTIDEPRESI DAN ANTIMANIA        
  2 Amitriptilin HCl tablet 25 mg Amitryptylline HCl  
tablet 25 mg
(generik)
  5 Fluoksetin kapsul 10 mg, 20 mg Prozac; Lodep;  
Kalxetin
21.3   ANTIOBSESI DAN ANTIKOMPULSI        

21.4   ANTIPSIKOSIS        
  2 Haloperidol tablet; inj, tab 0,5 mg, 1,5 Haloperidol tablet  
drops mg, 2 mg, 5 mg; 0,5 mg; 1,5 mg; 5

45
 inj 5 mg/ml; mg (generik)
drops 5mg/ml
  3 Haloperidol dekanoat inj 50 mg/ml Haldol Decanoas  
  4 Kloralhidat kapsul 500 mg Chloralhydrat 500  
  5 Klorpromazin HCl tab salut tab 25 mg, 100 Largactil; Promactil;  
selaput; mg; inj Cepezet-100
inj 25 mg/ml
  6 Klozapin tablet 25 mg, 100 mg Clozaril; Luften;  
Clorilex
  7 Risperidon tab: inj; tab 1 mg, 2 mg, 3 Risperidon tablet  
oral sol mg; inj 2 mg (generik)
25 mg, 37,5 mg,
50 mg;

oral sol 1 mg/ml

22   RELAKSAN OTOT PERIFER DAN        
PENGHAMBAT KOLINESTERASE

22.1   PENGHAMBAT NEUROMUSKULAR        

  1 Atrakurium besilat inj 25 mg/2,5 ml, 50    

mg/5ml  
  3 Eperison HCl tab salut 50 mg    
selaput
  4 Pankuronium bromida inj 2 mg/ml    
  5 Rokuronium bromida inj 50 mg    

46
   7 Vekuronium bromida inj 4 mg/mL, 10    
mg/vial
22.2   OBAT UNTUK MISTENIA GRAVIS        
  1 Neostigmin metilsulfat inj. 0,5 mg/ml Prostigmin;  
Neostigmin Hameln

  2 Piridostigmin bromida tablet 60 mg Mestinon  

23   OBAT UNTUK SALURAN CERNA        

23.1   ANTASIDA DAN ULKUS,        

ANTIBUSA
  1 Antasida DOEN tab; 500 mg Antasida DOEN  
suspensi tablet; suspensi
(generik)
  2 Alumunium hidroksida tab;      
+ Magnesium hidroksida + suspensi
Simetikon
  3 Esomeprazol tab; inj tab 20 mg, 40 mg; Nexium; Nexium IV  
inj 40 mg vial
  4 Lansoprazol kapsul 15 mg, 30 mg Lansoprazole  
kapsul
30 mg (generik)
  5 Misoprostol tablet 200 mcg    
  6 Omeprazol kapsul; inj kaps 10 mg, 20    
mg, 40 mg; inj 40 Omeprazole kapsul
mg
20 mg (generik)

47
   8 Ranitidin tab; inj tab 150 mg, 300 Ranitidin tablet  
mg; inj 25 mg/ml; 150 mg; inj. 50
Sirup 75 mg/5ml mg/2 ml (generik);
Sirup : Ranicare

  11 Sukralfat tab; fenolftalein 55 mg;    

Paraffin liq 1,2g;
gliserin
suspensi 378 mg
23.2   ANTIEMETIK        
1 Betahistin mesilat tablet 6 mg Betahistine  
  (generik)

  2 Dimenhidrinat tablet 50 mg    
  3 Domperidon tab; sirup; tab 10 mg; sirup 1 Domperidone  
mg/ tablet
drop ml; drop 5 mg/ml 10 mg (generik)
  4 Granisetron inj 1 mg/ml, 3 mg/3    
ml
  5 Metoklopramid HCl tablet; inj; tab 5mg, 10 mg; ; Metoclopramide  
inj 10 mg/2 ml; tablet 10 mg; inj.
sirup; sir 5 mg/5 ml; 10 mg/ 2 ml
drop drop 1 mg/10 (generik)
tetes
  6 Ondansetron HCl tab salut tab 4 mg; 8 mg; Zofran; Dantroxal;  
selaput; inj. 4 mg/2 ml, 8 Kliran;
kaplet mg/4 ml Ondansetron tablet
salut 4 mg; 8 mg; inj. 4
selaput; mg; 8 mg (generik)

48
 inj
  8 Piratiasin teoklat + tablet 40 mg + 37,5 mg Mediamer B6;  
vit B6 Zomivit
23.3   ANTIHEMORRHOID        
  1 Bismut subgalat + supp   Anti hemoroid  
supp
lidokain + seng oksida (generik)
+ supositoria  
  3 Hidrosmin kapsul; gel kaps 200 mg; gel Venosmil  
2%
  4 Diosmin + Hesperidin tablet 450 mg + 50 mg Ardium; Rhodium  
        + 2,5 mg    
23.4   ANTISPASMODIK        
  1 Atropin sulfat tab; inj tab 0,5 mg; inj Atropin Sulfat  
0,25 mg/
ml, 1 mg/ml (generik)
  2 Butropium bromida tablet 5 mg    
  3 Hiosin n-butil bromida tab salut tab 10 mg; inj 20    
gula; inj. mg/mL
23.5   OBAT UNTUK DIARE        
  1 Attapulgit tablet 600 mg    
  2 Garam Oralit serbuk NaCl 0,7 g + KCl Oralit  
0,3 g +
trinatrium sitrat (generik)
dihidrat
0,58 mg +  
Glukosa anhidrat
4g

49
   3 Kaolin + Pektin suspensi 550 mg + 20 mg    
  4 Loperamid HCl tablet 2 mg Loperamide tablet  
2 mg (generik)
  5 Smektit serbuk 3g Smecta  
  6 Seng sulfat tablet tablet dipersible; Zinkid; Serbuk :  
dispersible serbuk : 10 mg; Orezinx; sirup :
; serbuk; sirup : 20 mg/5 Zanic
sirup ml
23.6   LAKSATIF        
  1 Bisakodil tab; tab 5 mg; supp Dulcolax;  
suppos 5mg, Dulcolactol
10 mg
  2 Gliserin minum larutan      
  3 Kombinasi: Natrium lauril enema (45 mg + 450 mg Microlax  
sulfoasetat +5 mg + 625 mg +
+ Natrium sitrat + asam sorbat + 4465 mg)/5 ml
PEG + Sorbitol
  6 Laktulosa sirup 3,335 g/5 ml Duphalac; Lactulax;  
Constipan

  7 Magnesium sulfat kristal 30 g Garam Inggris  

  9 Parafin + Gliserin sirup Fenolftalein 55 Laxadine  
mg; Paraffin liq
1,2 g; gliserin
378 mg
23.7   Lain-lain        
  1 Asam ursodeoksikholat kapsul 250 mg Urdafalk; Estazor;  
Lofibra

50
   3 Curcumin tablet 200 mg Curcuma  
  6 Kombinasi enzim saluran cerna dragee   Enzyplex; Vitazym  
  7 Lactobacillus acidophilus serbuk   Lacto B  
24   OBAT UNTUK SALURAN NAFAS        

24.1   ANTIASMA        
  1 Aminofilin tab tab scored 200 Aminophyllin  
scored; mg; inj tablet
inj 24 mg/ml 200 mg; inj.
(generik)
  2 Budesonid aerosol 100 mcg; 200 Pulmicort;  
dosis mcg/puff Inflammide
terukur
  3 Budesonid + Fomoterol aerosol 80/4,5 mcg, Symbicort  
dosis 160/4,5 mcg
terukur
  4 Deksametason natrium fosfat tab; inj tab 0,5 mg; inj 4 Oradexon;  
mg/ ampul, 5 Kalmethason
mg/amp, 20
mg/vial
  5 Efedrin HCl inj, tab inj 50 mg/ml; tab Ephedrine HCl  
25 mg tablet
25 mg; inj. 50
mg/ml
(generik)
  6 Epinefrin inj 0,10% Epinephrine HCl  
  7 Fenoterol HBr larutan; lar 0,1 % 40 ml; Berotec  
MDI 100

51
 inhaler mcg/puff, 200
mcg/puff
  8 Salbutamol tab; sir; tab 2 mg, 4 mg; Ventolin; ;  
inhaler; sir 2 mg/5 mL; Salbutamol tablet
nebules; inhaler 100 2 mg; 4 mg
rotacap; mcg/puff; nebules (generik)
rotahaler; 2,5 mg; rot 200
rotadisk; mcg, 400 mcg; inj
diskhaler; 0.5 mg/ml
inj

  9 Salbutamol + Ipratropium UDV, 2,5 mg + 0,5 mg Combivent;  

Bromida inhaler UDV; MDI 200
puffs
  12 Salmoterol 25 mcg + Flutikason inhaler 50/120 dosis,    
proprionat 125/120 dosis
50 mcg / 125 mcg
  13 Teofilin kaps kaps lunak 130 Theophyllin tablet  
lunak; tab; mg; tab
eliksir; 150 mg, 300 mg; 150 mg (generik)
powder eliksir
130 mg/15ml;  
powder
1g  
  14 Terbutalin Sulfat tab; sir; tab 2,5 mg; sir 0,3 Bricasma; Nairet;  
inj; mg/ Forasma
canister; ml; inj 0,5 mg/ml;
turbuhaler can
; respules
0,25 mg/puff;
turb 0,25 mg, 0,5

52
 mg; resp 2,5
mg/ml
24.2   ANTITUSIF        
  1 Dekstrometorfan HBr tablet, sir tab 15 mg; sir 10 Dextromethorphan  
mg/5 ml e HBr tablet 15
mg; sirup 10 mg/ 5
ml (generik)
  2 Kodein HCl tablet 10 mg Codipront  
24.3   MUKOLITKK        
  1 Ambroksol tablet, tab 30 mg, sir 15 Ambroxol tablet  
sirup mg/5 ml 30 mg; sirup
(generik)
  2 Bromheksin HCl tablet; tab 8mg; eliksir    
eliksir; dan sirup
sirup; 4 mg/5ml; lar 8
larutan mg/4ml;
utk
inj 4 mg/2ml amp
inhalasi,
inj
  4 N-asetil Sistein serbuk; serbuk 100 mg,    
sirup 200 mg;
sir 150 mg/5 ml
24.4   EKSPEKTORAN        
  1 Gliseril Guaiakolat tablet 100 mg Glycerilguaiacolate  

(generik)
  2 Difenhidramin HCl+amonium sirup   Benadryl CM  
klorida+natrium
sitrat+mentol+alkohol

53
   3 Obat Batuk Hitam larutan   OBH Produksi  
RSCM
24.5   LAIN-LAIN        
  1 Beractant inj 25 mg/ml 8 ml Survanta  
vial
25   OBAT YANG MEMPENGARUHI        
SISTEM IMUN
25.1   SERUM DAN IMUNOGLOBULIN        
  1 Serum Antibisa Ular inj vial 5 ml ABU Polivalen  
  2 Serum Antitetanus inj 1.500 IU, 20.000 ATS  
IU
  3 Serum Imun Globulin inj 300 I.U., 0,5 mg/ Imogam Rabbies;  
Human Rabies 0,5 ml Verorab
  4 Tetanus Imun Globulin inj 250 IU Tetagam P  
  5 Vaksin Antipolio inj 40 antigen unit Imovax Polio  
(type 1);
4 antigen unit
(type 2);
32 antigen unit
(type 3)
  6 Vaksin antirabies inj 0,5 mg/ 0,5 ml Verorab  
  7 Vaksin IgG Hepatitis B inj 217 IU/ ml Hyperhep-B  
  8 Vaksin Influenza inj 0,5 ml Fluarix; Vaxigrip  
  9 Vaksin Meningitis meningokokal inj 0,5 ml Mencevax ACWY  
  10 Vaksin MMR inj 0,5 ml Trimovax; M-M-R II  
  11 Vaksin Pneumokokus inj 0,5 ml Prevenar (PCV);  
Pneumo 23
  19 Vaksin PPD inj 2 UT 1,5 ml Vaksin PPD  

54
   12 Vaksin Rotavirus inj   Rotarix  
  13 Vaksin Tifoid inj   Typhim VI  
  14 Vaksin TT inj vial 5 ml, 10 ml; Vaksin TT Bio  
uniject Farma
0,5 ml
  15 Vaksin Varisela inj 0,5 ml vial Varilrix; Okavax  
26   OBAT UNTUK TELINGA, HIDUNG,        
TENGGOROK
26.1   ANTIBAKTERI TOPIKAL        
  1 Kloramfenikol tetes 3% Cendo Fenicol  
telinga
  2 Ofloksasin tetes 3 mg/ml dlm 5 ml Tarivid  
telinga
26.2   LAIN-LAIN        
  1 Flutikason furoat semprot 27,5 mcg/semprot Avamys  
hidung
  2 Karbogliserin tetes 10% Waxsol;  
telinga Karbogliserin 30
mL;
1 L (generik)
  3 Larutan air laut isotonis semprot   Sterimar  
hidung
  4 Mometason furoat semprot 50 mcg/dosis Nasonex  
hidung
  5 Natrium klorida tetes 6,5 mg/ml Breathy nasal drop  
hidung
  6 Oksimetazolin HCl semprot 0,05%; 0,025% Afrin; Illiadin  
hidung; (tetes hidung ped)

55
 tetes
hidung
dws; tetes
hidung
ped
27   VITAMIN DAN MINERAL        
  1 Asam Askorbat tab; inj tab 50 mg, 100 Vitamin C tablet  
mg; inj 50 mg; inj.
(Vitamin C) 100 mg/ml, 200 (generik)
mg/ml,
  1g
  2 Kalium aspartat/klorida tablet 750 mg; 300 mcg KSR; Aspar-K  
  3 Kalsium glukonat inj 100 mg/ml Calcii gluconas  
  4 Kalsium karbonat tablet 500 mg O CaCO3 kapsul  
500 mg (generik)
  5 Kalsium laktat/fosfat tablet 500 mg Kalk  
  6 Kombinasi vitamin B tablet berbagai Neurobion;  
komposisi Neurobion
5000; Becombion
  7 Mineral-Mix        
  8 Multivitamin inj. inj vial 5 ml Cernevit  
  9 Piridoksin HCl (vit B6) tab; inj tab 10 mg, 25 mg; Pyridoxin HCl /  
inj Vitamin B6 tablet
100 mg/ml 10 mg (generik)
  10 Thiamin HCl tab; inj tab 50 mg, 100 vitamin B1 Soho/  
mg; inj Ethica; Vitamin B1
100 mg/ml tablet 50 mg
(generik)

56
   11 Thiamin Tetrahidrofurfuril Disulfid tab; inj tab 5 mg; inj 10 Alinamin/Alinamin-  
mg/2 ml F- Odorless
  12 Ubiquinon kapsul 50 mg, 100 mg VQ (50 mg); Ubi-Q;  
lunak Q-ten
  13 Vitamin A tablet 6.000 IU, 20.000 Vitamin A tablet  
IU,
50.000 IU 6.000 UI; 20.000
UI;
  50.000 UI (generik)

  14 Vitamin B12 tablet 50 mcg, 100 mcg Vitamin B12 tablet  

50 mcg (generik)
  15 Vitamin B12 + Ekstrak plasenta dragee 20 mcg + 15 mg Moloco + B12  
  16 Vitamin E (Tokoferol) kaplet 100 IU, 200 IU, Evion; Dalfarol;  
400 IU Naturol
  17 Vitamin K1 tab; inj tab 10 mg; inj 2 Phytomenadione  
mg/ml tablet 10 mg; inj
(generik)
28   OBAT YANG MEMPENGARUHI SALURAN KEMIH
28.1   ALPHA BLOCKER        
  1 Terazosin tablet 1 mg    
  2 Doksazosin tablet 1 mg, 2 mg, 4 mg    
28.2   ANTISEPTIK        
  1 Asam pipemidat kapsul 400 mg    
29   BAHAN GIGI        
  1 Spektra Minty pot 20 gr    
  2 Poliren Pasta pot 45 gr    

57
  3 Bioglass R paket      
  4 Zitemp set      
  5 G-aenial Quick Start Kit Syr set      
  6 Solare Flow A2 set      
  7 G-aenial Anterior & Posterior set      
  8 Amalgam kotak      
9 Elite Cement set      
 
  10 Freegenol set      
  11 Caviton pot 30 gr    
  12 Orafil Plus btl 40 gr    
  13 Champenol /CHKM btl 15 ml    
  14 Pulp-X pot 6 gr    
  15 Edta btl 15 ml    
  16 Paramonochlorfenol/CHKM btl 20 ml    
  17 Tricresol Formalin /TKF btl 10 ml    
  18 Pulp fill kit set      
30   LAIN-LAIN        
  1 Aqua untuk inhalasi botol 340 ml    
  2 Lubricant untuk USG Jelly   Aquasonic  
  3 Lubricant Jelly   KY Jelly  

Ditetapkan di Aeramo

58
 pada tanggal 1 Maret 2019
DIREKTUR RUMAH SAKIT DAERAH AERAMO

drg. EMERENTIANA R. W,MHlth&IntDev

NIP. 19722301200012 2 002

59