DAFTAR OBAT EDISI 2021 (Laptop)

DAFTAR ISI
Halaman
1 Sambutan Direktur Utama RS Khusus Bedah Rawamangun ………………… i
Keputusan Direktur No ….../KEP-DIR/RSKBR/III/2021 tentang Pembentukan Panitia

2 ii
Farmasi dan Terapi………………………..………………….…………...……………..
3 Petunjuk Pemakaian Buku Formularium RSKB Rawamangun Edisi X tahun 2021…. v

4 Daftar Obat Formularium RSKB Rawamangun …………………………………………… 1
5 Daftar Obat Emergency RSKB Rawamangun ………………………………..………. 28
6 Daftar Obat LASA ………………………………..………………………………………. 30
7 Daftar Obat High Allert ………………………………………………………….………… 32
8 Daftar B3 (Bahan-bahan Berbahaya) ……………………………………..…………….. 34
9 Daftar Obat Baru 2018-2020 RSKB Rawamangun …………………………………………. 37
10 Daftar Obat JKN-BPJS Tahun 2020 RSKBR Rawamangun………………………….. 39
11 Daftar Obat yang Keluar dari Formularium 2018……………………………………….. 41
12 Daftar Obat OOT dan Prekursor ………………………………………………………… 43
13 Indeks Nama Obat.……………………………………………………………………….. 44
FORMULARIUM RS KHUSUS BEDAH RAWAMANGUN
TAHUN 2021
KELAS BENTUK
NO NAMA GENERIK KEKUATAN NAMA DAGANG PABRIK KET
TERAPI SEDIAAN
1 ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NON STERID , ANTIPIRAI

1.1 ANALGESIK NARKOTIK
1 Fentanil inj 0.05 mg/ml, Fentanyl inj Mahakam High alert
ETANYL 2 ML Mahakam High alert

10 mg, 15 mg, Codein Kimia Farma High alert
2 Codein HCl tablet 20 mg Codikaf Kimia Farma High alert
3 Codipront kap dan Codipront cum Exp Kimia Farma High alert
syrup Codipront Kimia Farma High alert
4 Morphine sulfate inj 10mg/ml, Morphine inj Kimia Farma High alert
tablet 10 mg MST CONTINUS Kimia Farma High alert
5 Pethidin inj 50 mg/ml Pethidine HCl inj Kimia Farma High alert
1.2 ANALGESIK NON NARKOTIK
1.2.1 ANALGESIK ANTIPIRETIK
1 Metampiron inj im. 250 mg/ml Decamidon inj Harsen
2 Metamizol sodium inj 0,5 g/100 ml Antrain inj Interbat
tab 500 mg Novalgin Aventis
3 metamizol, diazepam 2 mg tab 2 mg Analsik Sanbe High alert
4 metamizol ,vit.B12 , B1 , B6 tab Neuralgin RX Kalbe

5 Asam Mefenamat kaplet 500 mg Ponstan Pfizer
MEFENAMIC ACID OGB
Lapistan Lapi
Mefinter Interbat
6 Asam asetil salisilat tab 80 mg Ascardia Pharos
Aspilets Uap
MINIASPI 80 MG JKN Mersi BPJS
7 Ketorolac tromethamine tab 10 mg Ketorolac10 mg OGB

inj 30 mg/ml Ketorolac 30 inj OGB
Scelto 30 inj Pharos
Ketrobat 30 inj Interbat
8 Parasetamol tab 500 mg Paracetamol OGB
Panadol kaplet biru Sterling
Panadol cold & flu Sterling
Panadol extra Sterling
Dumin Actavis
Sumagesic UAP
Pamol Interbat
Lanamol Landson pengganti
syrup 120 mg/5ml, 60 Tempra syr 60 ml Taisho

ml
Tempra syr 100 ml Taisho
Tempra Forte syr Taisho
Parasetamol syr OGB
Praxion syr Pharos
Praxion Forte syr Pharos
Pamol syr Interbat
drops 60 mg/15ml Tempra drop Taisho
2 Daftar Obat Edisi 2021

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
Praxion drop Pharos

8 Parasetamol drops 60 mg/15ml Pamol drop Interbat
suppos Propyretic 80 mg supp Combiphar
Pamol 125 mg supp Interbat
Pamol 250 mg supp Interbat
infus 1 gr/ 100 ml Paracetamol infus OGB
9 paracetamol +Tramadol tab Zaldiar Pharos
325 mg + 37,5
Analtram Lapi
mg
Acetram Pharos
10 paracetamol+Vit B12+B1+B6 tab Doloneurobion Merck
11 Ctm, DMP, Pseudoefedrin tab Anadex Interbat

syrup Anadex syr Interbat
12 Tramadol kap 50 mg Tramadol OGB
Tramal Pharos
Tradyl cap Interbat
inj Tramadol inj OGB
50 mg/ml @ 2ml
Tramal 50 inj Pharos
inj 100 mg/ml Tramal 100 inj Pharos
suppos 100 mg, Tramal supp Pharos
1.2.2 ANTI INFLAMASI NON STEROID
1 Ketoprofen suppos 100 mg, Fetik supp Interbat
tab 50 mg,100 mg Ketoprofen OGB
2 Dexketoprofen tab 25 mg Dexketoprofen OGB
3 Natrium Diklofenak tab salut 50 mg Natrium diklofenak OGB
Voltaren tab Novartis
1% tube 10 g,
emulgel Voltaren Emulgel Novartis
20 g, 50 g
4 Kalium Diklofenak tab 25 mg, 50 mg Cataflam Novartis
5 Etoricoxib kap 60 mg Arcoxia MSD
6 Ibuprofen tab 200 mg, 400 mg Ibuprofen OGB
syrup 100 mg/5ml Ibuprofen syr OGB
Proris syr Pharos
200 mg/5ml Ibuprofen syr OGB
Proris F syr Pharos
suppos 125 mg Proris supp Pharos
7 Meloksikam tab 7,5 mg. 15 mg Meloxicam OGB
Meloxin Interbat
8 Piroksikam kap 20 mg Piroxicam OGB
1.3 ANTI PIRAI
1 Allopurinol tab 100 mg, 300 mg Allopurinol OGB
Tdk diberikan saat
serangan akut
Isoric Interbat
2 colchicine tab 500 mg Recolfar fahrenheit

2 ANESTETIK
2.1 ANESTETIK LOKAL

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
20 mg / 4 ml Khusus untuk
1 Bupivakain HCl inj Heavy Regivell inj OGB analgesia spinal
2 Etil Klorida semprot 100 ml Chlorethyl Spray DrH

Khusus untuk
3 Lidokain HCl inj 2% Lidocain inj OGB analgesia spinal
4 Lidocain + Epinephrin inj inj 20 ml Pehacain inj Phapros High alert
5 Lignokain HCl inj 2% @ 6 ml / 5ml Instillagell Istem
Lidocain 20 mg tube ,
6 Ultraproct N cr Transfarma
+fluocortolone 1 mg suppos
2.2 ANESTETIK UMUM dan OKSIGEN
1 Enfluran inhalasi botol 250 ml Ethrane Abb
2 Isoflurane inhalasi btl. 250 ml ISORANE Dexa High alert
3 Sevoflurane inhalasi btl. 250 ml Sevodex Dexa High alert
4 Ketamin inj 100 mg/ml Ketalar inj Pfizer High alert
Venilam inj Pharos pengganti
IVANES 1000 mg/10mg ikapharmindo pengganti

5 Dinitrogen Oksida inhalasi Gas N2O
6 Oksigen inhalasi Gas O2
7 Propofol inj bolus 1%, Recofol inj Dexa High alert
2.3 ANESTETIK untuk PROSEDUR PRO OPERATIF

1 Atropin inj 0,25 mg/ml Atropin Sulfat inj OGB
2 Diazepam inj 5 mg/ml Stesolid 2 mg inj Actavis High alert
3 Midazolam inj 5 mg/ml, amp Sedacum inj Dexa High alert
3 ANTIALERGI dan OBAT untuk ANAFILAKSIS

10mg/ml (HCl)
1 Difenhidramin HCl inj Decadryl inj Harsen
vial
2 Klorfeniramin Maleat tab 4 mg, CTM OGB
3 Feksofenadin HCl tab OD 120 mg Telfast OD Aventis
HD. 180mg Telfast HD Aventis
4 Loratadin tab 10 mg Loratadin OGB
Loratadin 5 mg +
5 tab 5 mg + 60 mg Rhinos SR Dexa
pseudoephedrine
6 Pseudoephedrine drop 7,5 mg Alco drop Interbat
Rhinos Neo drop Dexa
7 pseudoephedrine + CTM syrup 7,5 mg + 1 mg Alco plus syr Interbat
Rhinos junior Dexa
8 pseudoephedrine + tab Trifed Interbat
triprolidine
Lapifed Lapi
syrup Trifed syr Interbat
9 CTM 2 mg + Dexamethasone tab Dextamine Phapros
10 CTM + Betamethasone tab 2 mg+ 0,25 mg Celestik Pyridam pengganti
11 Cetirizin tab 10 mg Incidal Bayer

Cetirizin OGB
Intrizin Interbat
Ozen Pharos

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
Tiriz Lapi
syrup 5 mg/ml Cetirizin syr OGB
Ozen syr Pharos
11 Cetirizin syrup 5 mg/ml Intrizin syr Interbat
drop 10 mg/ml Ozen drop Pharos
4 ANTIDOT dan OBAT LAIN untuk KERACUNAN
4.1 KHUSUS
1 Atropin Sulfat Inj 0,25 mg/ml Atropin Sulfat inj OGB
2 Kalsium Glukonas inj 10% (100mg/ml) CA GLUCONAS 10%/10CC OGB
3 Natrium Bikarbonat flacon 8,4% 25 ml Otsu Meylon Otsuka High alert
tab 500 mg Bic Natric OGB

4.2 UMUM
1 Karbo Adsorben tab 500 mg Norit
5 ANTIEPILEPSI - ANTIKONVULSI
1 Diazepam tab 2 mg Diazepam 2 OGB High alert
Valisanbe 2 Sanbe High alert
5 mg valisanbe 5 sanbe High alert
inj 5 mg/ml, amp Stesolid 2 mg inj Actavis High alert
lar rektal 5 mg/2,5 ml Stesolid rectal 5 mg Actavis High alert
10 mg/2,5 ml stesolid rectal 10 mg Actavis High alert

2 Fenitoin Na kap 100 mg, btl. Phenytoin Ikapharmindo
Inj 50 mg/ml, amp Phenytoin Natrium inj Ikapharmindo
3 Phenobarbital tab 30 mg, Phenobarbital Kimia Farma High alert
inj 50 mg/ml, amp Sibital inj Mersi High alert
4 Gabapentin kap 300 mg, Gabapentin OGB

100 mg Alpentin (JKN) ACTAVIS
5 Karbamazepin tab 200mg CARBAMAZEPIN 200 MG OGB
Bamgetol Mersi pengganti
6 Magnesium sulfat inj 20% , 40 % MgSO4 Otsuka High alert
7 Pregabalin kap 75mg Pregabalin OGB

8 Valproat tab DEPAKOTE 250 MG-JKN Abbot JKN
Depakote ER 250 mg-JKN Abbot

Depakote ER 500 mg-JKN Abbot
syr 250 mg/ml, VALPROATE SODIUM
syrup OGB
120 ml SYR
9 CLONAZEPHAM tab 2 mg CLONAZEPHAM 2 MG OGB High alert
6 ANTI INFEKSI
6.1 ANTELMENTIK
6.1.1 Antelmentik Intestinal
1 Pirantel tab 250 mg Combantrin Pfizer
suspensi 250 mg/5ml Combantrin susp Pfizer
6.2 ANTIBAKTERI
6.2.1 Golongan Penisilin
1 Amoksisilin kap 500mg Amoxicillin cap OGB
Lapimox Lapi
Intermoxil cap Interbat

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
syrup 125 mg/5ml, 60 Amoxicillin syr OGB

ml
Lapimox 125 mg syr Lapi
250 mg/5ml, 60
Lapimox 250 mg syr Lapi
ml
1 Amoksisilin drop Amoxan drop Sanbe
2 Amoksisillin + Asam kaplet 500 mg + 125 Co Amoxiclav OGB
klavulanat mg
Clabat 500 Interbat
syrup 125 mg/5ml, 60 Co Amoxiclav 125 mg OGB
ml
Clabat syr Interbat
250 mg/5ml, 60 Co Amoxiclav 250 mg OGB
ml
Clabat Forte syr interbat
3 Ampisillin inj 1 gr/vial Ampisillin inj OGB
6.2.2 Golongan Aminoglikosida
1 Gentamisin (sulfat) inj 80 mg/ml, @ 2 Gentamisin inj OGB
ml SALTICIN INJ Interbat
6.2.3 Golongan Kloramfenikol
1 Kloramfenikol kap 250 mg, Chloramphenikol OGB
2 Thiamfenikol kap 500 mg Thiamphenicol OGB
6.2.4 Golongan Kuinolon
1 Ciprofloxacin kap 500 mg Ciprofloxacin OGB - tdk sbg pilihan
utama utk infeksi
Quinobiotik Pharos kuman gram
Interflox Interbat positif,
Lapiflox Lapi
- tdk digunakan
infus 100 ml Ciprofloxacin infus OGB utk pasien <18
thn
2 Levofloxacin tab 500 mg Levofloxacin OGB
Cravox Lapi
Volox Interbat
500 mg/ml,
infus Levofloxacin infus OGB
botol 100 ml
6.2.5 Golongan Makrolida
1 Azithromicin kap 500 mg Azithromicin 500 OGB
Aztrin 500 Pharos
syrup 200 mg/5 ml Aztrin syr Pharos
2 Erithromisin kap 500 mg Erithromycin OGB
syrup 200 mg / 5ml ERYTHROMYCIN SYR OGB
3 Lincomycin tab 500 mg, Lincomycin OGB
Lincocin Upjhon
6.2.6 Golongan Sefalosforin
1 Cefadroxil kap 500mg, Cefadroxil 500 OGB
Lapicef 500 Lapi
Sedrofen 500 Interbat
syrup 125 mg/5ml Cefadroxil syr OGB
Lapicef syr Lapi
Sedrofen DS Interbat

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
2 Cefiksim kap 100 mg Cefixime 100 OGB

Cefila 100 Lapi
Ceptik 100 Interbat
Fixiphar 100 Pharos
kap 200 mg Cefixime 200 OGB
2 Cefiksim kap 200 mg Cefila 200 Lapi
Ceptik 200 Interbat
Fixiphar 200 Pharos
syrup 100 mg/5 ml, Cefixime syr OGB
Cefilla syr Lapi
Ceptik syr Interbat
Fixiphar syr 30 ml Pharos
Fixiphar syr 60 ml Pharos
3 Cefoperazon inj 1 g/vial Cefoperazon inj OGB
4 Cefoperazon + Sulbactam inj 1 g/vial Cefoperazon sulbactam inj OGB
5 Cefotaksim inj 1 g/vial Cefotaxime inj OGB

Lapixime inj Lapi
6 Ceftazidime inj 1 g/vial Ceftazidime inj OGB
7 Ceftriakson inj 1 g/vial Ceftriaxone inj OGB
Intrix inj Pharos
Starxon inj Interbat
Cefxon inj Lapi
8 Cefazolin inj 1 gr Cefazolin inj OGB
6.2.7 Antibakteri Lain
6.2.7.1 Golongan Tetrasiklin
1 Doksisiklin kap 100 mg DOXYCYCLINE 100 mg OGB
6.2.7.2 Golongan Lain-lain
1 Clindamicin kap 150 mg, 300 mg Clindamicin OGB
Clinium 300 Interbat
Clinmas 300 Lapi
2 Kotrimoksazol (anak) suspensi 200 mg, 40 mg Cotrimoksazol syr OGB
Sulfametoksazol-Trimetoprim Trimoxsul syr Interbat
Kotrimoksazol (dewasa) tab 400 mg, 80 mg Cotrimoksazol 480 mg OGB
Sulfametoksazol-Trimetoprim
3 Meropenem inj 1 g/vial Meropenem inj OGB

4 Metronidazole tab 500 mg, Metronidazole OGB
500 mg/ml,
infus Metronidazole infus OGB
botol 100 ml
6.3 ANTI INFEKSI KHUSUS
6.3.1 Antilepra
1 Rifampicin kap 300 mg Rifampicin OGB hanya utk lepra
6.3.2 Antituberkulosis
1 Ethambutol tab 500mg Ethambutol OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
utk profilaksis TB
2 Isoniazid tab 100 mg, 300mg Isoniazid OGB pada anak dan
HIV/AIDS
3 Pyrazinamide tab 500 mg Pyrazinamide OGB

300mg, 450 mg,
4 Rifampicin tab Rifampicin OGB
600 mg
150 mg+75
Rifampicin + inh
5 tab mg+400 Rifastar Indofarma
+Pyrazinamid + Ethambutol
mg+275 mg
6 Streptomisin sulfat inj 1 gr vial Streptomycin Inj Meiji
7 Paket Obat OAT tab FDC Kategori I Kemenkes
FDC Kategori II Kemenkes
FDC Kategori Anak Kemenkes
6.4 ANTIFUNGI
6.4.1 Antifungi, sistemik
1 Fluconazol kap 150 mg Fluconazol OGB
2 Itraconazole tab 100 mg Itzol Lapi
3 Ketokonazol tab 200mg Ketoconazol OGB
krim 2% 15 gr Ketoconazol cr OGB
500 mg +
4 Metronidazole + Nystatin tab vagina Flagystatin Aventis
10.000 ui
5 Nistatin suspensi 100.000 UI/ml Candistin drop Pharos
Nystatin drop OGB
6 Terbinafin krim tube 5 g , 10 g Interbi cr Interbat
tab 250 mg Interbi Interbat
6.5 ANTIPROTOZOA
6.5.1 Anti amuba dan Antigiardiasis
1 Metronidazole tab 500 mg, Metronidazole OGB
6.5.2 Antimalaria
6.5.2.1 Untuk Pencegahan
1 Doksisiklin kap 100 mg DOXYCYCLINE 100 mg OGB
6.6 ANTIVIRUS
1 Acyclovir tab 200mg, 400mg Acyclovir OGB
krim 5 gr Acyclovir cr OGB
Clinovir cr Pharos
2 Methisoprinol tab 500 mg, Isoprinosin Medifarma
syrup 250 mg/ 5 ml Isoprinosin syr Medi
Viridis syr Pharos
3 Valacyclovir HCl tab 500mg Inclovir Interbat
7 ANTIMIGRAIN
7.1 PROFILAKSIS
1 Propanolol tab 10mg; 40 mg Propanolol OGB
7.2 SERANGAN AKUT
1 Flunarizin tab 5mg Flunarizin OGB
7.3 ANTIVERTIGO
1 Betahistin tab 6 mg BETAHISTINE 6 MG JKN OGB BPJS

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
BETAHISTIN 6 MG OGB
Mertigo Dexa
24 mg BETAHISTINE 24 MG OGB
Betaserc abbot
Vertikaf 24 Kimia Farma
8 ANTINEOPLASTIK, IMUNOSUPRESAN dan OBAT untuk TERAPI PALIATIF
8.1 ANTINEOPLASTIK
9 ANTIPARKINSON / DEMENTIA
9.1 ANTI PARKINSON
1 pramipexole HCl tab 0.75 mg Sifrol 0.75 mg AS(JKN) Boehringer BPJS
0.375 mg Sifrol 0.375 mg AS(JKN) Boehringer BPJS
0.125 mg Sifrol 0.125 MG ASR(JKN) Boehringer BPJS
2 Trihexyphenidyl HCl tab 2 mg Trihexyphenidyl (THP) OGB
Hexymer Mersi
3 levodopa + benserazide tab LEVOPAR JKN Dexa BPJS
Levoben Tab Mersi

carbidopa + levodopa +
4 tab 100 mg Stalevo FCT (JKN) Novartis BPJS
entacapone
10 OBAT yang MEMPENGARUHI DARAH
10.1 ANTIANEMI
1 Asam Folat tab 1 mg, 5 mg Folic Acid OGB
2 Ferro Sulfate tab TAMBAH DARAH NEO OGB
Sangobion Merck
Nonemi Lapi
syrup, Ferlin syr Medifarma
drop Ferlin drop Medifarma
3 Sianokobalamin (Vit B12) tab 50 mcg Vitamin B12 OGB
10.2 OBAT yang MEMPENGARUHI DARAH
1 Asam Asetil Salisilat tab 80mg Ascardia Pharos
Aspilets UAP
MINIASPI 80 MG JKN Mersi BPJS
2 Heparin, Na inj 5000 UI/ml, vial Inviclot inj Fahrenheit high alert
krim 20 gr Thrombophob gel Tunggal I A

3 Clopidogrel tab 75 mg Clopidogrel JKN OGB high alert
4 Silostasol tab 100 mg Cilostazol OGB high alert
50 mg Pletaal eisai high alert
5 Warfarin tab 2 mg Simarc 2 Fahrenheit high alert
10.3 HEMOSTATIK
1 Asam Traneksamat kap 500mg Asam traneksamat OGB
plasminex sanbe pengganti
inj 100mg/ml Asam traneksamat inj OGB

2 Karbazokrom tab tab. 10mg Adona AC 17 Tanabe
inj 50mg/10ml Adona (AC-17) inj Tanabe
3 Fitomenadion (Vit K) tab 10mg PHYTOMENADIONE OGB
inj 2mg/ml, amp PHYTOMENADIONE inj OGB -dosis utk bayi

baru lahir 1 mg,
- dosis
utk bayi prematur
0,5 mg
TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN -dosis utk bayi
baru lahir 1 mg,
- dosis
utk bayi prematur
Mepro K 2 mg inj Mersi 0,5 mg
10.4 HEMATOPOETIK
11 PRODUK DARAH dan PENGGANTI PLASMA
11.1 FRAKSI PLASMA untuk PEMAKAIAN KHUSUS
inf 20%, 50 ml ,
1 Human Albumin inj Albuman 20% Graha PBJS
100 ml
11.2 PENGGANTI DARAH
1 Hydroxy ethyl starch infus 6%, 500 ml Widahes Widatra high alert
2 Poligelin infus 4% Gelafusal Dexa high alert
12 DIAGNOSTIK
12.1 TES FUNGSI
tuberkulin protein purified PPD (Purified Protein
1 inj 1:10, vial Biofarma
derivative Derivate) 2 TU
13 ANTISEPTIK dan DESINFEKTAN
13.1 ANTISEPTIK
larutan,
1 Alkohol 70%, 95% Alkohol Brataco
swab
0,1%, btl. 200
2 Etakridin larutan Rivanol Brataco
ml
3 Hidrogen peroksida cairan 3%, H2O2 3% Brataco
4 Iodin Povidon larutan 100 mg/ml Povidone Iodine Sol 1 ltr Mahakam
30 ml Povidone Iodine 30 ml Mahakam
1:5,000 /
5 Kalium Permanganat serbuk Pk (Pigmen) Brataco
1:10,000
6 Lactic acid lotion 60 ml, 100 ml Lactacyd Pink Stiefel
One Scrub 2% 500 ml+
7 Klorheksidin Glukonat larutan 2% Onemed
disp BH
SENTINEL HW-HAND
SENTINEL
WASH 500 ML
SENTINEL ID 1 LTR SENTINEL
13.2 DISINFEKTAN
1 Deterjen enzimatik larutan SENTINEL DEC 1 LTR SENTINEL
tab. 1 g, btl. 100
2 Formalin Formalin tab Brataco
tab
lar, 37%, Formalin cair Brataco
utk diencerkan
3 Klorheksidin Glukonat larutan 15% PD scrub SSL bila akan
digunakan
14 OBAT dan BAHAN untuk GIGI dan MULUT
1 Benzidamin HCl larutan 7,5mg/5ml Tantum Verde Soho
btl. 60 ml, 120
ml
2 Iodin Povidon larutan 1% Betadine kumur Mahakam
3 Fradiomisin, gramisidin lozenges FG Throches Meiji
4 klorhexidin glukonat 0,2% larutan 150 ml Minosep Obat kumur Minorock
5 Maltodextrin, aqua, ppg gargle 60 ml Aloclair Kalbe
15 DIURETIK
1 Furosemid tab 40mg, Furosemide OGB
inj 10 mg/ml, amp Furosemide inj OGB
2 Hidroklortiazid tab 25mg, 50mg HCT(hydrochlorotiazide) OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
3 Manitol inj 20% 250 ml Manitol Otsuka

4 Spironolakton tab 25mg; 100mg Spironolakton OGB
16 HORMON, OBAT ENDOKRIN LAIN dan KONTRASEPTIK
16.1 ANTIDIABETES
16.1.1 Antidiabetes, Oral
1 Acarbose tab 50mg, 100 mg Acarbose (JKN) OGB high alert
2 Glibenklamid tab 5mg, Glibenklamid OGB high alert
3 Gliklazid tab 80 mg Glucodex Dexa high alert
60 mg Diamicron MR 60 mg Darya high alert
4 Gliquidon tab 30mg, Gliquidone OGB high alert
Glurenorm Boehringer high alert
5 Glimepiride tab 1 mg, 2 mg, 3 Glimepiride 1 mg (JKN) OGB high alert

mg, 4 mg
Glimepiride 2 mg (JKN) OGB high alert
Glimepiride 3 mg (JKN) OGB high alert
Glimepiride 4 mg OGB high alert
6 Metformin tab 500mg, 850 mg Metformin 500 mg (JKN) OGB high alert
Metformin 850 mg JKN OGB high alert
Glucophage 500 mg Merck high alert
500 mg Glucophage XR 500 mg Merck high alert
7 PIOGLITAZONE tab 15 mg, 30 mg Pioglitazone OGB high alert
16.1.2 Antidiabetes, Parenteral

100 ui/ml @ Novorapid Flexpen
1 Insulin analog aspart flexpen Novo Nordisk high alert
10ml 100Ui/ml JKN
Levemir Flexpen 100 ml
2 Insulin analog detemir flexpen 100 ui/ml @ 3ml Novo Nordisk high alert
(JKN)
Insulin analog campu (lispro
3 inj 100 ui/ml @ 3ml Humalog kwikpen 3 ml JKN Ely lilly high alert
+ NPH)
Insulin lispro 25%+ lispro
4 pen 100 ui/ml @ 3ml HUMALOG MIX 25 KWIKPEEly lilly high alert
protamin 75%
5 Insulin analog glargine inj, penfill 100 ui/ml @ 3ml Lantus Solostar 100UI(JKN) Sanofi high alert
Insulin analog campur

Novomix 30 Flexpen
6 (aspart 30%-protamin, aspart flexpen 100 ui/ml @ 3ml Novo Nordisk high alert
100U/ML(JKN)
70%
Apidra Solostar Flexpen
7 Insulin glulisine flexpen 100 ui/ml @ 3ml Sanofi high alert
JKN
16.2 HORMON KELAMIN dan OBAT yang MEMPENGARUHI FERTILITAS
16.2.1 Androgen
16.2.2 Estrogen
16.2.3 Progestogen
1 Dydrogesteron tab 10 mg Duphaston Kimia Farma
2 Noretisteron tab 5mg, Primolut N Schering
3 Progesteron ovula 100 mg, 200 mg Microgest Lapi
16.2.4 Kontraseptik
16.2.4.1 Kontraseptik, Oral
levonorgestrel + 150 mcg+ 30
1 pil Microgynon LIBI 10X28 Bayer
etinilestradiol mcg
16.2.4.2 Kontraseptik, Parenteral

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
1 Medroksi progesteron asetat inj, depot 150 mg/ml Triclofem inj Tunggal I A
Medroksi progesteron asetat
2 inj, depot 0,5 ml Cyclofem Tunggal I A
+ estradiol
16.2.4.3 Kontraseptik, AKDR (IUD)
IUD set Nova T Bayer
Copper T Kimia Farma
16.2.5 Induktor Ovulasi
16.3 HORMON TIROID dan ANTITIROID
1 Propiltiouracil tab 50 mg PTU OGB
16.4 KORTIKOSTEROID dan KORTIKOTROPIN
1 Deksametason inj 5 mg/ml,amp Deksametason inj OGB
tab 0,5 mg. Deksametason OGB
Indexon Interbat
2 Methyl prednisolon tab 4 mg Methyl Prednisolon OGB
Lameson Lapi
Intidrol Interbat
inj 125 mg , 5 ml / Methyl Prednisolon inj OGB
vial Lameson inj Lapi
3 Prednison tab 5mg, Prednison OGB
4 Triamsinolon tab 4 mg Triamcort Interbat
Amtocort Pharos
inj IA/ID 10mg/ml FLAMICORT IA/ID Dexa
16.5 OBAT METABOLISME TULANG dan OTOT
1 Glukosamin sulfat krim 15 gr, 30 GR Flexamine cr Novell
tab Glucosamin MPL OGB
17 OBAT KARDIOVASKULER `
17.1 ANTIANGINA
1 Bisoprolol fumarat tab 5mg Bisoprolol 5 OGB
2,5 mg Concor 2,5 mg JKN Merck
2 Isosorbid Dinitrat tab 5 mg Isosorbid dinitrat OGB
Cedocard 5 Darya
3 Nitrogliserin inj 10 mg NITROGLYCERIN INJ Ferron
4 Nicardipine inj 10 mg/ 10 ml Nicardipine inj OGB
17.2 ANTI ARITMIA
1 Amiodaron inj 150 mg/3 ml Amiodaron inj OGB
2 Lidokain HCl inj 2% Lidocain inj OGB high alert
3 Propanolol tab 10 mg, 40 mg Propanolol OGB

17.3 ANTIHIPERTENSI
17.3.1 Penghambat ACE
1 Captopril tab 12,5mg ; 25mg Captopril OGB
2 Lisinopril tab 5 mg, 10 mg Lisinopril OGB
3 Ramipril tab 5 mg, 10 mg Ramipril OGB
17.3.2 Penghambat BETA
1 Bisoprolol fumarat tab 5mg Bisoprolol 5 OGB
2,5 mg Concor 2,5 mg JKN Merck
2 Propanolol tab 10 mg, 40 mg Propanolol OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
17.3.3 Antagonis Kalsium

1 Amlodipin tab 5 mg, 10 mg Amlodipin (JKN) OGB
Norvask Pfizer
Intervask Interbat
2 Nifedipin tab 10 mg Nifedipin OGB hanya utk pre
eklampsia dan
30 mg Adalat oros 30 (JKN) Bayer tokolitik
17.3.4 Angiotensin II antagonis

1 Irbesartan tab 150 mg, 300 mg Irbesartan OGB
2 Candesartan cilexetil tab 8 mg, 16 mg Candesartan (JKN) OGB
3 Losartan tab 50mg Losartan OGB
4 Valsartan tab 80mg, 160 mg Valsartan NI OGB
5 Telmisartan tab 40 mg, Telmisartan OGB
17.3.5 Lain-Lain
1 Klonidin HCl tab 0,15mg Clonidin OGB
digunakan utk
inj 10mg/ml Catapress inj (E/AS) Merck hipertensi berat
diberikan setiap 4
2 metildopa tab salut 250 mg Dopamet tab Actavis jam
17.4 GLIKOSIDA JANTUNG

1 Digoksin tab 0,25 mg Digoxin OGB
inj 0,25 mg/ml Fargoxin inj Fahrenheit high alert
17.5 OBAT untuk SYOK KARSIOGENIK dan SEPSIS

17.5.1 Inotropik
1 Dobutamin inj 25 mg/ml Dobutamin inj OGB
2 Dopamin inj 40 mg/ml Dopamin inj OGB
Indop Inj / Cetadop inj Fahrenheit
17.5.2 Vasokonstriktor
Cortidex inj Sanbe pengganti

Indexon Interbat
2 Ephedrin HCl inj 50 ml/ml Ephedrin inj Ethica
3 Epinefrin (adrenalin) inj 1 mg/ml Epinephrine inj Ethica high alert
4 Norepinephrine inj 1 mg/ml Raivas inj Dexa high alert
Vascon inj Fahrenheit pengganti
17.6 ANTIHIPERLIPIDEMIA
1 Atorvastatin tab 10 mg Lipitor10 Pfizer
20mg, Atorvastatin 20 (JKN) OGB
Lipitor 20 Pfizer
Fastor 20 Lapi
2 Fenofibrate kap 100 mg Fenofibrate 100 mg (JKN) OGB
200 mg fenofibrate OGB
300 mg Fenofibrate 300 mg (JKN) OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
utk hipertrigliserid,
3 gemfibrozil tab 300 mg gemfibrozil OGB tdk diberikan
bersama statin
4 Simvastatin tab 10 mg Simvastatin 10 OGB

20 mg Simvastatin 20 mg JKN OGB
17.7 VASODILATOR
1 Flunarizin tab 5mg Flunarizin OGB
2 Citicolin inj 125 mg/ml Citicolin 125 mg inj OGB
tab 500 mg Citicoline OGB
17.8 LAIN-LAIN
1 Piracetam kap 800mg Piracetam 800 OGB
18 OBAT TOPIKAL untuk KULIT
18.1 ANTIAKNE
1 Adepslanae gel 0,1% 10 gr Evalen gel Ferron
2 Sulfur lotion 6,6% 110 ml Acne Feldin Galenika
0,025% tube 15
3 Asam Retinoat krim Vitacid 0,025% SDM
gr
0,05% tube 20
Vitacid 0,05% SDM
gr
4 Isotretinoin kap 10 mg Roacutan Roche
5 Triclosan Emulsi btl 50 ml, 110 ml Phisohex Facial Wash PHC
6 Clindamycin Phospate lotion, gel 30 ml, 15 gr Mediklin SDM

18.2 ANTIBAKTERI
1 Framisetin sulfat kasa steril 1% VASELINE SWAB Winner
2 Chloramphenicol krim 2% 15 gr Kalmicetine Kalbe
Chloramphenicol+
3 krim 10 gr tube Chloramfecort Kimia Farma
Hydrocortison
Chloramphenicol
4 krim 10 gr tube Chloramfecort H Kimia Farma
+Prednisolon
5 Mupirocin salep, 2% 10 gr Mupirocin oint OGB
krim
Bactoderm cr SDM
Bactoderm oint SDM
6 Nadifloxacin krim 10 gr tube Acuatim cr Otsuka
7 Silver sulfadiazine krim 35 gr tube Burnazin Darya
8 Mometasone Furoate krim Mofacort cr SDM
0,1%, tube 5
Mofacort oint SDM
gr, 10 gr
Mometasone cr OGB
Neomycin sulfate + Plasenta
9 krim 15 gr Bioplacenton Kalbe
Extr
10 Gentamycin Sulphate krim, tube 5 gr, 15 gr Gentamycin oint OGB
salep Gentalex cr Molex ayus pengganti
11 Neomycin Sulfate+bacitracin krim 5 gr tube Nebacetin oint Pharos

250 IU powder 5 gr powder Nebacetin powder Pharos
18.3 ANTIFUNGI
1 Ketokonazol krim 2%, tube 5 gr Ketokonazol OGB
2 Miconazol krim 2% 5 gr, 10 gr Myconazole OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
3 Nystatin + Zn Oxyde krim 10 gr tube Myco-Z cr Taisho

4 Selenium sulfida botol 120 ml Selsun Blue 120 ML Abbot
Selsun Yellow Double
50 ml, 100 ml Abbot
Impact
5 Terbinafin krim tube 10 g Interbi cr Interbat
18.4 ANTIVIRUS
1 Acyclovir krim 5 gr Acyclovir cr OGB
Clinovir cr Pharos
18.5 ANTIINFLAMASI dan ANTIPRURITIK
1 Betametasone valerat krim 0,1% 10 gr Betamethason cr OGB
15 gr Benoson cr Bernofarm
2 Betamethasone + Neomycin krim tube 5 g Betason N cr Kimia Farma
tube 5 gr, 15 gr Benoson N cr Bernofarm
3 Betamethasone + Miconazol krim 5 gr tube Benoson M cr Bernofarm
Clotrimazole +
4 salep Inerson salep Interbat
Deksamethasone
5 Hidrokortison Asetat krim 2,5%, tube 5 g Hydrocortisone OGB
lotion, lotio 15%,
6 kalamin Caladine Yupharin
bedak bedak 10%
7 Klobetasol Propionate krim, 10 gr Lotasbat oint Interbat
salep 5 gr, 10 gr Kloderma SDM
0,1%, tube 5
8 Mometasone Furoate krim Mofacort cr SDM
gr, 10 gr
Mofacort oint SDM
Mometasone cr OGB
9 Triamsinolon salep 0,1%, tube 5 g Kenalog In Orabase Taisho
18.6 ANTISKABIES
1 Permetrin krim 5% 10 gr tube Scabimite cr Galenika
30 gr tube
18.7 LAIN-LAIN
1 Asam salisil, talkum serbuk 2% Salicyl talk Kimia farma
2 Centella asiatica powder Madecassol powder Corsa
Dimethicone + vinyl
3 gel 5 gr, 15 gr Dermatix ultra cr Transfarma
dimethicone
Radix
4 scutellariae+phellodendri salep 20 gr Mebo oint Combiphar
cortex
5 Pseudo-dermal lipids krim 80 ml Noroid Soothing cr Soho
6 Ethylhexyl + titanium dioxide lotion 100 ml Parasol SPF 30 lotion SDM
krim 20 gr Parasol SPF 33 20 gr SDM
lotion 30 ml Heliatec SPF 45+ SDM
7 Metilsalisilat + menthol + krim 15 gr, 30 gr, Counterpain Bristol
eugenol 60 gr Lafalos 20 gr Sanbe
Counterpain Cool Bristol
8 Eucalyptus Oil + menthol + krim 10 gr tube Transpulmin balsem Transfarma
champhor 10 gr, 50 gr pot Vicks Vaporub P&G
inh Vicks Inhaler P&G
9 Conc camomiel + eucalyptus krim 10 gr tube Transpulmin BB Transfarma

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
19 LARUTAN ELEKTROLIT, NUTRISI dan LAIN-LAIN

19.1 ORAL
1 NaCl + KCl + trinatrium sitrat serbuk Oralit OGB diminum sedikit
dihidrat + glukosa anhidrat 0.52 demi sedikit 2-3
gr+0.30gr+0.58 Pharolit Pharos teguk untuk
gr+2.7 gr menghindari
larutan Pedyalite Otsuka muntah
siap larut 300

2 kalium klorida powder KCl powder Brataco
mg
tab 600mg KSR 600 MG JKN Merck
19.2 PARENTERAL
1 Asam amino +vit + elektrolit infus btl 500 ml Aminofusin Paed Kalbe
Asam amino +glukosa +
2 softbag infus B fluid B Braun
elektrolit Vitamin B
3 Glukosa infus btl 500 ml INFUS D5-MJB Emjebe
Otsu D5 500 ml Widatra pengganti
btl 500 ml Otsu D10 500 ml Otsuka

25 ml Otsu D40 25 ml Otsuka
4 Kalium klorida inj 25 ml Otsu KCl 7,46 Otsuka High alert
5 Kalsium Glukonat inj 10% Calcium Gluconas inj OGB

6 NaCl 1,125 gr, Glukose infus btl. 500 ml Infusan Tridex Plain SP Sanbe
18,75 gr Otsu KaEn 1B Otsuka pengganti
NaCl 1,75 g, KCl 1,5 g, Na

7 Laktat 2,24 g, Dextrose infus btl 500 ml Otsu Ka-En Mg 3 Otsuka
anhydrat 100 g
NaCl 2,34 g, KCl 0,75 g, Na

8 Laktat 2,24 g, Dextrose infus btl 500 ml Otsu Ka-En 3A Otsuka
anhydrat 27 g
NaCl 1,75 g, KCl 1,50 g, Na INFUSAN TRIDEX 27B SP Sanbe

9 Laktat 2,24 g, Dextrose infus btl 500 ml
anhydrat 27 g Otsu Ka-En 3B Otsuka pengganti
Glukosa 2,5%, Natrium

10 infus btl 500 ml Otsu D2,5- 1/2 NS Otsuka
Klorida 0,45%
Glukosa 5%, Natrium
11 infus btl 500 ml Otsu D5 - 1/4 NS Otsuka
Klorida 0,225%
Glukosa 10%, Natrium

12 infus btl 500 ml OTSU D10 1/5 NS Otsuka
Klorida 0,18%
perlu dilakukan
13 Natrium Bikarbonat inj 8,4%, vial 25 ml Otsu Meylon Otsuka pemeriksaan gas
darah
14 Natrium Klorida infus botol 500 ml INFUS NS-MJB Emjebe

INFUSAN NS 500 ML SP Sanbe pengganti
ECOSOL NACL 0.9% 100
btl 100 ml B Braun
ML
25 ml Otsu NS 25 ml Otsuka
infus 3% Otsu Salin 3% 500 ml Otsuka High alert
15 Ringer Asetat infus btl. 500 ml Infusan Ring As 500 ml SP Sanbe

Otsu Asering 500 ml Otsuka pengganti
16 Ringer Laktat infus btl. 500 ml Infusan RL 500 ml SP Sanbe

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
INFUS RL-MJB(500ML) Emjebe pengganti

5% + 95% btl.
17 Dextrose + Ringer asetat infus Otsu- RD Otsuka
500 ml
19.3 LAIN-LAIN
1 air untuk injeksi / irigasi flacon 25 ml Otsu water 25 ml Otsuka
botol 500 ml Aqua bidestilata steril Ikapharmindo
1000 ml Wida WI Widatra irigasi
20 OBAT untuk MATA

20.1 ANTIMIKROBA
1 Gentamycin tetes mata 0,3 % C-GENTA 03% ED Cendo
salep
3,5 gr C-GENTAMYCIN EO 0,3% Cendo
mata
C-FENICOL EYE OINT
2 Kloramfenikol salep Cendo
3,5 g, 3,5GR
mata
CHLORAMFENICOL 1% OGB
0,25%, 0,5%,
2 Kloramfenikol tetes mata C-Fenicol Cendo
1%
Dexametason + Neomycin +
3 tetes mata 5 ml C-Xitrol eye drop Cendo
Polymixin B Sulfate
Dexametason + Neomycin + salep
3 3,5 gr C-Xitrol eye oint Cendo
Polymixin B Sulfate mata
Tobramisin + Deksametason
4 tetes mata Tarivid ophtal Kalbe
20.2 ANTI INFLAMASI

20.3 MIDRIATIK
20.4 MIOTIK DAN ANTIGLAUKOMA
1 Timolol Maleat tetes mata 0.25% 5 ml C- Timol ED 0,5 Cendo
20.5 LAIN-LAIN
KI, KCl, Na Tiosulfat,
1 tetes mata 15 ml C-Catarlent Cendo
Thimerosal
2 Antazolina + Nafazolina tetes mata 15 ml C-Vasacon Cendo
Tetrahydrozolin +
3 tetes mata 7,5 ml, 15 ml Insto Sterling
benzalkonium Cl
4 Tetrahydrozolin tetes mata 6 ml Visine Pfizer
5 Na Hyaluronat tetes mata 5 ml C-Hyalub Cendo
21 OKSITOKSIK dan RELAKSAN UTERUS

21.1 OKSITOKSIK
1 Metil Ergometrin Maleat tab salut 0,125 mg
Metil Ergometrin Maleat OGB
inj 0,2 mg/ml
2 Misoprostol tab 200 mcg Cytotec Searle
Gastrul Fahrenheit
3 Oksitosin inj 10 IU/ml PROTOCIN INJ mepro High alert
21.2 RELAKSAN UTERUS

1 Isoksuprin HCl tab 20 mg Duvadilan Kimia Farma

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
inj 10 mg/2 ml Proterin inj Novell pengganti

25 ml, 20% -
2 Magnesium Sulfat flacon MgSO4 Otsuka High alert
40%
22 PSIKOFARMAKA
22.1 ANTIANSIETAS dan ANTIINSOMNIA
1 Alprazolam tab 0,25 mg Alprazolam 0,25 OGB High alert
0,5 mg Alprazolam 0,5 OGB High alert
1 mg Alprazolam 1 OGB High alert
2 Diazepam tab 2 mg Diazepam 2 OGB High alert
Valisanbe 2 Sanbe High alert
5 mg valisanbe 5 sanbe High alert
inj 5 mg/ml, amp Stesolid 2 mg inj Actavis pengganti
lar rektal 5 mg/2,5 ml Stesolid rectal 5 mg Actavis High alert
10 mg/2,5 ml stesolid rectal 10 mg Actavis High alert
3 Clobazam tab 10 mg CLOBAZAM 10MG OGB High alert
22.2 ANTIDEPRESI dan ANTIMANIA

1 Amitriptiline HCl tab 25 mg Amitriptilin OGB
2 Valproat tab Depakote ER (JKN) Abbot bpjs
250 mg, 500 mg
250 mg Depakote (JKN) Abbot bpjs

syr 250 mg/ml, VALPROATE SODIUM
syrup OGB
120 ml SYR
22.3 ANTIPSIKOSIS
2 Klorpromazin tab 25 mg Chlorpromazin OGB
3 quetiapin tab 100 mg, Seroquel Abbot
4 Risperidone tab 2 mg, Risperidon OGB
23 RELAKSAN OTOT PERIFER dan PENGHAMBAT KOLINESTERASE
23.1 PENGHAMBAT TRANSMISI NEUROMUSKULER
1 Atracrium besylate inj 25 mg/2,5 ml TRAMUS 1% 2.5ML Dexa
2 Eperison HCl tab 50 mg Eperison OGB
Myonep Lapi
3 Tizanidine HCl tab 2 mg Tizanidine HCl OGB
4 Pyridostigmine Br tab 60 mg MESTINON TAB (JKN) Menarini
23.2 OBAT untuk MISTENIA GRAVIS
1 Neostigmin methylsulfate inj 0,5 mg/ml Prostigmin inj Transfarma
24 OBAT untuk SALURAN CERNA
24.1 ANTASIDA dan ANTIULKUS
1 Antasida DOEN,kombinasi: tab kunyah Antasida DOEN OGB
200 mg + 200
Al(OH)3 + Mg(OH)2 Promag Kalbe
mg
suspensi Antasida syr OGB
tab Mylanta Pfizer
2 Al(OH)3 + Mg(OH)2 larutan 200 mg+200 Mylanta liq Pfizer
+Simetikon mg+20mg Acitral syr Interbat
Polysilane syr Pharos
3 Esomeprazol tab 20 mg Nexium Astra Zeneca
4 Lansoprazol kap 30mg Lansoprazol OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
Lasgan Lapi
Lanpracid Pharos
5 Misoprostol tab 200 mcg Cytotec Searle
Gastrul Fahrenheit
6 Omeprazole kap 20mg, Omeprazole OGB
Protop Interbat
Inhipump Pharos
inj 40 mg/10 ml Omeprazole inj OGB
Inhipump inj Pharos
7 Pantoprazol tab 20mg, 40 mg Pantoprazole tab OGB
PANTOPUMP 40 MG Interbat
inj 40mg Pantoprazole inj OGB
Pantopump inj Interbat
8 Ranitidin tab 150mg Ranitidin OGB
Gastridin Interbat
inj 50 mg / 2 ml Ranitidin inj OGB
Gastridin inj Int
syrup Ranivell syr Novell
9 Rebamipide tab 100 mg Rebamid Lapi
10 Sukralfat suspensi Taxilan susp Pharos

500mg/ml, @
100ml Inpepsa susp Fahrenheit
Sukralfat susp OGB
tab Ulsidex Dexa
11 Polymigel tab 400mg Strocain-p Eisai
12 Dimetilpolisiloksan tab Disflatyl Pharos
13 Polisakarida sulfat tab Fucoidan Soho
24.2 ANTI EMETIK
1 Betahistin tab 6 mg, Betahistin (JKN) OGB
Mertigo Dexa
24 mg Vertikaf Kimia Farma
Betaserc abbot
2 Dimenhidrinat tab 50 mg Dramamine Searle
3 Domperidone tab 10mg Domperidone OGB
Mothilium Johnson &J
DOM Lapi
Tilidon Interbat
suspensi 5 mg/ 5 ml Domperidone syr OGB
Tilidon syr Interbat
4 Metoklopramid tab 10mg Primperan soho
inj 5 mg/ml Tomit inj Interbat
5 Ondansentron tab 4mg, 8mg Ondansetron 4 mg OGB
Ondansetron 8 mg OGB
Narfoz 4 mg Pharos
Narfoz 8 mg Pharos

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
Invomit 4 mg interbat
inj 4 mg Ondansetron 4 mg inj OGB
Narfoz 4 mg inj Pharos
Invomit 4 mg inj Interbat
inj 8 mg Ondansetron 8 mg inj OGB
Narfoz 8 mg inj Pharos
Invomit 8 mg inj Interbat
syrup 4 mg/ 5 ml Narfoz syr 60 ml Pharos
Narfoz syr 30 ml Pharos
24.3 ANTIHEMOROID
1 Fluocortolone + lidocain suppos Ultraproct N Transfarma
2 Hydrosmin tab 200 mg Venosmil Kalbe
krim 2% 60 gr Venosmil gel Kalbe
500 mg,
3 Hesperidin+Diosmin tab Ardium Darya
1000 mg
Lithospermi radix +
4 suppos Borraginol N Takeda
benzocaine
Lithospermi radix +
5 suppos Borraginol S Takeda
Prednisolon
Policresulen+cinchocaine
6 suppos Faktu Pharos
HCl
24.4 ANTISPASMODIK
1 Atropin Sulfat inj 0,25mg/ml Atropin Sulfas inj OGB
2 Hiosin N butil bromida tab 10 mg Buscopan tab Boehringer
inj 20mg/ml Buscopan inj Boehringer
3 Hiosin N butil bromida + Pct tab Buscopan plus Boehringer
metamizole Na + extr.
4 tab Spasminal Hexpharma
Belladone + papaverin
24.5 OBAT UNTUK DIARE
1 Attapulgite tab New diatab Medi tidak utk anak
Diagit Interbat
2 Garam Oralit (kombinasi) serbuk Oralit OGB diminum sedikit
0.52 demi sedikit 2-3
gr+0.30gr+0.58 Pharolit Pharos teguk untuk
gr+2.7 gr menghindari
larutan Pedyalite Otsuka muntah
3 Loperamid tab 2 mg Imodium Janssen

tab - harus diberikan
4 Zinc dispersibl 20 mg Zinc 20 mg OGB bersama oralit
e dan diberikan
syrup 60 ml / 100 ml Interzinc syr 60 ml Interbat selama 10 hari
L-zinc syr lapi

5 Nifuroksasid syrup 60 ml Nifural syr Darya
24.6 LAKSATIF
1 Bisakodil tab 5 mg Dulcolax tab Boehringer
suppos 5 mg, 10 mg Dulcolax supp Boehringer
2 Gliserin cairan tts 10 mg/ml Glycerin Brataco
syrup 60 ml, 110 ml Laxadine syr Galenika
3 Laktulosa syrup 3.335 g/5 ml Lactulax syr Ikapharmindo

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
(60 ml. 120 ml)

4 Magnesium Sulfat Kristal 30 gr Garam Inggris Brataco
sorbitol, Na laurilsulfate, Na
5 enema 5 ml Microlax supp Pharos
Sitrat
6 Na Fosfat, Na monofosfat enema 133 ml Fosen enema Fahrenheit
24.7 LAIN-LAIN
1 asam ursodeoxycholat kap 250mg Urdafalk Darya
CURCUMA FORCE TAB
2 serbuk rhizoma curcuma tab 200 mg BLISTER
Soho
CURCUMA PLS SHARPY
syrup 60 ml ORANGE
Soho
3 Lacto Bacillus sachet L-Bio Lapi

INTERLAC SACHET Interbat
tab Interlac tablet kunyah Interbat
4 Schisandrin kap 400 mg Hp Pro Unira
25 OBAT untuk SALURAN NAFAS
25.1 ANTIASMA
1 Aminophyllin tab 200 mg Aminofillin OGB
150 mg DECAFIL Harsen
inj 24 mg/ml Aminofillin inj OGB
0,25 mg/ml , 2
2 Budesonide respule Pulmicort Respules 0,25 Astra Zeneca
ml
0,5 mg/ml, 2 ml Pulmicort Respules 0,5 Astra Zeneca
Cortidex inj pengganti

Indexon Interbat
4 Ephedrin HCl inj 50 ml/ml Ephedrin inj Ethica
5 Epinefrin (adrenalin) inj 1 mg/ml Epinephrine inj Ethica High alert
6 Fluticasone propionate inhaler 0,5 mg/2 ml Flixotide nebule Glaxo

7 Prokaterol syrup 60 ml Vactiv syr Pharos
8 Salbutamol tab 2mg Salbutamol OGB
Lasal Lapi
4 mg Salbutamol OGB
syrup 100 ml Lasal syr Lapi
Salbuven syr Pharos
Salbutamol syr OGB
inhaler/ 100 mcg/dosis Ventolin inhaler Glaxo
aerosol SALBULIN INHALER JKN Imedco inhalasi utk
serangan
larutan intermitten dan
respirator 2,5 mg/2,5 ml utk serangan akut
Ventolin nebulizer Glaxo pertama
untuk NaCl
nebulizer
9 Salbutamol+guafenesin syrup 100 ml Lasal exp syr Lapi
Seretide Discus 250 mg
10 Salmeterol + fluticasone Inhaler Glaxo bpjs
JKN
Seretide Discus 500 mg
Glaxo bpjs
JKN

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
11 Theophyllin tab 130 mg Theobron Interbat

Spiriva 2.5 mcg Respimat
12 Tiotropium Bromida inhaler 18 mcg Boehringer
ASR (JKN)
Berotec 0.1 mg MDI HFA
13 Fenoterol hydrobromide inhaler 100 mcg/10 ml Boehringer
AS (JKN)
160 mcg/4,5 Symbicort turb 160 DOS
14 Budesonide + formoterol turbuhaler Astra Zeneca bpjs
mcg 120 dosis 120 JKN
25.2 ANTITUSIF
10 mg, 15 mg, Codein Kimia Farma High alert

1 Codein HCl tablet
20 mg Codikaf Kimia Farma High alert
kap , syr Codipront Kimia Farma High alert
2 tab Anadex Interbat
DMP, difenhydramin, NH4Cl,
Na sitrat syrup syr 60 ml Anadex syr Interbat
25.3 EKSPEKTORAN
1 Codipront kap 30 mg Codipront cum exp Kimia Farma High alert
syrup 60 ml Codipront cum exp syr Kimia Farma High alert
2 Gliseril Guaiakolat tab 100mg Gliseril Guaikolas OGB
gliseril guaiakolat +
3 syrup 60ml, 100 ml Oroxin syr Pharos
oxomemazine
4 Gliseril guaiakolat + ctm tab 50 mg + 1 mg Cohistan syr Medifarma
(60 ml, 100 ml)
5 Obat Batuk Hitam syrup 55 ml, 60 ml, OBH Itrasal OGB
100 ml
OBH IKA 100 ML Ikapharmindo
55 ml, 60 ml,
5 Obat Batuk Hitam syrup Combi btk b'dahak menthol Combiphar
100 ml
OBAT BATUK HERBAL Deltomed
37,5 mg + 250
6 guaifenesin+ extr. Thyme syrup Silex syr Darya
mg (100ml)
25.4 MUKOLITIK
1 Ambroxol tab 30 mg Ambroxol OGB
Mucopect Boehringer
Limoxin Pharos
elixir 15 mg/ml Ambroxol syr OGB
Mucopect pediatric syr Boehringer
30 mg/ml Ambroxol 30 mg/5 ml elixir OGB
Mucopect dewasa syr Boehringer
Limoxin 30 mg syr Pharos
drop 15 mg/ml, 20 ml Mucopect drop Boehringer
2 Bromheksin HCl tab 8mg, Bisolvon Boehringer
elixir btl 125 ml Bisolvon elixir Boehringer
8 mg/4ml, btl.
solution Bisolvon drop Boehringer
40ml
3 Erdosteine kap 300 mg Erdostein OGB
Erdobat Interbat
sirup 175 mg/5ml Erdostein syr OGB
kering Ethiros syr Pharos

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
4 N- Asetilsistein kap 200 mg, Fluimucil cap Zambon

ACETYLCYSTENINE OGB
sirup 100 mg/5 ml, 75
Fluimucil dry syrup Zambon
kering ml
25.5 OBAT untuk PENYAKIT PARU OBSTRUKSI KRONIS
1 Ipratropium Br + salbutamol inj vial 2,5 mg COMBIVENT UDV(AS) Boehringer
26 OBAT yang MEMPENGARUHI SISTEM IMUN
26.1 SERUM dan IMUNOGLOBULIN
1 Serum Antitetanus inj 1500 ui ATS Biofarma suhu 2 - 8°C
2 Tetanus Imun Globulin inj 250 ui Tetagam Dexa suhu 2 - 8°C
26.2 VAKSIN
1 Vaksin antiPolio tetes Vaksin Polio Biofarma suhu 2 - 8°C
2 Vaksin BCG inj 2 ml, 4 ml BCG Vaksin Biofarma suhu 2 - 8°C
3 Vaksin Campak inj 5 ml Vaksin Campak Biofarma suhu 2 - 8°C
4 Vaksin Jerap Difteri Tetanus inj 5 ml Infanrix Glaxo suhu 2 - 8°C
Vaksin DT Biofarma
5 Vaksin Jerap Difteri Tetanus inj 5 ml Vaksin DPT Biofarma suhu 2 - 8°C
Pertusis (DTP) Tripacel Glaxo
Vaksin Haemophilus meningitis (utuk
6 inj vial+syringe Hiberix Glaxo dewasa)
influenzae type b
7 Vaksin Hepatitis - A inj 720 iu/ml Havrix 720 junior Glaxo suhu 2 - 8°C
8 Vaksin Hepatitis B inj Engerix B 0,5 ml Glaxo suhu 2-8°C

0,5ml/vial
Euvax 0,5 ml sanofi
VAKSIN HEPATITIS B REK
8 Vaksin Hepatitis B inj 1 ml/vial; 0,5ML
OGB suhu 2-8°C
0,5ml/vial
Engerix B 1 ml Glaxo
9 Vaksin HPV inj i.m 0,5 ml Cervarix Glaxo
suhu 2-8°C
Prevenar Wyeth
10 Vaksin Influenza type B inj 0,5 ml Vaxigrip dewasa sanofi
11 Vaksin Kombinasi : inj 0,5 ml Pentabio 0,5 ml Biofarma
DPT- Hepatitis B-Haemofilus Pentabio 2,5 ml Biofarma suhu 2-8°C
influenza type b INFANRIX HEXA Glaxo
Vaksin Kombinasi : DPT-
12 Hepatitis B-polio- Influenza inj 0,5 ml Hexaxim Aventis suhu 2-8°C
Type B
13 vaksin MMR inj 0,5 ml +syringe Vaksin MMR Biofarma suhu 2 - 8°C
14 Vaksin PPD inj 2 UT 1,5 ml Vaksin PPD 2 TU Biofarma suhu 2 - 8°C
15 Vaksin Typus (tifoid) inj 0,5 ml + syringe Typhym VI sanofi suhu 2 - 8°C
utk dewasa dan
16 Vaksin Jerap Tetanus inj 5 ml Vaksin TD Biofarma anak > 7 tahun
17 Vaksin Cacar (varicella) inj 0,5 ml + syringe Varilrix Glaxo suhu 2 - 8°C
18 Vaksin Influenza type A & B inj 0,5 ml + syringe Vaksin Fluquadri - SH sanofi suhu 2 - 8°C
19 Vakin diare oral Vaksin Rotarix Glaxo suhu 2 - 8°C
20 Vaksin Pneumococus inj Vaksin Synflorix Glaxo suhu 2 - 8°C
27 OBAT untuk TELINGA, HIDUNG dan TENGGOROKAN

27.1 ANTIBAKTERI TOPIKAL

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
polimiksin B sulfat +
tetes
1 Neomisin sulfat + btl 8 ml Otopain Ear drop Interbat
telinga
fludrokortison
tetes
2 Ofloksasin 3 mg/ml Tarivid otic Kalbe
telinga
27.2 LAIN-LAIN
semprot 27,5
1 Fluticasone furoat Avamys Glaxo
hidung mcg/semprot
semprot
2 oksimetazolin 0,5 mg/ml Illiadin 0,05% SPRAY Merck
hidung
tetes
0,25 mg/ml Illiadin 0,025% DROP Merck
hidung
disimpan dalam
botol kedap
3 Hidrogen Peroksida botol cairan 3%, btl H2O2 3% Brataco udara, terlindung
dari cahaya
28 VITAMIN dan MINERAL

1 Asam askorbat (Vit C) tab 50 mg, 100 mg Vit C tab OGB
500 mg Enervon C Medifarma
Ester C Hollisticare
tab eff 500 mg Redoxon Zinc eff Roche
Redoxon Fortimun eff Roche
inj 500 mg/5 ml, LAVIT-C 500 MG/5ML INJ lapi
1000 mg/5 ml LAVIT-C 1000 MG/5ML INJ
2 Kalium :
K-L aspartat tab 300 mg Aspar K Tanabe
Kalium Chlorida tab 600 mg KSR 600 MG JKN Merck bpjs
3 Kalsium :
kalsium karbonat tab 500 mg CaCO3 Brataco
kalsium laktat tab 500 mg Calcium Lactat (KALK) OGB
4 Kombinasi kolekalsiferol, tab Cavit D3 Merck
Calsium
Cal-95 lapi
5 B1, B6 dan B12 tab Neurobion tab Merck
NEUROBION FORTE CT Merck
inj NEUROBION 5000 AMP Merck
6 kombinasi Vit C, Calcium tab eff CDR sweet eff Roche
7 Coenzym Q10 tab Coten 100 Interbat
UBIQUINOL KAP Puspa
8 Nattokinase dll kap Fibrinase Escolab
9 Mecobalamin kapsul 500 mg Mecobalamin 500 OGB
Lapibal 500 Lapi
Interco 500 Interbat
inj 500mg/ml, Mecobalamin inj OGB
10 Multivitamin tab Provital Landson
11 Piridoksin (Vit B6) tab 10 mg Vitamin B6 10 mg OGB
12 Tiamin (Vit B1) tab 50 mg Vitamin B1 OGB
13 Vitamin A tab salut 6.000 UI Vitamin A 6000 UI OGB
14 Sianokobalamin (Vit B12) tab 10 mg Vitamin B12 OGB

TAHUN 2021
KELAS BENTUK
TERAPI SEDIAAN
15 Sianokobalamin (B12)+ ext tab Moloco B 12 Darya

placenta Milmor Pharos
16 Vitamin D3 tab 5000 UI PROVE D3-5000 IU Kalbe
17 Fitomenadion (Vit K) tab 10mg Phytomenadion tab OGB
-dosis utk bayi
inj 2mg/ml, amp Phytomenadion inj OGB baru lahir 1 mg,
- dosis
Mepro K inj Mepro utk bayi prematur
0,5 mg
18 vitamin B kompleks tab 50 mg Vitamin B compleks OGB
19 Vitamin dan Mineral pediatric syrup Ferlin syr Medifarma
Apialys Syr Lapi
drop Ferlin drop Medifarma
Apialys drop Lapi
tab Fitkom Soho
FITKOM GUMMY Soho
Sakatonik ABC Saka
20 VITAMIN dengan MINERAL tab Pharmaton F Boehringer
Theragran M Taisho
21 Anti anemia / Pre dan tab Sangobion Merc
Post Natal vitamin Nonemi Lapi
Vit A, B6, B12, D3, Ca, Mg,
22 tab Promavit Lapi
Asam Folat, Tuna Oil
23 Immuno Modulator kaplet Imunos Lapi
Imunos plus Lapi
Immu-cea Interbat
Albusmin Pharos
23 Immuno Modulator syrup Imunos syr Lapi
Imunos plus syr Lapi
Immu-cea syr Interbat
24 SUSU Box 160 gr BEBELOV GOLD Nutricia
200 gr SGM BBLR Sari Husada
25 Glucosamin tab 500 mg GLUCOSAMINE MPL Medikon
29 OBAT yang MEMPENGARUHI SALURAN KEMIH
29.1 ALPHA BLOCKER
1 Tamsulosin HCL tab 0,2 mg Harnal Astelas
0,4 mg Harnal Ocas Astelas
29.2 5 ALPHA REDUCTASE INHIBITOR
29.3 ANTISEPTIK
1 flavoxate HCl tab 200 mg Urispas Indo farma
29.4 LAIN-LAIN
1 Eks daun tempuyung botol 300 ml Batugin Elixir Kimia Farma
2 Heksamine dll tab Nephrolit Bintang Toejoe

DAFTAR OBAT EMERGENSI
RS KHUSUS BEDAH RAWAMANGUN
NO NAMA ALKES / OBAT SEDIAAN KETERANGAN
1 ADONA (AC-17)INJ 10ML/50MG AMPUL IGD, LT 2, LT 3

2 AMINOPHYLLIN 2,4% INJ AMPUL IGD, LT 2, LT 3, OK
3 AMIODARONE IV INJ 150MG/3ML AMPUL IGD, LT 2, LT 3
4 AMLODIPIN 5 MG TABLET IGD, LT 2, LT 3
5 ASAM TRANEKSAMAT INJ 500 MG AMPUL IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA
6 Aspilets CHEWEBEL TABLET IGD, LT 2, LT 3
IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA,

7 ATROPIN INJ 0,25 MG AMPUL
BAYI, AMBULANCE, RADIOLOGI
8 ATS (SERUM ANTI TETANUS) KUDA 1,500 SI AMPUL IGD, LT 2, LT 3
9 CA GLUCONAS 10%/10CC AMPUL IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA
10 Captopril 12,5 mg TABLET IGD, LT 2, LT 3

11 CATAPRES 0,15 MG/ML AMPUL OK
12 CLOPIDOGREL 75MG TAB TABLET IGD, LT 2, LT 3
IGD, LT 2, LT 3, OK, AMBULANCE,
13 Dexamethasone Amp AMPUL
RADIOLOGI
14 STESOLID 2 MG INJ AMPUL IGD, LT 2, LT 3, AMBULANCE
15 Digoxin 0,25 MG TABLET IGD, LT 2, LT 3
16 DOBUTAMIN 250MG/5ML INJ AMPUL IGD, LT 2, LT 3, OK
17 DOPAMIN GIULINI 200 MG AMPUL IGD, LT 2, LT 3, OK
18 EPHEDRIN HCL INJ AMPUL OK
IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA,
19 EPINEPHRINE 0,1% 1 CC AMPUL
AMBULANCE, RADIOLOGI
20 FARGOXIN INJ AMPUL IGD, LT 2, LT 3
21 FUROSEMIDE 10 MG/ML INJ AMPUL IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA
22 INVICLOT INJ VIAL IGD, LT 2, LT 3

23 ISORBIDE DINITRATE 5 MG TABLET IGD, LT 2, LT 3
24 LIDOCAIN HCL 2%40MG/2ML AMP AMPUL IGD, LT 2, LT 3, OK, KEBIDANAN DEWASA
25 METHYLERGOMETRINE MALEATE 0.2MG/ML AMPUL KEBIDANAN DEWASA

26 MEYLON -OTSU AMPUL IGD, LT 2, LT 3, OK, BAYI
27 MgSO4 20 % 25 ML FLC IGD, LT 2, LT 3
28 NEO K 2MG/ML AMPUL IGD, LT 2, LT 3, OK, BAYI
29 NICARDIPINE HCL 10MG/10ML AMPUL IGD, LT 2, LT 3
30 NIFEDIPIN TAB TABLET OK
31 NITROGLYCERIN 10MG/10ML INJ AMPUL IGD, LT 2, LT 3
32 OTSU D 40 25 ML FLC IGD, LT 2, LT 3, BAYI
DAFTAR OBAT EMERGENSI
NO NAMA ALKES / OBAT SEDIAAN KETERANGAN
33 OTSU KCL 7,46 (25 MG) AMPUL IGD, LT 2, LT 3, OK

34 OTSU MGSO4 40 % 25 ML AMPUL IGD, LT 2, LT 3, OK
35 PAMOL 125 MG SUP SUPP IGD, LT 2, LT 3
36 PEHACAIN AMP AMPUL OK
37 PITOGIN INJ AMPUL KEBIDANAN DEWASA
38 RAIVAS INJ 4ML (NOR EPINEPHRINE) AMPUL IGD, LT 2, LT 3
39 SEDACUM INJ 0.1% 5MG/5ML AMPUL IGD, LT 2, LT 3, AMBULANCE
40 SIBITAL INJ 200 MG AMPUL IGD, LT 2, LT 3
41 STESOLID RECTAL TUBE 10 SUPP IGD, LT 2, LT 3
42 STESOLID RECTAL TUBE 5 SUPP IGD, LT 2, LT 3
43 VENTOLIN NEBULES 2,5 MG FLC IGD, LT 2, LT 3
DAFTAR OBAT LASA / NORUM
TAHUN 2021
INSTALASI FARMASI LASA
A. PENGGOLONGAN LASA/NORUM BERDASARKAN 'UCAPAN MIRIP' (TALLMAN LETTERING)
NO NAMA OBAT
1 AlloPURINOL HaloPERIDOL
2 AmiTRIPTILIN AmiNOPHILIN
3 Asam MEFENamat Asam TRANEKSamat
4 PropraNOLOL BisoPROLOL
5 AZITHROmycin ERITHROmycin
6 ePHEDrine ePHINEphrine
7 DOPamine DOBUTamine
8 PIRAcetam PARAcetamol
9 RECOLfar RECOFol
10 NORvask NARfoz
B. PENGGOLONGAN LASA/NORUM BERDASARKAN 'KEMASAN MIRIP'
NO NAMA OBAT
1 Kenalog In Orabase Myco Z Oint

2 Ceftriaxon inj Ampicillin inj
3 Meloxicam 7,5 Cetirizine 10
4 Piracetam 800 Omeprazole
5 Piracetam 800 Gabapentin 300
6 Glimepirid 1 Glimepiride 2, dan 3
7 Acarbose 50 Acarbose 100
8 Glucophage 800 Glucophage XR 500
C. Nama Obat Sama Kekuatan Berbeda

NO NAMA OBAT NO NAMA OBAT
1 Amlodipin 5 Amlodipin 10 28 Buscopan Buscopan plus
2 Acyclovir 200 Acyclovir 400 29 Meloxicam 7,5 Meloxicam 15
3 Captopril 12,5 Captopril 25 30 Methylprednisolon 4 Methylprednisolon 8
4 Allopurinol 100 Allopurinol 300 31 Ketoprofen 50 Ketoprofen 100
5 Stesolid rec 5 Stesolid rec 10 32 Irbesartan 150 Irbesartan 300
6 Metformin 500 Metformin 850 33 Ondancentron 4 Ondancentron 8
7 Sifrol 0,125 Sifrol 0,375 dan Sifrol 34 Pantoprazole 20 Pantoprazole 40
8 Cataflam 25 0,75
Cataflam 50 35 Propranolol 10 Propranolol 40
DAFTAR OBAT LASA / NORUM
TAHUN 2021
INSTALASI FARMASI LASA
9 Ardium 500 Ardium 1000 36 Valsartan 80 Valsartan 160

10 Fastor 10 Fastor 20 37 Salbutamol 2 Salbutamol 4
11 Intervask 5 Intervask 10 38 Simvastatin 10 Simvastatin 20
12 Narfoz 4 Narfoz 8 39 Ramipril 5 Ramipril 10
13 Norvask 5 Norvask 10 40 Rifampicin 300 Rifampicin 450,
Rifampicin 600
14 Voltaren 25 Voltaren 50 41 Codein 10 Codein 15, Codein 20
15 Utrogestan 100 Utrogestan 200 42 Codikaf 10 Codikaf 15. Codikaf 20
16 Telfast OD Telfast HD 43 Valisanbe 2 Valisanbe 5
17 Meloxin 7,5 Meloxin 15 44 Narfoz 4 mg inj Narfoz 8 mg inj
18 Isoric 100 Isoric 300 45 Invomit 4 mg inj Invomit 8 mg inj
19 Cefila 100 Cefila 200 46 Lavit C 500 mg inj Lavit C 1000 mg inj
20 Ceptik 100 Ceptik 200 47 Glimepiride 1 Glimepiride 2, Glime 3,
Glimepiride 4
21 Fixiphar 100 Fixiphar 200 48 Acarbose 50 Acarbose 100
22 Betahistin 6 Betahistin 24 49 Pioglitazone 15 Pioglitazone 30
23 Cefixime 100 Cefixime 200 50 Glucophage 500 Glucophage 500 XR,
Glucophage 850
24 Captopril 12,5 Captopril 25 51 Tramal 50 mg inj Tramal 100 mg inj
25 Clindamycin 150 Clindamycin 300 52 Depakote 250 Depakote 250 XR,
Depakote 500
26 Candesartan 8 Candesartan 16 53 Ibuprofen 200 Ibuprofen 400
27 Fenofibrat 100 Fenofibrat 200, 54 INH 100 INH 300
Fenofibrat 300
28 Buscopan Buscopan plus 55 MgSO4 20 % MgSO4 40 %
Sumber : Farmasi Komunitas, 2017

DAFTAR OBAT HIGH ALERT
TAHUN 2021
HIGH ALERT
BENTUK
NO KELAS TERAPI NAMA GENERIK NAMA DAGANG KEKUATAN KET
SEDIAAN
Kalium klorida Otsu KCl 7,46 flacon 25 ml LEMARI
Natrium Bikarbonat Otsu Meylon flacon 8,4%, vial 25 ml LEMARI
1 Elektrolit Pekat
Natrium Klorida Otsu Salin 3% 500 ml botol infus 3% LEMARI
Magnesium Sulfat MgSO4 flacon 20%, 40% LEMARI
Propofol Recofol inj inj bolus 1%, KULKAS

Ketalar inj/Ivanes
anestesi (umum, Ketamine inj 100 ml KULKAS
2 inj/Venilam inj
inhalasi, dan IV)
sevoflurane Sevodex inhalasi 250 ml LEMARI
Isoflurane Isorane inhalasi 250 ml LEMARI
3 blok neuromuskular Atacrium TRAMUS 1% 2.5ML inj 10 mg/ml KULKAS
0,5% 20 ml,
0,5% spinal
Bupivakain HCl REGIVEL 4ML AMP inj KULKAS
heavy 5 mg/ml
4 anestesi lokal (HCl)
Lidocain + Epinephrin Pehacain inj inj inj 20 ml LEMARI
Lidokain HCl Lidocain inj inj 2% LEMARI
5 Vasokonstriksi Midazolam Sedacum inj inj 5 mg/ml, amp OKT
6 Agonis adrenergik IV Epinefrin (adrenalin) Epinephrine inj inj 1 mg/ml LEMARI

Nor ephineprin Raivas inj/ Vascon inj inj 4 mg/ml LEMARI
Heparin, Na Inviclot inj inj 5000 UI/ml, vial KULKAS

warfarin Simarc 2 tablet 2 mg LEMARI
7 Anti-trombotik Cilostazol Cilostazol tablet 50 mg LEMARI
Cilostazol Pletaal 50 tablet 50 mg LEMARI
Clopidogrel Clopidogrel tablet 75 mg LEMARI
8 Dekstrosa hipertonik dextrose Otsu D40 flacon 25 ml LEMARI

( ≥ 20%)
1mg, 2 mg, 3
Glimepiride Glimepiride tablet LEMARI
mg, 4 mg
Gliquidone Gliquidone tablet 30 mg LEMARI
Gliquidone Glurenorm tablet 30 mg LEMARI
Glibenclamide Glibenclamid tablet 5 mg LEMARI
Gliclazide Glucodex tablet 80 mg LEMARI
Obat hipoglikemik
9 Gliclazide Diamicron MR 60 mg tablet 60 mg LEMARI
(oral)
Acarbose Acarbose tablet 50 mg, 100 mg LEMARI
Metformin Metformin tablet 500 mg, 850 mg LEMARI
Metformin Glucophage XR tablet 500 mg LEMARI
Metformin Glucophage tablet 500 mg, 850 mg LEMARI
Pioglitazone Pioglitazone tablet 15 mg, 30 mg LEMARI
Insulin reguler APIDRA SOLOSTAR inj, penfill 100 ui/ml @ 3ml KULKAS
OBAT HIGH ALERT
10 Insulin (SC dan IV)

TAHUN 2021
HIGH ALERT
BENTUK
SEDIAAN
Insulin analog campu HUMALOG MIX 25
inj 100 ui/ml @ 3ml KULKAS
(lispro + NPH) KWIKPEN
HUMALOG CART
Insulin lispro inj 101 ui/ml @ 3ml KULKAS
100IU/ML,3,ML
10 Insulin (SC dan IV) Insulin analog detemir Levemir flexpen inj 100 ui/ml @ 3ml KULKAS
Insulin analog glargine Lantus solostar inj, penfill 100 ui/ml @ 3ml KULKAS
Insulin analog aspart Novorapid flexpen inj 100 ui/ml @ 10ml KULKAS
Insulin analog campur

Novomix 30 flexpen inj 100 ui/ml @ 3ml KULKAS
(aspart + NPH)
11 Obat Jantung Digoksin Fargoxin inj inj 0,25 mg/ml LEMARI
12 HUMAN ALBUMIN Albumin Albuman 20% 100ML botol 200 ml/ l KULKAS
13 sedasi IV Midazolam Sedacum inj inj 0,1% 5 mg/ml OKT
14 Oksitosin IV Oksitoksin PROTOCIN INJ inj 10 iu/ml KULKAS
Alprazolam Alprazolam 0,25 tab 0,25 mg OKT

Alprazolam Alprazolam 0,5 tab 0,5 mg OKT
Alprazolam Alprazolam 1 tab 1 mg OKT
metamizol, diazepam 2 Analsik tab 2 mg OKT
Clobazam CLOBAZAM 10MG tab 10 mg OKT
Diazepam stesolid rectal 10 mg lar rektal 10 mg/2,5 ml KULKAS
Diazepam Stesolid rectal 5 mg lar rektal 5 mg/2,5 ml KULKAS
15 Psikotropika
Diazepam Valisanbe 2 tab 2 mg OKT
Diazepam valisanbe 5 tab 5 mg OKT
Diazepam Diazepam 2 tab 2 mg OKT
Diazepam STESOLID 2 MG INJ inj 5 mg/ml OKT
Phenobarbital Phenobarbital 30 MG tab 30 mg OKT
Phenobarbital SIBITAL INJ 200 MG ampul 200 mg OKT
Clonazepam CLONAZEPHAM 2 MG tab 2 mg OKT
Pethidin PETHIDIN HCL inj 50 mg/ml NARKOTIK

Codein HCl Codein tablet 10 mg, 15 mg NARKOTIK
Codein HCl CODIKAF tablet 10 mg, 15 mg NARKOTIK
kap dan
Codipront Codipront NARKOTIK
syrup
16 Narkotika
kap dan
Codipront Codipront cum Exp NARKOTIK
syrup
Fentanil Fentanyl inj/ Etanyl inj inj 0.05 mg/ml, NARKOTIK
Morphine sulfate Morphine inj inj 10mg/ml, NARKOTIK
Morphine sulfate MST CONTINUS 10 MG tablet 10 mg, 15 mg NARKOTIK
HES 6% dalam
Hes WIDAHES UNICAP plabot LEMARI
Nutrisi hipertonik (≥ NaCl 0,9%
17
20%)
OBAT HIGH ALERT

TAHUN 2021
HIGH ALERT
BENTUK
Nutrisi hipertonik (≥ SEDIAAN
17
20%) GELAFUSAL INFUS 500
gelatin polisuccinat softbag LEMARI
ML
OBAT HIGH ALERT

DAFTAR BAHAN BERBAHAYA DAN BERACUN ( B3 )
TAHUN 2021
BENTUK NO KATA MAKSIMAL.
NO NAMA B3 MEREK SIMBOL
SEDIAAN LOG PEYIMPANAN
ONEMED
1 ALKOHOL 70 %
ALKOHOL 70%
CAIRAN 1.3.A.0018 2 BOTOL
MUDAH TERBAKAR
CAIRAN/
2 FORMALIN FORMALIN 37% 1.3.S.0034 1 BOTOL @ 10 L
TABLET
MUDAH TERBAKAR
HYDROGEN
3 H202 3%
FEROXYDEN 3 %
CAIRAN 1.3.H.0009 2 BOTOL
KOROSI
4 PARAFIN LIQUID PARAFIN LIQUID CAIRAN 1 BOTOL

MUDAH TERBAKAR
POVIDONE
IODINE /
5 POVIDONE IODINE
STARDINE /
CAIRAN 1.4.P.0024 2 BOTOL
BETADINE IRITAN
INTERSORB
6 SODALIME
PLUS SERBUK 1 BOTOL @ 5 L
KRISTAL KOROSI IRITAN
20 BOTOL @ 500
7 HANDSCRUB ASEPTAN LIQUID CAIRAN mL
MUDAH TERBAKAR
8 HANDWASH NEREKA CAIRAN 1 BOTOL @ 20 L

MUDAH TERBAKAR
1 BOTOL @ 500
9 RUBYSTA POWDER RUBYSTA POWDE POWDER mL
IRITAN
10 STERALD 30 STERALD 30 CAIRAN 1 BOTOL @ 5 L

IRITAN
REAGEN ZIELH - REAGEN ZIELH - KARSINOGEN IRITAN

11 NEELSEN NEELSEN
CAIRAN 20 BOX
KOROSI
12 ALKOHOL 95 % LAMERSINDO CAIRAN 1,3,A,0017 2 BOTOL

MUDAH TERBAKAR
13 FENOL FENOL LIQUID CAIRAN 1.4.F.0020 1 BOTOL @ 5 L

KARSINOGEN IRITAN
14 ACETON ACETON CAIRAN 1 BOTOL

MUDAH TERBAKAR
FORMULARIUM RS KB RAWAMANGUN 2014 BAHAN B3

TAHUN 2021
15 GLYCERIN GLYCERIN CAIRAN 1.3.G.0006 1 BOTOL @ 5 L

IRITAN
16 SPIRTUS SPIRTUS CAIRAN 5.1.B.0001 1 BOTOL @ 5 L

IRITAN MUDAH TERBAKAR
20 BOX @ 100
17 RIVANOL RIVANOL CAIRAN 1.4.R.0001 mL
BERACUN
ASAM
18 SULFOSALISILAT
CAIRAN 3 BOTOL @100
KOROSI mL
BARIUM KLORIDA 10
19 %
CAIRAN
TOKSISITAS AKUT/ 1 BOTOL @ 500
BERACUN mL
20 BAYCLIN CAIRAN
BERACUN LITER
21 CELLCLEAN CAIRAN 2 BOTOL @50

KOROSI mL
22 CHLORLIQ CAIRAN 2 BOTOL @ 20

IRITAN LITER
23 CIDEX CAIRAN 1 BOTOL @ 500

IRITAN ML
24 CLORIN CAIRAN
KOROSI @ 50 TABLET
25 DETERLIQ CAIRAN 3 BOTOL @ 20

IRITAN LITER
26 DEVELOPER CAIRAN
IRITAN 3 BOTOL @ 5 L
27 EASY PINE CAIRAN 3 BOTOL @ 20

IRITAN LITER
28 EASY SOFTENER CAIRAN 3 BOTOL @ 20

IRITAN LITER

TAHUN 2021
29 DEXTRAN CAIRAN
TOKSISITAS AKUT/ 1 BOTOL @2500
BERACUN mL
30 FIXER CAIRAN
IRITAN MUDAH TERBAKAR 2 BOTOL @ 5 L
31 LART.BCB 1% CAIRAN
BERACUN mL
32 LART.EOSIN CAIRAN 1 BOTOL @ 100

IRITAN mL
33 LART.FOUCHET CAIRAN 1 BOTOL @ 100

IRITAN mL
34 LART.GABBETE CAIRAN
BERACUN mL
35 LART.GIEMSA CAIRAN 1 BOTOL @ 100

IRITAN mL
36 LART.PEWARNA GRAM CAIRAN

BERACUN mL
37 LART.XYLENE CAIRAN 1 BOTOL @ 100

IRITAN mL
38 OIL IMERSI CAIRAN 1 BOTOL @ 150

IRITAN mL
39 OXYCLEAN CAIRAN 2 BOTOL @ 20

IRITAN LITER
40 REAGEN BILIRUBIN 1 CAIRAN 1 BOTOL @100

KOROSI mL

KOROSI mL

KOROSI mL

TAHUN 2021

KOROSI mL
44 SENTINEL DEC 1 LTR CAIRAN 1 BOTOL @ 1

IRITAN LITER
45 USG JELLY CAIRAN

IRITAN 1 BOTOL @ 5 L
46 WASH DETERGEN CAIRAN

BERACUN mL

DAFTAR OBAT BARU TAHUN 2018-2020
BENTUK
NAMA GENERIK NAMA DAGANG PABRIK
SEDIAAN
ACARBOSE TAB ACARBOSE 100 MG TAB (JKN) OGB
ACETYLCYSTENINE TAB ACETYLCYSTENINE 200 MG OGB
GABAPENTIN TAB ALPENTIN 100 MG JKN ACTAVIS
AMBROXOL FLS AMBROXOL 30MG/5 ML ELIXIR OGB
INSULIN FLEXPEN APIDRA SOLOSTAR FLEXPEN JKN SANOFI
Hesperidin+Diosmin TAB ARDIUM 1000MG DARYA
BOX BEBELOV GOLD 160 GR NUTRICIA
Fenoterol hydrobromide BOTOL BEROTEC 0.1 MG MDI HFA AS (JKN BOEHRINGER
BETAHISTINE HCL TAB BETAHISTINE 24 MG OGB
BETAHISTINE MESILATE TAB BETAHISTINE 6 MG JKN OGB
CLONAZEPHAM TAB CLONAZEPHAM 2 mg OGB
BISOPROLOL TAB Concor 2,5 mg JKN MERCK
AMINOPHYLIN TAB DECAFIL 150 ML HARSEN
GLICLAZIDE TAB DIAMICRON MR 60 MG DARYA
DOXYCYCLINE TAB DOXYCYCLINE 100 mg OGB
ERYTHROMYCIN FLS ERYTHROMYCIN SYR 200MG/5ML OGB
FENTANYL AMPUL ETANYL 2 ML MAHAKAM
ATORVASTATIN TAB FASTOR 20 MG TAB LAPI
FENOFIBRATE TAB FENOFIBRATE 100 MG (JKN) OGB
FENOFIBRATE TAB FENOFIBRATE 300MG (JKN) OGB
INSULIN TAB HUMALOG KWIKPEN 3 ML JKN ELY LILY
TAB INFUSAN RING AS 500 ML SP SANBE
TAB INFUSAN RL 500 ML/SP SANBE
TAB INFUSAN TRIDEX PLAIN 500ML SP SANBE
INFUSAN TRIDEX 27B 500ML SP
LACTOBACILUS TAB INTERLAC SACHET interbat
KETALAR TAB IVANES 1000 MG/10MG ikapharmindo
Vitamin C AMPUL LAVIT-C 500 MG/5ML INJ LAPI
Vitamin C AMPUL LAVIT-C 1000 MG/5ML INJ LAPI
METILDOPA- BENZERAZIDE TAB LEVOBEN TAB(30.S) Mersi
LEVODOPA-BENSERAZIDE TAB LEVOPAR JKN Dexa
MEPRO K INJ TAB MEPRO K INJ Mepro
Pyridostigmine Br TAB MESTINON 60 MG TAB (JKN) Menarini
ASETPSAL TAB MINIASPI 80 MG JKN Mersi
MORPHIN TAB MST CONTINUS 10 MG kimia farma
Klorheksidin Glukonat TAB ONE SCRUB 2% 500 ML+DISP BH Onemed
OBAT BARU
DAFTAR OBAT BARU TAHUN 2018-2020
BENTUK
SEDIAAN
PETHIDIN TAB Pethidine HCl inj kimia farma
PIOGLITAZONE TAB PIOGLITAZONE 15 MG OGB
PIOGLITAZONE TAB PIOGLITAZONE 30 MG OGB
POVIDONE IODINE TAB POVIDONE IODINE 10% 1 LTR OGB
POVIDONE IODONE TAB POVIDONE IODONE 10% 30 ML OGB
Oksitosin TAB PROTOCIN INJ Mepro
Vitamin D3 TAB PROVE D3-5000 IU Kalbe
RAMIPRIL TAB Ramipril 10 mg OGB
SALBUTAMOL TAB SALBULIN INHALER JKN Imedco
CHLORHEXIDIN BOTOL SENTINEL DEC 1 LTR SENTINEL
CHLORHEXIDIN BOTOL SENTINEL ID 1 LTR SENTINEL
CHLORHEXIDIN BOTOL SENTINEL HW-HAND WASH 500 ML SENTINEL
PRAMIPEXOLEMONOHYDRATE TAB Sifrol 0.125 MG ASR(JKN) Boehringer
Tiotropium Bromida TAB SPIRIVA 2.5 MCG RSPMT ASR (JKN) BOEHRINGER
carbidopa + levodopa +
TAB STALEVO FCT 100MG TAB(JKN) Novartis
entacapone
Budesonide + formoterol BOTOL SYMBICORT TURB 160 DOS 120 JKN(F) Astra Zeneca
TRIHEXYPEHAENIDIAL TAB TRIHEXYPEHAENIDIAL(THP) 2MG OGB
VALPROATE SODIUM TAB VALPROATE SODIUM 250MG/5ML SYR OGB
KETALAR TAB VENILAM 100MG/ML INJ Pharos
OBAT BARU
DAFTAR OBAT YANG KELUAR DARI
FORMULARIUM 2020
BENTUK
NO NAMA DAGANG PABRIK ALASAN DIKELUARKAN
SEDIAAN
1 ACLAM 500 LAPI TAB NON MOVING
2 ACLAM FORTE SYR LAPI FLS NON MOVING
3 ACLAM SYR 60 ML LAPI FLS NON MOVING
4 ACTIFED PLUS COUGH 60ML(MERAH) GLAXO FLS NON MOVING
5 Actifed PLUS EXP 60ML(HIJAU) GLAXO FLS NON MOVING
6 Actifed SYR 60 ML(KUNING) GLAXO FLS NON MOVING
7 ACTRAFID HM PENFILL 3 ML NOVO AMP NON MOVING
8 Adona AC 17 TANABE TAB NON MOVING
9 AMIKASIN 250MG/12.5% INJ OGB VIAL NON MOVING
10 Aprion 75 PHAROS TAB NON MOVING
11 APRION 75 MG TAB PHAROS TAB NON MOVING
12 AVITER SACHET INTERBAT SACHET NON MOVING
13 AVODART 0,5 TAB GLAXO TAB NON MOVING
14 AVOGIN TAB LAPI TAB NON MOVING
15 Azithromicin inj OGB VIAL NON MOVING
16 Azithromicin syr OGB FLS NON MOVING
17 Aztrin 250 MG PHAROS TAB NON MOVING
18 BACTROBAN OINT 10 GR 2% GLAXO TUBE NON MOVING
19 BACTROBAN OINT 5 GR GLAXO TUBE NON MOVING
20 BORAX GLYCERIN OGB FLS NON MOVING
21 Braxidin SANBE TAB NON MOVING
22 C-ASTHENOF ED CENDO BOTOL NON MOVING
23 C-CATARLENT 5 CC ED CENDO FLS NON MOVING
24 Cedocard 5 mg DARYA VARIA TAB NON MOVING
25 Ceftixozime inj OGB VIAL NON MOVING
26 CELESTAMIN 30 ML SYRUP SCHERING PLOU FLS NON MOVING
27 Celestamin 60 ML SYR SCHERING PLOU FLS NON MOVING
28 Clinmas 150 mg LAPI TAB NON MOVING
29 CLINOVIR 200 MG PHAROS TAB NON MOVING
30 CLINOVIR 400 MG PHAROS TAB NON MOVING
31 COUNTERPAIN BALM 5 GR TAISHO TUBE NON MOVING
32 CRESTOR 10 MG ASTRA ZENECA TAB NON MOVING
33 CRESTOR 20 MG ASTRA ZENECA TAB NON MOVING
34 C-VASACON ED 15 CC CENDO FLS NON MOVING
35 CYCLO-PROGYNOVA BAYER TAB NON MOVING
36 Decolgen MEDIFARMA TAB NON MOVING
37 DIANE -35(21.S) BAYER TAB NON MOVING
KELUAR DARI FORM SEBELUMNYA

FORMULARIUM 2020
BENTUK
SEDIAAN
38 Diazepam inj KIMIA FARMA AMP NON MOVING
39 DICYNONE AMP CORSA AMP NON MOVING
40 DIZINE 5 MG TAB PHAROS TAB NON MOVING
41 Drovax 500* PHAROS CAP NON MOVING
42 ENKASARI 120 ML KIMIA FARMA FLS NON MOVING
43 EPIDOSIN INJ 1 ML OGB AMP NON MOVING
44 EPREX PROPECS 2000 IU INJ JOHNSON & JOH AMP NON MOVING
45 Esilgan 1 mg TAKEDA TAB NON MOVING
46 Esilgan 2 mg TAKEDA TAB NON MOVING
47 ETHIROS 300 MG KAP Pharos TAB NON MOVING
48 ETORICOXIB 60 MG OGB TAB NON MOVING
49 EXTRACE 500 INJ ETHICA AMP NON MOVING
50 FARSIX INJ FAHRENHEIT AMP NON MOVING
51 FELDENE GEL 0,5 % 15 GR PFIZER TUBE NON MOVING
52 FELDENE GEL 0,5 % 25 GR PFIZER TUBE NON MOVING
53 Flagyl forte Aventis TAB NON MOVING
54 Flagyl ORAL SUSPENSI SANOFI FLS NON MOVING
55 FLORAGYN KAPSUL LAPI TAB NON MOVING
56 Fluarix SK PCS NON MOVING
57 FLUIMUCIL DRY SYR 150 ML ZAMBON FLS NON MOVING
58 FOLIC ACID 5 MG OGB TAB NON MOVING
59 FUTADERM OINTMENT 10GR INTERBAT TUBE NON MOVING
60 Handy Clean Kalbe BOTOL NON MOVING
61 HELIATEC SPF 45+ RECKIT BECKINS TUBE NON MOVING
62 Hemobion Merck TAB NON MOVING
63 INBION TAB Interbat TAB NON MOVING
64 INTERCO INJ INTERBAT AMP NON MOVING
65 INTERDOXIN 100 MG TAB INTERBAT TAB NON MOVING
66 INTERLAC PROBIOTIC ORAL INTERBAT FLS NON MOVING
67 INTERMOXIL SYR 60 ML INTERBAT FLS NON MOVING
68 KAMILLOSAN OINT 10 GR TRANSFARMA TUBE NON MOVING
69 LACTACYD LIQUID BABY 60 ML(BIRU) PHF FLS NON MOVING
70 LEPARSON DEXA MEDICA TAB NON MOVING
71 LIMOXIN DROPS 20 ML Pharos FLS NON MOVING
72 LIZOR CAP PHAROS CAP NON MOVING
73 MAGERIX 500 MG PHAROS KAP NON MOVING
74 MECOLA FORTE LAPI TAB NON MOVING

FORMULARIUM 2020
BENTUK
SEDIAAN
75 Mediamer B6 tab DARYA VARIA TAB NON MOVING
76 MOXAM 15 MG PHAROS TAB NON MOVING
77 MOXAM 7.5 MG PHAROS TAB NON MOVING
78 Nalgestan Biomedis TAB NON MOVING
79 Neozep Forte Medifarma TAB NON MOVING
80 NEXA 500 MG KALBE TAB NON MOVING
81 OBH COMBI PLUS ANAK STRAWBERY 60 COMBIPHAR FLS NON MOVING
82 OBH COMBI PLUS JUN ORANGE 60 ML COMBIPHAR FLS NON MOVING
83 OBH Nellco spesial 100 ML NELLCO FLS NON MOVING
84 OBH NELLCO SPESIAL 55 ML NELLCO FLS NON MOVING
85 OBHCOMBI BTK FLU MADU 60 ML COMBIPHAR FLS NON MOVING
86 OSFLEX PREFILLED SYRINGE 5 NOVELL SYRING NON MOVING
87 PHARDEX TAB PHAROS TAB NON MOVING
88 Piroxicam 10 mg tab generik OGB TAB NON MOVING
89 PLEXION 50 MG TAB Pharos TAB NON MOVING
90 Proris 200 mg KAPLET PHAROS TAB NON MOVING
91 Provera 10 mg PFIZER TAB NON MOVING
92 RAMOLIT SACHET RAMA EMERALD SACHET NON MOVING
93 Redoxon ZINC EFF(15) ROCHE TUBE NON MOVING
94 REFAQUIN CR SDM TUBE NON MOVING
95 RENOGEN 2000 IU/1ML DARYA VARIA SYRING NON MOVING
96 RENOGEN 3000 IU/1ML DARYA VARIA SYRING NON MOVING
97 RHINOFED SYR 60 ML DEXA MEDICA FLS NON MOVING
98 SALBUVEN SYR 100 ML PHAROS FLS NON MOVING
99 SELSUN YELLOW 120 ML ROHTO BOTOL NON MOVING
100 Sistenol DEXA MEDICA TAB NON MOVING
101 STARDINE SOL 1 LTR ml NON MOVING
DAPAT HARGA YANG LEBIH
102 Sterilizyme Blesindo BOTOL MURAH DENGAN MUTU YANG
SAMA
103 SUPRAZID FORTE ARMOXINDO TAB NON MOVING
104 TELMISARTAN 40 MG OGB TAB NON MOVING
105 Transpulmin 60 ML TRANSFARMA FLS NON MOVING
106 TRIMOXSUL TAB INTERBAT TAB NON MOVING
107 TRIOFUSIN E 1000 KALBE BOTOL NON MOVING
108 TRIPACEL VAKSIN SANOFI SYRING NON MOVING
109 Trolit Sacchet KALBE SACHET NON MOVING
110 ULTRAPROCT N CREAM 10 GR TAKEDA TUBE NON MOVING

FORMULARIUM 2020
BENTUK
SEDIAAN
111 Ventolin 100 ML SYR GLAXO FLS NON MOVING
112 Ventolin Exp 100 ML GLAXO FLS NON MOVING
113 VENTOLIN INHALER 100 MCG GLAXO BOTOL NON MOVING
114 VIOSTIN DS tab PHAROS TAB NON MOVING
115 VIOSTIN X PHAROS TAB NON MOVING
116 VIRIDIS TAB PHAROS TAB NON MOVING
117 VIT C AMP 10 % 2CC ETHICA AMP NON MOVING

DAFTAR OBAT-OBAT TERTENTU (OOT)
& PREKURSOR
BENTUK NAMA GENERIK
NO NAMA DAGANG 1 PABRIK
SEDIAAN
1 ACETRAM TAB TAB PHAROS PCT-TRAMADOL

2 ALCO ORAL DROP FLS INTERBAT
3 ALCO PLUS SYR 100 ML FLS INTERBAT
4 Amitriptilline 25 MG TAB OGB AMITRIPTILINE
5 Anadex TAB INTERBAT CTM, DMP, PCT,PPA
6 ANADEX SYR FLS INTERBAT CTM, DMP, PCT,PPA
7 ANALTRAM TAB TAB LAPI PCT-TRAMADOL
8 Ephedrin inj TAB Ethica Ephedrin inj
9 Hexymer TAB Mersi Trihexyphenidyl (THP)
10 Lapifed TAB Lapi PSEUDOEFEDRIN, TRIPOLIDIN
11 RHINOS JUNIOR SYR 60 ML FLS DEXA MEDICA CTM, PSEUDOEFEDRIN
12 RHINOS NEO DROP 10 ML FLS DEXA MEDICA PSEUDOEFEDRIN
13 Rhinos SR TAB DEXA MEDICA LORATADINE, PSEUDOEFEDRIN
14 TRADYL KAP 50 MG TAB Interbat TRAMADOL
15 Tramadol 50 mg TAB OGB TRAMADOL
16 TRAMADOL AMP AMP OGB TRAMADOL
17 TRAMAL 100 MG INJ AMP PHAROS TRAMADOL
18 TRAMAL 50 MG INJ AMP PHAROS TRAMADOL
19 TRAMAL KAPSUL TAB PHAROS TRAMADOL
20 TRAMAL SUPP PCS PHAROS TRAMADOL
21 Trifed TAB INTERBAT PSEUDOEFEDRIN, TRIPOLIDIN
22 TRIFED SYR 60 ML FLS INTERBAT PSEUDOEFEDRIN, TRIPOLIDIN
23 Trihexyphenidyl (THP) TAB OGB Trihexyphenidyl (THP)
24 ZALDIAR TAB TAB PHAROS PCT, TRAMADOL
OOT-PREKURSOR
DAFTAR OBAT JKN/BPJS TAHUN 2021
BENTUK
SEDIAAN
ACARBOSE TABLET ACARBOSE 100 MG TAB (JKN) OGB
ACARBOSE TABLET ACARBOSE TAB 50 MG(JKN) OGB
NIFEDIPIN TABLET ADALAT OROS 30 MG (JKN) BAYER
GABAPENTIN TABLET ALPENTIN 100 MG JKN ACTAVIS
Allopurinol TABLET ALLOPURINOL 100 MG (E-CAT) OGB
AMLODIPIN TABLET AMLODIPIN 10 MG JKN OGB
AMLODIPIN TABLET AMLODIPIN 5 MG JKN OGB
INSULIN FLEXPEN APIDRA SOLOSTAR FLEXPEN JKN SANOFI
ATORVASTATIN TABLET ATORVASTATIN 20 MG JKN OGB
Fenoterol hydrobromide BOTOL BEROTEC 0.1 MG MDI HFA AS (JKN BOEHRINGER
BETAHISTINE TABLET BETAHISTINE 6 MG JKN OGB
CANDESARTAN TABLET CANDESARTAN 16 MG (JKN) OGB
CANDESARTAN TABLET CANDESARTAN 8 MG(JKN) OGB
Klonidin HCl AMPUL Catapress inj (E/AS) MERCK
Ipratropium Br + salbutamol AMPUL COMBIVENT UDV(AS) BOEHRINGER
BISOPROLOL TABLET Concor 2,5 mg JKN MERCK
Valproat TABLET DEPAKOTE 250 MG-JKN(F) ABBOT
Valproat TABLET DEPAKOTE ER 500 MG-JKN(F) ABBOT
GLICLAZIDE TABLET DIAMICRON MR 60 MG DARYA VARIA
ERYTHROMYCIN BOTOL ERYTHROMYCIN SYR 200MG/5ML OGB
FENOFIBRATE TABLET FENOFIBRATE 100 MG (JKN) OGB
FENOFIBRATE TABLET FENOFIBRATE 300MG (JKN) OGB
GLIMEPIRIDE TABLET GLIMEPIRIDE 4 MG OGB
GLIMEPIRIDE TABLET GLIMEPIRIDE TAB 1 MG(JKN) OGB
GLIMEPIRIDE TABLET GLIMEPIRIDE TAB 2MG(JKN) OGB
GLIMEPIRIDE TABLET GLIMEPIRIDE TAB 3 MG (JKN) OGB
INSULIN FLEXPEN HUMALOG KWIKPEN 3 ML JKN Eli lily
INSULIN FLEXPEN LANTUS SOLOSTAR 100UI(JKN) SANOFI
INSULIN FLEXPEN LEVEMIR FLEXPEN 100 ML(JKN) Novo Nordisk
METILDOPA- BENZERAZIDE TABLET LEVOPAR JKN Dexa
Pyridostigmine Br TABLET MESTINON 60 MG TAB (JKN) Menarini
METFORMIN TABLET METFORMIN 500MG (JKN) OGB
METFORMIN TABLET METFORMIN 850 MG JKN OGB
ASETOSAL TABLET MINIASPI 80 MG JKN Mersi
DAFTAR OBAT JKN/BPJS TAHUN 2021
BENTUK
SEDIAAN
INSULIN FLEXPEN NOVOMIX 30 FLEXPEN 100U/ML(JKN) Novo Nordisk
INSULIN FLEXPEN NOVORAPID FLEXPEN 100U/ML JKN Novo Nordisk
PIOGLITAZONE TABLET PIOGLITAZONE 15 MG OGB
PIOGLITAZONE TABLET PIOGLITAZONE 30 MG OGB
Ramipril TABLET Ramipril 10 mg OGB
Ramipril TABLET Ramipril 5 mg OGB
SALBUTAMOL BOTOL SALBULIN INHALER JKN Imedco
Salmeterol + fluticasone BOTOL SERETIDE DISCUS 250 MG JKN(F) Glaxo
Salmeterol + fluticasone BOTOL SERETIDE DISCUS 500 MG (JKN) Glaxo
pramipexole HCl TABLET SIFROL 0.75 MG AS(JKN) BOEHRINGER
pramipexole HCl TABLET Sifrol 0.125 MG ASR(JKN) BOEHRINGER
pramipexole HCl TABLET SIFROL 0.375 MG AS(JKN) BOEHRINGER
Simvastatin TABLET Simvastatin 10 mg OGB
SIMVASTATIN TABLET SIMVASTATIN 20 MG JKN OGB
Tiotropium Bromida BOTOL SPIRIVA 2.5 MCG RSPMT ASR (JKN) BOEHRINGER
carbidopa + levodopa + TABLET STALEVO FCT 100MG TAB(JKN) Novartis

entacapone
Budesonide + formoterol BOTOL SYMBICORT TURB 160 DOS 120 JKN(F) Astra Zeneca
TRIHEXYPEHAENIDIAL(THP) TABLET TRIHEXYPEHAENIDIAL(THP) 2MG OGB
VALPROATE SODIUM SYRUP VALPROATE SODIUM 250MG/5ML SYR OGB
INDEKS NAMA OBAT
NO NAMA OBAT HAL NO NAMA OBAT

1 Acarbose 50 mg (JKN) 9 40 Ampisillin inj
2 Acarbose 100 mg (JKN) 9 41 Amtocort
3 Acetram 2 42 Anadex
4 ACETYLCYSTENINE 21 43 Anadex syr
5 Acitral syr 17 44 Analsik
6 Acne Feldin 12 45 Analtram
7 Acuatim cr 13 46 Antasida DOEN
8 Acyclovir 200 7 47 Antasida syr
9 Acyclovir 400 7 48 Antrain inj
10 Acyclovir cr 7, 13 49 Apialys drop
11 Adalat oros 30 (JKN) 11 50 Apialys Syr
12 Adona AC 17 8 51 Apidra Solostar Flexpen JKN
13 Adona (AC-17) inj 8 52 Aqua bidestilata steril
14 Albuman 20% 8 53 Arcoxia 60 mg
15 Albusmin 23 54 Ardium 500 mg
16 Alco drop 3 55 Ardium 1000 mg
17 Alco plus syr 3 56 Asam traneksamat
18 Alkohol 100 ml 9 57 Asam traneksamat inj
19 Alkohol 1000 ml 9 58 Ascardia
20 Allopurinol 100 mg (E-CAT) 2 59 Aspar K
21 Allopurinol 300 mg 2 60 Aspilets
22 Aloclair 9 61 Atorvastatin 20 (JKN)
23 Alpentin 100 mg (JKN) 4 62 Atropin Sulfat inj
24 Alprazolam 0,25 16 63 ATS
25 Alprazolam 0,5 16 64 Avamys
26 Alprazolam 1 16 65 Azithromicin 500
27 Ambroxol 21 66 Aztrin 500
28 Ambroxol 30 mg/5 ml elixir 21 67 Aztrin syr
29 Ambroxol 15mg/5 ml syr 60 ml 21 68 B fluid
30 Aminofillin 19 69 Bactoderm cr
31 Aminofillin inj 19 70 Bactoderm oint
32 Aminofusin Paed 14 71 Bamgetol
33 Amiodaron inj 11 72 Batugin Elixir
34 Amitriptilin 25 mg 16 73 BCG Vaksin
35 Amlodipin 5 mg (JKN) 11 74 BEBELOV GOLD
36 Amlodipin 10 mg (JKN) 11 75 Benoson cr
37 Amoxan drop 5 76 Benoson M cr
38 Amoxicillin cap 4 77 Benoson N cr
INDEKS NAMA OBAT

Berotec 0.1 mg MDI HFA AS
39 Amoxicillin syr 4 78
(JKN)
79 Betadine kumur 9 118 Cefazolin inj
80 BETAHISTIN 6 MG 7,18 119 Cefila 100
81 BETAHISTINE 24 MG 7,18 120 Cefila 200
82 BETAHISTINE 6 MG JKN 7,18 121 Cefilla syr
83 Betamethason cr 13 122 Cefixime 100
84 Betaserc 7,18 123 Cefixime 200
85 Betason N cr 13 124 Cefixime syr
86 Bic Natric 4 125 Cefoperazon inj
87 Bioplacenton 13 126 Cefoperazon sulbactam inj
88 Bisolvon 21 127 Cefotaxime inj
89 Bisolvon drop 21 128 Ceftazidime inj
90 Bisolvon elixir 21 129 Ceftriaxone inj
91 Bisoprolol 5 11 130 Cefxon inj
92 Borraginol N 18 131 Celestik
93 Borraginol S 18 132 Ceptik 100
94 Burnazin 13 133 Ceptik 200
95 Buscopan inj 19 134 Ceptik syr
96 Buscopan plus 19 135 Cervarix
97 Buscopan tab 19 136 Cetirizin
98 C- Timol ED 0,5 16 137 Cetirizin syr
99 CA GLUCONAS 10%/10CC 4,15 138 C-Fenicol
100 CaCO3 23 139 C-FENICOL EYE OINT 3,5GR
101 Cal-95 23 140 C-GENTA 03% ED
102 Caladine 14 141 C-GENTAMYCIN EO 0,3%
103 Calcium Lactat (KALK) 23 142 Chloramfecort
104 Candesartan 8 mg (JKN) 11 143 Chloramfecort H
105 Candesartan 16 mg (JKN) 11 144 CHLORAMFENICOL 1%
106 Candistin drop 7 145 Chloramphenikol
107 Captopril 12,5 mg 11 146 Chlorethyl Spray
108 Captopril 25 mg 11 147 Chlorpromazin
109 CARBAMAZEPIN 200 MG 4 148 C-Hyalub
110 Cataflam 25 2 149 Cilostazol
111 Cataflam 50 2 150 Ciprofloxacin
112 Cavit D3 23 151 Ciprofloxacin infus
113 C-Catarlent 16 152 Citicolin 125 mg inj
114 CDR sweet eff 23 153 Citicoline
115 Cedocard 5 11 154 Clabat 500
INDEKS NAMA OBAT

116 Cefadroxil 500 5 155 Clabat Forte syr
117 Cefadroxil syr 5 156 Clabat syr
157 Clindamicin 6 196 C-Xitrol eye oint
158 Clinium 300 6 197 Cyclofem
159 Clinmas 300 6 198 Cytotec
160 Clinovir cr 7,13 199 Decadryl inj
161 CLOBAZAM 10MG 16 200 DECAFIL
162 CLONAZEPHAM 2 MG 4 201 Decamidon inj
163 Clonidin 12 202 Deksametason
164 Clopidogrel JKN 8 203 Deksametason inj
165 Co Amoxiclav 5 204 DEPAKOTE 250 MG-JKN
166 Co Amoxiclav 125 mg 5 205 Depakote ER 250 mg-JKN
167 Co Amoxiclav 250 mg 5 206 Depakote ER 500 mg-JKN
168 Codein 10 1,20 207 Dermatix ultra cr
169 Codein 15 1,20 208 Dexketoprofen
170 Codein 20 1,20 209 Dextamine
171 Codikaf 10 1,20 210 Diagit
172 Codikaf 15 1,20 211 Diamicron MR 60 mg
173 Codikaf 20 1,20 212 Diazepam 2
174 Codipront 1,20 213 Digoxin
175 Codipront cum Exp 1,20 214 Disflatyl
176 Codipront cum exp syr 1,20 215 Dobutamin inj
177 Cohistan syr 20 216 Doloneurobion
178 Combantrin 4 217 DOM
179 Combantrin susp 4 218 Domperidone
180 Combi btk b'dahak menthol 21 219 Domperidone syr
181 COMBIVENT UDV(AS) 21 220 Dopamet tab
182 Concor 2,5 mg JKN 11 221 Dopamin inj
183 Copper T 10 222 DOXYCYCLINE 100 mg
184 Cortidex inj 12,20 223 Dramamine
185 Coten 100 23 224 Dulcolax supp
186 Cotrimoksazol 480 mg 6 225 Dulcolax tab
187 Cotrimoksazol syr 6 226 Dumin
188 Counterpain 14 227 Duphaston
189 Counterpain Cool 14 228 Duvadilan
190 Cravox 5 229 ECOSOL NACL 0.9% 100 ML
191 CTM 3 230 Enervon C
192 CURCUMA FORCE TAB BLISTER 19 231 Engerix B 0,5 ml
INDEKS NAMA OBAT

193 CURCUMA PLS SHARPY ORANGE 19 232 Engerix B 1 ml
194 C-Vasacon 16 233 Eperison
195 C-Xitrol eye drop 15 234 Ephedrin inj
235 Epinephrine inj 12,20 274 Fluimucil dry syrup
236 Erdobat 21 275 Fluimucil cap
237 Erdostein 21 276 Flunarizin
238 Erdostein syr 21 277 Folic Acid 1 mg
239 Erithromycin 5 278 Folic Acid 5 mg
240 ERYTHROMYCIN SYR 5 279 Formalin cair
241 Ester C 22 280 Formalin tab
242 ETANYL 2 ML 1 281 Fosen enema
243 Ethambutol 500 6 282 Fucoidan
244 Ethiros syr 21 283 Furosemide
245 Ethrane 3 284 Furosemide inj
246 Euvax 0,5 ml 21 285 Gabapentin
247 Evalen gel 12 286 Garam Inggris
248 Faktu supp 18 287 Gas N2O
249 Fargoxin inj 12 288 Gas O2
250 Fastor 20 12 289 Gastridin
251 FDC Kategori II 7 290 Gastridin inj
252 FDC Kategori Anak 7 291 Gastrul
253 FDC Kategori I 7 292 Gelafusal
254 fenofibrate 200 12 293 gemfibrozil
255 Fenofibrate 100 mg (JKN) 12 294 Gentalex cr
256 Fenofibrate 300 mg (JKN) 12 295 Gentamisin inj
257 Fentanyl inj 1 296 Gentamycin oint
258 Ferlin drop 8,23 297 Glibenklamid
259 Ferlin syr 8,23 298 Glimepiride 1 mg (JKN)
260 Fetik supp 2 299 Glimepiride 2 mg (JKN)
261 FG Throches 9 300 Glimepiride 3 mg (JKN)
262 Fibrinase 23 301 Glimepiride 4 mg
263 Fitkom 23 302 Gliquidone
264 FITKOM GUMMY 23 303 Gliseril Guaikolas
265 Fixiphar 100 5 304 Glucodex
266 Fixiphar 200 6 305 Glucophage 500 mg
267 Fixiphar syr 30 ml 6 306 Glucophage XR 500 mg
268 Fixiphar syr 60 ml 6 307 Glucosamin MPL
269 Flagystatin ovula 7 308 Glurenorm
INDEKS NAMA OBAT

270 FLAMICORT IA/ID 11 309 Glycerin
271 Flexamine cr 11 310 H2O2 3%
272 Flixotide nebule 20 311 Harnal
273 Fluconazol 7 312 Harnal Ocas
313 Havrix 720 junior 21 352 Inpepsa susp
314 HCT(hydrochlorotiazide) 9 353 Instillagell
315 Heliatec SPF 45+ 14 354 Insto
316 Hexaxim 22 355 Interbi
317 Hexymer 8 356 Interbi cr
318 Hiberix 21 357 Interco 500
319 Hp Pro 19 358 Interflox
320 Humalog kwikpen 3 ml JKN 10 359 INTERLAC SACHET
321 HUMALOG MIX 25 KWIKPEN(JKN) 10 360 Interlac tablet kunyah
322 Hydrocortisone 13 361 Intermoxil cap
323 Ibuprofen 200 2 362 Intervask
324 Ibuprofen 400 2 363 Interzinc syr 60 ml
325 Ibuprofen syr 2 364 Intidrol
326 Illiadin 0,025% DROP 22 365 Intrix inj
327 Illiadin 0,05% SPRAY 22 366 Intrizin
328 Immu-cea 23 367 Intrizin syr
329 Immu-cea syr 24 368 Inviclot inj
330 Imodium 19 369 Invomit 4 mg
331 Imunos 23 370 Invomit 4 mg inj
332 Imunos plus 23 371 Invomit 8 mg inj
333 Imunos plus syr 24 372 Irbesartan 150
334 Imunos syr 24 373 Irbesartan 300
335 Incidal 3 374 Isoniazid 100
336 Inclovir 7 375 Isoniazid 300
337 Indexon 11,12,20 376 Isoprinosin
338 Indop Inj / Cetadop inj 12 377 Isoprinosin syr
339 Inerson salep 13 378 ISORANE
340 Infanrix 21 379 Isoric 100
341 INFANRIX HEXA 22 380 Isoric 300
342 INFUS D5-MJB 14 381 Isosorbid dinitrat
343 INFUS NS-MJB 15 382 Itzol
344 INFUS RL-MJB(500ML) 15 383 IVANES 1000 mg/10mg
345 INFUSAN NS 500 ML SP 15 384 Kalmicetine
346 Infusan Ring As 500 ml SP 15 385 KCl powder
INDEKS NAMA OBAT

347 Infusan RL 500 ml SP 15 386 Kenalog In Orabase
348 INFUSAN TRIDEX 27B SP 15 387 Ketalar inj
349 Infusan Tridex Plain SP 15 388 Ketoconazol
350 Inhipump 17 389 Ketoconazol cr
351 Inhipump inj 17 390 Ketoprofen 50 mg
391 Ketoprofen 100 mg 2 430 Limoxin
392 Ketorolac 30 inj 1 431 Limoxin 30 mg syr
393 Ketorolac10 mg 1 432 Lincocin
394 Ketrobat 30 inj 1 433 Lincomycin
395 Kloderma 14 434 Lipitor 20
396 KSR 600 MG JKN 14,22 435 Lipitor10
397 Lactacyd Pink 9 436 Lisinopril 5
398 Lactulax syr 19 437 Lisinopril 10
399 Lafalos 20 gr 14 438 Loratadin
400 Lameson 11 439 Losartan
401 Lameson inj 11 440 Lotasbat oint
402 Lanamol 1 441 L-zinc syr
403 Lanpracid 17 442 Madecassol powder
404 Lansoprazol 17 443 Manitol
405 Lantus Solostar 100UI(JKN) 10 444 Mebo oint
406 Lapibal 500 23 445 Mecobalamin 500
407 Lapicef 500 5 446 Mecobalamin inj
408 Lapicef syr 5 447 Mediklin
409 Lapifed 3 448 MEFENAMIC ACID
410 Lapiflox 5 449 Mefinter
411 Lapimox 4 450 Meloxicam 7,5 mg
412 Lapimox 125 mg syr 4 451 Meloxicam 15 mg
413 Lapimox 250 mg syr 4 452 Meloxin 15 mg
414 Lapistan 1 453 Mepro K 2 mg inj
415 Lapixime inj 6 454 Meropenem inj
416 Lasal 20 455 Mertigo
417 Lasal exp syr 20 456 MESTINON TAB (JKN)
418 Lasal syr 20 457 Metformin 500 mg (JKN)
419 Lasgan 17 458 Metformin 850 mg JKN
420 LAVIT-C 1000 MG/5ML INJ 22 459 Methyl Prednisolon
421 LAVIT-C 500 MG/5ML INJ 22 460 Methyl Prednisolon inj
422 Laxadine syr 19 461 Metil Ergometrin Maleat
423 L-Bio 19 462 Metronidazole
INDEKS NAMA OBAT

424 Levemir Flexpen 100 ml (JKN) 10 463 Metronidazole infus
425 Levoben Tab 8 464 MgSO4 20%
426 Levofloxacin 5 465 MgSO4 40%
427 Levofloxacin infus 5 466 Microgest 100
428 LEVOPAR JKN 8 467 Microgest 200
429 Lidocain inj 3,11 468 Microgynon LIBI 10X28
469 Microlax supp 19 508 Nifural syr
470 Milmor 23 509 NITROGLYCERIN INJ
471 MINIASPI 80 MG JKN 1,8 510 Nonemi
472 Minosep Obat kumur 9 511 Norit
473 Mofacort cr 13,14 512 Noroid Soothing cr
474 Mofacort oint 13,14 513 Norvask
475 Moloco B 12 23 514 Nova T
476 Mometasone cr 13,14 515 Novalgin
Novomix 30 Flexpen
477 Morphine inj 1 516
100U/ML(JKN)
478 Mothilium 18 517 Novorapid Flexpen 100Ui/ml JKN
479 MST CONTINUS 1 518 Nystatin drop
480 Mucopect 21 519 OBAT BATUK HERBAL
481 Mucopect dewasa syr 21 520 OBH IKA 100 ML
482 Mucopect drop 21 521 OBH Itrasal
483 Mucopect pediatric syr 21 522 Omeprazole
484 Mupirocin oint 13 523 Omeprazole inj
485 Myconazole 13 524 Ondansetron 4 mg
486 Myco-Z cr 13 525 Ondansetron 4 mg inj
487 Mylanta 17 526 Ondansetron 8 mg
488 Mylanta liq 17 527 Ondansetron 8 mg inj
489 Myonep 17 528 One Scrub 2% 500 ml+ disp BH
490 Narfoz 4 mg 18 529 Oralit
491 Narfoz 4 mg inj 18 530 Oroxin syr
492 Narfoz 8 mg 18 531 Otopain Ear drop
493 Narfoz 8 mg inj 18 532 Otsu Asering 500 ml
494 Narfoz syr 30 ml 18 533 OTSU D10 1/5 NS
495 Narfoz syr 60 ml 18 534 Otsu D10 500 ml
496 Natrium diklofenak 2 535 Otsu D2,5- 1/2 NS
497 Nebacetin oint 13 536 Otsu D40 25 ml
498 Nebacetin powder 13 537 Otsu D5 - 1/4 NS
499 Nephrolit 24 538 Otsu D5 500 ml
500 Neuralgin RX 1 539 Otsu KaEn 1B
INDEKS NAMA OBAT

501 NEUROBION 5000 AMP 23 540 Otsu Ka-En 3A
502 NEUROBION FORTE CT 23 541 Otsu Ka-En 3B
503 Neurobion tab 23 542 Otsu Ka-En Mg 3
504 New diatab 19 543 Otsu KCl 7,46
505 Nexium 17 544 Otsu Meylon
506 Nicardipine inj 11 545 Otsu NS 25 ml
507 Nifedipin 11 546 Otsu- RD
547 Otsu Salin 3% 500 ml 15 586 Piroxicam 20
548 Otsu water 25 ml 15 587 Pk (Pigmen)
549 Ozen 3 588 plasminex
550 Ozen drop 4 589 Pletaal
551 Ozen syr 3 590 Polysilane syr
552 Pamol 1 591 Ponstan
553 Pamol 125 mg supp 2 592 Povidone Iodine 30 ml
554 Pamol 250 mg supp 2 593 Povidone Iodine Sol 1 ltr
PPD (Purified Protein Derivate) 2
555 Pamol drop 2 594
TU
556 Pamol syr 1 595 Praxion drop
557 Panadol cold & flu 1 596 Praxion Forte syr
558 Panadol extra 1 597 Praxion syr
559 Panadol kaplet biru 1 598 Prednison
560 Pantoprazole inj 17 599 Pregabalin
561 Pantoprazole tab 17 600 Prevenar
562 PANTOPUMP 40 MG 17 601 Primolut N
563 Pantopump inj 17 602 Primperan
564 Paracetamol 1 603 Promag
565 Paracetamol infus 2 604 Promavit
566 Parasetamol syr 1 605 Propanolol 10
567 Parasol SPF 30 lotion 14 606 Propanolol 40
568 Parasol SPF 33 20 gr 14 607 Propyretic 80 mg supp
569 PD scrub 9 608 Proris F syr
570 Pedyalite 14,19 609 Proris supp
571 Pehacain inj 3 610 Proris syr
572 Pentabio 0,5 ml 22 611 Prostigmin inj
573 Pentabio 2,5 ml 22 612 Proterin inj
574 Pethidine HCl inj 1 613 PROTOCIN INJ
575 Pharmaton F 23 614 Protop
576 Pharolit 14,19 615 PROVE D3-5000 IU
577 Phenobarbital 4 616 Provital
INDEKS NAMA OBAT

578 Phenytoin 4 617 PTU
579 Phenytoin Natrium inj 4 618 Pulmicort Respules 0,25
580 Phisohex Facial Wash 13 619 Pulmicort Respules 0,5
581 Phytomenadion inj 8,23 620 Pyrazinamide
582 Phytomenadion tab 8,23 621 Quinobiotik
583 Pioglitazone 15 mg 10 622 Raivas inj
584 Pioglitazone 30 mg 10 623 Ramipril 5 mg
585 Piracetam 800 12 624 Ramipril 10 mg
625 Ranitidin 17 664 Seretide Discus 500 mg JKN
626 Ranitidin inj 17 665 Seroquel 100 mg
627 Ranivell syr 17 666 Sevodex
628 Rebamid 17 667 SGM BBLR
629 Recofol inj 3 668 Sibital inj
630 Recolfar 2 669 Sifrol 0.75 mg AS(JKN)
631 Redoxon Fortimun eff 22 670 Sifrol 0.125 MG ASR(JKN)
632 Redoxon Zinc eff 22 671 Sifrol 0.375 mg AS(JKN)
633 Regivell inj 2 672 Silex syr
634 Rhinos Neo drop 3 673 Simarc 2
635 Rhinos junior 3 674 Simvastatin 10
636 Rhinos SR 3 675 Simvastatin 20 mg JKN
637 Rifampicin 300 6 676 Spasminal
Spiriva 2.5 mcg Respimat ASR
638 Rifampicin 450 6 677
(JKN)
639 Rifampicin 600 6 678 Spironolakton 25 mg
640 Rifastar 7 679 Spironolakton 100 mg
641 Risperidon 17 680 Stalevo FCT (JKN)
642 Rivanol 9 681 Starxon inj
643 Roacutan 13 682 Stesolid 2 mg inj
644 Sakatonik ABC 23 683 stesolid rectal 10 mg
645 SALBULIN INHALER JKN 20 684 Stesolid rectal 5 mg
646 Salbutamol 2 mg 20 685 Streptomycin Inj
647 Salbutamol 4 mg 20 686 Strocain-p
648 Salbutamol syr 20 687 Sukralfat susp
649 Salbuven syr 20 688 Sumagesic
650 Salicyl talk 14 689 Symbicort turb 160 DOS 120 JKN
651 SALTICIN INJ 5 690 TAMBAH DARAH NEO
652 Sangobion 8,23 691 Tantum Verde
653 Scabimite cr 14 692 Tarivid ophtal
654 Scelto 30 inj 1 693 Tarivid otic
INDEKS NAMA OBAT

655 Sedacum inj 3 694 Taxilan susp
656 Sedrofen 500 5 695 Telfast HD
657 Sedrofen DS 5 696 Telfast OD
658 Selsun Blue 120 ML 13 697 Telmisartan
659 Selsun Yellow Double Impact 13 698 Tempra drop
660 SENTINEL DEC 1 LTR 9 699 Tempra Forte syr
SENTINEL HW-HAND WASH
661 9 700 Tempra syr 100 ml
500 ML
662 SENTINEL ID 1 LTR 9 701 Tempra syr 60 ml
663 Seretide Discus 250 mg JKN 20 702 Tetagam
703 Theobron 20 742 Vaksin MMR
704 Theragran M 23 743 Vaksin Polio
705 Thiamphenicol 5 744 Vaksin PPD 2 TU
706 Thrombophob gel 8 745 Vaksin Rotarix
707 Tilidon 18 746 Vaksin Synflorix
708 Tilidon syr 18 747 Vaksin TD
709 Tiriz 3 748 Valisanbe 2
710 Tizanidine HCl 17 749 valisanbe 5
711 Tomit inj 18 750 VALPROATE SODIUM SYR
712 Tradyl cap 2 751 Valsartan NI
713 Tramadol 2 752 Varilrix
714 Tramadol inj 2 753 Vascon inj
715 Tramal 2 754 VASELINE SWAB
716 Tramal 100 inj 2 755 Vaxigrip dewasa
717 Tramal 50 inj 2 756 Venilam inj
718 Tramal supp 2 757 Venosmil
719 TRAMUS 1% 2.5ML 17 758 Venosmil gel
720 Transpulmin balsem 14 759 Ventolin inhaler
721 Transpulmin BB 14 760 Ventolin nebulizer
722 Triamcort 11 761 Vertikaf
723 Triclofem inj 10 762 Vertikaf 24
724 Trifed 3 763 Vicks Inhaler
725 Trifed syr 3 764 Vicks Vaporub
726 Trihexyphenidyl (THP) 8 765 Viridis syr
727 Trimoxsul syr 6 766 Visine
728 Tripacel 21 767 Vit C tab
729 Typhym VI 22 768 Vitacid 0,025%
730 UBIQUINOL KAP 23 769 Vitacid 0,05%
731 Ulsidex 18 770 Vitamin B12
INDEKS NAMA OBAT

732 Ultraproct N supp 18 771 Vitamin A 6000 UI
733 Ultraproct N cr 3 772 Vitamin B compleks
734 Urdafalk 19 773 Vitamin B1
735 Urispas 24 774 Vitamin B12
736 Vactiv syr 20 775 Vitamin B6 10 mg
737 Vaksin Campak 21 776 Volox
738 Vaksin DPT 21 777 Voltaren Emulgel
739 Vaksin DT 21 778 Voltaren tab
740 Vaksin Fluquadri - SH 22 779 Wida WI
741 VAKSIN HEPATITIS B REK 0,5ML 22 780 Widahes
781 Zaldiar 2
782 Zinc 20 mg 19
HAL
5
11
2,20
2,20
1
2
17
17
1
23
23
10
15
2
18
18
8
8
1,8
22
1,8
12
3,4,19
21
22
5
5
5
14
13
13
4
24
21
24
13
13
13
HAL
20
6
5
6
6
5
5
6
6
6
6
6
6
6
3
5
6
6
22
3
3
15
15
15
15
13
13
15
5
3
17
16
8
5
5
12
12
5
HAL
5
5
16
10
16,17
3
19
1
11,12,20
10,12,20
4,16
4,16
4,16
14
2
3
19
9
4,16
12
18
12
2
18
18
18
12
12
6,7
18
19
19
1
10
16
15
22
21
HAL
22
17
12,20
21
21
7,12
8
8
9
9
19
18
9
9
4
19
3
3
17
17
16,17
9
12
13
5
13
9
10
10
10
10
10
20
9
10
10
11,24
10
HAL
19
9,22
24
24
18
3
16
7
7,13
23
5
19
19
4
11
19
11
6
3
4
8
18
18
18
11
11
6
6
7
7
3
2
2
11
7
3
13
14
HAL
14
3
7,13
7
2
21
21
5
5
12
12
11
11
3
11
14
19
14
9
14
23
23
13
1
1
2
2
2
8, 23
6
7,18
17
10
10
11
11
16
6,7
HAL
6
4,16
4,16
10
10
10
19
11
8,23
4
14
11
10
1
10
10
7
21
20
20
17
17
18
18
18
18
9
14,19
20
22
15
15
14
15
14
15
14
15
HAL
15
15
15
14
4,15
15
15
2
9
8
8
17
1
9
9
9
1
1
1
11
4
22
10
18
17
23
7,11
7,11
2
2
2
2
17
16
16
17
23
23
HAL
10
19
19
6
5
12
11
11
20
17
3
24
4
8
8
8
21
8
12
12
19
20
9
9
8
6
3,4,16
4,16
4,16
7
18
18
1
20
8
9
16
22
HAL
18
3
3
12
1
1
1
1
21
22
21
22
22
22
22
4,16
4,16
4,17
11
22
12
13
22
3
18
18
20
20
18
7
14
14
7
16
22
13
13
8
HAL
23
23
23
23
23
5
2
2
15
9
NAMA DAGANG

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Keputusan Direktur No ….../KEP-DIR/RSKBR/III/2021 tentang Pembentukan Panitia

3 Petunjuk Pemakaian Buku Formularium RSKB Rawamangun Edisi X tahun 2021…. v

1 ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NON STERID , ANTIPIRAI

ETANYL 2 ML Mahakam High alert

4 metamizol ,vit.B12 , B1 , B6 tab Neuralgin RX Kalbe

7 Ketorolac tromethamine tab 10 mg Ketorolac10 mg OGB

syrup 120 mg/5ml, 60 Tempra syr 60 ml Taisho

2 Daftar Obat Edisi 2021

Praxion drop Pharos

10 paracetamol+Vit B12+B1+B6 tab Doloneurobion Merck

11 Ctm, DMP, Pseudoefedrin tab Anadex Interbat

2 colchicine tab 500 mg Recolfar fahrenheit

3 Daftar Obat Edisi 2021

2 Etil Klorida semprot 100 ml Chlorethyl Spray DrH

4 Lidocain + Epinephrin inj inj 20 ml Pehacain inj Phapros High alert

5 Lignokain HCl inj 2% @ 6 ml / 5ml Instillagell Istem

3 Sevoflurane inhalasi btl. 250 ml Sevodex Dexa High alert

4 Ketamin inj 100 mg/ml Ketalar inj Pfizer High alert

Venilam inj Pharos pengganti

IVANES 1000 mg/10mg ikapharmindo pengganti

2.3 ANESTETIK untuk PROSEDUR PRO OPERATIF

3 Midazolam inj 5 mg/ml, amp Sedacum inj Dexa High alert

3 ANTIALERGI dan OBAT untuk ANAFILAKSIS

9 CTM 2 mg + Dexamethasone tab Dextamine Phapros

10 CTM + Betamethasone tab 2 mg+ 0,25 mg Celestik Pyridam pengganti

11 Cetirizin tab 10 mg Incidal Bayer

4 Daftar Obat Edisi 2021

tab 500 mg Bic Natric OGB

Valisanbe 2 Sanbe High alert

5 mg valisanbe 5 sanbe High alert

inj 5 mg/ml, amp Stesolid 2 mg inj Actavis High alert

lar rektal 5 mg/2,5 ml Stesolid rectal 5 mg Actavis High alert

10 mg/2,5 ml stesolid rectal 10 mg Actavis High alert

4 Gabapentin kap 300 mg, Gabapentin OGB

6 Magnesium sulfat inj 20% , 40 % MgSO4 Otsuka High alert

7 Pregabalin kap 75mg Pregabalin OGB

Depakote ER 250 mg-JKN Abbot

5 Daftar Obat Edisi 2021

syrup 125 mg/5ml, 60 Amoxicillin syr OGB

6 Daftar Obat Edisi 2021

2 Cefiksim kap 100 mg Cefixime 100 OGB

4 Cefoperazon + Sulbactam inj 1 g/vial Cefoperazon sulbactam inj OGB

5 Cefotaksim inj 1 g/vial Cefotaxime inj OGB

Sulfametoksazol-Trimetoprim Trimoxsul syr Interbat

Kotrimoksazol (dewasa) tab 400 mg, 80 mg Cotrimoksazol 480 mg OGB

3 Meropenem inj 1 g/vial Meropenem inj OGB

7 Daftar Obat Edisi 2021

3 Pyrazinamide tab 500 mg Pyrazinamide OGB

8 Daftar Obat Edisi 2021

Levoben Tab Mersi

krim 20 gr Thrombophob gel Tunggal I A

4 Silostasol tab 100 mg Cilostazol OGB high alert

50 mg Pletaal eisai high alert

5 Warfarin tab 2 mg Simarc 2 Fahrenheit high alert

inj 100mg/ml Asam traneksamat inj OGB

3 Fitomenadion (Vit K) tab 10mg PHYTOMENADIONE OGB

inj 2mg/ml, amp PHYTOMENADIONE inj OGB -dosis utk bayi

2 Poligelin infus 4% Gelafusal Dexa high alert

10 Daftar Obat Edisi 2021

3 Manitol inj 20% 250 ml Manitol Otsuka

2 Glibenklamid tab 5mg, Glibenklamid OGB high alert

3 Gliklazid tab 80 mg Glucodex Dexa high alert