KELAS TERAPI DAN NAMA GENERIK FORMULASI

BPJS UMUM
1. ANESTETIK
1.1 . ANESTETIK LOKAL
1. Bupivakain (Khusus untuk Analgesia spinal) Inj 1. Bunascan 1. Bunascan
2. Levica 2. Levica
2. Etil klorida Spray 1. Chlor etil 1. Chlor etil
3. Lidokain 2% Inj 1. Lidocain 2% 1. Lidocain 2%
Gel 2. Cathjell 2. Cathjell
4. Lidocaine HCl + Epinephrine Inj 1. Pehacain
1.2 . ANASTETIK UMUM
1. Sevoflurane Cairan inhalasi 250 ml 1. Sevoflurane 1. Sevoflurane
2. Isoflurane Cairan inhalasi 250 ml 1. Aerrane 1. Aerrane

3. Ketamin Inj 50 mg/mL (i.v) 1. Ketamin 1. Ketamin

Inj 100 mg/mL (i.v) 2. KTM 1. KTM
4. Propovol Inj (i.v. Bolus) 1. Propovol 1. Recofol
5. Atracurium benzylate Inj 1. Atracurium 1. Atracurium
6. Rocuronium bromide Inj 1. Rocuronium bromide 1. Rocuronium bromide

1.3 Obat Pre-operatif dan Sedatif untuk tindakan kecil

1. Atropin Amp 0,5 mg 1. Atropin 1. Atropin
2. Diazepam Syrup 2 mg/5 ml 1. Stesolid 1. Stesolid
Tablet 2 mg 1. Valisanbe 1. Valisanbe
Tablet 5 mg 2. Valisanbe 2. Valisanbe
Inj 10 mg 1. Stesolid 1. Valisanbe
Lar rectal 5 mg/ml, tube 2,5 ml 1. Stesolid 1. Stesolid
Lar rectal 10 mg/ml, tube 2,5 ml 2. Stesolid 2. Stesolid
3. Midazolam (Dapat digunakan untuk pre medikasi sebelum induksi Inj 10 mg/ml, amp @ 1 ml 1. Sedacum 1. Sedacum
anestesi dan rumatan selama anestesi umum)
2. ANALGESIK, ANTIPIRETIK, OBAT ANTIINFLAMASI NON STEROID, ANTIPIRAI
2.1 Obat Analgesik Non-opioid dan NSAID
1. Allopurinol (Tidak untuk nyeri akut/untuk asam urat) Tab 100 mg, 300 mg 1. Allopurinol 100 1. Allopurinol 100
2. Asam mefenamat Kapl 500 mg 1. Asam Mefenamat 1. Mefinal
2. Lapistan
3. Parasetamol Tab 500 mg 1. Paracetamol 1. Sanmol
Infus 2. Paracetamol infus 2. Paracetamol infus
Syrup 3. Paracetamol 3. Sanmol
 Drop 4. Alphamol drop 4. Sanmol drop
Rectal tube 125 mg/2,5ml ; 250 mg/ 4ml 5. Dumin 5. Dumin
4. Ibuprofen Tab 200 mg 1. Ibuprofen 1. Bufect
Tab 400 mg 2. Ibuprofen 2. Bufect
Suspensi 100 mg/5ml 3. Salfenal 3. Bufect
Suspensi forte 200 mg/5ml 4. Salfenal 4. Bufect
5. ketoprofen (Untuk nyeri seang sampai berat pada pasien yang - Supp 100 mg 1. Protofen 1. Pronalges
tidak dapat menggunakan analgetik secara oral) Tab 50 mg, 100 mg 2. Ketoprofen 2. Ketoprofen
6. ketorolac tromethamine
(Untuk nyeri sedang sampai berat untuk pasien yang tidak dapat Inj 30 mg/ml 1. Ketorolac 1. Ketorolac
menggunakan analgetik secara oral) pemakaian2-3 amp/hari Tablet 10 mg 2. Ketorolac 2. Ketorolac
maksimal 3 hari
7. Metamizole sodium Inj 1. Metamizole 1. Metamizole
Syr 2. Norages
8. Meloxicam Tab 7,5 mg 1. Meloxicam 1. Meloxicam
Tab 15 mg 2. Meloxicam 2. Meloxicam
9. Tramadol (Untuk nyeri sedang sampai berat pasca operasi dan Kaps 50 mg 1. Tramadol 1. Tramadol
untuk terapi syaraf) Inj 100 mg/ 2ml 2. Tramadol 2. Tramadol
10. Eperison HCL Tab 50 mg 1. Eperison HCl 1. Eperison HCl
2.2 Analgesik Opioid
1. Morfin (Hanya untuk pemakaian pada tindakan anestesi atau pe- Inj 10 mg/ml amp @ 1 ml 1. Morfin 1. Morfin
rawatan di Rumah Sakit dan untuk mengatasi nyeri yang tidak- Tablet 10 mg 1. MST
respon terhadap analgetik non narkotik)
2. Petidin (Hanya untuk tindakan anestesi) Inj 50 mg/ml amp @ 2 ml 1. Pethidin 1. Pethidin
2. Clopedin 2. Clopedin
3. Fentanil Inj (Harus diberikan oleh tim medis yang dapat melakukan 1. Fentanil 1. Fentanil
resusitasi)
patch (Untuk nyeri yang tidak teratasi dengan analgetik- 1. Durogesic Patch 1. Durogesic Patch
non opioid)
4. Kodein Tab 10 mg 1. Kodein 1. Kodein
Tab 15 mg 2. Kodein 2. Kodein
Tab 20 mg 3. Kodein 3. Kodein
3. ANTIALERGI DAN ANAFILAKSIS
1. Klorfeniramin Tab 4mg 1. CeTeMe 1. CeTeMe

2. Cetirizine Tab 10 mg 1. Cetirizine 1. Cetirizine

Syr 5 mg/5 ml 2. Cetirizine 2. Cetirizine
Drop 10 mg/ml 3. Cetirizine 3. Cetirizine
3. Deksametason (Alergi diikuti radang) Kapl, 0,5 mg 1. Dexamethasone 1. Dexamethasone
Inj 5 mg/ml 2. Dexamethasone 2. Dexamethasone
4. Loratadine Tab 10 mg 1. Loratadine 1. Loratadine
5. Dipenhidramin Inj 1. Dipenidramin 1. Dipenidramin
6. Epinefrin (adrenalin) (Jika terjadi syok anafilaksis) Inj 0,1%, amp @ 1 ml 1. Epinefrin 1. Epinefrin
4. ANTIDOTUM UNTUK KERACUNAN
4.1 Umum
1. Karbon aktif bubuk/botol 1. Norit
4.2 Khusus
1. Atropin sulfas Inj 0,25 mg/ml, ampul 1 ml 1. Atropin Inj 1. Atropin Inj
2. Naloxone HCl (Hanya untuk mengatasi depresi pernafasan akibat - 0,4 mg/ml, ampul 2 ml 1. Nokoba 1. Nokoba
morfin/opioid)
3. Calsium Glukonat inj 1. Calcii Gluconate 1. Calcii Gluconate
5. ANTIEPILEPSI DAN ANTIKONVULSI
1. Diazepam Lar rectal 5 mg/ml, tube 2,5 ml 1. Stesolid Rectal 1. Stesolid Rectal
Lar rectal 10 mg/ml, tube 2,5 ml 2. Stesolid Rectal 2. Stesolid Rectal
Inj 10 mg/2 ml 1. Stesolid 1. Stesolid
2. Valisanbe 2. Valisanbe
2. Fenobarbital Tab 30mg 1. Fenobarbital 1. Fenobarbital
inj 2. Sibital 2. Sibital
3. Fenitoin Na (Untuk Pasien Epilepsi) Inj 50 mg/ml 1. Phenitoin 1. Phenitoin
Kaps 100mg 2. Phenitoin 2. Phenitoin
4. Asam valproic Syr 250 mg/5 ml 1. As. Valproid 1. As. Valproid
5. Levodopa (Untuk pasien tegak diagnosa Parkinson) Tab 200 mg 1. Stalevo 1. Stalevo
6. Levodopa + Benserazide Tab 1. Levopar 1. Levopar
7. Gabapentin Kaps 300 mg 1. Gabapentin 1. Gabapentin
8. Kabamazepin Tab 200 mg 1. Bamgetol 1. Bamgetol
9. Divalproex Sodium Tab 250 mg 1. Depakote 1. Depakote
Tab 500 mg 2. Depakote 2. Depakote
6. ANTIINFEKSI
6.1 Antelmintik
1. Pyrantel Pamoate Tab 250 mg 1. Pyrantel Pamoate 1. Pyrantel Pamoate
Suspensi 125 mg/5ml, 10 ml 1. Combantrin (Orange)
6.2 Antibakteri
6.2.1 Beta laktam
a. Amoksilin Kapl 500 mg 1. Amoxicillin 1. Amoxicillin
Syr 125 mg/5 ml, 60 ml 2. Amoxicillin 2. Amoxicillin
b. Co-Amoxiclav Tab 625 mg 1. Co-Amoxiclav 1. Co-Amoxiclav
c. Cefoperazone Inj 1. Cefoperazone 1. Cefoperazone
d. Meropenem (Jika infeksi berat, leukosit diatas 20.000) Inj 1g 1. Meropenem 1. Meropenem
6.2.2 Aminoglikosid
a. Gentamicin sulfat Inj 80 mg/2 ml 1. Gentamicin 1. Gentamicin
Salep 2. Gentamicin 2. Gentamicin
6.2.3 sefalosporin
a. Cefadroksil monohidrat Kaps 500 mg 1. Cefadroxil 1. Cefadroxil
Syr 125 mg/5 ml, btl 60 ml 2. Cefadroxil 2. Lapicef
b. Cefixime Kaps 100 mg, 200 mg 1. Cefixime 1. Cefixime
syr 100 mg/ 5 ml 2. Cefixime 2. Cefixime
c. Ceftriakson inj 1 g/ vial, 10 ml 1. Ceftriaxone 1. Broadced
d. Cefotaksim inj 1g/vial 1. Cefotaxime 1. Cefotaxime
e. Seftazidime fentahydrate inj 1. Ceftazidim 1. Ceftazidim
(Diberikan kepada pasien dengan infeksi yang disebabkan oleh -
bakteri yang resisten dengan antibiotika lain (resistensi test)
6.2.4 Makrolida
1. Clindamisin Kaps 300 mg, 150 mg 1. Clindamycin 1. Clindamycin
2. Eritromisin Kap 500 mg 1. Eritromisin 1. Eritromisin
 Syr 200mg/5ml 2. Eritromisin 2. Eritromisin
6.2.5 kuinolon
a. Ciprofloxacin (untuk pasien diatas umur 18th) Kapl 500 mg 1. Ciprofloxcin 1. Ciprofloxcin
Infus 200 mg/100 ml 2. Ciprofloxacin 2. Ciprofloxacin
b. Levofloxacin (untuk pasien diatas umur 18th) Kapl 500 mg 1. Levofloxacin 1. Levofloxacin
Infus 5mg/100 ml 2. Levofloxacin 2. Levofloxacin
6.2.6 Tetrasiklin
a. Tetrasiklin Kaps Tetracycline 250 mg 1. Tetracycline 1. Tetracycline
6.3 Anti Infeksi Khusus
6.3.1 Anti-tuberkulosis
a. Kombinasi : Rifampicin 150 mg + Isoniazid 75 mg + Pyrazinamid 400 mg Tab 1. Rifastar 4 FDC 1. Rifastar 4 FDC
+ etambuthol 275 mg
6.4 Antiprotozoa
6.4.1 Antiamuba dan Antiglardiasis
1. Metronidazol Tab 500 mg 1. Metronidazol 1. Metronidazol
Lar infus 5 mg/ml btl 100 ml 2. Metronidazol 2. Metronidazol
6.5 Antivirus
1. Asiklovir Tab 200 mg 1. Asiklovir 1. Asiklovir
Tab 400 mg 2. Asiklovir 2. Asiklovir
Krim 5 % 3. Asiklovir 3. Asiklovir
7. ANTIMIGREN
1. Antalgin Tab 500 1. Antalgin 1. Antalgin
3. Betahistin mesilat Tab 6 mg 1. Betahistin 1. Betahistin
4. flunarizin Tab 5 mg 1. Flunarizin 1. Flunarizin
8. KORTIKOSTEROID
a. Dexametason Kapl 0,5 mg 1. Dexamethasone 1. Dexamethasone
Inj 5 mg/1 mg 2. Dexamethasone 2. Dexamethasone
b. Metilprednisolon Tab 4 mg 1. Methylprednisolon 1. Methylprednisolon
Tab 8 mg 2. Methylprednisolon 2. Methylprednisolon
Tab 16 mg 3. Methylprednisolon 3. Methylprednisolon
Inj, 125 mg/vial 4. Methylprednisolon 4. Methylprednisolon
c. Kombinasi: betametason 0,25 mg+ dekslorpe Syr 60 ml 1. Proceles
niramin maleat 2 mg
9. OBAT YANG MEMPENGARUHI DARAH
9.1 Antianemia
9.2 ANTI AGREGASI PLATELET
1. Asam asetilsalisilat Tab 80 mg 1. Aspilet 1. Aspilet
Tab 100 mg 2. Aptor 2. Aptor
2. Clopidogrell Tab 75 mg 1. Clopidogrel 1. Clopidogrel
3. Lumbricus rubellus 490 mg Tab 490 mg 1. Disolf
9.3 OBAT YANG MEMPENGARUI KOAGULASI
1. Heparin Inj 5000 IU/ ml, vial 5 ml 1. Inviclot 1. Inviclot
2. Fondaprinux Inj 2,5 mg/0,5ml 1. Arixtra 1. Arixtra
3. Parnaparin Inj 0,6 ml 1. Fluxum 1. Fluxum
4. Enoxaparin Na Inj 0,4 ml 1. Lovenox 1. Lovenox
Inj 0,6 ml 2. Lovenox 2. Lovenox
5. Warfarin Tab 1. Simarch 1. Simarch
6. Asam traneksamat Inj 500 1. asam traneksamat 1. asam traneksamat
7. Phytomenadione (Vitamin K) Inj 1. Phytomenadion 1. Phytomenadion
10. MIASTENIA GRAVIS
1. Neostigmine methylsulfate Inj 0,5 mg 1. Neostigmin 1. Neostigmin
11. OBAT KARDIOVASKULER
11.1 Antiangina
1. Diltiazem HCl Inj 10 mg dan 50 mg 1. Farmabes 1. Farmabes
2. Isosorbide dinitrate Tab 5 mg, 10 mg, 20 mg 1. Isosorbide dinitrate 1. Isosorbide dinitrate
3. Glyceryl trinitrate Tab 2,5mg; 5 mg 1. Nitrokaf 1. Nitrokaf
11.2 Antiaritmia
1. Digoxin Tab 0,25 mg 1. Digoxin 1. Digoxin
Inj 2. Fargoxin 2. Fargoxin
2. Verapamil Tab 80 mg 1. Verapamil 1. Verapamil
3. Dopamine HCl Inj 40 mg/ml, vial 5 ml 1. Dopamin giulini 1. Dopamin giulini
4. Dobutamine HCl 1. Dobutamin 1. Dobutamin
5. Amiodarone Tab 200 mg 1. Kendaron 1. Kendaron
Injeksi 50 mg/ml 2. Amiodaron 2. Amiodaron
11.3 Antihipertensi
11.3.1 Ace-inhibitor
1. Captopril Tab 12,5 mg 1. Captopril 1. Captopril
Tab 25 mg 2. Captopril 2. Captopril
11.3.2 Beta blocker
1. Bisoprolol Tablet 1,25mg; 2,5 mg 1. Concor 1. Concor
Tab 5 mg 2. Bisoprolol 2. Bisoprolol
2. Propanolol Tab 10 mg, 40 mg 1. Propanolol 1. Propanolol
11.3.3 Kalsium Antagonis
1. Amlodipin besylate Tab 5 mg 1. Amlodipin 1. Amlodipin
Tab 10 mg 2. Amlodipin 2. Amlodipin
2. Diltiazem HCl Tab 30 mg 1. Diltiazem 1. Diltiazem
Tab 100 mg 2. Herbesser CD 100 2. Herbesser CD 100
Tab 200 mg 3. Herbesser CD 200 3. Herbesser CD 200
11.3.4 penghambat reseptor angiotensin II (ARB)
1. Candesartan Tab 8 mg ; 16 mg; 1. Candesartan 1. Candesartan
3. Telmisartan Tab 40 mg 1. Telmisartan 1. Telmisartan
Tab 80 mg
11.3.5 Antihipertensi Lain
1. Klonidin Tab 0,15 mg 1. Clonidin 1. Clonidin
Inj 150 mcg/ml 2. Catapres 2. Catapres
2. Hidroklorotiazid (HCT) Iab 25 mg 1. hidroklorotiazid (HCT) 1. hidroklorotiazid (HCT)
3. Mythyldopa Tab 250 mg 1. dopamet 250 1. dopamet 250
4. Nifedipin Tab 1. Nifedipin 1. Nifedipin
11.3.6 Antihipertensi (krisis)
1. Nicardipine hydrochloride Inj 2 mg amp @ 2 ml 1. Nicardipin 1. Nicardipin
11.3.7 Gagal Jantung
1. Furosemid Inj 10 mg/ml, amp @ 2 ml 1. Furosemid 1. Furosemid
2. Digoksin Tab 0,25 1. Digoxin 1. Digoxin
3. Ramipril Tab 2,5 mg ; 5 mg 1. Ramipril 1. Ramipril
4. Valsartan Tab 80 mg ; 160 mg 1. Valsartan 1. Valsartan
5. Karvedilol Kap 6,25 mg 1. V-Block 1. V-Block
11.3.8 Syok Kardiogenik
1. Dopamin hidroklorid Inj 40 mg/ml amp @ 5 ml 1. Dopamin Glulini 1. Dopamin Glulini
2. Dobutamin Inj 250 mg/vial 5 ml 1. Dobutamin 1. Dobutamin
3. Epinefrin (adrenalin) Inj 0,1 % 1. Ephineprine 1. Ephineprine
4. Norefineprin Inj 1mg/ml 1. Norefineprin 1. Norefineprin
11.3.9 Antihiperlipedemia
1. Gemfibrozil Tab 300 mg, 600 mg 1. Gemfibrozil 1. Gemfibrozil
2. Simvastatin Tapl 10 mg, 20 mg 1. Simvastatin 1. Simvastatin
3. Atorvastatin Tab 20 mg 1. Atorvastatin
12. KULIT dan OBAT TOPIKAL
12.1 Antifungi
1. Ketokonazol Krim 10 g 1. Ketoconazole 1. Ketoconazole
Tab 2. Ketoconazole 2. Ketoconazole
2. Mikonazol Krim 2 % 1. Mikonazol 1. Mikonazol
3. Nystatin Susp 100.000 IU/ml 1. Nystatin 1. Nocandis
12.2 Antiinflamasi dan Antipruritik
1. Hidrokortison Krim 2,5 % tube 5 gr, 10 g 1. Hidrocortisone Cream 1. Hidrocortisone Cream
2. Kombinasi: betametasone valerate 0,1%+ Krim 5 g 1. Betason-N
neomycin sulfat 0,5%
3. Betametason Krim 0,1 % 1. Betametason 1. Betametason
4. Betametason + Gentamisin 1 mg Krim 1. Benoson-G
12.3 Lain-lain
1. Kombinasi : Neomycin sulfat 0,5%+extract placenta Gel 15 g 1. Bioplacenton 1. Bioplacenton
(hanya untuk luka bakar lebih dari 30%)
2. Lithospermi radix extr, Dibucain HCl, Salep 15 gram 1. Borraginol-N
Diphenhydramine HCl, Cetrimide, Aethylis Aminobenzoas
3. Fusidic Acid Krim 5 gram 1. Fucilex 1. Fucilex
4. Silver sulphadiazine Krim 10 mg 1. Silver sulphadiazine 1. Burnazin
13. ANTISEPTIK dan DESINFEKTAN
13.1 Antiseptik
1. Hidrogen peroksida (H2O2) Cairan 3% btl 10 ml 1. Hidrogen Peroksida 1. Hidrogen Peroksida
2. Povidon iodin Lar 10% btl 1000 ml 1. Povidon iodin 1. Povidon iodin
13.2 Desinfektan
1. Etakridin (rivanol) Lar 0,1% botol 300 ml 1. Rivanol 1. Rivanol
2. Etanol 70% Btl 1000ml 1. Alkohol 1. Alkohol
14. DIURETIK
1. Furosemid inj 10 mg/ml ampul 2 ml 1. Furosemid 1. Furosemid
2. Hidroklorotiazid (HCT) tab 25 mg 1. Hidroklorotiazid 1. Hidroklorotiazid
3. Spironolakton tab 25 mg ; 100 mg 1. Spironolacton 1. Spironolacton
15. OBAT SALURAN CERNA
15.1 Antasida dan Antiulkus
1. Antasida Syr 1. Antasida Doen 1. Sanmag
a. kombinasi: Mg trisilicate+Al(OH)3 koloidal+
papaverin HCl+chlordiazepoxide+niasinamide
b. kombinasi : aluminium hidroksida+magnesium Kapl kunyah 2. Antasida Doen 2. Antasida Doen
hidrosida+magnesium carbonate+methylpolysiloxane
2. Antiulkus
a. Ranitidine (H2 Blocker) Inj 25 mg/ml 1. Ranitidin 1. Ranitidin
Tab 150 mg 2. Ranitidin 2. Ranitidin
Syr 75 mg/5 ml 3. Ranicho 3. Ranicho
b. Lansoprazole (proton pump inhibitor) Kaps 30 mg 1. Lansoprazole 1. Lansoprazole
c. Omeprazole (proton pump inhibitor) Kaps 20 mg 1. Omeprazole 1. Omeprazole
Inj 40 mg 2. Omeprazole 2. Omeprazole
d. Pantoprazole (proton pump inhibitor) Inj 40 mg 1. Pantoprazol 1. Topazol
3. Sucralfate Susp 500 mg/5 ml, 120 ml 1. Sucralfat 1. Sucralfat
4. Rebamipide Tab 100 mg 1. Rebamipide
15.2 Antiemetik
1. Omperidon Tab 10 mg 1. Domperidon 1. Domperidon
Syr 5mg/5ml 2. Domperidon 2. Domperidon
2. Ondansetron Inj 4 mg/2 ml inj ; 8 mg/4 ml 1. Ondansetron 1. Ondansetron
Tab 4 mg ; 8 mg 2. Ondansetron 2. Ondansetron
3. Metocloperamide Inj 1. Metocloperamid 1. Metocloperamid

15.3 Obat Diare

1 . Loperamide HCl Tab 2 mg 1. Loperamid 1. Loperamid
2. Nifuroxazide Suspensi 250 mg/5 ml, 60 ml 1. Nifudiar 1. Nifudiar
3. Attapulgit Tab 600 mg 1. New diatab 1. New diatab
4. Lctobacillus acidophillus Sachet Lctobacillus acidophillus 75 mg 1. Geebio 1. Geebio
15.4 Antihemoroid
1. Kombinasi:bismuth subgallate,bismuth resorcin, Supp 1. Anti hemoroid 1. Anti hemoroid
bismuth subiodide, zn oxide
15.5 Antispasmodik
1. Atropin sulfat Inj 0,25 mg/ml @ ampul 1 ml 1. Atropin inj 1. Atropin inj
2. Hyoscine-N-butyl bromid Tablet 10 mg 1. Buscopan 1. Buscopan
inj 2. Hyoscine-N-butyl bromid 2. Hyoscine-N-butyl bromid
15.6 Laxatives & Purgatives
1. Bisacodyl Tab 5 mg 1. Dulcolax 1. Dulcolax
Supp 5 mg child 2. Dulcolax 2. Dulcolax
Supp 10 mg adult 3. Dulcolax 3. Dulcolax
2. Lactulose Syr 3,335 gr/5 ml 1. Lactulac 1. Lactulac
3. Microlax Tiap 5ml mengandung : 1. Microlax 1. Microlax
Natrium lauril sulfoasetat 45 mg
Na. Sitrat, Sorbitol, PEG 400
4. Fleet Enema Monobasic Na phosphate 19 g, dibasic Na phosphate 7 g 1. Fleet enema
15.7 Hepatitis
1. Asam ursodeoxycholic Kapsul 250 mg 1. Asam ursodeoxycholic 1. Asam ursodeoxycholic
16. HORMON
a. Kombinasi Estrogen & Progesteron Hormon
1. Allylestrenol 5 mg Tab 1.Preabor 1.Preabor
2. Norethisterone 5 mg Tab 1.Regumen 1.Regumen

4. Methylergometrine maleat Tab, 125 mcg 1. methylergometrine maleat 1. methylergometrine maleat

 Inj,200 mcg/ml 2. methylergometrine 2. methylergometrine
5. Oxytocin 10 IU/ml Inj 1. Oxytosin 1. Oxytosin
6. Bromocriptine Mesylate 2,5 mg Tab 1. Cripsa 1. Cripsa
7. Isoxsuprine Tab 1. Hystolan 1. Hystolan
17. Obat Hipoglikemik
17.1 Sulfonilurea
1. Glibenklamid Tab 5 mg 1. Glibenclamide 1. Glibenclamide
2. Glimepiride Tab 1 mg; 2mg; 3mg; 4mg 1. Glimepiride 1. Glimepiride
17.2 Biguanid
1. Metformin HCl Tab 500 mg 1. Metformin 500 1. Metformin 500
17.3 Insulin
1. Insulin Aspart 100 U/ml 3 ml 1. Novorapid 1. Novorapid
2. Biphasic Insulin Aspart 100 U/ml 3 ml 1. Novomix 1. Novomix
3. Insulin Detemir 100 U/ml 3 ml 1. Levemir 1. Levemir
4. Insulin Glulisine 100 U/ml 3 ml 1. Apidra 1. Apidra
5. Insulin Glargine 100 U/ml 3 ml 1. Lantus 1. Lantus
17.3 Alfa Glukosidase Inhibitor
1. Acarbose Tab 100 mg 1. Acarbose 1. Capribose
18. OBAT SALURAN NAFAS
18.1 Antiasma

1. Aminofilin Inj 24 mg/ml 1. Aminofilin 1. Aminofilin

Tab 200 mg 2. Erphafillin 2. Erphafillin
2. Salbutamol Tab 2 mg, 4 mg 1. Salbutamol 1. Salbutamol
i.h 100 mcg/puff 200 semprot nebules 2,5 mg 2. Ventolin 2. Ventolin
Syr 100 ml 3. Salbutamol 3. Salbutamol
3. Teofillin Tab 300 mg 1. Retaphyl 1. Retaphyl
4. Fenoterol Inhaler 100 mcg/semprot x 200 semprot x 10 mL x 1 1. Berotec 1. Berotec
5. Fluticasone propionate nebules 1. Flixotide 1. Flixotide
6. Budesonide Inhaler 1. Symbicor 1. Symbicor
18.2 Dekongestan
1. Pseudoefedrin Hcl + Triprolidine Hcl Tab 2,5mg + 30mg 1. Crofed 1. Crofed
2. Tremenza 2. Tremenza
Syr 125mg + 30mg 2. Crofed 2. Crofed
2. Pseudoephedrin HCl Drop 1. Rhinos Neo 1. Rhinos Neo
18.3 Ekspektoran
1. Ambroksol Tab 30 mg 1. Ambroksol 1. Ambroksol
Syr 15 mg/5 ml, 60 ml 1. Ambroxol elixir 1. Ambroxol elixir
2. Kombinasi : Salbutamol + GG Syr 100 ml 1. Lasal Exp 1. Lasal Exp
3. OBH Syr 1. OBH 1. OBH
4. Erdosteine Syr 175mg/5ml 1. Rindovect
18.4 Antitusif
1. Kodein tab 10 mg (fosfat) 1. Codein 1. Codein
19. OBAT TELINGA dan HIDUNG
a. Obat Telinga
19.1 Antibakteri topikal
1. kombinasi : polymiksin B SO4 10.000 UI, neomisina btl 8 ml 1. Otopain 1. Otopain
sulfat 3,75 mg, lidokain HCl 40 mg, betametason 1 mg,
benzalkonium klorida 0,1 mg, propilenglikol+glisero dan aqua 1 ml
2. Ofloxacin btl 5 ml 1. Akilen 1. Akilen
19.2 kortikosteroid
19.3 Lain-lain
Oxymetazoline HCl 0,025%, 10 ml drop 1. Iliadin Infant drop 1. Iliadin Infant drop
0,05 %, 10 ml drop 2. Iliadin Spray 2. Iliadin Spray
20. OBAT MATA
20.1 Sistemik
1. Asetazolamid Tab 250 mg 1. Glaucon 1. Glaucon
20.2 Topikal
20.2.1 Anestetik Lokal
1. Tetrakain HCl TTS mata 0,5%, 2% btl 5 ml 1. Pantocain 1. Pantocain
20.2.2 Anti-Infeksi & Antiseptics
1. Chloramphenicol 0,25%, 0,5% & 1 % btl 5 ml 1. Cendo Fenicol drop 1. Cendo Fenicol drop
1% salep 3,5 g 1. Cendo Fenicol salep 1. Cendo Fenicol salep
btl 10 ml 2. Reco Eye drop 2. Reco Eye drop
2. Chloramfenicol Base 2 mg, hydrocortisone btl 5 ml 1. Mycos eye drop 1. Mycos eye drop
2. gentamicin sulfate Salep 1. Cendo Genta drop 1. Cendo Genta drop
1% btl 5 ml 2. Cendo gentamicyn 0,3 % 2. Cendo gentamicyn 0,3 %
3. polymixin-B sulfate 2,5 mg, gramicidin 0,025 mg 1. Polygran Eye drop 1. Polygran Eye drop
4. Ofloxacin Btl 5 ml 1. Cendo Floxa 1. Cendo Floxa
5. Hydrocortisone Acetate, Cholaramfenicol Salep 1. Cendo Mycos 1. Cendo Mycos
6. Natamicyn Btl 5 ml 1. Cendo Natacen 1. Cendo Natacen
20.2.3 Antiseptik with Corticosteroids
1. dexamethasone 0,1 %; neomycin sulfate 3,5 mg/ml Btl 5 ml 1.Cendo Xitrol Eye drop 1.Cendo Xitrol Eye drop
polymyxin B Sulfate 6.000 IU/ml
Tube 3,5 g 1. Cendo Xitrol Eye Oint 1. Cendo Xitrol Eye Oint
2. Prednisolon Acetate 10 mg btl 5 ml 1. Cendo p-pred 1. Cendo p-pred
3. Natrium Diklofenak Btl 5 ml 1. Cendo Noncort 1. Cendo Noncort
4. Sodium Sulfate 100 mg, Prednison 3,5 mg Btl 5 ml 1. Cendo Cetapred 1. Cendo Cetapred
5. Tobramicyn, Dexametasone sodium Btl 5 ml 1. Cendo Tobroson 1. Cendo Tobroson
6. Atropin Sulfate 10 mg Btl 5 ml 1% 1. Tropin 1. Tropin
20.2.4 Midriatik
1. Hydroxypropyl methylcellulose TTS mata2% btl 5 ml 1. Homatro 1. Homatro
20.2.5 Miotik dan Antiglaukoma
1. Timolol (Maleat) 0,25 % & 0,5 % x 0,6 ml 1. Cendo Timol Eye Drops 1. Cendo Timol Eye Drops
2. Pilokarpin (HCl Nitrat) 2% & 4 % btl 5 ml 2. Cendocarpine 2. Cendocarpine
20.2.6 Antikatarak
1. Potassium Iodide TTS mata btl 5 ml 1. Catarlent 1. Catarlent
2. Kombinasi : Potassium Iodide 5 mg, Sodium iodide 10 mg Btl 5 ml 1. Vitrolenta 1. Vitrolenta

20.2.7 Lain-lain
1. vit A palmitate 1.000 IU; Oxymetazoline Btl 5 mg 1. Asthenof 1. Asthenof
hydrochloride 0,25 mg;Hydroxypropyl Methylcellulose 5 mg

2. Vit A Btl 5 ml 1. Oculenta 1. Oculenta

3. Opthalgon Btl 5 ml 1. Cendo Opthalgon 1. Cendo Opthalgon
4. phenyleprine Hcl 10% btl 5 ml 1. Cendo Efrisel 1. Cendo Efrisel
5. Betaxolol Hcl Btl 5 ml 0,5% 1. Cendo tonor 1. Cendo tonor
6. Dextran HPMC Btl 5 ml 1. Cendo Eyefresh 1. Cendo Eyefresh
7. Tropicamide Btl 5 ml 0,5 % 1. Cendo Mydriatil 1. Cendo Mydriatil
8. Naphazoline Hcl Btl 5 ml 1.Cendo Vitrolenta 1.Cendo Vitrolenta
9. Idoxuridine btl 5 ml 1. Cendo Cendrid 1. Cendo Cendrid
10. Kombinasi : Npazoline 0,25 mg, Pheniramin Maleat 3 mg btl 5 ml 1. Cendo Vernacel 1. Cendo Vernacel
11. Kombinasi : Polymixin, neomicyn, Dexametasone btl 5 ml 1. Polydex 1. Polydex
12. Kombinasi : Fluorometholone 1 mg, Neomicyn sulfate 3,5 mg btl 5 ml 1. polynel 1. polynel
13. Fluorometolon btl 5 ml 1. Posop 1. Posop
14. NaCl 4,4 mg, kalium chlorida 0,8 mg/m drop 5x 0,6 ml 1.Lyteers Eye drop 1.Lyteers Eye drop
15. (moxifloxacin) Ophthalmic Solution btl 5 ml 1. Vigamox
21. OKSITOSIK DAN RELAKSAN UTERUS
21.1 Oksitosik
1. Metilergometrin (Maleat) Tab salut 0,125 mg 1. Methylergometrin 1. Methylergometrin
Inj 0,200 mg/ml amp @ 1 ml 2. Methylergometrin 2. Methylergometrin
21.2 Relaksan Uterus
1. Magnesium sulfat Inj 20 % amp 20 ml 1. Otsu-MgSO4 1. Otsu-MgSO4
Inj 40 % amp 20 ml 2. Otsu-MgSO4 2. Otsu-MgSO4
21.3 Parenteral
1. Glukose Lar. infus 5% btl 500 ml 1. Otsu-D5 1. Otsu-D5
Lar. infus 10% btl 500 ml 1. Otsu-D10 1. Otsu-D10
Lar. infus 40% btl 500 ml 1. Otsu-D40 1. Otsu-D40
2. Kalium klorida Inj 25 ml/vial 1.Otsu-KCl 1.Otsu-KCl
3. Natrium klorida Lar infus 0,9% btl 100 ml 1. Otsu-Ns 1. Otsu-Ns
Lar.Infus 0,9% btl 500 ml & 1.000 ml 1. Wida NS 1. Wida NS
4. kalsium glukonat Inj 100 mg/ml, 10 ml 1. Calcii Gluconas 1. Calcii Gluconas
5. Natrium bikarbonat Inj 8,4% vial 25 ml 1. Meylon 1. Meylon

6. Ringer laktat Lar.infus btl 500 ml 1. Wida Rl 1. Wida Rl

7. Manitol 20 % Larutan Infus 500 ml 1. Manitol 20 % 1. Manitol 20 %
8. Kombinasi :
A. NaCl 2,34 g g+KCl 0,75 g+Na Lactate 2,24 g + Lar infus btl 500 ml 1. KA-EN 3A 1. KA-EN 3A
dextrose anhydrat 27 g (infus per L )

B. NaCl 1,75 g+KCl 1,5 g+Na Lactate 2,24 g + Lar infus btl 500 ml 1. KA-EN 3B 1. KA-EN 3B
dextrose anhydrat 27 g (infus per L )

C. NaCl 2,25 g+dextrose anhydrat 37,5 g (inf/ L ) Lar infus btl 500 ml 1. KA-EN 1B 1. KA-EN 1B

D. NaCl 1,75 g+ KCl 1,5 g+ Na Lactate 2,24 g Lar infus btl 500 ml 1. KA-EN Mg3 1. KA-EN Mg3
dextrose anhydrat 100 g (infus per L )

E. Larutan mengandung elektrolit (KCl 0,15% + NaCl 0,9%) 500 ml Lar infus btl 500 ml 1. KN -1 1. KN -1

F. Larutan mengandung elektrolit (KCl 0,3% + NaCl 0,9%) 500 ml Lar infus btl 500 ml 1. KN-2 1. KN-2
G. NaCl 3 % Lar infus btl 500 ml 1. Otsu-Salin 3 1. Otsu-Salin 3

H. Asering Btl 500 ml 1. Asering 1. Asering

kombinasi infus per L : Natrium 130 mEq,
Kalium 4 mEq, Chlorida 109 mEq, Calcium 3 mEq,
Acetate 28 mEq

I. Larutan Nutrisi DOEN I Lar infus btl 500 ml 1. Aminofusin L-600

kombinasi : Asam Amino 50 g/l, D-Sorbitol 100 g/l,
Asam Askorbat (vitamin c ) 0,4 g/l, Inositol 0,5 g/l,
Nikotinamida (Niasinamida) 0,06 g/l, Piridoksin HCl
(vitamin B-6) 0,04 g/l, Riboflavin Natrium Fosfat
2,5 mg/ml, Rutosid (rutin) 0,4 g/l, Mineral

J. Kombinasi : Glucose 75 g, total free amino acid 30 g, Larutan Infus 500 ml 1. Aminofluid 1. Aminofluid
total nitrogen 4,7 g, essensial / non esential amino acid 1,44 g
, branched-chain amino acid 30%
K. Larutan Nutrisi DOEN V Lar infus btl 500 ml 1. Otsu 1/2 NS-D5 2,5 1. Otsu 1/2 NS-D5 2,5
kombinasi : Glukose 2,5%, Natrium Klorida 0,45%
L. Larutan Nutrisi DOEN VI Lar infus btl 500 ml 1.Otsu 1/4 NS-D5 2,5 1.Otsu 1/4 NS-D5 2,5
kombinasi : Glukose 5%, Natrium Klorida 0,225%
M. Larutan mengandung O-(2-hydroxyethyl)-amylopectin hydrolysate Larutan infus dalam flexy bag berisi 500 mL 1. Terastarch 1. Terastarch
HES BM 130.000 Dalton      60,00    g
(derajat substitusi  0,4) Sodium chloride 6,26 g
Potassium chloride               0,30 g
Calcium chloride 2H2O          0,37 g
Magnesium chloride 6H2O     0,20 g
Sodium acetate 3H2O           3,28 g
Malic acid                            0,67 g
N. Hydroxyethyl starch (HES 130/0.42) 60 g, Na 154 mEq, Lar infus btl 500 ml 1. Widahes 1. Widahes
Cl 154 mEq, (NaCl 9 g). Osmolaritas: 308 mOsm.
22. VITAMIN DAN MINERAL

1. Piracetam Inj 1 g/5 ml 1. Piracetam 1. Piracetam

Kapl 800 mg, 400 mg, 1200 mg 2. Piracetam 2. Piracetam

2. B1,B6,B12 Inj 1. Zyfort 1. Zyfort

2. B complex 2. B complex
3. B1 (Tiamin) Tab 1. B1 1. B1
4. B6 (Piridoksin) Tab 1. B6 1. B6
5. Vitamin A 4000 iu, vitamin D 400 iu, vitamin B1 3 mg, vitamin B2 4 mg Tab 1. Caviplex tablet 1. Caviplex tablet
vitamin B6 4 mg, vitamin B12 12 mcg, vitamin C 75 mg, nikotinamid 20 mg
Ca pantotenat 5 mg, Vitamin E 10 mg, Biotin 0,1 mg, Acid Folic 1 mg, 
Fe Fumarat 135 mg, Acid Glutamic 50 mg, Ca 100 mg, Mg karbonat 87.5 mg
Zn 15 mg, Cu 0.5 mg, Mn 0.5 mg, Fluor 0.5 mg, Iodium 0.15 mg
Sirup 60 ml 2. Caviplex Sirup 2. Caviplex Sirup
Drop 3. Caviplex Drop 3. Caviplex Drop
6. Per 5 mL syr Vit A 5.000 IU, vit B1 3 mg, vit B2 2 mg, vit B6 6 mg Sirup 100 ml 1. Apialys
, vit B12 5 mcg, vit C 50 mg, vit D 400 IU, nikotinamida 20 mg
, lisin HCl 250 mg, d- pantothenol 5 mg, asam l-glutamat 25 mg.
7. Mecobalamin Tab 1. Megabal 1. Megabal
Inj 2. Mecobalamin 2. Mecobalamin
8. Lecithin : 300 mg, Vitamin B1 : 1,4 mg , Vitamin B2 : 1,6 mg Kapsul 1. Escovit
Vitamin B6 : 2 mg , Vitamin B-12 :1.6 mcg , Nicotinamide :2 mg ,
Vitamin E :20 mg , Beta Carotene :2 mg
9. Calsium+genistein+vit.k+vit D Tab 1. Hibone 600
10. Genistein 15 mg, omega 3 200 mg, calcium lactate gluconate 250 mg Kapsul 1. Osteofortis
 vitamin D3 400 IU, vitamin K1 0,1 mg, vitamin C 50 mg.

11. Kalsium laktat ( Kalk) Tab 1. Kalk 1. Calos

12. Glucosamin Glucosamine 500 mg 1. Glucosamine 1. Glucosamine
13. Calcitriol Kapsul 1. Oscal
14. Asam folat Tab 400 µg, 1000 µg 1. Asam folat 1. Asam folat
15. Kombinasi: Ferros Sulfate 250 mg, Magnesium Sulfate 0,2 mg Kapsul 1. Fe + vit.B.comp 1. Fe + vit.B.comp
Vitamin C 50 mg, Folid Acid 1 mg, vit b12 7,5 m, Sorbitol 25 mg 2. Sangobion 2. Sangobion
23. IMUNOGLOBULIN DAN SERUM
23.1 Imunoglobulin
1. Imunoglobulin Anti Tetanus Inj 250 IU/amp 1. Tetagam
(Human Tetanus Imunoglobulin)

23.2 Serum
1. Anti Tetanus (ATS) Inj 1.500 IU/amp, 1 amp@ 1 ml 1. A.T.S 1. A.T.S
2. Anti rabies Inj 1. Verorab

24. Anti Parkinson

24.1 Anti parkinson
1. Triheksifenidil HCl Kaplet 2 mg 1. Triheksifenidil HCl 1. Triheksifenidil HCl
2. Arkine 2. Arkine
2. Levodopa Levodopa 100, carbidopa 25 mg, entacapone 200 mg 1. Stalevo 1. Stalevo
3. Pramipexole Tab 0,375 mg ; 0,75 mg 1. Sifrol 1. Sifrol
25. Hormon Tiroid
1. Propiltiourasil Tab 100 mg 1. Propiltiourasil 1. Propiltiourasil
2. Tiamazol Tab 10 mg 1. Thyrozol 1. Thyrozol
3. Levotiroksin Tab 100 mcg 1. Euthyrox 1. Euthyrox
26. HIPERTROFI PROSTAT
1. Tamsulosin Tab 0,4 mg 1. Harnal Ocas 1. Harnal Ocas

27. PENGHAMBAT KOLINESTERASE

1. Donepezil Hcl (Hanya untuk demensia alzheimer ringan sampai sedang) Tab 10 mg 1. Aricept
28. Anti Depresan
1. Amitriptilin Tab 25 mg 1. Amitriptilin 1. Amitriptilin
29. MIASTENIA GRAVIS
1. Piridostigmin Tab 60 mg 1. Mestinon
30. ANTIANSIETAS
1. Alprazolam Tab 0,25 mg, 0,5 mg, 1 mg 1. Alprazolam 1. Alprazolam
2. Clobazam Tab 10 mg 1. Clobazam 1. Clobazam
3. Clonazepam Tab 2 mg 1. Clonazepam 1. Clonazepam
32. ANTIPSIKOSIS
1. Klorpromazin Inj 50 mg 1. Cepezet 1. Cepezet
Tab 100 mg 1. Cepezet 1. Cepezet
33. NeurotropikVasodilator Perifer
1. Citicolin Tab 500 mg, 1000 mg 1. citicolin 1. citicolin
Inj 250 ml , 500 ml 2. citicolin 2. citicolin
34. Laruran elektrolit, nutrisi dan lain-lain
1. Kalium klorida Tablet 600 mg 1. KSR 1. KSR
2. Kalium Aspartat Tablet salut selaput 300 mg 1. Aspar-K
3. Oralit kombinasi: NaCl 0,7 g, KCl 0,3 g, trinatrium sitrat 1. Oralit 1. Oralit
dihidrat 0,58 g, glukose anhidrat 4 g
4. zink Zink sirup 20mg/5ml 1. zinc pro 1. zinc pro
Zink tablet 20 mg 2. Zink 2. Zink
35. Anti skabies
1. Permetrin Krim 5% 1. Scabimite

36. Herbal
1. Schizandrae fructus extract 7,5 mg Kapsul 1. HP-Pro
2. Psidii folium Syr 1. Psdii kapsul
Kapsul 1. Psdii sirup
3. Didymocarpus pedicellata 65 mg, Saxifraga ligulata 49 mg Tablet 1. Cystone
Rubia cordifolia 16 mg, Cyperus scariosus 16 mg,
Achyranthes aspera 16 mg, Onosma bracteatum 16 mg
4. Ekstrak curcuma xanthorrhiza 20 mg Tablet 1. Curcuma 1. Curcuma
 KELAS TERAPI DAN NAMA GENERIK FORMULASI
BPJS UMUM
1. ANESTETIK
1.1 . ANESTETIK LOKAL
1. Bupivakain (Khusus untuk Analgesia spinal) Inj 1. Bunascan 1. Bunascan
2. Levica 2. Levica
2. Etil klorida Spray 1. Chlor etil 1. Chlor etil
3. Lidokain 2% Inj 1. Lidocain 2% 1. Lidocain 2%
Gel 2. Cathjell 2. Cathjell
4. Lidocaine HCl + Epinephrine Inj 1. Pehacain
1.2 . ANASTETIK UMUM
1. Sevoflurane Cairan inhalasi 250 ml 1. Sevoflurane 1. Sevoflurane
2. Isoflurane Cairan inhalasi 250 ml 1. Aerrane 1. Aerrane

3. Ketamin Inj 50 mg/mL (i.v) 1. Ketamin 1. Ketamin

Inj 100 mg/mL (i.v) 2. KTM 1. KTM
4. Propovol Inj (i.v. Bolus) 1. Propovol 1. Recofol
5. Atracurium benzylate Inj 1. Atracurium 1. Atracurium
6. Rocuronium bromide Inj 1. Rocuronium bromide 1. Rocuronium bromide

1.3 Obat Pre-operatif dan Sedatif untuk tindakan kecil

1. Atropin Amp 0,5 mg 1. Atropin 1. Atropin
2. Diazepam Syrup 2 mg/5 ml 1. Stesolid 1. Stesolid
Tablet 2 mg 1. Valisanbe 1. Valisanbe
Tablet 5 mg 2. Valisanbe 2. Valisanbe
Inj 10 mg 1. Stesolid 1. Valisanbe
Lar rectal 5 mg/ml, tube 2,5 ml 1. Stesolid 1. Stesolid
Lar rectal 10 mg/ml, tube 2,5 ml 2. Stesolid 2. Stesolid
3. Midazolam (Dapat digunakan untuk pre medikasi sebelum induksi Inj 10 mg/ml, amp @ 1 ml 1. Sedacum 1. Sedacum
anestesi dan rumatan selama anestesi umum)
2. ANALGESIK, ANTIPIRETIK, OBAT ANTIINFLAMASI NON STEROID, ANTIPIRAI
2.1 Obat Analgesik Non-opioid dan NSAID
1. Allopurinol (Tidak untuk nyeri akut/untuk asam urat) Tab 100 mg, 300 mg 1. Allopurinol 100 1. Allopurinol 100
2. Asam mefenamat Kapl 500 mg 1. Asam Mefenamat 1. Mefinal
 2. Lapistan
3. Parasetamol Tab 500 mg 1. Paracetamol 1. Sanmol
Infus 2. Paracetamol infus 2. Paracetamol infus
Syrup 3. Paracetamol 3. Sanmol
Drop 4. Alphamol drop 4. Sanmol drop
Rectal tube 125 mg/2,5ml ; 250 mg/ 4ml 5. Dumin 5. Dumin
4. Ibuprofen Tab 200 mg 1. Ibuprofen 1. Bufect
Tab 400 mg 2. Ibuprofen 2. Bufect
Suspensi 100 mg/5ml 3. Salfenal 3. Bufect
Suspensi forte 200 mg/5ml 4. Salfenal 4. Bufect
5. ketoprofen (Untuk nyeri seang sampai berat pada pasien yang - Supp 100 mg 1. Protofen 1. Pronalges
tidak dapat menggunakan analgetik secara oral) Tab 50 mg, 100 mg 2. Ketoprofen 2. Ketoprofen
6. ketorolac tromethamine
(Untuk nyeri sedang sampai berat untuk pasien yang tidak dapat Inj 30 mg/ml 1. Ketorolac 1. Ketorolac
menggunakan analgetik secara oral) pemakaian2-3 amp/hari Tablet 10 mg 2. Ketorolac 2. Ketorolac
maksimal 3 hari
7. Metamizole sodium Inj 1. Metamizole 1. Metamizole
Syr 2. Norages
8. Meloxicam Tab 7,5 mg 1. Meloxicam 1. Meloxicam
Tab 15 mg 2. Meloxicam 2. Meloxicam
9. Tramadol (Untuk nyeri sedang sampai berat pasca operasi dan Kaps 50 mg 1. Tramadol 1. Tramadol
untuk terapi syaraf) Inj 100 mg/ 2ml 2. Tramadol 2. Tramadol
10. Eperison HCL Tab 50 mg 1. Eperison HCl 1. Eperison HCl
2.2 Analgesik Opioid
1. Morfin (Hanya untuk pemakaian pada tindakan anestesi atau pe- Inj 10 mg/ml amp @ 1 ml 1. Morfin 1. Morfin
rawatan di Rumah Sakit dan untuk mengatasi nyeri yang tidak- Tablet 10 mg 1. MST
respon terhadap analgetik non narkotik)
2. Petidin (Hanya untuk tindakan anestesi) Inj 50 mg/ml amp @ 2 ml 1. Pethidin 1. Pethidin
2. Clopedin 2. Clopedin
3. Fentanil Inj (Harus diberikan oleh tim medis yang dapat melakukan 1. Fentanil 1. Fentanil
resusitasi)
patch (Untuk nyeri yang tidak teratasi dengan analgetik- 1. Durogesic Patch 1. Durogesic Patch
non opioid)
4. Kodein Tab 10 mg 1. Kodein 1. Kodein
Tab 15 mg 2. Kodein 2. Kodein
Tab 20 mg 3. Kodein 3. Kodein
3. ANTIALERGI DAN ANAFILAKSIS
1. Klorfeniramin Tab 4 mg 1. CeTeMe 1. CeTeMe

2. Cetirizine Tab 10 mg 1. Cetirizine 1. Cetirizine

Syr 5 mg/5 ml 2. Cetirizine 2. Cetirizine
Drop 10 mg/ml 3. Cetirizine 3. Cetirizine
3. Deksametason (Alergi diikuti radang) Kapl, 0,5 mg 1. Dexamethasone 1. Dexamethasone
 Inj 5 mg/ml 2. Dexamethasone 2. Dexamethasone
4. Loratadine Tab 10 mg 1. Loratadine 1. Loratadine
5. Dipenhidramin Inj 1. Dipenidramin 1. Dipenidramin
6. Epinefrin (adrenalin) (Jika terjadi syok anafilaksis) Inj 0,1%, amp @ 1 ml 1. Epinefrin 1. Epinefrin
4. ANTIDOTUM UNTUK KERACUNAN
4.1 Umum
1. Karbon aktif bubuk/botol 1. Norit
4.2 Khusus
1. Atropin sulfas Inj 0,25 mg/ml, ampul 1 ml 1. Atropin Inj 1. Atropin Inj
2. Naloxone HCl (Hanya untuk mengatasi depresi pernafasan akibat - 0,4 mg/ml, ampul 2 ml 1. Nokoba 1. Nokoba
morfin/opioid)
3. Calsium Glukonat inj 1. Calcii Gluconate 1. Calcii Gluconate
4. Naloxon inj 1. Nokoba
5. ANTIEPILEPSI DAN ANTIKONVULSI
1. Diazepam Lar rectal 5 mg/ml, tube 2,5 ml 1. Stesolid Rectal 1. Stesolid Rectal
Lar rectal 10 mg/ml, tube 2,5 ml 2. Stesolid Rectal 2. Stesolid Rectal
Inj 10 mg/2 ml 1. Stesolid 1. Stesolid
2. Valisanbe 2. Valisanbe
2. Fenobarbital Tab 30mg 1. Fenobarbital 1. Fenobarbital
inj 2. Sibital 2. Sibital
3. Fenitoin Na (Untuk Pasien Epilepsi) Inj 50 mg/ml 1. Phenitoin 1. Phenitoin
Kaps 100mg 2. Phenitoin 2. Phenitoin
4. Asam valproic Syr 250 mg/5 ml 1. As. Valproid 1. As. Valproid
5. Levodopa (Untuk pasien tegak diagnosa Parkinson) Tab 200 mg 1. Stalevo 1. Stalevo
6. Levodopa + Benserazide Tab 1. Levopar 1. Levopar
7. Gabapentin Kaps 300 mg 1. Gabapentin 1. Gabapentin
8. Kabamazepin Tab 200 mg 1. Bamgetol 1. Bamgetol
9. Divalproex Sodium Tab 250 mg 1. Depakote 1. Depakote
Tab 500 mg 2. Depakote 2. Depakote
6. ANTIINFEKSI
6.1 Antelmintik
1. Pyrantel Pamoate Tab 250 mg 1. Pyrantel Pamoate 1. Pyrantel Pamoate
Suspensi 125 mg/5ml, 10 ml 1. Combantrin (Orange)
6.2 Antibakteri
6.2.1 Beta laktam
a. Amoksilin Kapl 500 mg 1. Amoxicillin 1. Amoxicillin
Syr 125 mg/5 ml, 60 ml 2. Amoxicillin 2. Amoxicillin
b. Co-Amoxiclav Tab 625 mg 1. Co-Amoxiclav 1. Co-Amoxiclav
c. Cefoperazone Inj 1. Cefoperazone 1. Cefoperazone
d. Meropenem (Jika infeksi berat, leukosit diatas 20.000) Inj 1g 1. Meropenem 1. Meropenem
6.2.2 Aminoglikosid
a. Gentamicin sulfat Inj 80 mg/2 ml 1. Gentamicin 1. Gentamicin
Salep 2. Gentamicin 2. Gentamicin
6.2.3 sefalosporin
a. Cefadroksil monohidrat Kaps 500 mg 1. Cefadroxil 1. Cefadroxil
Syr 125 mg/5 ml, btl 60 ml 2. Cefadroxil 2. Lapicef
b. Cefixime Kaps 100 mg, 200 mg 1. Cefixime 1. Cefixime
syr 100 mg/ 5 ml 2. Cefixime 2. Cefixime
c. Ceftriakson inj 1 g/ vial, 10 ml 1. Ceftriaxone 1. Broadced
d. Cefotaksim inj 1g/vial 1. Cefotaxime 1. Cefotaxime
e. Seftazidime fentahydrate inj 1. Ceftazidim 1. Ceftazidim
(Diberikan kepada pasien dengan infeksi yang disebabkan oleh -
bakteri yang resisten dengan antibiotika lain (resistensi test)
6.2.4 Makrolida
1. Clindamisin Kaps 300 mg, 150 mg 1. Clindamycin 1. Clindamycin
2. Eritromisin Kap 500 mg 1. Eritromisin 1. Eritromisin
Syr 200mg/5ml 2. Eritromisin 2. Eritromisin
6.2.5 kuinolon
a. Ciprofloxacin (untuk pasien diatas umur 18th) Kapl 500 mg 1. Ciprofloxcin 1. Ciprofloxcin
Infus 200 mg/100 ml 2. Ciprofloxacin 2. Ciprofloxacin
b. Levofloxacin (untuk pasien diatas umur 18th) Kapl 500 mg 1. Levofloxacin 1. Levofloxacin
Infus 5mg/100 ml 2. Levofloxacin 2. Levofloxacin
6.2.6 Tetrasiklin
a. Tetrasiklin Kaps Tetracycline 250 mg 1. Tetracycline 1. Tetracycline
6.3 Anti Infeksi Khusus
6.3.1 Anti-tuberkulosis
a. Kombinasi : Rifampicin 150 mg + Isoniazid 75 mg + Pyrazinamid 400 mg Tab 1. Rifastar 4 FDC 1. Rifastar 4 FDC
+ etambuthol 275 mg
6.4 Antiprotozoa
6.4.1 Antiamuba dan Antiglardiasis
1. Metronidazol Tab 500 mg 1. Metronidazol 1. Metronidazol
Lar infus 5 mg/ml btl 100 ml 2. Metronidazol 2. Metronidazol
6.5 Antivirus
1. Asiklovir Tab 200 mg 1. Asiklovir 1. Asiklovir
Tab 400 mg 2. Asiklovir 2. Asiklovir
Krim 5 % 3. Asiklovir 3. Asiklovir
7. ANTIMIGREN
1. Antalgin Tab 500 1. Antalgin 1. Antalgin
3. Betahistin mesilat Tab 6 mg 1. Betahistin 1. Betahistin
4. flunarizin Tab 5 mg 1. Flunarizin 1. Flunarizin
8. KORTIKOSTEROID
a. Dexametason Kapl 0,5 mg 1. Dexamethasone 1. Dexamethasone
Inj 5 mg/1 mg 2. Dexamethasone 2. Dexamethasone
b. Metilprednisolon Tab 4 mg 1. Methylprednisolon 1. Methylprednisolon
Tab 8 mg 2. Methylprednisolon 2. Methylprednisolon
Tab 16 mg 3. Methylprednisolon 3. Methylprednisolon
 Inj, 125 mg/vial 4. Methylprednisolon 4. Methylprednisolon
c. Kombinasi: betametason 0,25 mg+ dekslorpe Syr 60 ml 1. Proceles
niramin maleat 2 mg
9. OBAT YANG MEMPENGARUHI DARAH
9.1 Antianemia
9.2 ANTI AGREGASI PLATELET
1. Asam asetilsalisilat Tab 80 mg 1. Aspilet 1. Aspilet
Tab 100 mg 2. Aptor 2. Aptor
2. Clopidogrell Tab 75 mg 1. Clopidogrel 1. Clopidogrel
3. Lumbricus rubellus 490 mg Tab 490 mg 1. Disolf
9.3 OBAT YANG MEMPENGARUI KOAGULASI
1. Heparin Inj 5000 IU/ ml, vial 5 ml 1. Inviclot 1. Inviclot
2. Fondaprinux Inj 2,5 mg/0,5ml 1. Arixtra 1. Arixtra
3. Parnaparin Inj 0,6 ml 1. Fluxum 1. Fluxum
4. Enoxaparin Na Inj 0,4 ml 1. Lovenox 1. Lovenox
Inj 0,6 ml 2. Lovenox 2. Lovenox
5. Warfarin Tab 1. Simarch 1. Simarch
6. Asam traneksamat Inj 500 1. asam traneksamat 1. asam traneksamat
7. Phytomenadione (Vitamin K) Inj 1. Phytomenadion 1. Phytomenadion
10. MIASTENIA GRAVIS
1. Neostigmine methylsulfate Inj 0,5 mg 1. Neostigmin 1. Neostigmin
11. OBAT KARDIOVASKULER
11.1 Antiangina
1. Diltiazem HCl Inj 10 mg dan 50 mg 1. Farmabes 1. Farmabes
2. Isosorbide dinitrate Tab 5 mg 1. Isosorbide dinitrate 1. Cedocard 5
3. Glyceryl trinitrate Tab 2,5mg; 5 mg 1. Nitrokaf 1. Nitrokaf
11.2 Antiaritmia
1. Digoxin Tab 0,25 mg 1. Digoxin 1. Digoxin
Inj 2. Fargoxin 2. Fargoxin
2. Verapamil Tab 80 mg 1. Verapamil 1. Verapamil
3. Dopamine HCl Inj 40 mg/ml, vial 5 ml 1. Dopamin giulini 1. Dopamin giulini
4. Dobutamine HCl 1. Dobutamin 1. Dobutamin
5. Amiodarone Tab 200 mg 1. Kendaron 1. Kendaron
Injeksi 50 mg/ml 2. Amiodaron 2. Amiodaron
11.3 Antihipertensi
11.3.1 Ace-inhibitor
1. Captopril Tab 12,5 mg 1. Captopril 1. Captopril
Tab 25 mg 2. Captopril 2. Captopril
11.3.2 Beta blocker
1. Bisoprolol Tablet 1,25mg; 2,5 mg 1. Concor 1. Concor
Tab 5 mg 2. Bisoprolol 2. Bisoprolol
2. Propanolol Tab 10 mg, 40 mg 1. Propanolol 1. Propanolol
11.3.3 Kalsium Antagonis
1. Amlodipin besylate Tab 5 mg 1. Amlodipin 1. Amlodipin
Tab 10 mg 2. Amlodipin 2. Amlodipin
2. Diltiazem HCl Tab 30 mg 1. Diltiazem 1. Diltiazem
Tab 100 mg 2. Herbesser CD 100 2. Herbesser CD 100
Tab 200 mg 3. Herbesser CD 200 3. Herbesser CD 200
11.3.4 penghambat reseptor angiotensin II (ARB)
1. Candesartan Tab 8 mg ; 16 mg; 1. Candesartan 1. Candepress
3. Telmisartan Tab 40 mg 1. Telmisartan 1. Telmisartan
Tab 80 mg
11.3.5 Antihipertensi Lain
1. Klonidin Tab 0,15 mg 1. Clonidin 1. Clonidin
Inj 150 mcg/ml 2. Catapres 2. Catapres
2. Hidroklorotiazid (HCT) Iab 25 mg 1. hidroklorotiazid (HCT) 1. hidroklorotiazid (HCT)
3. Mythyldopa Tab 250 mg 1. dopamet 250 1. dopamet 250
4. Nifedipin Tab 1. Nifedipin 1. Nifedipin
11.3.6 Antihipertensi (krisis)
1. Nicardipine hydrochloride Inj 2 mg amp @ 2 ml 1. Nicardipin 1. Nicardipin
11.3.7 Gagal Jantung
1. Furosemid Inj 10 mg/ml, amp @ 2 ml 1. Furosemid 1. Furosemid
2. Digoksin Tab 0,25 1. Digoxin 1. Digoxin
3. Ramipril Tab 2,5 mg ; 5 mg 1. Ramipril 1. Ramipril
4. Valsartan Tab 80 mg ; 160 mg 1. Valsartan 1. followup escolab/novartis
5. Karvedilol Kap 6,25 mg 1. V-Block 1. V-Block
11.3.8 Syok Kardiogenik
1. Dopamin hidroklorid Inj 40 mg/ml amp @ 5 ml 1. Dopamin Glulini 1. Dopamin Glulini
2. Dobutamin Inj 250 mg/vial 5 ml 1. Dobutamin 1. Dobutamin
3. Epinefrin (adrenalin) Inj 0,1 % 1. Ephineprine 1. Ephineprine
4. Norefineprin Inj 1mg/ml 1. Norefineprin 1. Norefineprin
11.3.9 Antihiperlipedemia
1. Gemfibrozil Tab 300 mg, 600 mg 1. Gemfibrozil 1. Gemfibrozil
2. Simvastatin Tapl 10 mg, 20 mg 1. Simvastatin 1. Simvastatin
3. Atorvastatin Tab 20 mg 1. Atorvastatin 1. Atorvastatin
12. KULIT dan OBAT TOPIKAL
12.1 Antifungi
1. Ketokonazol Krim 10 g 1. Ketoconazole 1. Ketoconazole
Tab 2. Ketoconazole 2. Ketoconazole
2. Mikonazol Krim 2 % 1. Mikonazol 1. Mikonazol
3. Nystatin Susp 100.000 IU/ml 1. Nystatin 1. Nocandis
12.2 Antiinflamasi dan Antipruritik
1. Hidrokortison Krim 2,5 % tube 5 gr, 10 g 1. Hidrocortisone Cream 1. Hidrocortisone Cream
2. Kombinasi: betametasone valerate 0,1%+ Krim 5 g 1. Betason-N
neomycin sulfat 0,5%
3. Betametason Krim 0,1 % 1. Betametason 1. Betametason
4. Betametason + Gentamisin 1 mg Krim 1. Benoson-G
12.3 Lain-lain
1. Kombinasi : Neomycin sulfat 0,5%+extract placenta Gel 15 g 1. Bioplacenton 1. Bioplacenton
(hanya untuk luka bakar lebih dari 30%)
2. Lithospermi radix extr, Dibucain HCl, Salep 15 gram 1. Borraginol-N
Diphenhydramine HCl, Cetrimide, Aethylis Aminobenzoas
3. Fusidic Acid Krim 5 gram 1. Fucilex 1. Fucilex
4. Silver sulphadiazine Krim 10 mg 1. Silver sulphadiazine 1. Burnazin
13. ANTISEPTIK dan DESINFEKTAN
13.1 Antiseptik
1. Hidrogen peroksida (H2O2) Cairan 3% btl 10 ml 1. Hidrogen Peroksida 1. Hidrogen Peroksida
2. Povidon iodin Lar 10% btl 1000 ml 1. Povidon iodin 1. Povidon iodin
13.2 Desinfektan
1. Etakridin (rivanol) Lar 0,1% botol 300 ml 1. Rivanol 1. Rivanol
2. Etanol 70% Btl 1000ml 1. Alkohol 1. Alkohol
14. DIURETIK
1. Furosemid inj 10 mg/ml ampul 2 ml 1. Furosemid 1. Furosemid
2. Hidroklorotiazid (HCT) tab 25 mg 1. Hidroklorotiazid 1. Hidroklorotiazid
3. Spironolakton tab 25 mg ; 100 mg 1. Spironolacton 1. Spironolacton
15. OBAT SALURAN CERNA
15.1 Antasida dan Antiulkus
1. Antasida Syr 1. Antasida Doen 1. Sanmag
a. kombinasi: Mg trisilicate+Al(OH)3 koloidal+
papaverin HCl+chlordiazepoxide+niasinamide
b. kombinasi : aluminium hidroksida+magnesium Kapl kunyah 2. Antasida Doen 2. Antasida Doen
hidrosida+magnesium carbonate+methylpolysiloxane
2. Antiulkus
a. Ranitidine (H2 Blocker) Inj 25 mg/ml 1. Ranitidin 1. Ranitidin
Tab 150 mg 2. Ranitidin 2. Ranitidin
Syr 75 mg/5 ml 3. Ranicho 3. Ranicho
b. Lansoprazole (proton pump inhibitor) Kaps 30 mg 1. Inhipraz
c. Omeprazole (proton pump inhibitor) Kaps 20 mg 1. Omeprazole 1. Omeprazole
Inj 40 mg 2. Omeprazole 2. Omeprazole
d. Pantoprazole (proton pump inhibitor) Inj 40 mg 1. Pantoprazol 1. Topazol
3. Sucralfate Susp 500 mg/5 ml, 120 ml 1. Sucralfat 1. Propepsa
4. Rebamipide Tab 100 mg 1. Rebamipide
15.2 Antiemetik
1. Omperidon Tab 10 mg 1. Domperidon 1. Domperidon
Syr 5mg/5ml 2. Domperidon 2. Domperidon
2. Ondansetron Inj 4 mg/2 ml inj ; 8 mg/4 ml 1. Ondansetron 1. Ondansetron
Tab 4 mg ; 8 mg 2. Ondansetron 2. Ondansetron
3. Metocloperamide Inj 1. Metocloperamid 1. Metocloperamid
15.3 Obat Diare
1 . Loperamide HCl Tab 2 mg 1. Loperamid 1. Loperamid
2. Nifuroxazide Suspensi 250 mg/5 ml, 60 ml 1. Nifudiar 1. Nifudiar
3. Attapulgit Tab 600 mg 1. New diatab 1. New diatab
4. Lctobacillus acidophillus Sachet Lctobacillus acidophillus 75 mg 1. Geebio 1. L-Bio
15.4 Antihemoroid
1. Kombinasi:bismuth subgallate,bismuth resorcin, Supp 1. Anti hemoroid 1. Anti hemoroid
bismuth subiodide, zn oxide
15.5 Antispasmodik
1. Atropin sulfat Inj 0,25 mg/ml @ ampul 1 ml 1. Atropin inj 1. Atropin inj
2. Hyoscine-N-butyl bromid Tablet 10 mg 1. Buscopan 1. Buscopan
inj 2. Hyoscine-N-butyl bromid 2. Hyoscine-N-butyl bromid
15.6 Laxatives & Purgatives
1. Bisacodyl Tab 5 mg 1. Dulcolax 1. Dulcolax
Supp 5 mg child 2. Dulcolax 2. Dulcolax
Supp 10 mg adult 3. Dulcolax 3. Dulcolax
2. Lactulose Syr 3,335 gr/5 ml 1. Lactulac 1. Lactulac
3. Microlax Tiap 5ml mengandung : 1. Microlax 1. Microlax
Natrium lauril sulfoasetat 45 mg
Na. Sitrat, Sorbitol, PEG 400
4. Fleet Enema Monobasic Na phosphate 19 g, dibasic Na phosphate 7 g 1. Fleet enema
15.7 Hepatitis
1. Asam ursodeoxycholic Kapsul 250 mg 1. Asam ursodeoxycholic 1. Urdahex
16. HORMON
a. Kombinasi Estrogen & Progesteron Hormon
1. Allylestrenol 5 mg Tab 1.Preabor 1.Preabor
2. Norethisterone 5 mg Tab 1.Regumen 1.Regumen

4. Methylergometrine maleat Tab, 125 mcg 1. methylergometrine maleat 1. methylergometrine maleat

Inj,200 mcg/ml 2. methylergometrine 2. methylergometrine
5. Oxytocin 10 IU/ml Inj 1. Oxytosin 1. Oxytosin
6. Bromocriptine Mesylate 2,5 mg Tab 1. Cripsa 1. Cripsa
7. Isoxsuprine Tab 1. Hystolan 1. Hystolan
17. Obat Hipoglikemik
17.1 Sulfonilurea
1. Glibenklamid Tab 5 mg 1. Glibenclamide 1. Glibenclamide
2. Glimepiride Tab 1 mg; 2mg; 3mg; 4mg 1. Glimepiride 1. Glimepiride
17.2 Biguanid
1. Metformin HCl Tab 500 mg 1. Metformin 500 1. Metformin 500
17.3 Insulin
1. Insulin Aspart 100 U/ml 3 ml 1. Novorapid 1. Novorapid
2. Biphasic Insulin Aspart 100 U/ml 3 ml 1. Novomix 1. Novomix
3. Insulin Detemir 100 U/ml 3 ml 1. Levemir 1. Levemir
4. Insulin Glulisine 100 U/ml 3 ml 1. Apidra 1. Apidra
5. Insulin Glargine 100 U/ml 3 ml 1. Lantus 1. Lantus
17.3 Alfa Glukosidase Inhibitor
1. Acarbose Tab 100 mg 1. Acarbose 1. Capribose
18. OBAT SALURAN NAFAS
18.1 Antiasma

1. Aminofilin Inj 24 mg/ml 1. Aminofilin 1. Aminofilin

Tab 200 mg 2. Erphafillin 2. Erphafillin
2. Salbutamol Tab 2 mg, 4 mg 1. Salbutamol 1. Salbutamol
i.h 100 mcg/puff 200 semprot nebules 2,5 mg 2. Ventolin 2. Ventolin
Syr 100 ml 3. Salbutamol 3. Salbutamol
3. Teofillin Tab 300 mg 1. Retaphyl 1. Retaphyl
4. Fenoterol Inhaler 100 mcg/semprot x 200 semprot x 10 mL x 1 1. Berotec 1. Berotec
5. Fluticasone propionate nebules 1. Flixotide 1. Flixotide
6. Budesonide Inhaler 1. Symbicor 1. Symbicor
18.2 Dekongestan
1. Pseudoefedrin Hcl + Triprolidine Hcl Tab 2,5 mg + 30 mg 1. Crofed 1. Crofed
2. Tremenza 2. Tremenza
Syr 125 mg + 30 mg 2. Crofed 2. Crofed
2. Pseudoephedrin HCl Drop 1. Rhinos Neo 1. Rhinos Neo
18.3 Ekspektoran
1. Ambroksol Tab 30 mg 1. Ambroksol 1. Ambroksol
Syr 15 mg/5 ml, 60 ml 1. Ambroxol elixir
2. Kombinasi : Salbutamol + GG Syr 100 ml 1. Lasal Exp 1. Lasal Exp
3. OBH Syr 1. OBH 1. Sanadril DMP
4. Erdosteine Syr 175mg/5ml 1. Rindovect
18.4 Antitusif
1. Kodein tab 10 mg (fosfat) 1. Codein 1. Codein
19. OBAT TELINGA dan HIDUNG
a. Obat Telinga
19.1 Antibakteri topikal
1. kombinasi : polymiksin B SO4 10.000 UI, neomisina btl 8 ml 1. Otopain 1. Otopain
sulfat 3,75 mg, lidokain HCl 40 mg, betametason 1 mg,
benzalkonium klorida 0,1 mg, propilenglikol+glisero dan aqua 1 ml
2. Ofloxacin btl 5 ml 1. Akilen 1. Akilen
19.2 kortikosteroid
19.3 Lain-lain
Oxymetazoline HCl 0,025%, 10 ml drop 1. Iliadin Infant drop 1. Iliadin Infant drop
0,05 %, 10 ml drop 2. Iliadin Spray 2. Iliadin Spray
20. OBAT MATA
20.1 Sistemik
1. Asetazolamid Tab 250 mg 1. Glaucon 1. Glaucon
20.2 Topikal
20.2.1 Anestetik Lokal
1. Tetrakain HCl TTS mata 0,5%, 2% btl 5 ml 1. Pantocain 1. Pantocain
20.2.2 Anti-Infeksi & Antiseptics
1. Chloramphenicol 0,25%, 0,5% & 1 % btl 5 ml 1. Cendo Fenicol drop 1. Cendo Fenicol drop
1% salep 3,5 g 1. Cendo Fenicol salep 1. Cendo Fenicol salep
btl 10 ml 2. Reco Eye drop 2. Reco Eye drop
2. Chloramfenicol Base 2 mg, hydrocortisone btl 5 ml 1. Mycos eye drop 1. Mycos eye drop
2. gentamicin sulfate Salep 1. Cendo Genta drop 1. Cendo Genta drop
1% btl 5 ml 2. Cendo gentamicyn 0,3 % 2. Cendo gentamicyn 0,3 %
3. polymixin-B sulfate 2,5 mg, gramicidin 0,025 mg 1. Polygran Eye drop 1. Polygran Eye drop
4. Ofloxacin Btl 5 ml 1. Cendo Floxa 1. Cendo Floxa
5. Hydrocortisone Acetate, Cholaramfenicol Salep 1. Cendo Mycos 1. Cendo Mycos
6. Natamicyn Btl 5 ml 1. Cendo Natacen 1. Cendo Natacen
20.2.3 Antiseptik with Corticosteroids
1. dexamethasone 0,1 %; neomycin sulfate 3,5 mg/ml Btl 5 ml 1.Cendo Xitrol Eye drop 1.Cendo Xitrol Eye drop
polymyxin B Sulfate 6.000 IU/ml
Tube 3,5 g 1. Cendo Xitrol Eye Oint 1. Cendo Xitrol Eye Oint
2. Prednisolon Acetate 10 mg btl 5 ml 1. Cendo p-pred 1. Cendo p-pred
3. Natrium Diklofenak Btl 5 ml 1. Cendo Noncort 1. Cendo Noncort
4. Sodium Sulfate 100 mg, Prednison 3,5 mg Btl 5 ml 1. Cendo Cetapred 1. Cendo Cetapred
5. Tobramicyn, Dexametasone sodium Btl 5 ml 1. Cendo Tobroson 1. Cendo Tobroson
6. Atropin Sulfate 10 mg Btl 5 ml 1% 1. Tropin 1. Tropin
20.2.4 Midriatik
1. Hydroxypropyl methylcellulose TTS mata2% btl 5 ml 1. Homatro 1. Homatro
20.2.5 Miotik dan Antiglaukoma
1. Timolol (Maleat) 0,25 % & 0,5 % x 0,6 ml 1. Cendo Timol Eye Drops 1. Cendo Timol Eye Drops
2. Pilokarpin (HCl Nitrat) 2% & 4 % btl 5 ml 2. Cendocarpine 2. Cendocarpine
20.2.6 Antikatarak
1. Potassium Iodide TTS mata btl 5 ml 1. Catarlent 1. Catarlent
2. Kombinasi : Potassium Iodide 5 mg, Sodium iodide 10 mg Btl 5 ml 1. Vitrolenta 1. Vitrolenta

20.2.7 Lain-lain
1. vit A palmitate 1.000 IU; Oxymetazoline Btl 5 mg 1. Asthenof 1. Asthenof
hydrochloride 0,25 mg;Hydroxypropyl Methylcellulose 5 mg

2. Vit A Btl 5 ml 1. Oculenta 1. Oculenta

3. Opthalgon Btl 5 ml 1. Cendo Opthalgon 1. Cendo Opthalgon
4. phenyleprine Hcl 10% btl 5 ml 1. Cendo Efrisel 1. Cendo Efrisel
5. Betaxolol Hcl Btl 5 ml 0,5% 1. Cendo tonor 1. Cendo tonor
6. Dextran HPMC Btl 5 ml 1. Cendo Eyefresh 1. Cendo Eyefresh
7. Tropicamide Btl 5 ml 0,5 % 1. Cendo Mydriatil 1. Cendo Mydriatil
8. Naphazoline Hcl Btl 5 ml 1.Cendo Vitrolenta 1.Cendo Vitrolenta
9. Idoxuridine btl 5 ml 1. Cendo Cendrid 1. Cendo Cendrid
10. Kombinasi : Npazoline 0,25 mg, Pheniramin Maleat 3 mg btl 5 ml 1. Cendo Vernacel 1. Cendo Vernacel
11. Kombinasi : Polymixin, neomicyn, Dexametasone btl 5 ml 1. Polydex 1. Polydex
12. Kombinasi : Fluorometholone 1 mg, Neomicyn sulfate 3,5 mg btl 5 ml 1. polynel 1. polynel
13. Fluorometolon btl 5 ml 1. Posop 1. Posop
14. NaCl 4,4 mg, kalium chlorida 0,8 mg/m drop 5x 0,6 ml 1.Lyteers Eye drop 1.Lyteers Eye drop
15. (moxifloxacin) Ophthalmic Solution btl 5 ml 1. Vigamox
21. OKSITOSIK DAN RELAKSAN UTERUS
21.1 Oksitosik
1. Metilergometrin (Maleat) Tab salut 0,125 mg 1. Methylergometrin 1. Methylergometrin
Inj 0,200 mg/ml amp @ 1 ml 2. Methylergometrin 2. Methylergometrin
21.2 Relaksan Uterus
1. Magnesium sulfat Inj 20 % amp 20 ml 1. Otsu-MgSO4 1. Otsu-MgSO4
Inj 40 % amp 20 ml 2. Otsu-MgSO4 2. Otsu-MgSO4
21.3 Parenteral
1. Glukose Lar. infus 5% btl 500 ml 1. Otsu-D5 1. Otsu-D5
Lar. infus 10% btl 500 ml 1. Otsu-D10 1. Otsu-D10
Lar. infus 40% btl 500 ml 1. Otsu-D40 1. Otsu-D40
2. Kalium klorida Inj 25 ml/vial 1.Otsu-KCl 1.Otsu-KCl
3. Natrium klorida Lar infus 0,9% btl 100 ml 1. Otsu-Ns 1. Otsu-Ns
Lar.Infus 0,9% btl 500 ml & 1.000 ml 1. Wida NS 1. Wida NS
4. kalsium glukonat Inj 100 mg/ml, 10 ml 1. Calcii Gluconas 1. Calcii Gluconas
5. Natrium bikarbonat Inj 8,4% vial 25 ml 1. Meylon 1. Meylon

6. Ringer laktat Lar.infus btl 500 ml 1. Wida Rl 1. Wida Rl

7. Manitol 20 % Larutan Infus 500 ml 1. Manitol 20 % 1. Manitol 20 %
8. Kombinasi :
A. NaCl 2,34 g g+KCl 0,75 g+Na Lactate 2,24 g + Lar infus btl 500 ml 1. KA-EN 3A 1. KA-EN 3A
dextrose anhydrat 27 g (infus per L )

B. NaCl 1,75 g+KCl 1,5 g+Na Lactate 2,24 g + Lar infus btl 500 ml 1. KA-EN 3B 1. KA-EN 3B
dextrose anhydrat 27 g (infus per L )

C. NaCl 2,25 g+dextrose anhydrat 37,5 g (inf/ L ) Lar infus btl 500 ml 1. KA-EN 1B 1. KA-EN 1B

D. NaCl 1,75 g+ KCl 1,5 g+ Na Lactate 2,24 g Lar infus btl 500 ml 1. KA-EN Mg3 1. KA-EN Mg3
dextrose anhydrat 100 g (infus per L )

E. Larutan mengandung elektrolit (KCl 0,15% + NaCl 0,9%) 500 ml Lar infus btl 500 ml 1. KN -1 1. KN -1

F. Larutan mengandung elektrolit (KCl 0,3% + NaCl 0,9%) 500 ml Lar infus btl 500 ml 1. KN-2 1. KN-2
G. NaCl 3 % Lar infus btl 500 ml 1. Otsu-Salin 3 1. Otsu-Salin 3
H. Asering Btl 500 ml 1. Asering 1. Asering
kombinasi infus per L : Natrium 130 mEq,
Kalium 4 mEq, Chlorida 109 mEq, Calcium 3 mEq,
Acetate 28 mEq

I. Larutan Nutrisi DOEN I Lar infus btl 500 ml 1. Aminofusin L-600 1. Aminofusin L-600
kombinasi : Asam Amino 50 g/l, D-Sorbitol 100 g/l,
Asam Askorbat (vitamin c ) 0,4 g/l, Inositol 0,5 g/l,
Nikotinamida (Niasinamida) 0,06 g/l, Piridoksin HCl
(vitamin B-6) 0,04 g/l, Riboflavin Natrium Fosfat
2,5 mg/ml, Rutosid (rutin) 0,4 g/l, Mineral

J. Kombinasi : Glucose 75 g, total free amino acid 30 g, Larutan Infus 500 ml 1. Aminofluid 1. Aminofluid
total nitrogen 4,7 g, essensial / non esential amino acid 1,44 g
, branched-chain amino acid 30%
K. Larutan Nutrisi DOEN V Lar infus btl 500 ml 1. Otsu 1/2 NS-D5 2,5 1. Otsu 1/2 NS-D5 2,5
kombinasi : Glukose 2,5%, Natrium Klorida 0,45%
L. Larutan Nutrisi DOEN VI Lar infus btl 500 ml 1.Otsu 1/4 NS-D5 2,5 1.Otsu 1/4 NS-D5 2,5
kombinasi : Glukose 5%, Natrium Klorida 0,225%
M. Larutan mengandung O-(2-hydroxyethyl)-amylopectin hydrolysate Larutan infus dalam flexy bag berisi 500 mL 1. Terastarch 1. Terastarch
HES BM 130.000 Dalton      60,00    g
(derajat substitusi  0,4) Sodium chloride 6,26 g
Potassium chloride               0,30 g
Calcium chloride 2H2O          0,37 g
Magnesium chloride 6H2O     0,20 g
Sodium acetate 3H2O           3,28 g
Malic acid                            0,67 g
N. Hydroxyethyl starch (HES 130/0.42) 60 g, Na 154 mEq, Lar infus btl 500 ml 1. Widahes 1. Widahes
Cl 154 mEq, (NaCl 9 g). Osmolaritas: 308 mOsm.
N. Natrium laktat hipertonik o,5 M, Natrium laktat 28.25 gr, KCl 75 mg, Lat Infus 250 ml 1. Totilac
CaCl2. 2H2O 50mg
O. Glukose (11 %), amino acids & electrolyte (Vamin 18 Novum), Lar infus 1440 ml 1. Kabiven Peripheral
fat emulsion (Intralipid 20%)
P. Clinimix Lar infus 1. Clinimix
Q. Clinoleic 20% Lar infus 1. Clinoleic 20%
R. Triofusin Lar infus 1. Triofusin 1600
22. VITAMIN DAN MINERAL

1. Piracetam Inj 1 g/5 ml 1. Piracetam 1. Piracetam

Kapl 800 mg, 400 mg, 1200 mg 2. Piracetam 2. Piracetam

2. B1,B6,B12 Inj 1. Zyfort 1. Neurobion

 2. B complex 2. B complex
3. B1 (Tiamin) Tab 1. B1 1. B1
4. B6 (Piridoksin) Tab 1. B6 1. B6
5. Vitamin C Tab 1. Vitamin C 1. Vitamin C
6. Vitamin A 4000 iu, vitamin D 400 iu, vitamin B1 3 mg, vitamin B2 4 mg Tab 1. Caviplex tablet 1. Imunos tablet
vitamin B6 4 mg, vitamin B12 12 mcg, vitamin C 75 mg, nikotinamid 20 mg
Ca pantotenat 5 mg, Vitamin E 10 mg, Biotin 0,1 mg, Acid Folic 1 mg, 
Fe Fumarat 135 mg, Acid Glutamic 50 mg, Ca 100 mg, Mg karbonat 87.5 mg
Zn 15 mg, Cu 0.5 mg, Mn 0.5 mg, Fluor 0.5 mg, Iodium 0.15 mg
Sirup 60 ml 2. Caviplex Sirup
Drop 3. Caviplex Drop 2. Caviplex Drop
7. Per 5 mL syr Vit A 5.000 IU, vit B1 3 mg, vit B2 2 mg, vit B6 6 mg Sirup 100 ml 1. Apialys
, vit B12 5 mcg, vit C 50 mg, vit D 400 IU, nikotinamida 20 mg
, lisin HCl 250 mg, d- pantothenol 5 mg, asam l-glutamat 25 mg.
8. Mecobalamin Tab 1. Megabal 1. Megabal
Inj 2. Mecobalamin 2. Mecobalamin
9. Lecithin : 300 mg, Vitamin B1 : 1,4 mg , Vitamin B2 : 1,6 mg Kapsul 1. Escovit
Vitamin B6 : 2 mg , Vitamin B-12 :1.6 mcg , Nicotinamide :2 mg ,
Vitamin E :20 mg , Beta Carotene :2 mg
10. Calsium+genistein+vit.k+vit D Tab 1. Hibone 600
11. Genistein 15 mg, omega 3 200 mg, calcium lactate gluconate 250 mg Kapsul 1. Osteofortis
 vitamin D3 400 IU, vitamin K1 0,1 mg, vitamin C 50 mg.

12. Kalsium laktat ( Kalk) Tab 1. Kalk 1. Calos

13. Glucosamin Glucosamine 500 mg 1. Glucosamine 1. Glucosamine
14. Calcitriol Kapsul 1. Oscal
15. Asam folat Tab 400 µg, 1000 µg 1. Asam folat 1. Folac
16. Kombinasi: Ferros Sulfate 250 mg, Magnesium Sulfate 0,2 mg Kapsul 1. Fe + vit.B.comp
Vitamin C 50 mg, Folid Acid 1 mg, vit b12 7,5 m, Sorbitol 25 mg 2. Sangobion 1. Sangobion
17. kombinasi : Vitamin B1, mononitrate, Vitamin B6 HCl, Vitamin B12 Tablet salut selaput 1. Neurodex
18. Astaxanthin 4 mg, Selenium 15 mcg Kaplet salut selaput 1. Asta-plus
23. IMUNOGLOBULIN DAN SERUM
23.1 Imunoglobulin
1. Imunoglobulin Anti Tetanus Inj 250 IU/amp 1. Tetagam
(Human Tetanus Imunoglobulin)

23.2 Serum
1. Anti Tetanus (ATS) Inj 1.500 IU/amp, 1 amp@ 1 ml 1. A.T.S 1. A.T.S
2. Anti rabies Inj 1. Verorab

24. Anti Parkinson

24.1 Anti parkinson
1. Triheksifenidil HCl Kaplet 2 mg 1. Triheksifenidil HCl 1. Triheksifenidil HCl
 2. Arkine 2. Arkine
2. Levodopa Levodopa 100, carbidopa 25 mg, entacapone 200 mg 1. Stalevo 1. Stalevo
3. Pramipexole Tab 0,375 mg ; 0,75 mg 1. Sifrol 1. Sifrol
25. Hormon Tiroid
1. Propiltiourasil Tab 100 mg 1. Propiltiourasil 1. Propiltiourasil
2. Tiamazol Tab 10 mg 1. Thyrozol 1. Thyrozol
3. Levotiroksin Tab 100 mcg 1. Euthyrox 1. Euthyrox
26. HIPERTROFI PROSTAT
1. Tamsulosin Tab 0,4 mg 1. Harnal Ocas 1. Harnal Ocas

27. PENGHAMBAT KOLINESTERASE

1. Donepezil Hcl (Hanya untuk demensia alzheimer ringan sampai sedang) Tab 10 mg 1. Aricept
28. Anti Depresan
1. Amitriptilin Tab 25 mg 1. Amitriptilin 1. Amitriptilin
29. MIASTENIA GRAVIS
1. Piridostigmin Tab 60 mg 1. Mestinon
30. ANTIANSIETAS
1. Alprazolam Tab 0,25 mg, 0,5 mg, 1 mg 1. Alprazolam 1. Alprazolam
2. Clobazam Tab 10 mg 1. Clobazam 1. Clobazam
3. Clonazepam Tab 2 mg 1. Clonazepam 1. Clonazepam
32. ANTIPSIKOSIS
1. Klorpromazin Inj 50 mg 1. Cepezet 1. Cepezet
Tab 100 mg 1. Cepezet 1. Cepezet
33. NeurotropikVasodilator Perifer
1. Citicolin Tab 500 mg, 1000 mg 1. citicolin 1. Bralin
Inj 250 ml , 500 ml 2. citicolin 2. citicolin
34. Laruran elektrolit, nutrisi dan lain-lain
1. Kalium klorida Tablet 600 mg 1. KSR 1. KSR
2. Kalium Aspartat Tablet salut selaput 300 mg 1. Aspar-K
3. Oralit kombinasi: NaCl 0,7 g, KCl 0,3 g, trinatrium sitrat 1. Oralit 1. Oralit
dihidrat 0,58 g, glukose anhidrat 4 g
4. zink Zink sirup 20mg/5ml 1. zinc pro 1. zinc pro
Zink tablet 20 mg 2. Zink 2. Zink
35. Anti skabies
1. Permetrin Krim 5% 1. Scabimite

36. Herbal
1. Schizandrae fructus extract 7,5 mg Kapsul 1. HP-Pro
2. Psidii folium Syr 1. Psdii kapsul
Kapsul 1. Psdii sirup
3. Didymocarpus pedicellata 65 mg, Saxifraga ligulata 49 mg Tablet 1. Cystone
Rubia cordifolia 16 mg, Cyperus scariosus 16 mg,
Achyranthes aspera 16 mg, Onosma bracteatum 16 mg
4. Ekstrak curcuma xanthorrhiza 20 mg Tablet 1. Curcuma 1. Curcuma

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