Umtuk Rapat KFT

1.
evaluasi pemakaian dan efek samping obat baru 2022
2. evaluasi obat yg tidak digunakan selama 3 bulan berturut turut
3. daftar permintaan obat baru non fornas
4. obat - obat yang bisa di hapus dari formularium RS
5. restriksi pemberian obat non fornas , non kronis

FORMULARIUM RSUD TUGU KOJA th 2022
NO KELAS NO URUT
TERAPI OBAT F/NF NAMA BENTUK SEDIAAN KEKUATAN NAMA DAGANG DOSIS MAKSIMAL PER PASIEN
ANALGESIK, ANTIPIRETIK, ANTI-
1 REMATIK, ANTIPIRAI
1,1 ANALGESIK NARKOTIK
1 F Fentanil F: inj injeksi 0.05 mg/ml fentanyl injeksi 10 amp /bulan
2 F Kodein HCI F: tablet 10 mg Codein KF
3 F F: injeksi 10 mg/ml Morphine HCl KF infus per 24 jam
Dosis rumatan: 1 mg/jam (24
4 F Midazolam HCI F: inj 1 mg/ml miloz, hameln mg/hari). Dosis premedikasi: 2,5- 5
mg (hanya 1x pemberian)
5 F pethidine injeksi F: Inj 50 mg/ml pethidine injeksi 2 amp/hari
NO KELAS NO URUT
1,2 ANALGESIK NON NARKOTIK
1 F Asam Mefenamat F: tablet tab 500 mg Asam Mefenamat tablet 500 mg (generik) 30 kaps/bulan
2 F Na Diclofenak F: tab; 50 mg Natrium Diklofenak tablet 50 mg 30 tab/bulan
tab 400mg; sirup 100 mg/5 ml, Ibuprofen tablet 400 mg, ibu profen sirup
3 F Ibuprofen F: tab; sirup, vial 30 tab/bulan, 1 btl/kasus,
injeksi 100 mg/5ml, ibu profen infus 100mg/ml
4 F Ketoprofen F: suppos supp 100 mg suprafenid 2 sup/hari, maks 3 hari

5 F Ketorolak F: inj 30 mg/ml Ketorolak inj. 30 mg/ml(generik) 2-3 amp/hari, maks 2 hari.
6 NF Meloksikam NF: tab tab 15 mg Meloxicam tablet 15 mg; 15 tab/ bulan
tab 500 mg, supp 125 mg; supp 250 Paracetamol tablet 500 mg; parasetamol
7 F Parasetamol F: tab; sirup; drop, mg, sirup 125mg/5ml, infus 1 drop , dumin supp, parasetamol infus, tablet : 30 tab/bln, sir : 2 btl/kasus,
INFUS; NF: suppos drop: 1 btl/kasus, inf: 3btl/kasus
g/200ml, ; drops 60mg/0,6ml parasetamol sirup 125
F: injeksi 50mg/ml,
9 F Tramadol tab injeksi 50mg/ml, tablet 50 mg tramadol injeksi, tramadol tablet inj : 5 amp/hari
10 NF Kalium Diklofenak NF: tab; tab 50 mg Kalium Diklofenak tablet 50 mg Max. 7 hari pemakaian
11 F METAMIZOLE F : INJEKSI Ampul metamizole 4 amp selama dirawat
NO KELAS NO URUT
F/NF NAMA BENTUK SEDIAAN KEKUATAN NAMA DAGANG DOSIS MAKSIMAL PER PASIEN
TERAPI OBAT
1,3 ANTIREMATIK, ANTIPIRAI
1 F Allopurinol F: tablet 100 Allopurinol tablet 100 mg (generik) 30 tab/bulan
2 F Amitriptilin HCl F: tablet 25 mg Amitriptilin 30 tab/bulan
3 F Colchicine F: tablet 0,5 mg recolfar 30 tab/bulan
NO KELAS NO URUT
F/NF NAMA BENTUK SEDIAAN KEKUATAN NAMA BARANG DOSIS MAKSIMAL PER PASIEN
TERAPI OBAT
2 ANESTETIK
2,1 ANESTETIK LOKAL
1 F Etilklorida F: semprot Ethyl Chloride (generik) -
2 F Lidokain 2% + epineprine F: inj 20 mg + 0,0125 mg Pehacain, lidocain compositum -
Xylocain jelly, spray; Lidocaine inj 2%
3 F Lidokain HCl F: inj; gel; spray inj 2%; gel 2%, spray 10% dlm 50 ml (generik) -
4 F bupivacain F : injeksi bupivacaine spinal 20 mg/4ml bupivacaine spinal 20 mg/4ml regivel -
5 F sevoflurane F : Inhalasi sevoflurane 250 ml sevoflurane -
2,2 ANESTETIK UMUM
1 F propofol F : ampul injeksi 1% fresofol
NO KELAS NO URUT
TERAPI OBAT
Hanya untuk tindakan anestesi dan
2 F Atracurium besilate F Injeksi 10mg/ml atracurium besilate atracurium pasien ICU yang memerlukan,
karena menggunakan ventilator.
3 F Ketamin HCl F: inj 50 mg/ml Ketamin (generik), ketalar -
4 F isoflurane F : Inhalasi isoflurane 250 ml isoflurane -
5 F rokuronium F: amp 10 mg / ml rokuronium rokuronium, noveron
6 F neostigmin F : injeksi 0,5mg / ml neostigmin neostigmin
ANTIALERGI DAN OBAT UNTUK

3 ANAFILAKSIS
NO KELAS NO URUT F/NF NAMA BENTUK SEDIAAN KEKUATAN NAMA BARANG DOSIS MAKSIMAL PER PASIEN
TERAPI OBAT
1 F Difenhidramin HCl F: inj 10 mg/ml Diphenhydramine inj 30 mg/hari
2 F Klorfeniramin maleat F: tab; tab 4 mg Chlorpheniramine HCl tablet 3 tab/hari, maks 5 hari
3 F Loratadin F: tab; tab 10mg Loratadine tablet 10 mg 1 tab/hari, maks 5 hari
chlorphenamine maleate + NF: sirup, kapsul. Rhinos junior sirup, rhinos neo drop, rhinos
4 NF 15mg/5ml, kaps, drop Pasien umum
Pseudoefedrin Drop caps
5 F cetirizin F: tab, drop; sirup tab 10 mg; sir 5 mg/5ml, drop 10 Cetirizine kapsul 10 mg, Cetirizine drop, tab: 1 tab/hari, maks 5 hari ;sirup: 1
mg/ml ceterizine sirup (generik) btl/kasus
pseudo hcl 60 mg, tripolidine hcl 2.5
6 NF pseudoefedrine + tripolidine NF: Tablet tremenza tablet Max. pemakaian 3 hari
mg
TERAPI OBAT
4 ANTIDOT DAN OBAT LAIN UNTUK

KERACUNAN
4,1 KHUSUS
1 F Atropin Sulfat F: inj inj 1 mg/ml inj 0,25 mg/ml -
2 F Kalsium glukonat F: inj 100 mg/ml Calcium Gluconate 10% -
3 F Nalokson HCl F: inj 0,4 mg/ml Nokoba -
4 F Natrium Bikarbonat F: tab tab 500 mg Natrium Bikarbonat tablet 500 mg 90 tab/bulan
5 F neotigmin F : injeksi 0,5 mg / ml prostigmin
NO KELAS NO URUT
TERAPI OBAT
5 ANTIEPILEPSI
5,1 UMUM
tab 2 mg, inj 5 mg/ml; lar rektal 5 Stesolid; Diazepam tablet 2 , diazepam 10 amp/kasus, kecuali untuk kasus
1 F Diazepam F: tab; inj; lar rektal mg tube 2,5 ml; lar rektal 10 mg
injeksi di ICU
tube 2,5 ml
tab 30 mg, 50mg/ml; inj 200 mg/2 Phenobarbital tablet 30 mg; 50 mg/ml , tab 30mg : 120 tab/bulan, 100mg :
2 F Fenobarbital F: tab; inj
ml sibital injeksi 60 tab/bulan, injeksi : 40 mg/kgBB
3 F Karbamazepin F: tablet tab 200 mg Carbamazepine tablet 200 mg () 120 tab/bulan

4 F Magnesium sulfat F: inj kolf 25 ml 40% Magnesium Sulphate -
5 F Valproat (dlm btk asam/Natrium) F: tab; sirup tab ER 250 mg, tab 500 mg, sirup Depakote ER (tablet), asam valproat Maks 120 tab/bulan; Max 5
250 mg/5ml generik, asam valproat sirup btl/bln
100 mg : Maks 60 kaps/bulan; 300
6 F Gabapentin F: tab; tab 100 mg, 300 mg alpentine, gabapentin mg : 30 kaps/bulan
7 F na Fenitoin F: tab; injeksi tab 100 mg; inj 50 mg / ml NA Phenytoin Maks 120 kaps/bulan
8 F topiramat F: tablet topiramat 25 mg topomax maks 90 tab / bln
9 F clonazepam F : tablet 2 mg riklona
10 F levetiracetam F : tablet 500 mg keppra 500 90 tab/bulan
11 F lamotigrin F : tablet 100 mg/ml lamictal 100 120 tab/bulan
TERAPI OBAT
6 ANTIMIKROBA
6,1 ANTELMINTIK
6.1.1 Antelmintik Intestinal
1 F albendazole F: tablet 400 mg albendazole -
6,2 ANTIBAKTERI
1 F amikasin F : injeksi 250 mg / ml amikasin injeksi 250 mg, 500 mg
6.2.1 Golongan Penisilin
Amoksisilin drop (generik); kaplet 500 mg;
F: kapsul; kaplet; Kaps 500 mg; sirup 125 mg/5 ml; tab 500 mg : 10 hari, drop/si
1 F Amoksisilin sirup kering 125 mg/5 ml, amoxan sir
sirup kering; drops drops 100 mg/ml (umum), amoxan drop (umum) kering : 1 btl/kasus
2 F Ampisilin F: inj; 1g/vial, 250 mg/vial Ampicillin inj 1 g, 250 mg 10 hari

3 NF Ampisilin + sulbaktam 1,5 gr NF : inj Ampisilin + sulbaktam 1,5 gr viccillin sx 1.5
amoksisilin trihidrate + asam amoksisilin trihidrate 125 mg +
3 NF klavulanat NF: sirup kering asam klavulanat 31.25 mg Claneksi sirup 1 botol/kasus
NO KELAS NO URUT
TERAPI OBAT
6.2.2 Golongan Aminoglikosida
1 F Gentamisin F: inj, salep 40 mg/ml, krim 1 mg Gentamycin inj, Gentamisin salep kulit -
6.2.3 Golongan Kloramfenikol
F: kapsul; salep Colsancetine; Chloramphenicol kapsul 500
kap 500 mg; inj 1 g/ml; tetes telinga
1 F Kloramfenikol mata, tetes mata, 1%, salep kulit, tetes mata, salep mg; kloramfenikol salep kulit, erlamycetin 4 kaps/hari selama 10 hari, injeksi :
saleb kulit, tetes mata ear drop, bufacetine salep kulit, reco tetes 3 g/hari selama 14 hari
telinga, mata
6.2.4 Golongan Kuinolon
1 F Levofloksasin F: tab; infus tab 500 mg, infus 500 mg/ 100 ml Levofloxacin drip; tablet 500 mg (generik) tab dan infus : maks 10 hari
2 F Ofloksasin F: tablet, tetes 400 mg, 3mg/ml Ofloxacin tablet 400 mg (generik), akilen tab 10 hari. Tetes telinga 1 btl/kasus
telinga tetes telinga
500 mg; infus 200 mg/100 ml dlm Ciprofloxacin tablet 500 mg; infus
3 F ciprofloksasin F: tab; infus infus : 4 btl/hari
botol 100 ml (generik)
4 F moksifloxacin F infus infus 400 mg/250 ml moxifloxacin infus 10 hari
6.2.5 Golongan Makrolid
F: tab; sirup kering, tab 500 mg; sirup kering 200 mg/5 Azithromycine tablet 500 mg; sirup kering 3 tab/kasus, sirup kering : 1
1 F Azitromisin infus ml, infus 500 mg 200 mg/ 5 ml; (generik), azivol infus btl/kasus
2 F eritromisin sirup F : botol sirup 200 mg/5ml eritromisin sirup 2 btl/kasus

6.2.6 Golongan Sefalosporin
F: kapsul; sirup kap 500 mg; sirup kering 125 mg/5 Cefadroxil kapsul 500 mg; sirup kering 125
1 F Sefadroksil kering ml, 250 mg/5 ml mg/ 5 ml, 250 mg/5 ml (generik) 30 kaps/kasus, sirup : 1 btl/kasus
2 F Sefazolin F: inj 1g Cefazolin inj 1 g (generik) selama 24 jam
F: kapsul; sirup kapsul 200 mg; sirup kering 100 mg/ Cefixime 200 mg; sirup kering 100 mg/ 5
3 F Sefiksim 10 hari, sirup :  1 btl/kasus
kering 5 ml ml(),
4 F Sefotaksim F: inj 1g Cefotaxime inj 1 g 10 hari
2 g/hari selama 7 hari. Untuk
5 F Seftriakson F: inj 1g Ceftriaxone 1 g (generik) meningitis 4 g/hari selama 14 hari
6 F sefepime F : inj 1g sefepime 1 gram 3 g/hari sampai ANC > 500/mm3.
6.2.7 Golongan Tetrasiklin

1 F Doksisiklin F: kapsul 100 mg Doxicycline tablet 100 mg (generik) 2 kaps/hari selama 10 hari
6.2.7 Golongan betalaktam
1 NF piperacillin tazobaktam NF : inj piperacilin 4 g, tazobactam 0,5 g tazam harus kultur
2 F benzatin benzil p F : inj benzatin benzil p 1,2 juta IU benzatin benzil p 1,2 juta IU 2 vial / bln
3 F cefoperazone F : inj cefoperazone 1000 mg cefoperazone serbuk injeksi 1000 mg 3 g/hari selama 7 hari
4 F ceftazidime F : inj ceftazidime 1000 mg ceftazidime serbuk injeksi 1000 mg 3 g/hari selama 7 hari
5 NF amoxicillin dan asam klavulanat NF : tab co amoxivlav 625 mg co amoxivlav 625 mg max 15 tab / pasien
6.2.8 Golongan Lain-lain
4 kaps/hari selama 5 hari kecuali
1 F Klindamisin F: kapsul 300 mg Clindamycine kapsul 300 mg (generik) untuk toksoplasmosis selama 6
minggu
4 tab/hari selama 10 hari kecuali
2 F Kotrimoksazol (TMP+SMZ) F: tab; suspensi tab 80 mg + 400 mg, suspensi 40 Cotrimoxazole tablet 480 mg; suspensi pada imunocompromised selama
mg + 200 mg per 5 ml 240 mg/ 5 ml
21 hari
Untuk infeksi akibat bakteri

F: tab; infus; 500 mg; infus 5 mg/ml; susp 125 anaerob, dapat diberikan
3 F Metronidazol suspensi; ovula mg/5 ml; Metronidazole tablet 500 mg; drip maksimum 2 minggu/kasus. Infus :
3 btl/hari.
Febrile neutropenia:dosis 1-3
g/hari, sampai ANC > 500/mm3.
Sepsis dan infeksi berat

mengancam jiwa:
Dosis 1 - 3 g/hari sampai diperoleh

hasil kultur, maks 7 hari
4 F meropenem F: inj serbuk injeksi 1 gram meropenem injeksi Setelah hasil kultur diperoleh, maka
digantikan dengan antibiotika
spektrum sempit yang masih efektif
Meropenem hanya dapat
dilanjutkan apabila hasil kultur yang
diambil dari tempat yang dicurigai
sebagai sumber infeksi
menunjukkan bahwa bakteri
penyebab hanya sensitif terhadap
meropenem.
Hanya untuk wanita hamil

dengan infeksi saluran kemih
5 F fosfomisin F: inj granul 3 gram fosfomisin (ISK) tanpa komplikasi dan
dibuktikan dengan hasil
kultur.
Diberikan atas persetujuan

KFT/KPRA/pimpinan RS untuk
6 F vankomisin F: inj 500 mg vankomisin antibiotik lini ketiga (reserved
antibiotic) pada infeksi oleh
kuman MRSA atau MRSE
positif (dibuktikan dengan
hasil kultur).
NO KELAS NO URUT
TERAPI OBAT F/NF NAMA BENTUK SEDIAAN KEKUATAN NAMA BARANG DOSIS MAKSIMAL PER PASIEN
6,3 ANTITUBERKULOSIS
F: tablet salut 150 mg + 150 mg; Paed : 75 mg + OAT DEWASA FASE LANJUTAN, OAT ANAK
1 F Rifampisin + INH selaput 50 mg FASE LANJUTAN -
tab 100 (10mg/kgBB)maks 6 bln

2 F Rifampisin + INH + Pirazinamid F: kaplet Paed : 75 mg + 50 mg + 150 mg OAT ANAK FASE INTENSIF
tiap hari, tab 300//hari,maks 6 bln
3 F Rifampisin +INH + Pirazinamid + F: tablet 150 mg + 75 mg + 400 mg + 275 mg 4 FDC OAT DEWASA FASE INTENSIF 15 mg/kgBB, maks selama 4 bln
Ethambutol lanjutan pemberian 3X seminggu
4 F INH F: tablet 300 mg INH 30 hari
5 F ethambutol F: tablet 500 mg ethambutol 30 hari
6 F pirazinamid F: tablet 500 mg pirazinamid 30 hari
7 rifampisin F: tablet 450 mg, 600 mg rifampisin 30 hari
15 mg/kg BB maksimal 2 bulan
8 F streptomicin injeksi F: injeksi 1000 mg streptomicin injeksi pertama pemberian setiap hari.
TERAPI OBAT
6,5 ANTIFUNGI
Flukonazol kaps 150 mg, infus 200
1 F Flukonazol F: kapsul, drip 150 mg, infus 200 mg/100ml -
mg/100ml
2 F Griseofulvin F: tablet 125 mg Griseofulvin tablet 125 mg -
F: tablet, salep kulit, Ketoconazole tablet 200 mg , maks 30 tab/kasus, ketomed scalp
3 F Ketokonazol scalp shampo 200 mg, cream 2%, shampo ketoconazole krim, ketomed shampo shampo 1 btl/kasus
4 NF Metronidazol + Nistatin NF: ovula 500 mg + 10.000 IU Fladystin maks 3 ovula/kasus
susp 100.000 : 2 btl/kasus untuk 1
5 F Nistatin F: drop susp 100.000 IU/ml Nystatin drop (generik) dan constantia minggu
TERAPI OBAT
6,7 ANTIVIRUS
1 F Asiklovir F: tab; krim tab 200 mg, krim 5% Acyclovir tablet 200 mg; asiklovir krim 5%
Dapat diberikan oleh Faskes Tk.1

yang memiliki kemampuan
dolutegravir sodium 50/lamivudin pengobatan antiretroviral
2 F 300/tenofovir disoproxil fumarate F : tab tablet salut selaput ACRIPTEGA dengan persyaratan memiliki SK
300 Penunjukan sebagai unit
pelayanan yang berhak
memberikan obat ARV dari Dinas
Kesehatan setempat.
3 F efavirenz F : tab EFAVIRENZ 600 MG EFAVIRENZ 600 MG
4 F tenofovir 300/ lamivudine 300/ F : tab salut selaput tenofovir 300/ lamivudine 300/ TENOLAM E
efavirenz 600 efavirenz 600
5 F Lopinavir 200/ ritonavir 50 F : tab salut selaput Lopinavir 200/ ritonavir 50 LOPIVIA
6 F tenofovir disoproxil fumarate 300 F : tab salut selaput tenofovir tenofovir
7 F nevirapine 200 mg F : kaplet nevirapine nevirapine

8 F lamivudine 150 mg F : tablet lamivudine lamivudine
lamivudine 150 mg/ zidovudine lamivudine 150 mg/ zidovudine 300
9 F F : tablet lamivudine 150 mg/ zidovudine 300 mg
300 mg mg
10 F zidovudine 100 mg F : kapsul zidovudine 100 mg zidovudine 100 mg
11 NF favipiravir F : tablet tab 200 mg favipirafir

khusus kasus pandemic covid 19
12 NF oseltamivir F : tablet tab 75 mg oseltamivir

13 NF remdesivir NF : botol infus 100 mg/ vial remdac

Hanya untuk artritis reumatoid
(RA) berat yang telah gagal
dengan DMARDs konvensional.
Tidak digunakan sebagai lini
pertama.
14 F tosilizumab F: botol infus 20 mg / ml actemra Telah dibuktikan bahwa pasien
tidak menderita infeksi sistemik
termasuk TBC
Hanya boleh diresepkan oleh
dokter spesialis reumatologi dan
disetujui oleh KFT dan/atau
komite medik dan/atau Pimpinan
RS
NO KELAS NO URUT
7 ANTIMIGRAIN DAN ANTIVERTIGO 6

7,1 ANTIVERTIGO
1 F Betahistin mesilat NF: tablet 6 mg betahistin tab 6 mg (generik) 20 tab/bulan
7,2 ANTIMIGREN
1 F Ergotamin + Kafein F: tablet 1 mg + 100 mg ergotamin hcl 8 tab/minggu
TERAPI OBAT
8 ANTIPARKINSON / DEMENTIA
8,1 ANTIPARKINSON
1 F Levodopa + Karbidopa + F: tablet 100 mg + 25 mg + 200 mg Stalevo

Entekapon Maks 90 tab/bulan
2 F Levodopa + benserazid F: tablet 100 mg + 25 mg Levopar Maks 120 tab/bulan
3 F pramipexole F: tablet 0,375 mg sifrol maks 30 tab / bln
4 NF tizanidine NF: tablet 2 mg tizanidine
5 NF eperisone NF: tab tablet 50 mg estalex max 15 tab / kasus
6 F triheksifenidil F: tab tablet 2 mg thp Maks 90 tab/bulan
TERAPI OBAT
OBAT YANG MEMPENGARUHI
9
DARAH
9,1 ANTIANEMIA
1 F Asam Folat F: tab 1 mg Folic Acid tablet 1 mg -
2 F ferro sulfat eksikatus 200 mg + as F: tab 200 mg dan 0.25 mg tablet tambah darah -
folat 0.25 mg
3 NF vitamin dan zat besi NF: sirup Fe 15 mg / 5 ml ferro K sirup Maks. 1 botol
4 F Sianokobalamin F: tab tab 50 mcg Cyanocobalamine vitamin B12 -
NO KELAS NO URUT
OBAT YANG MEMPENGARUHI

9,2
DARAH
1 F asam asetil salisilat F: tablet 80 mg miniaspi tab Maks. 30 tab/bln
Dosis sesuai dengan target APTT
2 F Heparin natrium F: inj 25.000 IU/5ml Inviclot (maks 20.000-40.000 IU/hari)
3 F Klopidogrel F: tablet 75 mg Clopidogrel tablet 75 mg (generik)

Saat akan dilakukan tindakan
PTCA diberikan 4-8 tab.
Maintenance 1 tab/hari selama 1
tahun
4 F Warfarin natrium F: tablet 2 mg notisil, simarc Dosis harian disesuaikan dengan
target INR (2-3)
"Bahan dasar terbuat dari babi."

5 F enoksaparin sodium F : pen 40 mg/0,4 ml lovenox Dapat digunakan untuk
tromboemboli dan sindrom
koroner akut serta pencegahan
clotting pada hemodialisis, pada
bedridden post operasi, medium
dan high risk
Untuk pencegahan VTE (Venous

6 F rivaroksaban F : tablet 10 mg xarelto Thrombo Embolism) pada pasien
dewasa yang menjalani hip or
knee replacement surgery
NO KELAS NO URUT
TERAPI OBAT
9,3 Hemostatik
Asam Traneksamat tablet 500 mg; inj.
1 F Asam Traneksamat F: tab; inj tab 500 mg; inj 500 mg/ 5ml amp 500 mg/5ml -
2 F Vitamin K F: tab; inj tab 10 mg; inj 2 mg/ml Phytomenadione -

NO KELAS NO URUT
TERAPI OBAT
10 PRODUK DARAH DAN PENGGANTI

PLASMA
10,1 FRAKSI PLASMA UNTUK

PEMAKAIAN KHUSUS
1 F Poligelin F: infus 3,5% dlm 500 ml, 4% dlm 500 ml Gelofusin -
TERAPI OBAT
11 DIAGNOSTIK
11,1 OBAT KONTRAS
1 F Sodium bikarbonat F: tablet, infus 500 mg, flash 25 ml meylon sodium bicarbonate 500 mg
90 tab/bulan
NO KELAS NO URUT
12 ANTISEPTIK DAN DESINFEKTAN
12,1 ANTISEPTIK
1 F Alkohol F: cairan; swab 70% alcohol swab one med -
2 F Iodin Povidon F: larutan 10% povidone iodine -
3 F KoH F : larutan 10% kalium hidroksida
12,2 DESINFEKTAN
1 F Formalin F: larutan 10% Formalin -
2 F Klorheksidin diglukonat F: larutan 4%, 5%, 0,12% anios gel -
3 NF Lisol NF cairan 50% Lisol -
benzethonium chloride 0,3%,

4 F F: cairan 0,3%, 21% stericide / septalkan -
isopropanol 21%
5 F alkacide F : cairan 2% Alkacide -
6 alkazyme F : serbuk Alkazyme -
NO KELAS NO URUT
TERAPI OBAT
13 OBAT UNTUK GIGI DAN MULUT
OBAT TOPIKAL UNTUK GIGI DAN
13,1 MULUT
1 NF fenol Gliserin NF: cairan fenol Glycerol -
2 F Iodin Povidon F: larutan; obat 1% betadine obat kumur -
kumur;
NO KELAS NO URUT
TERAPI OBAT
14 DIURETIK
1 F Furosemid F: tab; inj tab 40 mg; inj 10 mg/ ml Furosemide tablet 40 mg; furosemid 30 tab/bulan
injeksi inj.
2 F Hidroklorotiazid F: tablet 25 mg Hydrochlorothizide (generik) 30 tab/bulan
3 F Manitol F: Inj 20% Manitol 2 btl/hari
30 tab/bulan 2. tab 100 mg  
4 F Spironolakton F: tablet 25 mg, 100 mg Spironolactone tablet 25 mg, 100mg Untuk penyakit sirosis hepatik 30
tab/bulan
14,1 HIPERTROFI PROSTAT
1 F silodosin F : tablet 4 mg 60 tab/bulan.
HORMON, ENDOKRIN LAIN DAN
15 KONTRASEPSI
15,1 ANTIDIABETIK
15.1.1 Antidiabetik oral
1 F Akarbose F: tablet 50 mg, 100 mg Acarbose tablet 50 mg; 100 mg 90 tab/bulan
Dosis maks 15 mg perhari. maks 90
2 F Glibenklamid F: tablet 5 mg Glibenclamide 5 mg (generik)
tab/bulan.
3 F Gliklazid F: tablet 80 mg Glicab 30 tab/bulan
4 F Glikuidon F: tablet 30 mg gliquiodone 90 tab/bulan
60 tab/bulan, glime 4 mg : 30
5 F Glimepirid F: tablet 1 mg, 2 mg, 3 mg, 4 mg Glimepiride 1 mg; 2 mg, 3 mg; 4 mg tab/bulan
6 F Metformin HCl F: tablet 500 mg,850 mg Metformin 500 mg; 850 mg maks 90 tab/bulan
7 F pioglitazone F: tablet 30 mg pioglitazone 30 mg maks 30 tab/bulan
Tidak digunakan sebagai lini

pertama/terapi inisial.
Sebagai terapi tambahan pada

metformin dan/atau sulfonilurea
8 F Vildagliptin F: tablet 50 mg Vildagliptin dengan dosis optimal yang masih
dapat ditoleransi oleh pasien.
Tidak digunakan sebagai obat

tunggal.
15.1.2 Antidiabetik parenteral
1 F Insulin Analog Aspart F: Inj 100 IU/ml 3 cc Apidra flexpen
Dalam kondisi tertentu, Dokter di

Faskes Tingkat Pertama dapat
melakukan penyesuaian dosis
Insulin Analog Campur (Aspart + insulin hingga 20 IU/hari.
2 F NPH) F: Inj 100 IU/ml 3 cc Humalog 25
3 F Insulin Analog Glargine F: inj; penfill inj 100 IU/ml 10 ml Lantus Solostar
4 F insulin degludec dan aspart F: inj; penfill inj 100 IU/ml (70% degludec dan ryzodeg pen
30% aspart)
5 F insulin aspart F: inj; penfill inj 100 IU/ml novorapid pen
TERAPI OBAT
HORMON KELAMIN DAN OBAT

15,2 YANG MEMPENGARUHI
FERTILITAS
15.2.3 Progestogen
1 F Noretisteron F: tablet 5 mg Norelut 30 tab/bulan
2 NF micronized progesteron NF : Tablet 100 mg uterogestan 100 mg Pasien Umum
3 NF dydrogesterone NF : Tablet 10 mg duphaston 10 mg Pasien Umum
15.2.4 Kontraseptik (BKKBN)
1 F Levonorgestrel + Etinilestradiol F: tablet 150 mcg + 30 mcg pil KB bkkbn -
medroxyprogesteron acetate medroxyprogesteron acetate
2 F F: vial obat suntik kb I -
150mg/3ml 150mg/3ml
medroxyprogesteron acetate, medroxyprogesteron acetate 50 mg,
3 F F: vial obat suntik kb II -
estradiol cypionate estradiol cypionate 10 mg
TERAPI OBAT
15,3 HORMON TIROID DAN

ANTITIROID
1 F Propiltiourasil F: tablet 100 mg Propylthiouracil tablet 100 mg Untuk bulan pertama maksimal
180 tab/bulan
2 F levothyroxin F: tab levothyroxin
3 F tiamazole F : Tablet 10 mg thyrozol Untuk bulan pertama maksimal

90 tab/bulan
KORTIKOSTEROID DAN
15,4
KORTIKOTROPIN
Dexamethasone tablet 0,5 mg; 5 mg; inj.
1 F Deksametason F: tab; inj tab 0,5 mg; inj 5 mg/amp (generik) inj: 20 mg/hari
Tablet: Methylprednisolone tablet 4 mg; 8 4 mg : Maksimal 10 tab/kasus

2 F Metil Prednisolon F: tab; inj 4 mg, 8 mg ; inj 125 mg/ ml mg;. Injeksi: Methylprednisolone inj 125
mg
3 F Prednison F: tablet 5 mg Prednison tablet 5 mg -
4 F Triamsinolon asetonid F: injeksi trilac inj 10 mg/ml trilac injeksi untuk keloid
15,5 HORMON LAIN
15,6 OBAT METABOLISME TULANG
DAN OTOT
Diberikan 1 vial/pre-filled syringe
1 F sodium hialuronate F: injeksi 10 mg / ml umarone per minggu. Maks 5 vial/ pre-filled
syringe per kasus.
TERAPI OBAT
16 OBAT KARDIOVASKULER
16.1 ANTIANGINA
1 F Bisoprolol F: tablet 5 mg Bisoprolol tablet 5 mg 30 tab/bulan
2 F Diltiazem F: inj inj 50 mg Diltiazem injeksi (generik)
3 F isosorbit dinitrat F: tab SL; inj 1mg/ml 5 mg, 1 mg / ml Isosorbide Dinitrate Maks 90 tab/bulan.
4 F Nitrogliserin F:tablet; injeksi tab retard forte, 2,5 mg Nitrokaf, nitrokaf Forte (tablet), NTG Max 90 tab/bln
injeksi
5 F carvedilol F : tablet tablet 25 mg, tab 6,25 mg carvedilol maks 30 tab / bln
6 F Silostazol F : tablet tablet 100 mg pletaal maks 60 tab / bln
7 F atenolol F : tablet tablet 50 mg fanormin maks 30 tab / bln
TERAPI OBAT
16.2 ANTIDISRITMIA
1 F Amiodaron F: tab, injeksi tab 200 mg, injeksi 50 mg / ml Kendaron, tyarit

Maks 30 tab/bln
2 F Propranolol HCl F: tab salut selaput 10 mg Propranolol HCl tablet 10 mg 90 tab/ bulan
NO KELAS NO URUT
16.3 ANTIHIPERTENSI
16.3.1 Golongan ACE Inhibitor
1 F Kaptopril F: tablet 25 mg Captopril tablet 25 mg Maks 90 tab/bln
2 F Lisinopril F: tablet 10 mg lisinopril 10 mg 30 tab/bulan
3 F ramipril F: tablet 2,5 mg, 5 mg, 10 mg ramipril 5 mg : 30 tab/bulan
16.3.2 Golongan Beta Blocker
1 F Bisoprolol F: tab salut selaput 5 mg Bisoprolol tablet 5 mg (generik) 30 tab/bulan
2 F Propranolol HCl F: tablet 10 mg Propranolol HCl tablet 10 mg (generik) 10 mg : 90 tab/bulan, 20 mg dan 30
mg : 30 tab/bulan
Golongan Calcium Channel
16.3.3
Blocker
1 F Amlodipin besilat F: tablet 5 mg; 10 mg Amlodipine tablet 5 mg; 10 mg Maks 30 tab/bulan
Adalat/ Adalat oros; Nifedipine tablet 10
2 F Nifedipin F: tablet 10 mg, 30 mg (oros/retard) Max 30 tab/bulan
mg (generik)
16.3.4 Golongan Alpha Blocker
16.3.5 Golongan Angiotensin II
Antagonist
1 F Valsartan F: tab salut selaput 160 mg Valsartan tab 160 mg 90 tab/bulan
2 F candesartan F: tab 16 mg candesartan Maks 30 tab/bulan
3 F irbesartan F : kapsul 300 mg irbesartan 300 mg Maks 30 tab/bulan
16.3.6 Golongan Lain-lain
Clonidine HCl tablet 0,15 mg, clonidine inj
1 F Klonidin HCl F: tab, injeksi 0,15 mg; 150 mcg/ml 90 tab/bulan
150 mcg/ml catapress
2 F Metildopa anhidrat F: tab salut selaput 250 mg Dopamet Maks 90 tab/bulan selama hamil.
Hanya untuk pasien dengan
3 F nicardipine F : injeksi 1 mg / ml nicardipine hipertensi berat dan memerlukan
perawatan
NO KELAS NO URUT
TERAPI OBAT
16.4 GLIKOSIDA JANTUNG
1 F Digoksin F: tab, injeksi tab 0,25 mg, injeksi 0,5 mg/2 ml Fargoxin (inj.); Digoxin tablet 0,25 mg Maks 30 tab/bln
16,5 OBAT UNTUK SYOK
16.5.1 Inotropik
1 F Dobutamin F: inj 250 mg/5 ml Dobutamin injeksi (generik) -
2 F Dopamin HCl F: inj 40 mg/ml Dopamin injeksi (cetadop) -
16.5.2 Vasokonstriktor
1 F Epinefrin HCl F: inj 1 mg/ml Ephinephrine inj (generik) -
2 F norepineprine F: inj 2 mg/ml norepineprine
NO KELAS NO URUT
TERAPI OBAT
16.6 PENURUN KOLESTEROL
1 F Gemfibrozil F: kapsul 300 mg Gemfibrozil tablet 300 mg (generik) Maks 30 kapl/bulan.
2 F Simvastatin F: tablet 20 mg Simvastatin 20 mg Max. 30 tab/bulan.
3 F fenofibrat F: tablet 100 mg fenofibrat 100 mg Max. 30 tab/bulan.
4 F atorvastatin F : tablet 20 mg atorvastatin Maks 30 tab/bln
16.7 VASODILATOR
1 NF Flunarizin NF: tablet 5 mg Flunarizin tab 5 mg (generik) Maks. 7 hari
16.8 LAIN-LAIN
TERAPI OBAT
17 OBAT TOPIKAL UNTUK KULIT
17.1 ANTIAKNE
17.2 ANTIBAKTERI
F: krim (asam); salep
1 F Fusidat (Natrium) 2% Fucilex -
2 F Kloramfenikol F: salep 2% kloramfenicol salep kulit -
3 F Mupirosin F: krim 2% Mupirocin salep (generik) maks 10 hari.
4 F Perak Sulfadiazin F: krim 1% perak Sulfadiazin -
5 F Urea F : krim 20 %, 10% Carmed Krim, soft u derm -
6 NF Vaselin album NF : krim Vaselin album (generik) -
7 NF Asam Salisilat NF : Serbuk Asam salisilat (generik) -
17.3 ANTIFUNGI
1 F Ketokonazol F: krim, shampo 2% Ketoconazole cream 2 %, ketomed ss
2 F mikonazole F: krim 2% miconazole salep kulit
17.4 ANTIVIRUS
1 NF Asiklovir NF: krim 5% Acyclovir cream 1 tube/kasus
NO KELAS NO URUT
ANTIINFLAMASI DAN
17.5 ANTIPRURITIK
1 F Betametason F: krim 0,1% Betamethasone cream 0,1% (generik) -
2 F Hidrokortison asetat F: krim 2,5% Hydrocortisone cream (generik) -
3 F momethasone F krim salep kulit Mometason krim (generik), mofacort -
4 F mupirocin F salep, krim Mupirocin salep (generik) maks 10 hari.
5 F clobetasol F krim, salep clobetasol krim 5 gr Kloderma maks 10 hari.
6 NF Desonide NF : krim desolex krim 1 tube/kasus
7 NF Flutikason propionat NF : krim 0,5 mg Medicort krim 1 tube/kasus
17.6 ANTISKABIES
1 F permethrine F 0,5% permetrin -
17.7 LAIN-LAIN
NO KELAS NO URUT
TERAPI OBAT
18 LARUTAN DIALISIS
19 LARUTAN ELEKTROLIT, NUTRISI,
DLL
19.1 ORAL
1 F Kalium klorida F: tablet siap larut; tab siap larut 600 mg KSR -
2 F Oralit F: serbuk 100 g/sachet Oralit (generik) -
19.2 PARENTERAL
1 F Aqua pro injeksi F: larutan 25 ml; 1000 ml WFI ; WIDA WI (1000 ml) -
Asam amino + elektrolit + vitamin
2 F F: infus 500 ml B fluid 500 ml -
B dan glukosa
3 F Glukosa F: infus 5%, 10%, 40% glukosa 5%, glukosa 10%, D40% -
4 F Kalium klorida F: inj 25 meq/vial KCl 7,46% -
5 F Kalsium glukonat F: inj 10% Calcii Gluconas -
Larutan kombinasi (dlm 1 liter):
6 F Natrium 38,5 mek, Cl 38,5 mek, F: infus 500 ml KA-EN 1B -
glukosa 37,5 g
7 F Natrium 50 mek, K 20 mek, Cl 50 F: infus 500 ml KA-EN 3B -
mek, laktat 20 mek, glukosa 27 g
8 F Natrium 60 mek, K 10 mek, Cl 50 F: infus 500 ml KA-EN 3A -
mek, laktat 20 mek, glukosa 27 g
9 F Natrium klorida F: inj; infus infus 100 ml, 500 ml NaCl otsuka; Ecosol -
10 F Ringer Asetat F: infus Asering; -
11 F Ringer Laktat F: infus 500 ml RL; Wida RL -
12 F Sodium Chloride 3% F infus infus 500 ml salin 3% -
13 F Dextrose, sodium chloride F infus infus 500 ml d5 1/2 saline -
14 F Dextrose, sodium chloride F infus infus 500 ml d5 1/4 saline -
dextrose, sodium chloride, sodium

15 F F : infus infus 500 ml kaen 4A -
lactate
16 F sodium chloride, Potassium F : infus infus 500 ml kaen 4B -

chloride, Sodium lactate, Dextrose
17 F Human albumin F : infus infus botol 100 ml albapure 100 mL/hari, 300 mL/minggu
asam amino 5%, karbohidrat,
18 elektrolit dan vitamin F infus infus 500 ml amino L-600
Tiap 500 mL mengandung Asam

asetat, Glycine, L-Alanine, L-
Arginine, L-Histidin, L-Isoleusin, L-
19 F Leusin, L-Lysine Acetate, L- F infus botol 500 ml aminosteril infant
Metionin, L-Ornitin, L-Aspartat, L-
Fenilalanin, L-Proline, L -Serine, L-
Threonine, L-Tryptophan, L-
Valine, N-Acetyl-L-Tyrosine,
Taurin.
20 F asam amino 7,2% F infus infus 200 ml kidmin
NO KELAS NO URUT
20 OBAT UNTUK MATA
20.1 SISTEMIK
Mengandung : Lutein 3 mg,
lycopene 2 mg, vitamin E 25 mg,
1 NF vitamin C 100 mg, zinc 10 mg, NF : kaplet kaplet OPTIMAX kAPLET, OPTIMAX O3 Maks. 3 kaplet/kasus
beta carotene 6.000 iu, bilberry
ekstrak 80 mg.
Komposisi: Bilberry dry extr 80

2 NF mg, retinol 1,600 IU, vit E 40 mg, NF : TABLET TABLET berry vision tablet Maks. 5 tab/kasus
beta-carotene 5 mg.
20.2 TOPIKAL
1 F Cendo cenfresh NF : minidose 5 ml Cendo cenfresh eyedrop 5 ml Maks. 7 hari
2 NF Polyvinylpyrolidone 20 mg NF : minidose 5 ml protagenta tetes mata 5 ml Maks. 7 hari
Ofloxacin 3 mg, dapar fosfat pada

3 NF NF : minidose 5 ml floxa mini dose Maks. 7 hari
pH 6,0-7,0 dan Natrium Klorida.
tobramycin 3 mg, dexametasone
4 F 1 mg F : mini dose 5 ml cendo tobroson mini dose Maks. 7 hari
5 NF Cromolyn sodium 20 mg NF : mini dose 15 ml cendo conver 2% Maks. 7 hari
6 F Timolol maleate F : mini dose, botol Timol mini dose, timolol 0,5% timol eye drop, isotic adretor Maks 2 strip /bulan, 2 btl/bln
Hanya untuk pasien glaukoma

7 F Latanoprost 0.05mg F : mini dose mini dose C GLAOPEN ED 0,6ML MD yang tidak memberikan respon
pada timolol.
Nafazolin HCl.; antazoline
8 NF hcl+naphazoline hcl NF : mini dose minidose cendo vasacon A 3 hari
Vitamin A palmitate 1,000 iu, CENDO OCULENT A OPHTHALMIC GEL 5 G

9 NF NF: tube Gel 10 gram 3 hari
carbomer 980 3,5 mg salep mata
10 F Tropicamide 5 mg F : botol 5 ml CENDO MYDRIADTYL 0.5% 5ML, 1% -
Per 15 ml mengandung CaCl2
anhidrat 0,075 gram, Kalium
11 NF Iodida 0,075 gram, Natrium NF : mini dose 15 ml CENDO CATARLENT TETES MATA 15 ML 3 hari
Tiosulfat 0,0075 gram,
Fenilmerkuri nitrat 0,3 mg.
Ion Natrium & Kalium dengan

12 F F : botol Tetes mata 0,01 % x 15 ml. CENDO LYTEERS TETES MATA 15 ML 1 BTL/BLN
Benzalkonium Cl.
13 F levofloxacin F : botol 5 ml lfx, Cravit cravit untuk Pasien Umum
14 NF tobramycin, dexametasone NF: botol 5 ml Bralifex plus 3 hari
15 NF potasium iodide, sodium iodide NF: botol 5 ml vitrolenta 3 hari
16 F natrium hialuronat F : mini dose minidose 0,6 ml cendo hyalub
17 F natrium diklofenak F : mini dose minidose 0,6 ml cendo noncort
deksametason, neomisin, cendo xitrol minidose, cendo xitrol salep
18 NF polimiksin NF : mini dose, tube minidose 0,6 ml, tube 3,5 g mata
19 F fluorometholon F : minidose 0,1% cendo posop
20 F natrium hialuronat F : botol 5 ml siloxan
21 F Prednison F : minidose 10 mg/ml p-pred
20.2.1 Antimikroba
TERAPI OBAT
F: salep mata, tetes salep mata 1%, tetes mata, tetes kloramfenicol salep mata 0,1% 5 g (); reco,
1 F Kloramfenikol -
mata, tetes telinga telinga erlamicetin ear drop
20.2.2 Antiinflamasi
20.2.3 Midriatik
20.2.4 Miotik dan antiglaukoma
50 tab / bln untuk galukoma akut 1
1 F Glauseta tablet asetazolamide tab 250 mg asetazolamide tab 250 mg minggu
20.2.5 Lain-lain
1 F Tetrakain HCl F: tetes mata 0,5% Pantocain
21 UTEROTONIK DAN RELAKSAN
UTERUS
21.1 Uterotonik
1 F Metilergometrin maleat F: tab; inj. 0,125 mg, 0,2 mg/ml Methergin -
2 NF Misoprostol NF: tablet 200 mcg misoprostol Maks. 3 hari
3 F Oksitosin F: inj 10 IU/ml oksitosin -
21.2 RELAKSAN UTERUS
1 NF Isoksuprin HCl NF: tab; inj. tab 20 mg; inj. 10 mg/2 ml amp proterine inj, proterine tab Maks. 3 hari
2 F Magnesium sulfat F: inj 40% Magnesium Sulphate -
3 F Nifedipin F: tablet 10 mg, tab 30 mg lepas lambat Adalat oros, dipin tablet 10 mg (generik)
90 tab/bulan
4 F Terbutalin sulfat F: injeksi injeksi 0,5 mg bricasma Maks. 7 hari
21.3 RELAKSAN OTOT PERIFER
1 F neotigmin F : injeksi 0,5 mg / ml prostigmin
2 F donepezil F : tablet kapsul salut selaput 5 mg donepezil 10 mg 30 tab/bulan
3 F Piridostigmin F : tablet 60 mg miastenia 120 tab/bln
22 PSIKOFARMAKA
ANTIANSIETAS DAN
22.1 ANTIINSOMNIA
Maks 2 minggu/kasus, 30 tab/
1 F Alprazolam F: tablet 0,5 mg Alprazolam 0,5mg (generik) bulan. Peresepan oleh Dr SP.PD
maks 5 hari/bulan.
tab 2 mg; inj 10 mg/2ml; lar rektal 5
Stesolid 5, stesolid 10; Diazepam tablet 2
2 F Diazepam F: tab; inj; F: rektal mg tube 2,5 ml; lar rektal 10 mg
mg (generik)
tube 2,5 ml Maks 30 tab/bln
3 F clobazam F tab tablet 10 mg clobazam 60 tab/bulan
22.2 ANTIDEPRESI DAN ANTIMANIA
1 F Amitriptilin HCl F: tablet 25 mg Amitryptylline HCl tablet 25 mg (generik)
Maks 60 tab/bulan.
2 F Valproat (dlm btk Natrium) F: tablet, sirup tab 250 mg, tab 500 mg, sirup 250 Depakote (salut enterik)
mg/5ml 90 tab/ bulan. Sirup 5 btl / bln
22.3 ANTIPSIKOSIS
1 F Haloperidol F: tablet, injeksi tab 5 mg, injeksi 5 mg/ml Haloperidol 90 tab/ bulan. 4 amp/hari, maks 3
hari
2 F
3 F fluoxetine F: tablet tab 20 mg fluoxetine

30 tab/kaps per bulan.
23 OBAT UNTUK SALURAN CERNA
23.1 ANTASIDA DAN ULKUS, ANTIBUSA
1 F Antasida DOEN F: tab; suspensi 500 mg Antasida DOEN tablet; suspensi (generik) -
2 F Lansoprazol F: kapsul, injeksi 30 mg Prosogan FD; Lansoprazole kapsul 30 mg Maks 30 tab/bln; 1-3 amp/ hari
(generik) maks 3 hari
3 NF Misoprostol NF: tablet 200 mcg misoprostol Maks. 3 hari
Omeprazole kapsul 20 mg (generik), Kapsul: 30 kaps/bulan; Inj : 1-3
4 F Omeprazol F: kapsul; inj kaps 20 mg, inj 40 mg/10ml Omeprazole injeksi amp/hari maks 3 hari
5 F Ranitidin F: tab; inj, sirup (NF) tab 150 mg, inj 25 mg/ml; Sirup 75 Ranivell sirup, Ranitidin tablet 150 mg; inj. tab : 30 tab/bulan; Inj: 2 amp/hari.
mg/5ml 50 mg/2 ml () Ranitidin sirup = 1 btl
6 F Sukralfat F: suspensi suspensi 500 mg/5 ml sukralfat sirup max 2 btl/pasien
23.2 ANTIEMETIK
1 F Betahistin mesilat F: tablet 6 mg Betahistine (generik)
Untuk vertigo perifer:BPPV: 1
minggu ; non BPPV: 30 tab/bulan
2 F Dimenhidrinat F: tablet 50 mg dimenhidrinat -
tab 10 mg; sirup 1 mg/ml; suspensi domperidon suspensi; Domperidone

3 F Domperidon F: tab; drop; sirup 5mg/5ml 60 ml tablet 10 mg (generik), domperidon drop -
(generik)
Metoclopramide tablet 10 mg; inj. 10 mg/

4 F Metoklopramid HCl F: tablet; inj tab 10 mg; ; ampul 10mg/2ml 2 ml (generik) -
tab 4 mg : maksimal 3 tab pasca

kemoterapi/post radioterapi; tab 8
F: tab salut selaput; mg : maksimal 3 tab pasca
5 F Ondansetron HCl inj tab 4 mg; 8 mg; inj. 4 mg/2 ml Ondansetron tablet 4 mg; 8 mg; inj. 4 mg kemoterapi/post radioterapi, inj :
inj diberikan 1 amp sebelum
kemoterapi
6 F chlorpromazine F: tab tab 25 mg chlorpromazine 25 mg
23.3 ANTIHEMORRHOID
Bismut subgalat + lidokain + seng
1 F F: supp supp Anti hemoroid doen supp (generik)
oksida + supositoria 5 sup/kasus.
2 NF ardium tab NF : tab herbal flavonoid ardium tab untuk pasien ranap
23.4 ANTISPASMODIK
1 F Atropin sulfat F: inj inj 0,25 mg/ml Atropin Sulfat (generik) -
2 F Hiosin n-butil bromida F: tab salut gula; inj. tab 10 mg; inj 20 mg/mL sopma tab, hiosin injeksi -
3 NF eperisone NF: tab tablet 50 mg eperison 15 tab / pasien
NF papaverine NF: tab tablet 40 mg papaverine tab 15 tab / pasien
23.5 OBAT UNTUK DIARE
1 F Attapulgit F: tablet 600 mg New antides; -
NaCl 0,7 g + KCl 0,3 g + trinatrium
2 F Garam Oralit F: serbuk sitrat dihidrat 0,58 mg + Glukosa Oralit (generik) -
anhidrat 4g
3 F Loperamid HCl F: tablet 2 mg Loperamide tablet 2 mg (generik) 10 tab/kasus
F: tablet dispersible; tablet dipersible: 20 mg ; sirup : 20
4 F Seng sulfat sirup mg/5 ml Zink tablet (generik), zink sirup (generik) -
23.6 LAKSATIF
tab : 15 tab/kasus.
1 F Bisakodil F: tab; suppos tab 5 mg; supp 5mg, supp 10 mg Dulcolax supp, dulcolax tab 5 mg
Supp : 3 sup/kasus
Kombinasi: Natrium lauril
(45 mg + 450 mg +5 mg + 625 mg +
2 NF sulfoasetat + Natrium sitrat + NF: enema microlax 1 sup/kasus
4465 mg)/5 ml
asam sorbat + PEG + Sorbitol
3 F Laktulosa F: sirup 3,335 g/5 ml lactulose sirup -
23.7 Lain-lain
1 F asam ursodeoksilat F: tab 250 mg asam ursodeoksilat
NO KELAS NO URUT
TERAPI OBAT
1 NF Curcumin NF: tablet 100 mg Curcuma Maks. 7 hari
2 NF Lactobacillus acidophilus NF: serbuk Lacto B 5 sachet/kasus
24 OBAT UNTUK SALURAN NAFAS
24.1 ANTIASMA
1 F Aminofilin F: tab scored; inj tab scored 200 mg; inj 24 mg/ml Aminophyllin tablet 200 mg; inj. (generik) -
Tidak untuk serangan asma akut.

2 F Budesonid F: aerosol dosis 0,5 mg/2 ml Pulmicort Asma persisten ringan-sedang: 1
tbg/bulan. Asma persisten berat
: 2 tbg/bulan
3 NF Efedrin HCl NF: inj, tab tab 25 mg, ampul 50 mg/ml Ephedrine HCl tablet 25 mg (generik) Maks. 7 hari
4 F Epinefrin HCl F: inj 0,1 % Epinephrine HCl -
5 F Flutikason propionat F: nebule nebules 0,5 mg/2ml Flixotide 1 canister/bulan
tab 2 mg, 4 mg; inhaler 100 Ventolin; Salbutamol tablet 2 mg; 4 mg

6 F Salbutamol F: tab; inhaler; mcg/puff; nebules 2,5 mg; rot 200 (generik), suprasma inhaler, salbutamol SOPT: 1 tbg/bulan. Asma persisten
nebules, sirup mcg, sirup sirup berat, PPOK: 2 tbg/bulan.
Hari pertama maks 8 vial/hari,

7 F
Salbutamol + Ipratropium
F: UDV, inhaler 2,5 mg + 0,5 mg UDV; MDI 200 puffs Combivent
selanjutnya maks 4 vial/hari
Bromida paling lama 5 hari. Kasus ICU
maks 10 vial/hari.
8 F Teofilin F: tab; tab 150 mg Bronsolvan 150 mg -
Asma intermiten: 1 tabung/bulan

Asma persisten ringan: 2 tabung
budesonide 160 mcg, formoterol /bulan.
10 F F: aerosol 160/4,5 symbicort
fumarate Asma persisten sedang-berat: 3-4
tabung/bulan
PPOK: 2 tabung/bulan
Salmeterol 25 mcg; Flutikason Seretide diskus dewasa, seretide diskus

11 F F : aerosol 50/250 mcg ; 25/50 mcg anak Maks 1 tbg/bln
propionat 50 mcg
12 NF ipatropium bromida NF :aerosol ipatropium bromida atrovent
24.2 ANTITUSIF
1 F Kodein HCl F: tablet 10 mg kodein (generik) 30 tab/bulan.
24.3 MUKOLITIK
1 NF Ambroksol NF:tablet; sirup; tab 30 mg, sir 15 mg/5 ml, 15mg/ml Ambroxol tablet 30 mg; sirup (generik), Maks. 15 tab/ pasien. 1
drop drops epexol drop botol/pasien
F N-acetylsistein F: tablet, injeksi kaps 200 mg, inj 200mg/ml N-ace tablet, resfar drip
Maks 10 kaps/kasus
NF erdostein F: tab erdostein 300 mg erdostein 300 mg untuk ranap. Untuk rajal 10
tab/kasus
24.4 EKSPEKTORAN
1 NF Obat Batuk Hitam NF: Sirup OBH 1 botol/kasus
2 NF glyceril guaiacolate NF: tablet tablet 100 mg glyceril guaiacolate 15 tab / pasien
24,5 LAIN-LAIN
1 NF beractant NF : botol 25 mg/ml survanta pasien nicu dan perina
25 OBAT YANG MEMPENGARUHI
SISTEM IMUN
25.1 SERUM DAN IMUNOGLOBULIN
1 F Serum Antitetanus F: inj 1.500 IU biosat 1,5 -
25.2 VAKSIN
1 F Vaksin antirabies F: inj 0,5 mg/ 0,5 ml Rabipur -
2 F Vaksin BCG F: inj 2 ml, 4 ml Vaksin BCG -
3 NF Vaksin TUBERCULIN PPD NF:vial 2 TU 1,5 ml Vaksin PPD mantux Maks. 7 hari
4 F Vaksin Tetanus toxoid F: ampul ampul 0.5 ml Vaksin TT Bio Farma 1 dose = 0,5 ml
5 F DTP-HB-HiB vaccine F : vial vial 2,5 ml pentabio
6 F vaksin jerap DT F : vial vial 5 ml vaksin jerap DT 1 vial 10 doses
7 F measles and rubella vaccine F : vial vial 5 ml vaksin MR 1 vial 10 doses
8 F poliomyelitis vaccine inactivated F : vial vial 2,5 ml vaksin ipv 1 vial 5 doses
9 F bivalent oral poliomyelitis vaccine F : vial vial 1 ml opv 1 ml = 10 doses
10 F vaksin hepatitis B rekombinan F : prefill injeksi 0,5 ml hep Bo 0,5 ml neonatus
11 F adsorbed Td vaccine F : vial 5 ml vaksin TD 10 doses (1 dose = 0,5 ml)
OBAT UNTUK TELINGA, HIDUNG,
26
TENGGOROK
26.1 ANTIBAKTERI TOPIKAL
1 F Kloramfenikol NF: tetes telinga 3% Kloramfenikol tetes telinga (generik) -
2 F Ofloksasin F: tetes telinga 3 mg/ml dlm 5 ml akilen -
3 NF neomisin, polimiksin, NF: tetes telinga otilon tetes telinga 1 botol / kasus
fludrokortison, lidocain
4 NF docusate sodium NF: tetes telinga 5 mg forumen tetes telinga 2 botol / kasus
26.2 LAIN-LAIN
1 F oxymetazoline Hcl F : tetes hidung, 0,025%; 0,05% iliadin 0,025% anak dan iliadin dewasa -
spray 0,05%
2 F fluticasone furoate F tetes hidung, spray 27,5 mcg/spray avamys

1 btl / bulan.
NO KELAS NO URUT
TERAPI OBAT
27 VITAMIN DAN MINERAL
hanya untuk ranap vit c injeksi 1
1 F Asam Askorbat (Vitamin C) F: tab, injeksi (NF) tab 50 mg, 500 mg (NF), inj 500 mg/ Vitamin C tablet 50 mg,Vitamin C tablet amp/hari, untuk rajal vit c 500 mg 5
5 ml (NF) 500 mg, extrace inj tab/pasien
untuk rawat inap. Untuk rajal 5
NF vitamin D NF : tablet vit D 1000 IU dan vit D 5000 IU vit D 1000 IU dan vit D 5000 IU
tab/pasien
2 F Kalium aspartat/klorida F: tablet 750 mg; 300 mcg KSR; Aspar-K 90 tab/bulan
3 F Kalsium glukonat F: inj 100 mg/ml Calcii gluconas -
4 F Kalsium karbonat F: tablet 500 mg CaCO3 kapsul 500 mg (generik) max 90 tab/bulan
5 F Kalsium laktat/fosfat F: tablet 500 mg Kalk -
8 NF Mekobalamin NF: kapsul kaps 500 mcg Mecobalamin kapsul 500 mcg max 15 tab / bln
9 NF Mineral-Mix Produksi kemenkes -
Pyridoxin HCl / Vitamin B6 tablet 10 mg
10 F Piridoksin HCl (vit B6) F: tab tab 10 mg (generik) 30 tab/bulan
11 F Thiamin HCl F: tab tab 50 mg Vitamin B1 tablet 50 mg (generik) 30 tab/bulan
F vitamin b komplek F: tab vitamin b komplek 30 tab/bulan
F: tablet, kapsul
12 F Vitamin A lunak 100.000 IU, 200,000 IU Vitamin A tablet 20.000 UI; (generik) 30 tab/bln
13 F Vitamin B12 F: tablet 50 mcg Vitamin B12 tablet 50 mcg (generik) -
Phytomenadione tablet 10 mg; inj
14 F Vitamin K F: tab; inj tab 10 mg; inj 2 mg/ml -
(generik)
15 NF multivitamin dan mineral NF : tablet berbagai komposisi Folamil Genio UMUM
16 NF multivitamin dan mineral NF : sirup berbagai komposisi Elkana sirup, univit sirup 1 botol/kasus
17 NF multivitamin dan mineral NF : drop berbagai komposisi San-b-plex drop 1 botol/kasus
18 NF multivitamin dan mineral NF : tablet berbagai komposisi farmabex tab 5 tab/ pasien
19 NF ; Komposisi. Schizandrae fructus
Extractum siccum 7.5 mg NF : kapsul berbagai komposisi neo hp pro khusus pasien rawat inap
Monoammonium glycyrrhizinate
20 NF (seperti glycyrrhizin), asam amino NF : ampul berbagai komposisi SNMC khusus pasien rawat inap
asetat, dan L-sistein HCl.
21 NF citicoline NF : kapsul 500 mg citicoline 5 tab/pasien

28 OBAT YANG MEMPENGARUHI ian
SALURAN KEMIH
28.1 ANTISEPTIK
1 F Asam pipemidat F: kapsul 400 mg Urinter 28 kaps/kasus
28.2 ANTI MUSKARINIK
NO KELAS NO URUT
29 LAIN-LAIN
15-30 gram/hari dibagi dalam 2-3
kali pemberian.
1 F kalsium polistirena sulfonat F : sachet sachet 5 g kalitake
Maks selama 5 hari sampai dengan
dialisis dilakukan
2 NF Lubricant untuk USG NF: Jelly Aquasonic 1 tube /kasus
Mengetahui, Mengetahui, Mengetahui, Mengetahui,
Ketua KFT Penanggung Jawab Instalasi Farmasi Kasie Penunjang dan Keperawatan Direktur RSUD Tugu Koja
dr. Salsabila SpN Nurhayati, S.Si, Apt. Deden Muliadi, Apt dr. Dwian Andhika
SIP. NIP. 197902112007012011 NIP. 197801112008011012 NIP 198311072010011021
ANTIMIKR 6 ANTIMIKR 6 ANTIMIKR
OBA OBA OBA
6 ANTIMIKR 6 ANTIMIKR 6
OBA OBA
OBA OBA OBA
OBA OBA
OBA OBA OBA
OBA OBA
OBA OBA OBA
OBA OBA
OBA OBA OBA
OBA OBA
OBA OBA OBA
OBA OBA
ANTIMIKR
OBA
ibu injeksi
ampi 250 mg
ampi sulbaktam
reco tetes mata
oflox tetes telinga akilen
sefepime
fluconazole drip
ketokonaole shampo
ryodeg insulin
ntg injeksi
carve 25mg
rani sirup
n-ace drip resfar
vit c injeksi
vit d tab
otilon tt
silostazol kaps
neostigmin inj
piperacillin tazobactam inj
amikasin inj
asam ursodeoksilat
ardium tab
atenolol
benzatin benzil p
cefoperazone
ceftazidime
cendo hyalub
cendo noncort
chlorpromazine
cendo xitrol
clobazam
donepezil tab
dolutegravir
dydrogesterone
dolutegravir sodium 50/lamivudin 300/tenofovir disoproxil fumarate 300
efavirenz
tenofovir 300/ lamivudine 300/ efavirenz 600
tenofovir disoproxil fumarate 300
Lopinavir 200/ ritonavir 50
nevirapine 200 mg
lamivudine 150 mg
lamivudine 150 mg/ zidovudine 300 mg
zidovudine 100 mg
propofol
gg
fosfomicin inj
favipiravir tab
ipatropium bromida
kalsium polistirena sulfonat
pirenoxine
kidmin inf
enoksaparin sodium
mikonazole
hp pro
oseltamivir
snmc
beractant
tiamazole
remdesivir
actemra
vankomisin
ryzodeg insulin
silodosin
levetiracetam
lamotigrin
Piridostigmin
vildagliptin
sodium hialuronate inj
citicoline inj
salep mebo
adona ampul
venosmil tab
natamisin tetes mata
mecobalamin inj
OBAT YANG DI HAPUS DARI FORMULARIUM THN 2017
1 VITANORM
2 HALOPERIDOL TAB, INJEKSI
3 Cavit D3
4 Laktafit
5 Terazosin hidrokloride (hytrin)
6 Antalgin
7 Tetrasiklin

1 kodein 15 mg
2 piroxicam tab
3 thiamfenicol
4 kanamisin sulfat
5 linkomisin

1 oksitetrasiklin sk,sm
2 Halotan
3 pseudoefedrin + Loratadine
4 pseudoefedrine + terfenadine
5 methisoprinol
6 polymaltosa
7 Atenolol
8 ISDN tab SR (fasorbid)
9 Asam Salisilat + Belerang endap
10 Bromheksin HCl
11 neurosanbe plus
12 ossein hydroxyapatite 200 mg
13 flamar gel
14 pirantel pamoat
15 nistatin tab vaginal
16 termisil tube
17 itrakonazole kaps
18 trombopob
19 gentian violet
20 humalog 50
21 cygest supp
22 triamsinolon tab
23 triam salep
24 diltiazem tab
25 isosorbit moononitrat
26 triamsinolon krim
27 wida rd
28 FLAMAR TETES MATA
29 gentamisin salep mata
30 kaolin pektin tab
31 terbutalin tab
32 karbogliserol tt
33 breathy nasal drop
34 neurosanbe tab
35 karyuni
PEMAKAIAN OBAT FORNAS DAN NON FORNAS PERIODE OKTOBER
2022
NAMA OBAT SAT RAJAL IGD RANAP

ACARBOSE 100MG Tablet 12.385
ACARBOSE 50MG Tablet 354
ADALAT OROS 30MG TAB Tablet 8.797
ALBENDAZOL 40MG Tablet 0
ALLOPURINOL 100 MG TAB Tablet 6098
ALPRAZOLAM 1mg Tablet 0
ALPRAZOLAM 0,5MG Tablet 425
AMBROXOL 30MG Tablet 2.635 35
AMBROXOL DROP Botol 0
AMBROXOL SYR 15MG/5ML Botol 89
BFLUID Kolf 0 11
AMINOPHYLIN 200MG Tablet 6
AMINOPHYLIN 24MG/ML INJEKSI IV Ampul 0 16
AMIODARONE HCL TABLET Tablet 0
AMIODARONE HCL INJEKSI Ampul 0 34
AMITRIPILIN 25 MG Tablet 3.138
AMLODIPIN 10 MG Tablet 8.595
AMLODIPIN 5MG Tablet 5.042
AMOXICILIN 250MG Tablet 0
AMOXICILIN 500MG Tablet 1.655
AMOXICILIN DROP (AMOBIOTIC) Botol 0
AMOXICILIN DROP (AMOKSAN) Botol 0
AMOXILLIN SYR 125MG/5ML Botol 0
AMOXILLIN SYR 250MG/5ML Botol 2 3
AMPISILLIN 1GRAM INJEKSI Vial 0 13
ANALSIK TAB (METAMPIRON + DIAZEPAM) Tablet 0
ANTALGIN Tablet 0
ANTASIDA DOEN Tablet 3.701 50
ANTASIDA DOEN SUSP Botol 39
Supposito
ANTIHEMOROID DOEN SUPPOS 46
ria
VAKSIN ANTIRABIES (VERORAB) Box 0
AQUA PI 20ML Botol 0
ASAM FOLAT 1MG Tablet 10.541
ASAM FUSIDAT (FUSYCOM) CREAM Tube 0
ASAM MEFENAMAT 500MG Tablet 5.341
ASAM PIPEMIDAT (URINTER) Tablet 219
ASAM TRANEKSAMAT 500MG Tablet 519
ASAM TRANEKSAMAT 500MG/5ML INJEKSI Ampul 0 216
ASAM URSODEOKSIKOLAT Tablet 1.809
ASCARDIA 160 Tablet 0
ASERING Kolf 0 114
ASIKLOVIR 200MG Tablet 515
ASIKLOVIR 5% KRIM Tube 3
ASPARTAT KALIUM TAB Tablet 182
ASPILET Tablet 0
ATENOLOL (FARNORMIN) Tablet 0
ATRACURIUM INJ 25MG/2.5ML Vial 0 5
ATROPIN SULFAT 0,25MG/ML Ampul 0 5 41
ATTAPULGIT Tablet 748
AVAMYS (FLUTICASONE FUMARATE) NASAL
Botol 84
SPRAY
AZITROMICIN 200MG/5ML SYRUP KERING Botol 12
AZITROMICIN 500MG Tablet 260
BACTROBAN (MUPIROCIN) OINTMENT Tube 0
BAQUINOR TETES MATA Botol 0
BASITRASIN - POLIMIKSIN Tube 0
BENZATIN BENZIL P 1,2 JT IU INJ Vial 0
BERRYVISION TAB Kapsul 1.158
BETAHISTIN MESILATE 6MG Tablet 2.516
BETAMETASON 0,1% KRIM Tube 222
BISOPROLOL 5 MG TAB Tablet 4.198
BRALIFEX TETES MATA Botol 50
BROMHEKSIN SYR (LEXAVON) Botol 0
BUPIVACAIN SPINAL 5MG/ML INJEKSI (REGIVEL) Ampul 0
63
SULFADIAZINE SALEP (BURNAZIN) Tube 0
BUSCOPAN Tablet 0
HIOSIN BUTIL BROMIDA 20 MG/ML INJEKSI Ampul 0 9
CA. GLUCONAS 100MG/ML Ampul 0 5
CANDESARTAN 8MG Tablet 0
CAPTOPRIL 12,5MG Tablet 0
CAPTOPRIL 25MG Tablet 2.963
CARBAMAZEPIN 200MG Tablet 682
CEFADROXIL SUSP KERING 250MG/ML Botol 0
CEFADROXIL 500MG Tablet 474
CEFADROXIL SUSP KERING 125/5ML Botol 18
CEFAZOLIN 1GRAM INJEKSI Vial 0
CEFEPIME INJEKSI Ampul 0 24
CEFIXIM 100MG TAB Kapsul 0
CEFIXIME SYRUP 100MG/5ML Botol 22
CEFIXIME SYRUP 100MG/5ML (ABIXIM) Botol 0
CEFOTAXIME INJEKSI Vial 0 46
CEFTRIAXONE INJEKSI Vial 0 1001
CENDO AUGENTONIC 0,6ML Minidose 0
CENDO ASTHENOF Minidose 0
CENDO CATARLENT Minidose 1
CENDO CENFRESH (KARBOKSIMETIL SELULOSA) Minidose 15
CENDO CHROMOPTAL Minidose 0
CENDO CONVER 2% MINIDOSE Minidose 3
CENDO FLOXA (OFLOXACIN) Minidose 250
CENDO GLAOPEN (LATANA PROST) Minidose 18
CENDO HERVIS Tube 0
CENDO HYALUB Minidose 0
CENDO LYTEERS Botol 349
CENDO MIDRIATIL Botol 1
CENDO OCULENTA SALEB MATA Tube 3
CENDO PANTOCAIN Botol 2
CENDO POLIDEMISIN Minidose 0
CENDO POLYDEX (POLIMIKSIN B-SULFAT,
Minidose 0
NEOMYCIN SULFAT, DEXAMETASON)
CENDO TIMOL (TIMOLOL 0,5%) Minidose 233
CENDO TOBROSON ( TOBRAMYCIN
Minidose 325
DEXAMETASON)
CENDO VASACON (ANTAZOLIN HCl) Minidose 0
CENDO VITROLENTA Botol 3
CENDO XITROL TETES MATA Minidose 155
CENDO XITROL SALEP MATA Tube 47
CENDO PROTAGENTA (POLIPYVIL PIROLIDONE) Minidose 240
CETIRIZINE 10 MG TAB Tablet 5.285
CETIRIZINE 5MG/5ML SIRUP Botol 118
CETIRIZINE DROP (LERZIN) Botol 0
CHLORPROMAZINE 100MG Tablet 111
CIPROFLOXACIN 500MG Tablet 1.105
CIPROFLOXACIN DRIP Botol 0 223
CLINDAMISIN 300MG Kapsul 758
CLOBAZAM 10MG TAB Tablet 514
CLONIDIN 0,15MG Tablet 4.176
CLOPIDOGREL 75MG Tablet 3.879
CO AMOXICLAV 625 MG TAB Tablet 251
COLCHICINE 0,5 MG Tablet 91
COTRIMOXAZOLE 480 Tablet 191
COTRIMOXAZOLE SYR Botol 1
CTM 4MG Tablet 1.103
CURCUMA TAB Tablet 2.806
Supposito
CYGEST SUPPOS 0
ria
DIVALPROAT SODIUM 250MG TAB Tablet 148
DEXAMETASONE 0,5MG Tablet 1.097
DEXAMETASONE INJ 5MG/ML Ampul 0 60 368
DIAFORM Tablet 40 20
Supposito
DIAZEPAM 10MG/2,5ML SUPP (STESOLID) 1
ria
DIAZEPAM 2 MG TAB Tablet 4.488
DIAZEPAM 5 MG TAB Tablet 0
Supposito
ria 9
DIAZEPAM INJEKSI 2 ML (10 MG) Ampul 10 5 5
DIFENHYDRAMIN 10MG/ML INJEKSI Ampul 0 15 100
DIGOXIN 0,25MG Tablet 89
DIMENHYDRINATE 50 MG Tablet 198
DOBUTAMIN 250MG/5ML Ampul 0 81
DOKSISIKLIN 100MG Kapsul 92
DOLONES (LIDOCAIN, PRILOCAIN) Tube 0
DOMPERIDON 10MG Tablet 2.419
DOMPERIDON SYRUP 5MG/5ML (MONELL) Botol 0
DOMPERIDON SYRUP 5MG/5ML (VOMETA) Botol 0
DOMPERIDONE 5MG/5ML SUSP Botol 65
DOMPERIDONE DROP (MONELL) Botol 0
DOPAMIN HCL 40MG/ML INJEKSI (INDOP) Ampul 8
Supposito
DULCOLAX SUPPOS 10MG (BISAKODIL) 14
ria
Supposito
DULCOLAX SUPPOS 5MG ria 4
DULCOLAX TAB Tablet 93
DUPHASTON DYDROGESTERONE 10MG Tablet 19
DUROGESIC 12,5 MU Tablet 0
DUVADILAN 10MG/2ML Ampul 0
EFEDRIN HCL Tablet 0
EFEDRIN HCL 5MG/ML Ampul 0 59
EPINEFRIN HCl 0,1% INJEKSI Ampul 0 174
EPIDOSIN INJEKSI Vial 0
ERGOTAMIN CAFFEIN Tablet 0
ETHAMBUTOL 600MG TAB Kapsul 0
FARTISON Vial 0
FENITOIN INJEKSI Ampul 0 10
FENOBARBITAL 30MG Tablet 170
FENOBARBITAL 50MG/ML IM Ampul 0 1 1
FENOL GLISEROL Botol 0
FENTANYL 2 CC (100 mcg) Ampul 0 5 60
FERITRIN Kapsul 0
FLADYSTIN Ovula 30
FLAMAR TETES MATA Botol 0
FLIXOTIDE RESPULES Respules 63 5 5
FLUCONAZOLE 150 Tablet 0
FLUNARIZINE 10MG Tablet 481
FOLAMIL GENIO Box 10
FORTANEST (MIDAZOLAM 1 mg) Ampul 0
FUROSEMIDE 40MG TAB Tablet 2.455
FUROSEMIDE IM. IV INJEKSI 10MG/ML Ampul 0 10 389
GABAPENTIN 100MG Tablet 13.664
G. ORALIT 200 Sachet 142 40
GELOFUSIN Kolf 0 15
GEMFIBROZIL 300MG CAPS Kapsul 2.041
GENTAMICIN 40MG/ML INJEKSI Ampul 0 130
GENTAMICIN SULFAT 1% KRIM Tube 0
GENTAMISIN SALEB KULIT 0,1% Tube 162
GENTIAN VIOLET Botol 0
GG 100 Tablet 94
GLICLAZID 30MG Tablet 0
GLICLAZID 80MG Tablet 2.923
GLIMEPIRIDE 1 MG Tablet 2.158
GLIQUIDONE 30MG Tablet 2.906
GLUKOSA 10% Botol 0 53
GRISEOFULVIN 125MG Tablet 0
HIDROGEN PEROKSIDA / H2O2 25 ML Botol 40
HALOTAN Vial 0
HIDROCHLORTIAZID TAB (HCT) Tablet 4.812
HIDROKORTISON 2,5% KRIM Tube 35
HIDROKSI ETIL STARCH (HES) INFUS Kolf 0
IBUPROFEN 100MG/5ML SUSPENSI Botol 6
IBUPROFEN 200MG Tablet 0
ILLIADIN NASAL DROP ANAK Botol 2
INTERZINK Tablet 0
INVICLOT (HEPARIN) Ampul 0 29
IPATROPIUM BROMIDA (ATROVENT) Botol 0
COMBIVENT RESPULES Respules 0
IRBESARTAN 300MG Tablet 473
ISDN 5MG Tablet 753
ISDN INJEKSI Vial 0 13
ISOFLURAN 250ML Botol 0
ISONIAZID 300MG Tablet 2.257
ISOXSUPRINE (PROTERINE) TAB Tablet 129
KAEN 1B Botol 0 9
KAEN 3A Botol 0 7
KAEN 3B Botol 0 25
KAEN 4A Kolf 0 0
KAEN 4B Kolf 0 0
KALIUM DIKLOFENAK 50MG Tablet 1.406
KALSIUM LAKTAT Tablet 5.427
KANAMISIN SULFAT INJ Vial 0
KCL 7,46 Botol 0 8 130
Supposito
KETOPROFEN SUPP (SUPRAFENID) 100
ria 48
KETAMIN HAMELN 50MG/ML Vial 0
KETOKONAZOLE 200MG Tablet 35
KETOKONAZOLE KRIM Tube 40
KETOROLAC INJEKSI Ampul 0 10 521
KLORAMFENIKOL 1% saleb mata Tube 4
KLORAMFENIKOL IM. IV INJEKSI Vial 0
KLORAMFENIKOL SALEB KULIT Tube 3
KLORAMFENIKOL TABLET Tablet 10
KLORAMFENIKOL TETES MATA (ERLAMYCETIN) Botol 0
KLORAMFENIKOL TETES TELINGA Botol 1
KODEIN 10MG Tablet 1.263
KODEIN 15MG Tablet 0
LANSOPRAZOL 30mg Kapsul 11.622
LANSOPRAZOL INJEKSI Ampul 0 55 40
Pen
LANTUS SOLOSTAR 100IU/ML 238
Insulin
LEVODOPA Tablet 0
LEVOFLOXACINE 500 MG TAB Tablet 266
LEVOFLOXACINE DRIP Botol 0 137
LIDOCAIN 2ML INJEKSI Ampul 300 57
LINCOMYCIN 500MG Kapsul 0
LISINOPRIL 10MG Tablet 2.015
LOPERAMID Tablet 126
LORATADINE 10MG Tablet 2.293
MANITOL INFUS Botol 0 18
MELOXICAM 15MG Tablet 1.409
MELOXICAM 7,5MG Tablet 0
METFORMIN 500 MG TAB Tablet 16.258
METILDOPA 250 MG (DOPAMET) Tablet 143
METILERGOMETRIN 0,125MG Tablet 24
METILERGOMETRIN 0,2MG/ML INJEKSI Ampul 0 108
METOCLOPRAMIDE 10 MG Tablet 1.723
METOCLOPRAMIDE HCL 10MG/2ML INJEKSI Ampul 0 100 300
METOKLORPAMIDE DROP Botol 0
METRONIDAZOL SUSPENSI (FARIZOL) Botol 0
METRONIDAZOLE 500MG Tablet 568
METRONIDAZOLE 5MG/ML DRIP Botol 0 96
METRONIDAZOLE SIRUP (FARIZOL) Botol 5
MEYLON 8,4% Kolf 0 6
MGSO4 20% INJ Botol 0
MGSO4 40% 25ML Botol 0 10 22
METILPREDNISOLON 4MG TAB Tablet 0
METILPREDNISOLON 8MG TAB Tablet 3.259
METILPREDNISOLON INJ 125 MG/ML Vial 0 12 101
MICONAZOLE 2% KRIM Tube 3
MICROLAX SUPPOS Tube 24
MIDAZOLAM 5 ML (5 MG) MILOZ Ampul 75
MISOPROSTOL Tablet 129
MORFIN INJEKSI 10MG/ML Ampul 0 4
NACL 0,9% 500ML Botol 123 120 600
NACL 0.9% 100ML Botol 0 55 1000
NALOXON HCl 0,4MG/ML (NOKOBA) Vial 0
NASACORT (TRIAMSINOLON) NASAL SPRAY Botol 0
NATRIUM DIKLOFENAK 25MG Tablet 0
NATRIUM DIKLOFENAK 50MG Tablet 3.402
NEOMISIN SULFAT Tube 0
NIFEDIPIN 10MG Tablet 1006
NISTATIN DROP (CAZETIN) Drop 0
NISTATIN TAB.SLAUT 100.000 IU/G Tablet 0
NITROKAF 2,5 MG Tablet 3.879
NITROKAF 5 MG Tablet 585
NOREPINEFRIN INJEKSI Vial 0 200
NORETHYLSTERON 5MG (NOSTHYRA) Tablet 0
Pen
NOVOMIX-30 Insulin 0
Pen
NOVORAPID FLEXPEN 139
Insulin
OAT ANAK 3FDC (INTENSIF) Tablet 1.333
OAT KATEGORI 1 4FDC (INTENSIF) Tablet 2.406
OAT KATEGORI 2 2FDC (LANJUTAN) Tablet 96
OBAT SUNTIK KB 2 Vial 0
OBH SYR Botol 65
OFLOXACIN 200MG Tablet 0
OKSITETRASIKLIN SALEB KULIT Tube 0
OKSITOSIN INJEKSI Ampul 0 289
OMEPRAZOL 20MG Kapsul 6004
OMEPRAZOL 40MG/10ML Botol 0 200 368
ONDANSENTRON 4 MG Tablet 543
Ondansentron IV/IM 4mg Ampul 0 166 1000
OTILON TETES TELINGA Botol 45
PAPAVERINE Tablet 26
Supposito
PARACETAMOL 125MG SUPPOS (DUMIN) 20
ria
Supposito
PARACETAMOL 160MG SUPPOS 0
ria
Supposito
ria
Supposito
ria
PARACETAMOL 500MG Tablet 21.887
Supposito
PARACETAMOL 80MG SUPPOS (PROPYRETIC) 29
ria
PARACETAMOL DRIP Kolf 0 654
PARACETAMOL DRIP ANAK Botol 0
PARACETAMOL DROP (FASIDOL) Botol 0
PARACETAMOL DROP (SANMOL) Botol 4
PARACETAMOL DROP GENERIK Botol 13
PARACETAMOL SYR 125MG Botol 158
PARACETAMOL SYRUP (SANMOL SYRUP) Botol 6
LIDOCAIN 2% + EPINEFRIN INJ (PEHACAIN) Ampul 136
PETHIDIN HCl 2 CC (100 MG) Ampul 0 1
PHYTOMENADIONE (VIT K) Tablet 29
PHYTOMENADIONE 2MG/ML (VIT K) Ampul 0 78
PIRANTEL PAMOAT SUSPENSI Botol 0
PIRANTEL PAMOAT 250MG Tablet 0
POTASSIUM KLORIDA (KSR) Tablet 904
PREDNISON 5MG Tablet 1.68
PREFOSOL 1% HCT/LCT Ampul 0
PRITAGESIC (METAMPIRON, VITAMIN B1,B6.
Kaplet 0
B12)
PROPANOLOL 10MG Tablet 2.015
PROPILTIOURASIL 100MG (PTU) Tablet 313
PROSTIGMIN (NEOSTIGMINE
Vial 10
METHYLSULPHATE) INJEKSI
PULMICORT RESPULES Respules 0
RANITIDIN 150MG Tablet 1.644
RANITIDIN 25MG/ML INJEKSI 2ML Ampul 1.255
RANITIDIN SIRUP (RANIVEL) Botol 13
Supposito
RECTOLAX 0
ria
RHINOS SR Kapsul 174
RHINOS JUNIOR SIRUP (PSEUDOEPHEDRINE HCL
Botol 21
15MG + CTM 1MG)
RHINOS NEO DROP (PSEUDOEPHEDRINE 7,5MG) Botol 6

RIFAMPISIN 300MG Kapsul 0
ROCURONIUM BROMIDA 10MG/ML Vial 3
SALBUTAMOL 2MG TAB Tablet 415
SALBUTAMOL 4MG TAB Tablet 1.416
SAKARIN Tablet 0
SALEP 2-4 KOMBINASI Pot 0
SEVOFLURAN Vial 0
SF (TABLET (+) DARAH) Tablet 4.636
SIMVASTATIN 20MG Tablet 9.146
SINTOSINON (OKSITOSIN) INJEKSI Ampul 0
SODIUM BICARBONAT Tablet 3.383
SPIRONOLACTONE TAB 25MG Tablet 2.11
SUKRALFAT SUSPENSI Botol 620
SYMBICORT 120 Botol 0
OFLOXACIN TETES TELINGA (TARIVID) Botol 0
TEOFILIN (BRONSOLVAN) Tablet 1.247
TERBUTALIN 2,5MG Tablet 0
TETRASIKLIN Kapsul 0
THIAMPENICOL Kapsul 0
TRAMADOL HCL 100mg/2ml IM.IV Vial 0 219
TRIAMSONOLON INJEKSI Ampul 0
TREMENZA Kapsul 0
TROMBOFOB GEL Tube 0
UMARONE (SOD HYALURONATE) INJEKSI Vial 0
UNI BABY COUGH Botol 0
VAKSIN GARDASIL Vial 0
MANTOUX Vial 0
VAKSIN TETANUS TOKSOID Vial 7
VAKSIN HEPATITIS B REKOMBINAN 1ML Vial 2
VAKSIN BIOSAT 1.5 (ANTI TETANUS SERUM 1500
UI) Vial 0
VALSARTAN 160 Tablet 1.726
VALSARTAN 80 Tablet 0
VANCEP INJEKSI Ampul 0
SALBUTAMOL (VENTOLIN) RESPULES Respules 335 35
VENTOLIN ROTACAP Kapsul 0
VERMOX Tablet 0
VIT A 100.000 UI (RETINOL) Kapsul 0
VITAMIN B COMPLEX Tablet 6.415
VITAMIN B1 (THIAMIN HCL) Tablet 182
VIT B12 Tablet 2.552
VIT B6 Tablet 2.918
VIT. C 250MG Tablet 0
VIT C 50MG Tablet 1.565
VOLUVEN INFUS Kolf 0
WARFARIN 2MG TAB (SIMARC / NOTISIL) Tablet 530
WI 1000ML Botol 0 78
WI 25ML Botol 0 100 164
XYLOCAIN SPRAY Botol 0
XYLOCAIN 2% JELLY Syringes 0
ZINK 20 MG TAB Tablet 916
ZINKID SIRUP 10MG/5ML Botol 0
ZINK SIRUP 20MG/5ML Botol 47
ATORVASTATIN 20 MG Tablet 1.683
N-ASETILSISTEIN TAB Tablet 4008 50 50
DILTIAZEM INJEKSI Vial 0
MEROPENEM 1 GR INJEKSI Vial 0 150
ARTESUNATE INJEKSI Tablet 0
MOXIFLOXACIN HCL 500 Botol 0
CENDO NONCORT Minidose 44
CITICOLINE 500MG Tablet 290
FENOBARBITAL IV (SIBITAL) Ampul 0 7 37
KALITAKE SACH Sachet 0 40
KLORAMFENIKOL 125mg/5ml Botol 0
NACL 3% Kolf 0 8 40
SALBUTAMOL 10mcg INHALER Botol 0
RINGER LAKTAT 500ML (RL) Kolf 0 700 1100
RAMIPRIL 2.5 MG TABLET Tablet 1111
AMOKSISILIN DRY SIRUP (AMOKSAN) Syrup 2
GABAPENTIN 300MG Kapsul 6.533
NATRIUM DIKLOFENAK GEL (FLAMAR GEL Tube 0
ERITROMISIN 250 MG Kapsul 20
ERITROMISIN 200MG/5ML Botol 0
SALBUTAMOL INHALER (DIPSAMOL) Botol 0
RD (RINGER DEXTROSE) INFUS Kolf 1
CEFIXIME 200 MG TAB Tablet 3.979
ETHAMBUTOL 500 MG TAB Tablet 4.168
AMBROXOL DROP (EPEXOL DROP) Botol 9
OFLOXACIN TETES TELINGA (AKILEN) - 77
BREATHY NASAL DROP Botol 0
CO AMOXICLAV (CLANEKSI) SIRUP Botol 8
FLAMAR GEL Pieces 0
UTROGESTAN 200MG Kapsul 0
ETORICOXIB (ORINOX) TAB Tablet 0
METHISOPRINOL (ISPRINOL) SYR Botol 0
FRESOFOL (PROPOFOL) INJEKSI Vial 0 27
SISTENOL Tablet 3
LEVOFLOXACIN TTS MATA BTL (CRAVIT) Botol 0 8
PIL KB KOMBINASI 1 Tablet 0
pil KB kombinasi 1 Lembar 0
CETIRIZIN DROP (CERINI DROP) Botol 3
OPTIMAX O3 TAB VIT MATA Kapsul 167
LEVOFLOXACIN TTS MATA BTL (LEVOCIN) Tube 0
ISOXSUPRINE (PROTERINE) INJEKSI Vial 0 36
OPTIMAX TAB VIT MATA Tablet 74
KARY UNI TETES MATA Botol 0
DIGOXIN INJEKSI (FARGOXIN) Ampul 0 4
PYRAZINAMID 500MG TAB Tablet 1.116
DESONIDE (DESOLEX) CREAM 10 GR Tube 26
CLOBETASOL KRIM 10 GR Tube 102
CLOBETASOL (KLODERMA) SALEP 5 GR Tube 0
MOMETASONE KRIM 10 GR Tube 0
MOMETASONE (MOFACORT) SALEP 10 GR Tube 0
MUPIROCIN (PIROTOP) KRIM 5 GR Tube 0
MUPIROCIN (PIROTOP) SALEP 10 GR Tube 10
PERMETHRIN KRIM Tube 0
ASAM FUSIDAT (FUCILEX) CREAM Tube 74
NITROGLISERIN (NTG) INJEKSI Ampul 0 2
TIMOLOL 0.25% (ADRETOR TETES MATA) Botol 2
MEROPENEM 0,5 GR INJEKSI Vial 0
VAKSIN BIO TD (TETANUS - DIFTERI) JERAP TD Vial 0
VAKSIN MR (MEASLES - RUBELLA) Vial 0
VAKSIN BCG (ANTI - TBC) Vial 0
VAKSIN POLIO Vial 0
VAKSIN DPT + HEPATITIS B REKOMBINAN Vial 0
ILLIADIN NASAL SPRAY DEWASA Botol 15
PROCAIN PENISILIN (PENICILIN G) INJ Vial 0
STALEVO TABLET Tablet 0
INFUS BES (BALANCE ELECTROLYTE SOL) Kolf 0 2
HUMAN ALBUMIN (ALBAPURE) Botol 0 5
ATRACURIUM - HAMELN INJ Ampul 0
PRONTOSAN SOL 350 ML Botol 0
BUSCOPAN TABLET Tablet 296
DEXTROSE 5% 1/2 SALINE (D5 1/2 NS) Kolf 0 106
LEVOFLOXACIN TTS MATA BTL (CENDO LFX) Kolf 0
CENDO FENICOL 0.5% Botol 0
MOMETHASONE CREAM 10 GR Tube 37
GENTAMISIN SALEP MATA Tube 0
NACL (KAPSUL GARAM) 500 MG Kapsul 0 56
IOPAMIDOL Botol 0
CANDESARTAN 16 MG Tablet 10.701
SUKRALFAT SIRUP 200 ML Botol 0
ACETAZOLAMIDE TAB (GLAUSETA) Tablet 92
FORUMEN TETES TELINGA Botol 22
TRAMADOL 50 MG TABLET Tablet 3001
RAMIPRIL 10 MG TABLET Tablet 1.431
MINIASPI 80 MG (ASPILET) Tablet 7.865
CARMED CREAM (UREA 20%) Tube 8
KETOMED CREAM (KETOKONAZOL) 15 GR Tube 1
MEDICORT CREAM (FLUTICASONE) 5 GR Tube 0
BUPIVACAIN (MARCAIN) Ampul 0
amoxan sirup Botol 0
KETOMED SCALP SOLUTION (SHAMPOO) Botol 17
MORFIN 10 MG TABLET Tablet 0
RIFAMPISIN 450 MG Tablet 1.242
LISINOPRIL 5 MG TABLET (TENSIPHAR) Tablet 0
RAMIPRIL 5 MG TABLET Tablet 2094
NISTATIN DROP (KANDISTATIN) Botol 0
GENTAMISIN SULFAT KRIM (GENTALEX) Tube 0
OAT KATEGORI 2 : INJ STREPTOMISIN Vial 45
OAT ANAK 2FDC (LANJUTAN) Tablet 2.197
OAT KATEGORI 2 4FDC (INTENSIF) Tablet 60
OAT KATEGORI 1 2FDC (LANJUTAN) Tablet 3.027
OAT KATEGORI 2 : SPUIT 5 CC Pieces 0
OAT KATEGORI 2 : AQUA PI 5 ML Pieces 0
triamcinolon injeksi (trilac) (1 ml) - 0
triamcinolon injeksi (0,01) - 0
PROPOFOL INJEKSI 20 ML Ampul 0 34
SALBUTAMOL 2MG/5ML SIRUP Botol 65
KLORAMFENIKOL TETES MATA (RECO) Botol 7
NISTATIN DROP (CAZETIN) Botol 9
VAKSIN HEPATITIS B REKOMBINAN 0.5 ML Ampul 0 53
CETIRIZINE 5MG/5ML SIRUP (TRISELA) Botol 0
Pantocain tetes mata 1 ml Mili Liter 0
Cendo LFX tetes mata 1 ml Mili Liter 0
Cendo Midriatil 1 ml Mili Liter 0
Cravit 1 ml Mili Liter 0 35
Isofluran 1 ml Mili Liter 0
Sevofluran 1 ml Mili Liter 0
Ketamin injeksi 1 ml Mili Liter 0 1
TRIHEXYLPHENIDYL 2MG TAB Tablet 966
ASAM VALPROAT SIRUP 250MG/5ML Botol 24
MOMETASONE (MOFACORT) KRIM 5 GR Tube 2
EPERISONE HCL TAB 50MG (ESTALEX) Tablet 6.135
TIZANIDINE 2MG TAB Tablet 1.289
AMBROXOL SYR 30MG/ML Botol 0
Supposito
PARACETAMOL 125MG SUPP (PAMOL) 0
ria
Supposito
ria
ZINK DROPS 10MG/ML (ZINCPRO) Botol 0
SPORACID CAP 100MG (ITRACONAZOLE) Kapsul 0
TERMISIL CREAM (TERBINAFINE HCL) 5 GRAM Tube 0
NATRIUM FENITOIN 100MG KAPSUL Kapsul 765
AMPISILIN-SULBACTAM (VICILIN SX 1.5 GRAM) Vial 0
262
SALBUTAMOL SIRUP 2MG/5ML (ASTHAROL
Botol 0
SIRUP)
ZINK 20MG/5ML (OREZINC) SYRUP Botol 0
ASAM FUSIDAT (AFUCID) CREAM Tube 0
AMPISILIN 250MG (VICILIN) Vial 0
ASAM TRANEKSAMAT 250MG/5ML INJEKSI Vial 0
FERRO-K SUSPENSI 120 ML Botol 0
HISTERINE LEVO 5MG TAB Tablet 0
SALBUTAMOL INHALER (SUPRASMA) Botol 30
AGNO3 25% Botol 0
HYOCINE INJEKSI 20MG/ML Ampul 0 10 19
VAKSIN TETANUS TOKSOID (1 ML) Vial 0 3
HEP IMUNOGLOBULIN Vial 0
Platogrix Tablet 0
LEVOPAR Tablet 1.164
KETAMIN INJEKSI Ampul 0 5
CENDO XITROL 5 ML TTS MATA Botol 0
LAMIVUDIN (3TC) Tablet 0
EFAVIRENZ (EFV) 600 MG Tablet 0
NEVIRAPINE (NVP) 600 MG Tablet 0
TENOFOVIR (TDF) 300 MG Tablet 10
ABACAVIR (ABC) 300MG Tablet 0
LOPINAVIR Tablet 0
FDC : ZIDOVUDIN (AZT/ZDV) + LAMIVUDIN (3TC)
Tablet 0
300/150 MG
TRIPLE FDC DEWASA : TDF + 3TC + EFV
Tablet 541
(300/300/600) MG
ASAM ASETAT SATUAN PER 10 ML Mili Liter 0
Pen
HUMALOG MIX 25 KWIK PEN 136
Insulin
Pen
APIDRA 113
Insulin
TRIDEX 27 A Softbag 0
TRIDEX 27 B Softbag 0
BUNASCAN SPINAL 0.5PCT HEAVY 4 ML Ampul 0
Pen
HUMALOG MIX 5O KWIKPEN 0
Insulin
VERORAB Ampul 0
AMOXICILIN DROP GENERIK Botol 8
Pen
HUMALOG KWIKPEN 5 ML RAPID 0
Insulin
METAMIZOL INJEKSI Ampul 0 17
LACTULOSA SYRUP Botol 53
CHLOROQUIN 250 MG Tablet 0
REGUMEN (NORETHISTERONE) Tablet 347
VIT C INJEKSI Ampul 0 111
OSELTAMIVIR CAPS 75 MG Kapsul 0
VIT C INJEKSI SANKORBIN Ampul 0
VIT C 500 MG Kapsul 841 500 600
CATAPRESS / CLONIDIN 0,15 MG/ML Ampul 0
carmed pot 10 gr Pot 0
PIOGLITAZONE 30MG TAB Tablet 5.264
Flamicort 10 mg/ml Vial 0
Flamicort per 1 ML Vial 0
CLONAZEPAM 2 MG Tablet 95
CACO3 500 MG Kapsul 560
SULFADIAZIN KRIM GENERIK Tube 2
THIAMAZOLE 10 MG TAB Tablet 858
MIDAZOLAM 1 ML (1 MG) Ampul 0 4
FENTANYL 1,5 CC (75 MCG) Ampul 0
FENTANYL 1 CC (50 MCG) Ampul 0 5
FENTANYL 0,5 CC (25 MCG) Ampul 0 3
PETHIDIN HCL 1 CC (50 MG) Ampul 0
PETHIDIN HCL 1,5 CC (75 MG) Ampul 0
DIAZEPAM INJEKSI 1,5 ML (7,5 MG) Ampul 0
DIAZEPAM INJEKSI 1 ML (5 MG) Ampul 0
MIDAZOLAM 4 ML (4 MG) Ampul 0
SCOPMA (HYOSCINE BUTILBROMIDE) TABLET Tablet 179
BISACODYL TABLET (LAXANA) Tablet 8
KIDMIN 200ML SOFTBAG Softbag 0 15
CEFOPERAZONE 1GR/MBF Vial 0 16
RIFAMPISIN 600MG Tablet 924
ERDOSTEIN TAB Tablet 551
ISONIAZID 100 MG Tablet 0
GLIBENCLAMID 2,5 MG Tablet 0
GLIBENCLAMID 5 MG Tablet 0
HALOPERIDOL 5 MG Tablet 0
PIRANTEL PAMOAT Tablet 0
CARVEDILOL 6,25 MG (V BLOCK) Tablet 2.454
HYOSCINE N BUTIL BROMIDE INJEKSI Ampul 39
CILOSTAZOL KAPS (PLETAAL SR) Kapsul 921
FARMABEX-C MULTIVITAMIN Tablet 0
FENOFIBRATE 100 MG Kapsul 3.436
LOVENOX 0.6 (ENOXAPARIN) Syringes 0
LOVENOX 0.4 (ENOXAPARIN) Syringes 0 56
RESFAR 25 ML INJEKSI Botol 0
N-ASETILSISTEIN INJEKSI (RESFAR) Vial 0
FARMABEX-C TABLET Tablet 0
N-ASETILSISTEIN INJEKSI (RESFAR) Botol 0 59
DOMPERIDON DROP Botol 3
REMDESIVIR INJEKSI 100 MG (COVIFOR) Vial 0
UREA CREAM 10% (SOFT U DERM) Tube 71
AZITROMICIN 500MG INJEKSI (AZIVOL) Vial 0
HP PRO KAPSUL Kapsul 0 371
CARVEDILOL 25 MG TAB Tablet 1.097
VIT D3 1000 IU (PROVE) Tablet 600 80 180
METHISOPRINOL Tablet 19
FAVIFIRAPIR 200 MG Tablet 0 18
AMINOSTERIL INFANT 10% Botol 0 4
PEINLOSS INJEKSI (IBUPROFEN INJEKSI) Vial 0 13
SURVANTA Botol 0 1
VANCOMISIN INJEKSI Vial 0
FERRO K SIRUP Botol 31
FLUCONAZOLE INFUS Botol 3
COMBIVENT RESP Pieces 96
PRAMIPEXOL 0,375MG TAB (PRAMIFROL) Tablet 274
PIPERACILIN + TAZOBAKTAM (TAZAM) Vial 0
ARDIUM TAB Tablet 0
PULMICORT Ampul 142
NICARDIPIN 1MG/ML 10 ML AMPUL Ampul 0 3
CEFTAZIDIM INJEKSI Vial 0 19
TREMENZA TABLET Tablet 666
AMIKACIN INJEKSI Vial 0
FDC : TENOFOVIR + LAMIVUDIN +
DOLUTOGRAVIR Botol 32
FOSFOMYCIN SODIUM INJEKSI 2 GRAM

Ampul 0
(FOSMICIN)
TOPIRAMAT 25MG TAB (MIGATROP) Tablet 120
VITAMIN C 250 MG Tablet 116
SERETIDE ANAK 50 MCG Botol 4
VIT D3 5000 IU (HI-D) TAB Tablet 9
STRONGER NEO MINOPHIGEN C (SNMC) Tablet 0 1
DONEPEZIL TAB Tablet 0
AMINO L600 INFUS Botol 0 2
XARELTO 10MG TAB (RIVAROXABAN) Kaplet 0 20
LIDOCAIN COMPOSITUM Ampul 4
REMDESIVIR 100 MG (REMDAC) Botol 0 52
REMDESIVIR 100 MG (REMCOR) Botol 0 2
AMIKACIN INJEKSI 250 MG Vial 0 3
NISTATIN DROP GENERIK Botol 6
Pen
RYZODEG INSULIN 217
Insulin
IPRATOPROPIUM Ampul 0 1
HALOPERIDOL INJEKSI Ampul 0 3
AMOXICILLIN SYR 125MG/5ML Syrup 20
ZIDOVUDIN 100 MG Kaplet 0
CENDO MIDRIATIL 1 ML Botol 73
CENDO PANTOCAIN 1 ML Botol 73
SILOXAN ED 5 ML Botol 9
SILOXAN 1 ML Botol 36
NATRIUM HYALURONAT (UMARONE) Botol 17
TRIAMCINOLON INJEKSI Vial 0
Triamcinolon 1 ML Vial 458
VAKSIN POLIO PER TETES - 1
VAKSIN BCG PER ML Mili Liter 0
OCTENIC GEL 20 GR Tube 18
OCTENIC GEL 10 GR (POT) Pot 31
BUPIVACAIN INJ (MARCAIN) Ampul 0 3
CARBAZOCHROME SODIUM (ADONA) INJ Ampul 0
FLUOKSETIN Tablet 92
CARBAZOCHROME INJEKSI Ampul 0
CENDO P-PRED Minidose 49
CETIRIZINE DROP (GENERIK) Botol 0
MEPROVENT RESPULES - 182
LACIDOFIL SACHET Sachet 0
ROCURONIUM INJEKSI (NOVERON) Vial 21
LEVOTIROKSIN Tablet 0
CITICOLINE INJEKSI Ampul 0 8
LEVOTIROKSIN 100MG Tablet 104
DONEPEZIL 5MG TAB Tablet 636
ALBENDAZOL TAB Tablet 1
TERBUTALIN NEBU (BRICASMA) Ampul 0
LAMOTIGRIN (LAMICTAL) Tablet 143
MECOBALAMIN KAPSUL 500 MG Tablet 14.367
MCB Kapsul 0
PHYTOMENADIONE 10MG/ML (VIT K) Ampul 2
MECOBALAMINE Ampul 0 43
HISPHAGEN INJ Ampul 0
AZITROMICIN 500MG INJ Vial 0
MESTINON 60 MG Kapsul 0
LEVETIRACETAM TAB Tablet 0
KLORAMFENIKOL SALEP KULIT (BUFACETIN) Tube 1
KLORAMFENIKOL SALEP MATA (ERLAMICETIN) Tube 1
VIT A 100.000 UI Kapsul 0
VAKSIN INFLUSENZA (FLUBIO) Vial 0
all 60801.2 2555 13429

non fornas 19238 615 1439
fornas 41563.2 1940 11990
PEMAKAIAN OBAT FORNAS DAN NON FORNAS PERIODE NOVEMBER
2022

ACARBOSE 100MG Tablet 14.184
AMBROXOL 30MG Tablet 3600 50 20
BFLUID Kolf 0 1
AMIODARONE HCL INJEKSI Ampul 0 4 4
AMLODIPIN 5MG Tablet 5
ANTALGIN Tablet 0
ANTASIDA DOEN Tablet 3.638
Supposito
ria
ASAM FOLAT 1MG Tablet 11970
ASAM MEFENAMAT 500MG Tablet 6.093 20
ASAM TRANEKSAMAT 500MG/5ML INJEKSI Ampul 0 230
ASERING Kolf 0 104
ASPILET Tablet 0
ATRACURIUM INJ 25MG/2.5ML Vial 0
AVAMYS (FLUTICASONE FUMARATE) NASAL
Botol 57
SPRAY
AZITROMICIN 200MG/5ML SYRUP KERING Botol 0
BACTROBAN (MUPIROCIN) OINTMENT Tube 0
BERRYVISION TAB Kapsul 972
BUPIVACAIN SPINAL 5MG/ML INJEKSI
Ampul 76
(REGIVEL)
BUSCOPAN Tablet 0
HIOSIN BUTIL BROMIDA 20 MG/ML INJEKSI Ampul 0 8
CEFAZOLIN 1GRAM INJEKSI Vial 0 2
CEFEPIME INJEKSI Ampul 0 8
CEFIXIME SYRUP 100MG/5ML (ABIXIM) Botol 0
CENDO CENFRESH (KARBOKSIMETIL SELULOSA) Minidose 15
CENDO HERVIS Tube 0
CENDO POLYDEX (POLIMIKSIN B-SULFAT,
Minidose 0
NEOMYCIN SULFAT, DEXAMETASON)
Minidose 337
DEXAMETASON)
CENDO PROTAGENTA (POLIPYVIL PIROLIDONE) Minidose 133
ETIL KLORIDA SPRAY Botol 0
CIPROFLOXACIN 500MG Tablet 962
CIPROFLOXACIN DRIP Botol 0 79
CTM 4MG Tablet 1.283
Supposito
CYGEST SUPPOS 0
ria
DEXAMETASONE 0,5MG Tablet 1083
DIAFORM Tablet 35
Supposito
ria
Supposito
ria 8
DIGOXIN 0,25MG Tablet 170
DIMENHYDRINATE 50 MG Tablet 191
DOBUTAMIN 250MG/5ML Ampul 0 14
DOMPERIDON SYRUP 5MG/5ML (MONELL) Botol 0
DOMPERIDON SYRUP 5MG/5ML (VOMETA) Botol 0
DOPAMIN HCL 40MG/ML INJEKSI (INDOP) Ampul 0
Supposito
DULCOLAX SUPPOS 10MG (BISAKODIL) 18
ria
Supposito
DULCOLAX SUPPOS 5MG ria 1
DUPHASTON DYDROGESTERONE 10MG Tablet 24
EPINEFRIN HCl 0,1% INJEKSI Ampul 0 3 60
FARTISON Vial 0
FENOBARBITAL 50MG/ML IM Ampul 0
FENTANYL 2 CC (100 mcg) Ampul 0 67
FERITRIN Kapsul 0
FLADYSTIN Ovula 21
FOLAMIL GENIO Box 8
FUROSEMIDE IM. IV INJEKSI 10MG/ML Ampul 0 87 300
G. ORALIT 200 Sachet 142
GELOFUSIN Kolf 0
GENTAMICIN 40MG/ML INJEKSI Ampul 0 21 100
GG 100 Tablet 108
HALOTAN Vial 0
HIDROCHLORTIAZID TAB (HCT) Tablet 5048
HIDROKSI ETIL STARCH (HES) INFUS Kolf 0
ISDN 5MG Tablet 893
KAEN 1B Botol 0 18
KAEN 3A Botol 0 24
KAEN 3B Botol 0 41
KAEN 4A Kolf 0
KAEN 4B Kolf 0
KALIUM DIKLOFENAK 50MG Tablet 1.217
KCL 7,46 Botol 0 10 161
KENACORT-A SALEP KULIT (TRIAMSINOLON) Tube 0
Supposito
ria 39 200
KETAMIN HAMELN 50MG/ML Vial 0
KLORAMFENIKOL TETES MATA (ERLAMYCETIN) Botol 0
LACTULOSE SYRUP (LACTULAX) Botol 0
LAKTO B / L-BIO Sachet 622
LANSOPRAZOL 30mg Kapsul 12.765 40 100
Pen
Insulin
LEVODOPA Tablet 0
LIDOCAIN 2ML INJEKSI Ampul 100 22 200
LOPERAMID Tablet 66
METAMPIRON Tablet 0
METILERGOMETRIN 0,2MG/ML INJEKSI Ampul 0 131
METOCLOPRAMIDE 10 MG Tablet 1.608
METOCLOPRAMIDE HCL 10MG/2ML INJEKSI Ampul 0 283
MEYLON 8,4% Kolf 0 6
MGSO4 40% 25ML Botol 0 23
METILPREDNISOLON INJ 125 MG/ML Vial 4 4 77
MICROLAX SUPPOS Tube 20
MIDAZOLAM 5 ML (5 MG) MILOZ Ampul 0 19
MINERAL MIX Box 0
NACL 0,9% 500ML Botol 50 200 600
NACL 0.9% 100ML Botol 0 400 600
NASACORT (TRIAMSINOLON) NASAL SPRAY Botol 0
NEUROBION 500MG INJEKSI Ampul 0
NIFEDIPIN 10MG Tablet 1.208
Pen
NOVOMIX-30 Insulin 0
Pen
Insulin
OAT ANAK 3FDC (INTENSIF) Tablet 756
OBH SYR Botol 7
OMEPRAZOL 20MG Kapsul 6.919
ONDANSENTRON 8 MG Tablet 1.457
Supposito
ria
Supposito
PARACETAMOL 160MG SUPPOS ria 0
Supposito
ria
Supposito
ria
PARACETAMOL 500MG Tablet 23580
Supposito
PARACETAMOL 80MG SUPPOS (PROPYRETIC) 14
ria
PARACETAMOL SYRUP (SANMOL SYRUP) Botol 0
LIDOCAIN 2% + EPINEFRIN INJ (PEHACAIN) Ampul 145
PETHIDIN HCl 2 CC (100 MG) Ampul 0 5
PIROKSIKAM 10MG Tablet 0
POTASSIUM KLORIDA (KSR) Tablet 1.269
PRITAGESIC (METAMPIRON, VITAMIN B1,B6.
Kaplet 0
B12)
PROPANOLOL 10MG Tablet 1710
Supposito
PRORIS 0
ria
Vial 0
METHYLSULPHATE) INJEKSI
PSEUDOEFEDRIN HCl DROP Botol 0
RANITIDIN 150MG Tablet 2150
RANITIDIN 25MG/ML INJEKSI 2ML Ampul 0 455 700
Supposito
RECTOLAX 0
ria
RHINOS SR Kapsul 42
RHINOS JUNIOR SIRUP (PSEUDOEPHEDRINE
Botol 0
HCL 15MG + CTM 1MG)
RHINOS NEO DROP (PSEUDOEPHEDRINE
Botol 0
7,5MG)
RINGER LAKTAT 1000CC Kolf 0
RINGER LAKTAT 500ML Kolf 0
SALEP 2-4 KOMBINASI Pot 0
SEVOFLURAN Vial 0
TEOFILIN (BRONSOLVAN) Tablet 1.004
TRAMADOL HCL 100mg/2ml IM.IV Vial 0 37 200
TREMENZA Kapsul 0
MANTOUX Vial 0
VAKSIN TETANUS TOKSOID Vial 0 5
VAKSIN BIOSAT 1.5 (ANTI TETANUS SERUM
Vial 0
1500 UI)
SALBUTAMOL (VENTOLIN) RESPULES Respules 417
VERMOX Tablet 0
VIT B6 Tablet 3.109
VIT C 50MG Tablet 2.226 100
VOLUVEN INFUS Kolf 0
WARFARIN 2MG TAB (SIMARC / NOTISIL) Tablet 560
WI 25ML Botol 0 100 110
ZINK 20 MG TAB Tablet 1140
N-ASETILSISTEIN TAB Tablet 5.547
MOXIFLOXACIN HCL 500 Botol 0
FENOBARBITAL IV (SIBITAL) Ampul 1 5 5
NACL 3% Kolf 0 33
RAMIPRIL 2.5 MG TABLET Tablet 994
ASAM ASETAT 20 LITER DERIGEN Derigen 0
NATRIUM DIKLOFENAK GEL (FLAMAR GEL Tube 0
RD (RINGER DEXTROSE) INFUS Kolf 0
CEFIXIME 200 MG TAB Tablet 4.418
FLAMAR GEL Pieces 0
FRESOFOL (PROPOFOL) INJEKSI Vial 0 20
LEVOFLOXACIN TTS MATA BTL (CRAVIT) Botol 0
LEVOFLOXACIN TTS MATA BTL (LEVOCIN) Tube 0
IPROX (IBUPROFEN) SIRUP Botol 0
OPTIMAX TAB VIT MATA Tablet 18
PYRAZINAMID 500MG TAB Tablet 1.308
CLOBETASOL (KLODERMA) SALEP 5 GR Tube 0
MOMETASONE (MOFACORT) SALEP 10 GR Tube 0
NITROGLISERIN (NTG) INJEKSI Ampul 0
TIMOLOL 0.25% (ADRETOR TETES MATA) Botol 0
VAKSIN BIO TD (TETANUS - DIFTERI) JERAP TD Vial 0
VAKSIN BCG (ANTI - TBC) Vial 1
VAKSIN POLIO Vial 0
VAKSIN DPT + HEPATITIS B REKOMBINAN Vial 2
INFUS BES (BALANCE ELECTROLYTE SOL) Kolf 0
LEVOFLOXACIN TTS MATA BTL (CENDO LFX) Kolf 0
CENDO FENICOL 0.5% Botol 0
NACL (KAPSUL GARAM) 500 MG Kapsul 0 22
IOPAMIDOL Botol 0
TRAMADOL 50 MG TABLET Tablet 3.093
KETOMED CREAM (KETOKONAZOL) 15 GR Tube 0
MEDICORT CREAM (FLUTICASONE) 5 GR Tube 0
KETOMED SCALP SOLUTION (SHAMPOO) Botol 12
RIFAMPISIN 450 MG Tablet 1.082
LISINOPRIL 5 MG TABLET (TENSIPHAR) Tablet 0
GENTAMISIN SULFAT KRIM (GENTALEX) Tube 0
PROPOFOL INJEKSI 20 ML Ampul 0 37
VAKSIN HEPATITIS B REKOMBINAN 0.5 ML Ampul 99
Isofluran 1 ml Mili Liter 225
Sevofluran 1 ml Mili Liter 220
Ketamin injeksi 1 ml Mili Liter 0 4
TRIHEXYLPHENIDYL 2MG TAB Tablet 998
MOMETASONE (MOFACORT) KRIM 5 GR Tube 6
TIZANIDINE 2MG TAB Tablet 1.281
Supposito
ria
Supposito
ria
SPORACID CAP 100MG (ITRACONAZOLE) Kapsul 0
AMPISILIN-SULBACTAM (VICILIN SX 1.5 GRAM) Vial 0
197
SALBUTAMOL SIRUP 2MG/5ML (ASTHAROL
Botol 0
SIRUP)
ASAM TRANEKSAMAT 250MG/5ML INJEKSI Vial 0
HYOCINE INJEKSI 20MG/ML Ampul 0 28
VAKSIN TETANUS TOKSOID (1 ML) Vial 1
HEP IMUNOGLOBULIN Vial 0
DESOLEX LOTION Tube 0
KETAMIN INJEKSI Ampul 0 3
LOPINAVIR Tablet 0
FDC : ZIDOVUDIN (AZT/ZDV) + LAMIVUDIN
(3TC) 300/150 MG Tablet 0
TRIPLE FDC DEWASA : TDF + 3TC + EFV

Tablet 531
(300/300/600) MG
ASAM ASETAT SATUAN PER 10 ML Mili Liter 0
Pen
Insulin
Pen
APIDRA 70
Insulin
TRIDEX 27 A Softbag 0
TRIDEX 27 B Softbag 0
BUNASCAN SPINAL 0.5PCT HEAVY 4 ML Ampul 0
HUMALOG MIX 5O KWIKPEN Pen 0
Insulin
VERORAB Ampul 0
Pen
Insulin
METAMIZOL INJEKSI Ampul 0 20
VIT C 500 MG Kapsul 1.061 50 100
CATAPRESS / CLONIDIN 0,15 MG/ML Ampul 0 2
DIAZEPAM INJEKSI 1 ML (5 MG) Ampul 0 1
SCOPMA (HYOSCINE BUTILBROMIDE) TABLET Tablet 299
KIDMIN 200ML SOFTBAG Softbag 0
HYOSCINE N BUTIL BROMIDE INJEKSI Ampul 0 25
CILOSTAZOL KAPS (PLETAAL SR) Kapsul 1.223
N-ASETILSISTEIN INJEKSI (RESFAR) 1200 MG -
6ML Botol 0
29
REMDESIVIR INJEKSI 100 MG (COVIFOR) Vial 0
ACTEMRA Botol 0
AZITROMICIN 500MG INJEKSI (AZIVOL) Vial 0 1
CARVEDILOL 25 MG TAB Tablet 1.128
VIT D3 1000 IU (PROVE) Tablet 0 1317
PEINLOSS INJEKSI (IBUPROFEN INJEKSI) Vial 0 36
SURVANTA Botol 0
COMBIVENT RESP Pieces 0 52
PRAMIPEXOL 0,375MG TAB (PRAMIFROL) Tablet 128
ARDIUM TAB Tablet 0
PULMICORT Ampul 185 50
TREMENZA TABLET Tablet 1.644
Botol 11
DOLUTOGRAVIR
FOSFOMYCIN SODIUM INJEKSI 2 GRAM
Ampul 0
(FOSMICIN)
VITAMIN C 250 MG Tablet 88
VIT D3 5000 IU (HI-D) TAB Tablet 0 90
STRONGER NEO MINOPHIGEN C (SNMC) Tablet 0 4
AMINO L600 INFUS Botol 0
XARELTO 10MG TAB (RIVAROXABAN) Kaplet 0 53
REMDESIVIR 100 MG (REMDAC) Botol 0 8
REMDESIVIR 100 MG (REMCOR) Botol 0 43
Pen
RYZODEG INSULIN 350
Insulin
HALOPERIDOL INJEKSI Ampul 0
PARAFIN WAX Bungkus 0
CENDO MIDRIATIL 1 ML Botol 0 67
CENDO PANTOCAIN 1 ML Botol 0 65
SILOXAN ED 5 ML Botol 0 11
SILOXAN 1 ML Botol 0 40
VAKSIN POLIO PER TETES - 0
VAKSIN BCG PER ML Mili Liter 0
CARBAZOCHROME SODIUM (ADONA) INJ Ampul 0
UNIVIT SYRUP Botol 0
LACIDOFIL SACHET Sachet 0
ROCURONIUM INJEKSI (NOVERON) Vial 0 11
MECOBALAMIN KAPSUL 500 MG Tablet 15.695
MECOBALAMINE Ampul 16
HISPHAGEN INJ Ampul 0
KLORAMFENIKOL SALEP KULIT (BUFACETIN) Tube 2
KLORAMFENIKOL SALEP MATA (ERLAMICETIN) Tube 3
all 100011.395 2816 14608
non fornas 20722 100 2487
fornas 79289.395 2716 12121
PEMAKAIAN OBAT FORNAS DAN NON FORNAS PERIODE
DESEMBER 2022

AMBROXOL 30MG Tablet 2.933 130 50
BFLUID Kolf 0 12
AMIODARONE HCL INJEKSI Ampul 0 22
AMLODIPIN 5MG Tablet 4024
AMOXICILIN 500MG Tablet 1.512 100
ANALSIK TAB (METAMPIRON +
Tablet 0
DIAZEPAM)
ANTALGIN Tablet 0
ANTASIDA DOEN Tablet 2.722
Supposito
ria 47
ASAM FOLAT 1MG Tablet 12.086
ASAM MEFENAMAT 500MG Tablet 5200 88
ASAM TRANEKSAMAT 500MG/5ML
Ampul 0
INJEKSI 333
ASERING Kolf 0 55
ASPILET Tablet 0
ATRACURIUM INJ 25MG/2.5ML Vial 0 3
AVAMYS (FLUTICASONE FUMARATE)
Botol 66
NASAL SPRAY
AZITROMICIN 200MG/5ML SYRUP
Botol 0
KERING
BACTROBAN (MUPIROCIN)
Tube 0
OINTMENT
BERRYVISION TAB Kapsul 975
BERRYVISION FORTE Kapsul 0
BROMHEKSIN SYR (LEXAVON) Botol 0
BUPIVACAIN SPINAL 5MG/ML INJEKSI
(REGIVEL) Ampul 0
67
BUSCOPAN Tablet 0
HIOSIN BUTIL BROMIDA 20 MG/ML
Ampul 0
INJEKSI 24
CALGAE Kapsul 0
CALCIFAR Kapsul 0
CEFADROXIL SUSP KERING
Botol 0
250MG/ML
CEFAZOLIN 1GRAM INJEKSI Vial 0
CEFEPIME INJEKSI Ampul 0
CEFIXIME SYRUP 100MG/5ML
(ABIXIM) Botol 0
CENDO CENFRESH (KARBOKSIMETIL
Minidose 0
SELULOSA)
CENDO HERVIS Tube 0
CENDO POLYDEX (POLIMIKSIN B-
SULFAT, NEOMYCIN SULFAT, Minidose 0
DEXAMETASON)
Minidose 284
DEXAMETASON)
CENDO PROTAGENTA (POLIPYVIL
Minidose 159
PIROLIDONE)
ETIL KLORIDA SPRAY Botol 0
CIPROFLOXACIN 500MG Tablet 673
CIPROFLOXACIN DRIP Botol 127
CRIPSA (BROMKRIPTIN MESILAT) Tablet 0
CTM 4MG Tablet 989 40
Supposito
CYGEST SUPPOS 0
ria
DEXAMETASONE 0,5MG Tablet 1.427
DIAFORM Tablet 0
DIAZEPAM 10MG/2,5ML SUPP Supposito
0
(STESOLID) ria 2 1
DIAZEPAM 5MG/2,5ML SUPP Supposito
2
(STESOLID) ria 0 5
DIAZEPAM INJEKSI 2 ML (10 MG) Ampul 0 10 10
DIGOXIN 0,25MG Tablet 77 0 0
DIMENHYDRINATE 50 MG Tablet 151 0 0
DOBUTAMIN 250MG/5ML Ampul 0 10 8
DOMPERIDON SYRUP 5MG/5ML
Botol 0
(MONELL)
DOMPERIDON SYRUP 5MG/5ML
Botol 0
(VOMETA)
DOPAMIN HCL 40MG/ML INJEKSI
Ampul 0
(INDOP) 3
DULCOLAX SUPPOS 10MG Supposito
16
(BISAKODIL) ria
Supposito
DULCOLAX SUPPOS 5MG 2
ria
DUPHASTON DYDROGESTERONE Tablet 26
10MG
ELKANA SYRUP Botol 0
EPINEFRIN HCl 0,1% INJEKSI Ampul 0 25 28
FARTISON Vial 0
FENOBARBITAL 50MG/ML IM Ampul 0
FENTANYL 2 CC (100 mcg) Ampul 0 56
FERITRIN Kapsul 0
FLADYSTIN Ovula 27
FOLAMIL GENIO Box 9
FUROSEMIDE IM. IV INJEKSI
Ampul 0
10MG/ML 100 97
G. ORALIT 200 Sachet 100 43
GELOFUSIN Kolf 0 9
GENTAMICIN 40MG/ML INJEKSI Ampul 0 35 100
GG 100 Tablet 85
GRALYSIN Botol 0
HALOTAN Vial 0
HIDROCHLORTIAZID TAB (HCT) Tablet 1.787
ISDN 5MG Tablet 1.229
KAEN 1B Botol 0 17
KAEN 3A Botol 0 15
KAEN 3B Botol 0 26
KAEN 4A Kolf 0
KAEN 4B Kolf 0
KALIUM DIKLOFENAK 50MG Tablet 708
KCL 7,46 Botol 0 10 65
KENACORT-A SALEP KULIT
(TRIAMSINOLON) Tube 0
Supposito
ria 148
KETAMIN HAMELN 50MG/ML Vial 0 2
KLORAMFENIKOL TETES MATA
Botol 0
(ERLAMYCETIN)
LACIDOFIL Sachet 0
LACTULOSE SYRUP (LACTULAX) Botol 0
LAKTO B / L-BIO Sachet 600 105
LANSOPRAZOL 30mg Kapsul 11027 100 500
Pen
Insulin
LEVODOPA Tablet 0
LIDOCAIN 2ML INJEKSI Ampul 80 80 120
LOPERAMID Tablet 78
METAMPIRON Tablet 0
METILERGOMETRIN 0,2MG/ML
Ampul 0
INJEKSI 119
METOCLOPRAMIDE 10 MG Tablet 817
METOCLOPRAMIDE HCL 10MG/2ML
INJEKSI Ampul 0
100 115
MEYLON 8,4% Kolf 0 6 5
MGSO4 40% 25ML Botol 0 4 5
METILPREDNISOLON INJ 125 MG/ML Vial 0
5 127
MICROLAX SUPPOS Tube 6 5
MIDAZOLAM 5 ML (5 MG) MILOZ Ampul 0 67
MINERAL MIX Box 0
NACL 0,9% 500ML Botol 55 201 500
NACL 0.9% 100ML Botol 0 200 662
NASACORT (TRIAMSINOLON) NASAL
Botol 0
SPRAY
NEOCENTA GEL Tube 0
NEOMISIN SULFAT Tube 0
NEUROBION 500MG INJEKSI Ampul 0
NIFEDIPIN 10MG Tablet 678
Pen
NOVOMIX-30 0
Insulin
Pen
Insulin
OAT ANAK 3FDC (INTENSIF) Tablet 705
OBH SYR Botol 2
OMEPRAZOL 20MG Kapsul 5.949
PARACETAMOL 125MG SUPPOS Supposito
0
(DUMIN) ria 10 7
Supposito
ria
Supposito
ria
PARACETAMOL 250MG SUPPOS Supposito
0
(DUMIN) ria 3
PARACETAMOL 500MG Tablet 20.183 100
PARACETAMOL 80MG SUPPOS Supposito 0
(PROPYRETIC) ria 10 8
PARACETAMOL SYRUP (SANMOL
Botol 0
SYRUP)
LIDOCAIN 2% + EPINEFRIN INJ
Ampul 133
(PEHACAIN)
PETHIDIN HCl 2 CC (100 MG) Ampul 0
POTASSIUM KLORIDA (KSR) Tablet 1.438
PRITAGESIC (METAMPIRON, VITAMIN
B1,B6. B12) Kaplet 0
PROPANOLOL 10MG Tablet 1063
Supposito
PRORIS 0
ria
Vial 0
METHYLSULPHATE) INJEKSI 3
PSEUDOEFEDRIN HCl DROP Botol 0
RANITIDIN 150MG Tablet 1.404 20
RANITIDIN 25MG/ML INJEKSI 2ML Ampul 0 400 550
Supposito
RECTOLAX ria 0
RHINOS SR Kapsul 0
RHINOS NEO DROP
Botol 2
(PSEUDOEPHEDRINE 7,5MG)
RINGER LAKTAT 1000CC Kolf 0
RINGER LAKTAT 500ML Kolf 0
SALBUTAMOL 4MG TAB Tablet 1089 15 20
SEVOFLURAN Vial 0
STIMUNO Botol 0
TEMPRA SIRUP 60ML Botol 0
TEOFILIN (BRONSOLVAN) Tablet 533
TRAMADOL HCL 100mg/2ml IM.IV Vial 0 254
TREMENZA Kapsul 0
UMARONE (SOD HYALURONATE)
Vial 0
INJEKSI
MANTOUX Vial 0
VAKSIN TETANUS TOKSOID Vial 0 12 0
VAKSIN BIOSAT 1.5 (ANTI TETANUS
Vial 0
SERUM 1500 UI)
SALBUTAMOL (VENTOLIN) RESPULES Respules 0 219 210
VERMOX Tablet 0
VIT B6 Tablet 2.525
VIT C 50MG Tablet 1.582
WARFARIN 2MG TAB (SIMARC /
Tablet 407
NOTISIL)
WI 25ML Botol 0 31 200
ZINK 20 MG TAB Tablet 767 50 50
N-ASETILSISTEIN TAB Tablet 3.105
MOXIFLOXACIN HCL 500 Botol 0 16
FENOBARBITAL IV (SIBITAL) Ampul 0 6
NACL 3% Kolf 5 30 5
RAMIPRIL 2.5 MG TABLET Tablet 1.189
CEFIXIME 200 MG TAB Tablet 3074
FLAMAR GEL Pieces 0
FRESOFOL (PROPOFOL) INJEKSI Vial 22
LEVOFLOXACIN TTS MATA BTL
(CRAVIT) Botol 0
1
Tube 0
(LEVOCIN)
IPROX (IBUPROFEN) SIRUP Botol 0
PYRAZINAMID 500MG TAB Tablet 972
CLOBETASOL (KLODERMA) SALEP 5
Tube 0
GR
MOMETASONE (MOFACORT) SALEP
Tube 0
10 GR
NITROGLISERIN (NTG) INJEKSI Ampul 0
TIMOLOL 0.25% (ADRETOR TETES
Botol 3
MATA)
VAKSIN BIO TD (TETANUS - DIFTERI)
Vial 0
JERAP TD
VAKSIN POLIO Vial 9
VAKSIN DPT + HEPATITIS B
Vial 0
REKOMBINAN
INFUS BES (BALANCE ELECTROLYTE
Kolf 0
SOL)
ASKINA FOAM Botol 0
DEXTROSE 5% 1/2 SALINE (D5 1/2 NS) Kolf 0
48
DEXTROSE 5% 1/4 SALINE (D5 1/4 NS) Kolf 0
138
Kolf 0
(CENDO LFX)
NACL (KAPSUL GARAM) 500 MG Kapsul 18
IOPAMIDOL Botol 0
TRAMADOL 50 MG TABLET Tablet 3.138
KETOMED CREAM (KETOKONAZOL)
Tube 1
15 GR
MEDICORT CREAM (FLUTICASONE) 5
Tube 3
GR
KETOMED SCALP SOLUTION
Botol 19
(SHAMPOO)
PRONTOSAN GEL SATUAN PER POT Pot 0
RIFAMPISIN 450 MG Tablet 856
LISINOPRIL 5 MG TABLET
Tablet 0
(TENSIPHAR)
GENTAMISIN SULFAT KRIM
Tube 0
(GENTALEX)
VASELIN PUTIH SATUAN PER POT 50
Pot 24
GR

PROPOFOL INJEKSI 20 ML Ampul 21
VAKSIN HEPATITIS B REKOMBINAN
Ampul 64
0.5 ML

Isofluran 1 ml Mili Liter 0 456
Sevofluran 1 ml Mili Liter 0 456
Ketamin injeksi 1 ml Mili Liter 0
TRIHEXYLPHENIDYL 2MG TAB Tablet 1.217
MOMETASONE (MOFACORT) KRIM 5

Tube 4
GR
TIZANIDINE 2MG TAB Tablet 842
PARACETAMOL 125MG SUPP Supposito
0
(PAMOL) ria
PARACETAMOL 250MG SUPP Supposito
0
(PAMOL) ria
SPORACID CAP 100MG
Kapsul 0
(ITRACONAZOLE)
AMPISILIN-SULBACTAM (VICILIN SX
1.5 GRAM) Vial 0
315
SALBUTAMOL SIRUP 2MG/5ML
Botol 0
(ASTHAROL SIRUP)
ASAM TRANEKSAMAT 250MG/5ML
Vial 0
INJEKSI
HYOCINE INJEKSI 20MG/ML Ampul 0 10 43
SERETIDE DISKUS 50/250MCG Tube 90
KETAMIN INJEKSI Ampul 0
LOPINAVIR Tablet 0
FDC : ZIDOVUDIN (AZT/ZDV) +
Tablet 0
LAMIVUDIN (3TC) 300/150 MG
TRIPLE FDC DEWASA : TDF + 3TC +
Tablet 501
EFV (300/300/600) MG
Pen
Insulin
Pen
APIDRA 62
Insulin
BUNASCAN SPINAL 0.5PCT HEAVY 4
Ampul 0
ML
Pen
HUMALOG MIX 5O KWIKPEN 0
Insulin
Pen
Insulin
METAMIZOL INJEKSI Ampul 24
VIT C 500 MG Kapsul 162
SCOPMA (HYOSCINE BUTILBROMIDE)
Tablet 198
TABLET
KIDMIN 200ML SOFTBAG Softbag 0 15
HYOSCINE N BUTIL BROMIDE INJEKSI Ampul 0
38
CILOSTAZOL KAPS (PLETAAL SR) Kapsul 869
N-ASETILSISTEIN INJEKSI (RESFAR)
Botol 0
1200 MG - 6ML 48
CLOSED SUCTION NO 12 Pieces 0
REMDESIVIR INJEKSI 100 MG
Vial 0
(COVIFOR)
ACTEMRA Botol 0
AZITROMICIN 500MG INJEKSI
Vial 0
(AZIVOL)
CARVEDILOL 25 MG TAB Tablet 847
VIT D3 1000 IU (PROVE) Tablet 161 500
PEINLOSS INJEKSI (IBUPROFEN
Vial 30
INJEKSI)
COMBIVENT RESP Pieces 62
PRAMIPEXOL 0,375MG TAB
Tablet 106
(PRAMIFROL)

ARDIUM TAB Tablet 2 13
PULMICORT Ampul 331
TREMENZA TABLET Tablet 1015
Botol 125
DOLUTOGRAVIR
FOSFOMYCIN SODIUM INJEKSI 2
Ampul 0
GRAM (FOSMICIN)

VIT D3 5000 IU (HI-D) TAB Tablet 100 85
STRONGER NEO MINOPHIGEN C
Tablet 0
(SNMC) 3
AMINO L600 INFUS Botol 0
XARELTO 10MG TAB (RIVAROXABAN) Kaplet 0
9
REMDESIVIR 100 MG (REMDAC) Botol 0
REMDESIVIR 100 MG (REMCOR) Botol 0
AMIKACIN INJEKSI 250 MG Vial 0
Pen
RYZODEG INSULIN 78
Insulin
HALOPERIDOL INJEKSI Ampul 0 3
CENDO MIDRIATIL 1 ML Botol 0 49
CENDO PANTOCAIN 1 ML Botol 0 47
SILOXAN ED 5 ML Botol 0 18
SILOXAN 1 ML Botol 0 22
OCTENIC GEL 20 GR Tube 7
OCTENIC GEL 10 GR (POT) Pot 19
CARBAZOCHROME SODIUM (ADONA)
Ampul 0
INJ
ROCURONIUM INJEKSI (NOVERON) Vial 0 10
LIDOCAIN CATHETER GEL (CATHEJELL) Tube 4
CEFADROXIL SUSP KERING
Botol 0
250MG/ML
MECOBALAMIN KAPSUL 500 MG Tablet 13063
PHYTOMENADIONE 10MG/ML (VIT K) Ampul 0
2
MECOBALAMINE INJEKSI Ampul 0 25
KLORAMFENIKOL SALEP KULIT
(BUFACETIN) Tube 1
KLORAMFENIKOL SALEP MATA

Tube 6
(ERLAMICETIN)
VAKSIN INFLUSENZA (FLUBIO) Vial 0
REMDESIVIR (VEKLURY) Vial 0 5
TEOFILIN (THEOBRON) Tablet 646
all 98554.055 3962 13483

non fornas 18236 130 1159
fornas 80318.055 3832 12324
LAPORAN STOK OPNAME DESEMBER 2022
NO. NAMA OBAT SATUAN EXPIRED DATE STOK AWAL GUDANG HARGA SATUAN RUPIAH STOK AWAL DES PENERIMAAN DES SELAIN PEMBELIAN DISTRIBUTOR RUPIAH PENERIMAAN DES (Rp) PENGELUARAN DES RUPIAH PENGELUARAN DES (Rp) STOK FISIK (GUDANG) ED
1 ACARBOSE 100MG TABLET Jan-24 0 807 - - - - 0 -

2 ACARBOSE 100MG TABLET Jun-24 64800 807 52,293,598 - - - 64800 52,293,598
3 ACARBOSE 50MG TABLET Jun-23 5000 585 2,925,000 - 400 234,000 4600 2,691,000
4 ACARBOSE 50MG TABLET Oct-23 3200 1,059 3,388,800 - 3,200 3,388,800 0 -
5 ACETAZOLAMIDE (GLAUSETA) TABLET Oct-23 0 4,258 - - - - 0 -
6 ACETAZOLAMIDE (GLAUSETA) TABLET May-24 200 3,837 767,400 - - - 200 767,400
7 ACETAZOLAMIDE (GLAUSETA) TABLET Jun-24 500 2,268 1,134,240 - - - 500 1,134,240
8 ACTEMRA VIAL Jan-23 0 7,413,992 - - - - 0 -
9 ADALAT OROS 30mg TABLET Jan-25 28350 3,986 113,003,100 - 3,780 15,067,080 24570 97,936,020
10 ADALAT OROS 30mg TABLET Jul-24 0 4,424 - - - - 0 -
11 ALBENDAZOL TAB TABLET May-23 1000 366 366,000 - 1,000 366,000 0 - karantina produk kftd
12 ALLOPURINOL 100MG TABLET Mar-24 0 189 - - - - 0 -
13 ALLOPURINOL 100MG TABLET Mar-24 0 87 - - - - 0 -
14 ALLOPURINOL 100MG TABLET Sep-24 67200 87 5,846,402 - - - 67200 5,846,402
15 ALPRAZOLAM 0,5MG TABLET Nov-23 0 78 - - - - 0 -
16 ALPRAZOLAM 0,5MG TABLET Apr-25 0 79 - - - - 0 -
17 ALPRAZOLAM 0,5MG TABLET May-25 4500 291 1,311,188 - - - 4500 1,311,188
18 AMBROXOL 30MG TABLET Dec-25 0 133 - - - - 0 -
21 AMBROXOL 30MG TABLET Dec-25 2900 239 692,986 - 1,500 358,441 1400 334,545
22 AMBROXOL DROP (EPEXOL) BOTOL May-24 0 34,232 - - - - 0 -
23 AMBROXOL SYR BOTOL Sep-23 50 3,297 164,850 - - - 50 164,850
24 AMIKACIN INJEKSI 250 MG VIAL May-23 100 28,875 2,887,500 - - - 100 2,887,500
25 AMIKACIN INJEKSI 500 MG VIAL Mar-23 68 49,500 3,366,000 - - - 68 3,366,000
26 AMINO L 600 BOTOL Dec-23 45 51,190 2,303,550 - - - 45 2,303,550
27 AMINOPHYLIN 24MG/ML INJEKSI IV AMPUL Sep-24 90 2,704 243,359 - - - 90 243,359
28 AMINOPHYLLIN TAB 200 MG TABLET Nov-23 200 110 22,000 - - - 200 22,000
29 AMINOPHYLLIN TAB 200 MG TABLET Oct-24 200 231 46,200 - - - 200 46,200
30 AMINOSTERIL INFANT BOTOL Jun-23 0 44,099 - - - - 0 -
31 AMINOSTERIL INFANT BOTOL Nov-23 20 44,099 881,984 - 10 440,992 10 440,992
32 AMIODARONE HCL 50MG/ML INJEKSI AMPUL Sep-23 25 6,118 152,950 - - - 25 152,950
33 AMIODARONE HCL 50MG/ML INJEKSI AMPUL Nov-23 50 6,118 305,905 - - - 50 305,905
34 AMIODARONE HCL TABLET TABLET 0 934 - - - - 0 -
35 AMITRIPILIN 25 MG TABLET Mar-25 0 187 - - - - 0 -
36 AMITRIPILIN 25 MG TABLET Apr-26 4000 177 708,000 - 2,000 354,000 2000 354,000
37 AMLODIPIN 10 MG (1) TABLET Jan-25 0 69.93 - - - - 0 -
38 AMLODIPIN 10 MG (1) TABLET Jan-25 69000 70 4,829,766 - - - 69000 4,829,766
39 AMLODIPIN 5MG TABLET Jan-25 0 167 - - - - 0 -
40 AMLODIPIN 5MG TABLET Jan-25 12150 167 2,022,975 - - - 12150 2,022,975
41 AMOXICILIN 500MG TABLET Mar-24 0 402 - - - - 0 -
42 AMOXICILIN 500MG TABLET Mar-24 1000 583 582,750 - 1,000 582,750 0 -
43 AMOXICILIN DROP BOTOL 0 17,760 - - - - 0 -
44 AMOXICILIN DROP BOTOL 0 3,498 - - - - 0 -
45 AMOXILLIN SYR 125 MG/5ML BOTOL Mar-25 247 4,440 1,096,680 - - - 247 1,096,680
46 AMOXILLIN SYR 125 MG/5ML BOTOL Aug-25 400 5,328 2,131,200 - - - 400 2,131,200
47 AMPISILLIN + SULBAKTAM 1.5 GR (BACTESYN) I VIAL Jul-24 1522 20,010 30,455,224 - 120 2,401,200 1402 28,054,024
48 AMPISILLIN + SULBAKTAM 1.5 GR (VICCILLIN SX) VIAL Jun-23 0 20,024 - - - - 0 -
49 AMPISILLIN 1GRAM INJEKSI VIAL Mar-23 660 6,000 3,960,000 - 60 360,000 600 3,600,000
50 AMPISILLIN 250 MG (VICCILLIN) INJEKSI VIAL - 0 5,500 - - - - 0 -
51 ANTASIDA DOEN TABLET Nov-24 1000 111 111,000 - 500 55,500 500 55,500
52 ANTASIDA DOEN SUSP BOTOL Sep-23 0 1,679 - - - - 0 -
53 ANTASIDA DOEN SUSP BOTOL Oct-24 10 1,681 16,810 - - - 10 16,810
54 ANTIHEMOROID DOEN SUPPOS SUPPOS Jul-24 234 3,250 760,500 - - - 234 760,500
55 ANTIHEMOROID DOEN SUPPOS SUPPOS Nov-24 90 5,772 519,480 - - - 90 519,480
56 ANTIRABIES (VERORAB) VIAL 0 153,000 - - - - 0 -
57 APIDRA PEN Feb-24 250 90,314 22,578,399 - 30 2,709,408 220 19,868,991
58 APIDRA PEN Mar-23 335 90,314 30,255,055 - - - 335 30,255,055
59 ARDIUM TAB Feb-25 0 7,700 - - - - 0 -
60 ASAM FOLAT 1MG TABLET Sep-24 45000 92 4,120,875 - 10,000 915,750 35000 3,205,125
61 ASAM FOLAT 1MG TABLET Feb-24 0 56 - - - - 0 -
62 ASAM MEFENAMAT 500MG TABLET Jul-24 0 111 - - - - 0 -
63 ASAM MEFENAMAT 500MG TABLET Jul-25 27700 170 4,704,291 - 2,500 424,575 25200 4,279,716
64 ASAM PIPEMIDAT (URINTER) TABLET Jan-23 1500 1,583 2,374,290 - - - 1500 2,374,290
65 ASAM PIPEMIDAT (URINTER) TABLET May-24 2000 1,583 3,165,387 - 1,800 2,848,848 200 316,539
66 ASAM TRANEKSAMAT 500MG TABLET Aug-24 5000 1,712 8,559,999 - - - 5000 8,559,999
67 ASAM TRANEKSAMAT 500MG TABLET Feb-24 1000 1,362 1,361,970 - - - 1000 1,361,970
68 ASAM TRANEKSAMAT 500MG/5ML INJEKSI AMPUL Aug-24 1120 1,880 2,105,599 - 100 188,000 1020 1,917,599
69 ASAM TRANEKSAMAT 500MG/5ML INJEKSI AMPUL Sep-25 0 5,245 - - - - 0 -
70 ASAM TRANEKSAMAT 500MG/5ML INJEKSI AMPUL Feb-25 0 3,289 - - - - 0 -
71 ASAM URSODEOKSIKOLAT TABLET Dec-24 0 1,694 - - - - 0 -
72 ASAM URSODEOKSIKOLAT TABLET Jul-25; Aug-25 6300 1,694 10,672,198 - 900 1,524,600 5400 9,147,599
73 ASAM VALPROAT BOTOL Aug-24 60 11,637 698,220 - 22 256,014 38 442,206
74 ASERING KOLF Jul-23 0 8,800 - - - - 0 -
75 ASERING KOLF Aug-24 900 8,799 7,919,073 - 40 351,959 860 7,567,114
76 ASIKLOVIR 200MG TABLET Nov-23 0 611 - - - - 0 -
77 ASIKLOVIR 200MG TABLET Jun-24 0 563 - - - - 0 -
78 ASIKLOVIR 5% KRIM TUBE Aug-24 75 1,900 142,500 - 25 47,500 50 95,000
79 ASPARTAT KALIUM TABLET Jan-23 0 630 - - - - 0 -
80 ASPILET (MINIASPI) TABLET Jan-24 0 89 - - - - 0 -
81 ASPILET (MINIASPI) TABLET Sep-24 20900 253 5,292,852 - 2,900 734,415 18000 4,558,437
82 ATENOLOL (FARNORMIN) TABLET Jul-23 100 700 70,000 - - - 100 70,000
83 ATORVASTATIN 20MG TABLET Sep-24 19980 471 9,410,580 - 2,490 1,172,790 17490 8,237,790
84 ATORVASTATIN 20MG TABLET Sep-24 0 471 - - - - 0 -
85 ATRACURIUM BESILATE 25/2,5ML AMPUL Apr-23 10 14,236 142,360 - - - 10 142,360
86 ATRACURIUM BESILATE 25/2,5ML AMPUL Aug-23 120 14,235 1,708,183 - - - 120 1,708,183
87 ATROPIN SULFAT 0,25MG/ML AMPUL Dec-24 500 1,031 515,384 - - - 500 515,384
88 ATROPIN SULFAT 0,25MG/ML AMPUL Aug-24 600 1,718 1,030,800 - - - 600 1,030,800
89 ATTAPULGIT TABLET Nov-24 1100 131 144,100 - - - 1100 144,100
90 ATTAPULGIT TABLET Aug-24 1100 289 317,460 - - - 1100 317,460
91 BOTOL May-24 0 115,400 - - - - 0 -
92 BOTOL May-25 336 116,449 39,126,861 - - - 336 39,126,861
93 AZITROMICIN 200MG/5ML SYRUP KERING BOTOL Sep-24 0 28,860 - - - - 0 -
94 AZITROMICIN 200MG/5ML SYRUP KERING BOTOL Aug-24 100 20,686 2,068,600 - - - 100 2,068,600
95 AZITROMICIN 500MG TABLET Nov-26 2540 1,250 3,175,000 - 200 250,000 2340 2,925,000
96 AZITROMYCIN INFUS BOTOL Jun-23 100 47,920 4,792,000 - - - 100 4,792,000
97 AZITROMYCIN INFUS (AZIVOL) BOTOL Jun-23 120 64,000 7,680,000 - - - 120 7,680,000
98 BENZATIN BENZIL P 1,2 JT IU INJ VIAL - 0 9,800 - - - - 0 -
99 BERRYVISION TABLET Jul-24 1700 2,958 5,028,600 - 500 1,479,000 1200 3,549,600
100 BERRYVISION TABLET Jul-24; Aug-24 3100 2,599 8,057,962 - - - 3100 8,057,962
101 BETAHISTIN MESILATE 6MG TABLET Sep-24 8000 89 712,000 - - - 8000 712,000
102 BETAHISTIN MESILATE 6MG TABLET Dec-23 0 90 - - - - 0 -
103 BETAMETASON 0,1% KRIM (1) TUBE Feb-24 0 2,720 - - - - 0 -
104 BETAMETASON 0,1% KRIM (1) TUBE Sep-24 1100 3,330 3,663,000 - 100 333,000 1000 3,330,000
105 BFLUID KOLF Sep-23 10 76,300 763,000 - 10 763,000 0 -
106 BFLUID KOLF May-25 60 76,300 4,578,024 - - - 60 4,578,024
107 BISACODYL TAB TABLET 0 319 - - - - 0 -
108 BISACODYL TAB (LAXANA) TABLET Feb-26 0 322 - - - - 0 -
109 BISOPROLOL FUMARATE 5 MG TABLET Sep-25 24600 138 3,394,800 - 2,700 372,600 21900 3,022,200
110 BISOPROLOL FUMARATE 5 MG TABLET Sep-24 0 440 - - - - 0 -
111 BISOPROLOL FUMARATE 5 MG TABLET May-25 0 138 - - - - 0 -
112 BRALIFEX PLUS TETES MATA BOTOL 0 38,321 - - - - 0 -
113 BRALIFEX PLUS TETES MATA BOTOL Apr-23 10 39,270 392,700 - 10 392,700 0 -
114 BRALIFEX PLUS TETES MATA BOTOL Feb-24; Mar-24 350 38,306 13,407,135 - 14 536,285 336 12,870,850
115 BREATHY NASAL DROP BOTOL 0 20,000 - - - - 0 -
116 BRICASMA RESPULES AMPUL Feb-23 40 20,929 837,160 - - - 40 837,160
117 BUPIVACAIN SPINAL 0,5% 20 ML AMPUL Jan-23 2 79,421 158,842 - - - 2 158,842
118 AMPUL Apr-24 0 75,174 - - - - 0 -
119 AMPUL Sep-23 0 50,820 - - - - 0 -
120 AMPUL Jun-24 320 46,620 14,918,400 - 20 932,400 300 13,986,000
121 CA. GLUCONAS 100MG/ML AMPUL Aug-25 216 5,775 1,247,400 - - - 216 1,247,400
122 CA. GLUCONAS 100MG/ML AMPUL Jan-25 0 5,723 - - -
360 GLIMEPIRID 2mg TABLET Apr-26 12800 123 1,574,400 - - - 12800 1,574,400
361 GLIMEPIRID 3MG (2) TABLET Mar-24 0 473 - - - - 0 -
362 GLIMEPIRID 3MG (2) TABLET Dec-24 0 247 - - - - 0 -
363 GLIMEPIRID 3MG (2) TABLET Aug-26 20000 473 9,457,200 - 4,800 2,269,728 15200 7,187,472
364 GLIMEPIRID 4MG TABLET Aug-24 0 799 - - - - 0 -
365 GLIMEPIRID 4MG TABLET Jun-25 12500 526 6,574,197 - 3,500 1,840,775 9000 4,733,422
366 GLIQUIDONE 30MG TABLET Sep-23; Jan-24 0 1,000 - - - - 0 -
367 GLIQUIDONE 30MG TABLET Jun-24 15500 1,009 15,639,500 - - - 15500 15,639,500
368 GLUKOSA 10% BOTOL Sep-24 60 7,199 431,968 - - - 60 431,968
369 GLUKOSA 10% BOTOL May-24 100 7,199 719,946 - - - 100 719,946
370 GLUKOSA 40% BOTOL Feb-24 0 7,000 - - - - 0 -
371 GLUKOSA 40% BOTOL Jul-24 204 7,000 1,427,930 - - - 204 1,427,930
372 GLUKOSA 5% BOTOL Jan-23 40 5,200 208,000 - 20 104,000 20 104,000
373 GLUKOSA 5% BOTOL May-24 120 6,627 795,204 - - - 120 795,204
374 GRISEOFULVIN 125MG TABLET 0 219 - - - - 0 -
375 GRISEOFULVIN 125MG TABLET 0 219 - - - - 0 -
376 HALOPERIDOL TABLET Jul-24 800 54 43,200 - - - 800 43,200
377 HALOPERIDOL INJEKSI AMPUL Jan-23 0 1,190 - - - - 0 -
378 HCT TABLET Jul-26 0 148 - - - - 0 -
379 HCT TABLET Mar-27 0 150 - - - - 0 -
380 HCT TABLET Mar-27 0 149 - - - - 0 -
381 HEPARIN INJEKSI VIAL Apr-23 450 46,635 20,985,750 - - - 450 20,985,750
382 HIDROKORTISON 2,5% KRIM TUBE Apr-23 312 4,727 1,474,824 - 48 226,896 264 1,247,928
383 HIOSIN BUTIL BROMIDA 20 mg/ml AMPUL Jan-25 0 5,678 - - - - 0 -
384 HIOSIN BUTIL BROMIDA 20 mg/ml AMPUL Jan-25 50 5,678 283,899 - 50 283,899 0 -
385 HISHIPAGEN KOLF Oct-23 60 74,925 4,495,500 - - - 60 4,495,500
386 HIV : DOLUTEGRAVIR BOTOL - 0 - - - - 0 -
387 HIV : EFAVIRENZ (PROGRAM HIV) BOTOL - 0 - - - - 0 -
388 HIV : FDC (TDF + 3TC +DTG) BOTOL Aug-23 0 104,970 - 12 HIBAH SUDINKES 1,259,640 - - 12 1,259,640
389 HIV : LAMIVUDIN BOTOL Nov-23 0 98,400 - - - - 0 -
390 HIV : LAMIVUDIN + ZIDOVUDIN BOTOL Apr-24 0 230,880 - - - - 0 -
391 HIV : TDF +3TC + DTG BOTOL Aug-23 0 104,970 - - - - 0 -
392 HIV : TENOFOVIR BOTOL - 0 - - - - 0 -
393 HIV : TRIPLE FDC : TDF + 3TC ++EFV BOTOL Apr-24 0 204,000 - 16 HIBAH SUDINKES 3,264,000 - - 16 3,264,000
394 HIV :FDC : DOLUTEGRAVIR BOTO; - 0 - - - - 0 -
395 HIV: LAMIVUDIN BOTOL Nov-23 0 98,400 - - - - 0 -
396 HIV: ZIDOVUDIN BOTOL Jul-24 0 230,880 - - - - 0 -
397 HUMALOG MIX 25 PEN Feb-24 0 112,000 - - - - 0 -
398 HUMALOG MIX 25 PEN Oct-24 440 112,000 49,279,951 - 170 19,039,981 270 30,239,970
399 HUMAN ALBUMIN (ALBAPURE) BOTOL Jan-24 0 911,727 - - - - 0 -
400 HUMAN ALBUMIN (ALBAPURE) BOTOL Jan-24 0 913,227 - - - - 0 -
401 HUMAN ALBUMIN (ALBAPURE) BOTOL Mar-24 15 913,227 13,698,405 - - - 15 13,698,405
402 HUMAN ALBUMIN (ALBAPURE) BOTOL Aug-24 12 913,227 10,958,723 - - - 12 10,958,723
403 IBUPROFEN 100MG/5ML SUSPENSI BOTOL Aug-23 0 3,180 - - - - 0 -
404 IBUPROFEN 100MG/5ML SUSPENSI BOTOL Aug-24 47 6,105 286,935 - - - 47 286,935
405 IBUPROFEN 400MG TABLET Oct-24 4500 297 1,336,500 - - - 4500 1,336,500
406 IBUPROFEN INJEKSI VIAL Jan-23 465 55,000 25,575,000 - - - 465 25,575,000
407 ILLIADIN NASAL ANAK DROP BOTOL Jul-23 13 35,068 455,884 - - - 13 455,884
408 ILLIADIN NASAL DEWASA SPRAY BOTOL Nov-23 5 36,971 184,854 - - - 5 184,854
409 ILLIADIN NASAL DEWASA SPRAY BOTOL Jul-24 50 36,971 1,848,538 - - - 50 1,848,538
410 IPATROPIUM BROMIDA (ATROVENT) BOTOL 0 190,000 - - - - 0 -
411 RESPULES 0 3,636 - - - - 0 -
412 IPRATROPIUM VIAL Apr-23 0 11,000 - - - - 0 -
413 IRBESARTAN TABLET Feb-24 0 2,642 - - - - 0 -
414 IRBESARTAN TABLET Jun-24 4290 749 3,214,283 - - - 4290 3,214,283
415 ISDN 1MG/ML INJEKSI AMPUL Oct-24 450 17,500 7,875,000 - - - 450 7,875,000
416 ISDN 1MG/ML INJEKSI AMPUL Mar-24 0 15,766 - - - - 0 -
417 ISDN 1MG/ML INJEKSI AMPUL Sep-24 60 30,525 1,831,500 - 50 1,526,250 10 305,250
418 ISDN 5MG TAB TABLET May-25 0 87 - - - - 0 -
419 ISDN 5MG TAB TABLET Jul-25 4500 87 390,510 - 1,000 86,780 3500 303,730
420 ISOFLURAN 250ML BOTOL Dec-24 0 603,931 - - - - 0 -
421 ISOFLURAN 250ML BOTOL Feb-25 12 368,318 4,419,816 - - - 12 4,419,816
422 ISONIAZID 300MG TABLET Apr-25 0 377 - 22,000 SALAH INPUT STOK BLN LALU 8,302,800 8,900 3,358,860 13100 4,943,940
423 ISONIAZID 300MG TABLET Aug-23 0 250 - - - - 0 -
424 ISONIAZID 300MG (3HP) TABLET Oct-23 0 234,036 - 20 HIBAH SUDINKES 4,680,720 - - 20 4,680,720
425 ISOTIC ADRETOR (TIMOLOL 0,5%) BOTOL 0 11,275 - - - - 0 -
426 AMPUL Aug-26 60 26,640 1,598,400 - 25 666,000 35 932,400
427 ISOXSUPRINE TAB (PROTERINE) TABLET May-24 0 3,347 - - - - 0 -
428 ISOXSUPRINE TAB (PROTERINE) TABLET Aug-24 840 4,795 4,027,968 - - - 840 4,027,968
429 ITRACONAZOL (SPORACID) TABLET Mar-25 50 15,305 765,256 - - - 50 765,256
430 KAEN 1B BOTOL May-24 0 10,350 - - - - 0 -
431 KAEN 1B BOTOL Mar-23 0 8,767 - - - - 0 -
432 KAEN 3A / TRIDEX 27 A BOTOL Mar-24 0 11,500 - - - - 0 -
433 KAEN 3A / TRIDEX 27 A BOTOL Aug-25 200 11,500 2,299,920 - 20 229,992 180 2,069,928
434 KAEN 3B / TRIDEX 27 B BOTOL Feb-23 100 9,136 913,600 - 20 182,720 80 730,880
435 KAEN 3B / TRIDEX 27 B BOTOL Nov-23 240 11,500 2,760,000 - - - 240 2,760,000
436 KAEN 3B / TRIDEX 27 B BOTOL Sep-25 500 11,500 5,749,800 - - - 500 5,749,800
437 KAEN 4A KOLF - 0 - - - - - 0 -
438 KAEN 4B KOLF Jan-23 160 22,850 3,656,000 - - - 160 3,656,000
439 KALIUM DIKLOFENAK 50MG (KADITIC) TABLET Mei-24 500 330 165,000 - - - 500 165,000
440 KALSIUM LAKTAT TABLET Aug-25 0 61 - - - - 0 -
441 KALSIUM LAKTAT TABLET Aug-25 0 61 - - - - 0 -
442 KALSIUM LAKTAT TABLET Aug-25 14000 61 847,707 - 3,000 181,652 11000 666,056
443 SACHET Sep-24 0 17,325 - - - - 0 -
444 SACHET May-24 220 5,370 1,181,345 - 60 322,185 160 859,160
445 KCL 7,46 BOTOL Jun-23 0 3,223 - - - - 0 -
446 KCL 7,46 BOTOL Apr-24 0 3,222 - - - - 0 -
447 KCL 7,46 BOTOL Jul-24 546 3,222 1,759,392 - - - 546 1,759,392
448 KETAMIN) INJEKSI VIAL Nov-23 100 10,588 1,058,800 - - - 100 1,058,800
449 KETOKONAZOLE 200MG TABLET Jul-24 0 252 - - - - 0 -
450 KETOKONAZOLE KRIM TUBE Jul-23 0 3,920 - - - - 0 -
451 KETOKONAZOLE KRIM TUBE Feb-25 120 2,370 284,400 - 24 56,880 96 227,520
452 KETOMED SS SAMPO BOTOL Sep-24 190 33,383 6,342,818 - 10 333,833 180 6,008,985
453 KETOMED SS SAMPO BOTOL Jan-24 0 44,511 - - - - 0 -
454 KETOMED SS SAMPO BOTOL Oct-23 0 44,110 - - - - 0 -
455 KETOPROFEN SUPP (PROTOFEN) SUPPOS Sep-24 0 7,726 - - - - 0 -
456 KETOPROFEN SUPP (PROTOFEN) SUPPOS Aug-25 1120 2,016 2,258,088 - 160 322,584 960 1,935,504
457 KETOPROFEN SUPP (SUPRAFENID) SUPPOS Apr-25 0 6,660 - - - - 0 -
458 KETOROLAC INJEKSI AMPUL Apr-24 0 2,428 - - - - 0 -
459 KETOROLAC INJEKSI AMPUL Jun-24 0 - - - - - 0 -
460 KETOROLAC INJEKSI AMPUL Jun-24 4580 2,428 11,118,271 - 200 485,514 4380 10,632,757
461 KIDMIN INFUS KOLF Nov-23 60 54,621 3,277,260 - - - 60 3,277,260
462 BOTOL Sep-25 0 5,500 - - - - 0 -
463 KLORAMFENIKOL 250MG TABLET TABLET Sep-24 300 799 239,760 - - - 300 239,760
464 KLORAMFENIKOL 250MG TABLET TABLET Apr-24 100 777 77,700 - - - 100 77,700
465 KLORAMFENIKOL IM. IV INJEKSI VIAL 0 7,954 - - - - 0 -
466 KLORAMFENIKOL SALEB KULIT TUBE Jul-24 0 3,265 - - - - 0 -
467 KLORAMFENIKOL SALEB KULIT TUBE Jun-23 192 3,242 622,464 - - - 192 622,464
468 KLORAMFENIKOL SALEP MATA TUBE Sep-22; Jun 23 0 6,859 - - - - 0 -
469 KLORAMFENIKOL SALEP MATA TUBE Oct-25 50 9,990 499,500 - - - 50 499,500
470 KLORAMFENIKOL TETES MATA (RECO) BOTOL Feb-24 0 9,435 - - - - 0 -
471 KLORAMFENIKOL TETES MATA (RECO) BOTOL Feb-23 25 8,800 220,000 - - - 25 220,000
472 KLORAMFENIKOL TETES TELINGA BOTOL Apr-24 25 5,913 147,825 - - - 25 147,825
473 KLORAMFENIKOL TETES TELINGA BOTOL Mar-25 25 9,435 235,875 - - - 25 235,875
474 KODEIN 10MG TABLET Sep-25 0 600 - - - - 0 -
475 KODEIN 10MG TABLET Jun-24 1000 605 605,450 - - - 1000 605,450
476 KODEIN 10MG TABLET Feb-26 5900 605 3,569,500 - - - 5900 3,569,500
477 KOLKISIN 0,5 MG TAB Aug-23 4800 138 662,400 - - - 4800 662,400
478 LACIDOFIL SASET Oct-23 0 6,216 - - - - 0 -
479 LACTULOSE SYRUP BOTOL Sep-24 280 21,090 5,905,200 - 24 506,160 256 5,399,040
480 LACTULOSE SYRUP BOTOL May-24 0 12,533 - - - - 0 -
481 LAKTO B / L-BIO SACHET Jan-24 0 4,954 - - -
734 ROCURONIUM INJEKSI (GENERIK) VIAL Nov-23 0 100,000 - - - - 0 -
735 ROCURONIUM INJEKSI (NOVERON) VIAL Dec-24 72 88,800 6,393,600 - - - 72 6,393,600
736 RYZODEG INSULIN PEN Sep-24 0 113,018 - - - - 0 -
737 RYZODEG INSULIN PEN May-24 0 113,018 - - - - 0 -
738 RYZODEG INSULIN PEN Nov-23 0 113,018 - - - - 0 -
739 SABUTAMOL 2MG TABLET Feb-25 3000 144 432,900 - - - 3000 432,900
740 SABUTAMOL 4MG TABLET Jun-23 0 81 - - - - 0 -
741 SABUTAMOL 4MG TABLET Jun-23 0 155 - - - - 0 -
742 BOTOL Jun-23 0 20,900 - - - - 0 -
743 BOTOL Des-23; Mei-24 350 21,090 7,381,500 - - - 350 7,381,500
744 SALBUTAMOL SIRUP 2 MG/5 ML (ASTHAROL) BOTOL May-24 52 13,675 711,110 - - - 52 711,110
745 SAN B-PLEX BOTOL Nov-23 0 16,961 - - - - 0 -
746 SAN B-PLEX BOTOL Nov-23 0 16,960 - - - - 0 -
747 SAN B-PLEX BOTOL Jun-23 0 16,808 - - - - 0 -
748 SCOPMA TABLET Feb-26 100 875 87,500 - - - 100 87,500
749 SCOPMA TABLET Feb-26 0 875 - - - - 0 -
750 SERETIDE 50 MCG ANAK PCS Dec-23 0 59,536 - - - - 0 -
751 SERETIDE 50 MCG ANAK PCS May-24 20 59,536 1,190,719 - - - 20 1,190,719
752 SERETIDE DISKUS PCS Jan-24 0 126,858 - - - - 0 -
753 SERETIDE DISKUS PCS Jan-24 0 126,859 - - - - 0 -
754 SERETIDE DISKUS PCS Apr-24 700 126,859 88,800,998 - 50 6,342,928 650 82,458,070
755 SEVOFLURAN BOTOL Jul-23 0 1,094,381 - - - - 0 -
756 SEVOFLURAN BOTOL Jul-24 5 899,000 4,495,001 - - - 5 4,495,001
757 SF (TABLET (+) DARAH) TABLET Sep-23 0 226 - - - - 0 -
758 SF (TABLET (+) DARAH) TABLET Sep-23 0 294 - - - - 0 -
759 SF (TABLET (+) DARAH) TABLET Nov-23; Feb-24 35000 228 7,981,733 - 6,000 1,368,297 29000 6,613,436
760 SILOXAN ED BOTOL Nov-24 0 53,383 - - - - 0 -
761 SILOXAN ED BOTOL Jun-25 150 53,868 8,080,245 - 50 2,693,415 100 5,386,830
762 SIMVASTATIN 20MG TABLET Jan-24 0 435 - - - - 0 - 5000 RETUR KFTD
763 SIMVASTATIN 20MG TABLET Jun-27 33000 151 4,994,867 - 16,700 2,527,705 16300 2,467,161
764 SIMVASTATIN 20MG TABLET Sep-24 30000 257 7,699,959 - - - 30000 7,699,959
765 SPIRONOLACTONE TAB 25MG TABLET Oct-23 19200 190 3,648,000 - 2,400 456,000 16800 3,192,000
766 SPIRONOLAKTON 100 MG TABLET Jum-24; Jul-24 0 535 - - - - 0 -
767 SPIRONOLAKTON 100 MG TABLET May-24 4400 535 2,354,000 - - - 4400 2,354,000
768 STOP TB KIT PAKET Sep-23 0 409,461 - - - - 0 -
769 STRONGER NEO MINOPHEGEN C AMPUL Jan-24 0 105,000 - - - - 0 -
770 STRONGER NEO MINOPHEGEN C AMPUL Jun-24 0 98,175 - - - - 0 -
771 STRONGER NEO MINOPHEGEN C AMPUL Jun-24 0 99,000 - - - - 0 -
772 SUKRALFAT SUSPENSI BOTOL Sep-24 0 5,034 - - - - 0 -
773 SUKRALFAT SUSPENSI BOTOL May-24 192 5,034 966,527 - 48 241,632 144 724,895
774 SULFADIAZIN TUBE Aug-25 0 18,726 - - - - 0 -
775 SURVANTA VIAL Jul-25 2 3,450,000 6,899,999 - - - 2 6,899,999
776 SYMBICORT 60 DOSES BOTOL Aug-23 0 135,577 - - - - 0 -
777 SYMBICORT 60 DOSES BOTOL Oct-23 30 136,809 4,104,270 - 30 4,104,270 0 -
778 SYMBICORT 60 DOSES BOTOL May-24 180 136,810 24,625,749 - - - 180 24,625,749
779 TBC : KDT DOSIS HARIAN PAKET Sep-23 0 409,461 - - - - 0 -
780 TBC : OAT ANAK PAKET Oct-25 30 250,971 7,529,130 - - - 30 7,529,130
781 TBC : OAT KATEGORI 1 PAKET May-25 30 420,484 12,614,520 - - - 30 12,614,520
782 TBC : OAT KATEGORI 1 PAKET Mar-25 20 511,609 10,232,180 - - - 20 10,232,180
783 TBC : OAT KATEGORI 2 PAKET May-25 0 1,384,977 - - - - 0 -
784 TEOFILIN 150MG (BRONSOLVAN) TABLET May-27 0 324 - - - - 0 -
785 TEOFILIN 150MG (THEOBRON) TABLET Jun-26 2100 2,144 4,501,743 - 800 1,714,950 1300 2,786,794
786 TERBUTALIN INJEKSI 0,5 MG (BRICASMA) AMPUL 0 23,231 - - - - 0 -
787 THIAMAZOLE 10 MG TABLET Aug-24 4500 990 4,455,540 - 2,500 2,475,300 2000 1,980,240
788 TIZANIDINE 2MG TAB TABLET Jun-26 0 2,076 - - - - 0 -
789 TIZANIDINE 2MG TAB TABLET Jun-24 3510 2,442 8,571,420 - 1,170 2,857,140 2340 5,714,280
790 TOPIRAMAT 25 MG (MIGATROP) TABLET Dec-23 300 1,969 590,700 - - - 300 590,700
791 TOPIRAMAT 25 MG (MIGATROP) 1320 3,197 4,219,776 - - - 1320 4,219,776
792 TRAMADOL 50 MG TABLET May-25 0 710 - - - - 0 -
793 TRAMADOL 50 MG TABLET Mar-24 22500 466 10,489,500 - - - 22500 10,489,500
794 TRAMADOL HCL 100mg/2ml IM.IV AMPUL Jan-25 0 3,463 - - - - 0 -
795 TRAMADOL HCL 100mg/2ml IM.IV AMPUL Jul-25 280 3,608 1,010,100 - 100 360,750 180 649,350
796 TRAMADOL HCL 100mg/2ml IM.IV AMPUL Sep-25 1200 3,120 3,743,986 - - - 1200 3,743,986
797 TREMENZA TABLET TABLET Sep-25 2000 1,332 2,664,000 - - - 2000 2,664,000
798 TRIAMSINOLON INJEKSI Vial Nov-24 190 33,499 6,364,810 - - - 190 6,364,810
799 TRIHEKSILFENIDIL TABLET Sep-24 1000 63 63,000 - 1,000 63,000 0 -
800 TRIHEKSILFENIDIL TABLET Sep-25 3100 64 197,066 - 2,000 127,139 1100 69,927
801 UMARONE INJEKSI VIAL Nov-24 0 165,113 - - - - 0 -
802 UMARONE INJEKSI VIAL Jan-25 49 165,112 8,090,512 - - - 49 8,090,512
803 UNIVIT SIRUP BOTOL Jun-24 0 4,400 - - - - 0 -
804 UNIVIT SIRUP BOTOL Jun-24 174 4,440 772,560 - - - 174 772,560
805 UTROGESTAN 100MG TABLET Jul-26 0 1,499 - - - - 0 -
806 UTROGESTAN 200MG TABLET - 0 11,550 - - - - 0 -
807 VAKSIN BCG VIAL Feb-23 0 97,780 - - - - 0 -
808 VAKSIN BIO TD VIAL - 0 - - - - - 0 -
809 VIAL - 0 - - - - - 0 -
810 VAKSIN FLUBIO VIAL Mar-23 0 110,778 - - - - 0 -
811 VAKSIN GARDASIL VIAL - 0 675,000 - - - - 0 -
812 VAKSIN HEPATITIS B REKOMBINAN 0.5 ML VIAL Jun-24 0 25,839 - 100 HIBAH PKC KOJA 2,583,900 100 2,583,900 0 -
813 VAKSIN IPV VIAL 0 144,540 - - - - 0 -
814 VAKSIN JERAP DT VIAL - 0 - - - - 0 -
815 VAKSIN KOMBINASI DPT + HEPATITIS B VIAL Apr-23 0 85,102 - - - - 0 -
816 VAKSIN MANTOUX (1) (PPD) VIAL 0 622,441 - - - - 0 -
817 VAKSIN MANTOUX (2) VIAL Jul-23 0 850,000 - - - - 0 -
818 VAKSIN MR + PELARUT VIAL 0 167,860 - - - - 0 -
819 VAKSIN PCV VIAL 5 HIBAH PKC KOJA - 5 - 0 -
820 VAKSIN POLIO VIAL Apr-23 0 21,494 - - - - 0 -
821 VAKSIN TD VIAL - 0 18,128 - - - - 0 -
822 VAKSIN TETANUS TOKSOID VIAL 0 36,630 - - - - 0 -
823 VALSARTAN 160 TABLET May-24 0 725 - - - - 0 -
824 VALSARTAN 160 TABLET Jul-24 5700 725 4,132,501 - - - 5700 4,132,501
825 VANCOMICYN INJ VIAL Dec-23 4 99,900 399,600 - - - 4 399,600
826 VANCOMICYN INJ VIAL Nov-23; Sep-24 50 99,000 4,949,999 - - - 50 4,949,999
827 VENTOLIN REPULES RESPULES 0 4,800 - - - - 0 -
828 VENTOLIN REPULES RESPULES Apr-25 2520 4,800 12,095,931 - 200 959,995 2320 11,135,937
829 VIT A 100.000 KAPSUL Sep-23 50 411 20,535 - - - 50 20,535
830 VIT A 200.000 UI (RETINOL) TABLET 0 279 - - - - 0 -
831 VIT A 200.000 UI (RETINOL) TABLET 250 622 155,400 - - - 250 155,400
832 VIT B COMPLEX TABLET Oct-25 19500 111 2,164,500 - 4,000 444,000 15500 1,720,500
833 VIT B COMPLEX TABLET Dec-23 0 57 - - - - 0 -
834 VIT B1 (THIAMIN HCL) TABLET Jul-24 4000 86 344,000 - - - 4000 344,000
835 VIT B12 TABLET Sep-24 14000 43 602,020 - 2,000 86,003 12000 516,017
836 VIT B12 TABLET Aug-24 100 74 7,400 - - - 100 7,400
837 VIT B12 TABLET Jun-24 11000 43 472,988 - - - 11000 472,988
838 VIT B6 TABLET Jun-26 0 128 - - - - 0 -
839 VIT B6 25 MG TABLET Aug-26 12000 224 2,688,002 - 2,000 448,000 10000 2,240,002
840 VIT C 500 MG Oct-23 525 225 118,125 100 HIBAH SUDINKES 22,500 525 118,125 100 22,500
841 VIT C 500 MG TAB 0 473 - - - - 0 -
842 VIT C INJEKSI AMPUL Aug-23 240 3,330 799,200 - - - 240 799,200
843 VIT. C 50MG TABLET Jul-24 5000 42 211,899 - - - 5000 211,899
844 VIT. C 50MG TABLET Jul-24 2000 158 316,000 - - - 2000 316,000
845 VIT. C 50MG TABLET Apr-23 1500 1,137 1,705,023 - 1,000 1,136,682 500 568,341
846 WARFARIN TABLET TABLET 0 669 - - - - 0 -
847 WI 1000ML BOTOL Sep-24 0 27,616 - - - - 0 -
848 WI 1000ML BOTOL Feb-27 0 22,293 - - - - 0 -
849 WI 1000ML BOTOL Sep-24 370 22,293 8,248,499 - 10 222,932 360 8,025,566
850 WI 25ML BOTOL Jul-25 1460 2,648 3,866,752 - 120 317,815 1340 3,548,936
851 WI 25ML BOTOL Feb-24 0 2,650 - - - - 0 -
852 ZINK TABLET Jun-23 0 475 - - - - 0 -
853 ZINK TABLET Aug-23 6200 216 1,339,200 - - - 6200 1,339,200
854 ZINK SIRUP 20MG/5ML BOTOL Nov-24 0 7,770 - - - - 0 -
855 ZINK SIRUP 20MG/5ML BOTOL Jul-24 108 2,511 271,188 - - - 108
REKAP PERMINTAAN OBAT LAYANAN SPESIALIS THN 2022
FORNAS/ KATALOG OBAT PERKIRAAN KETERANGAN

KRONIS / SUDAH HARGA PER ACC/
NO NAMA OBAT NON /NON
NON SAT KANDUNGAN INDIKASI KEBUTUHAN/B TERSEDIA DI SATUAN TIDAK
FORNAS KATALOG KRONIS LN FARMASI
DR.SALSA SPS
1 LAMICTAL 100 MG FORNAS E-KAT NON TAB LAMOTRIGIN ANTI EPILEPSI - KEJANG 100 TAB √ 6,500 ACC
2 KEPPRA 500MG FORNAS NON NON TAB LEVETIRACETAM KEJANG 20 TAB √ 22,800 ACC
3 HALOPERIDOL INJ FORNAS E-KAT KRONIS AMP HALOPERIDOL PENENANG 8 AMP √ 9,300 ACC
4 LABETALOL INJ NON NON NON AMP LABETALOL HIPERTENSI 8 AMP 50,000 TDK ACC
PYRIDOSTIGMINE
5 MESTINON FORNAS E-KAT NON TAB BROMIDE 60 MG MIASTENIA 20 TAB √ 8,600 ACC
GANGGUAN PSIKIATRIK
6 RISPERIDON FORNAS E-KAT KRONIS RISPERIDONE PADA DEMENSIA 20 TAB blm 1,900 ACC
7 FLUOKSETIN 20 MG FORNAS E-KAT KRONIS FLUOKSETIN ANTI DEPRESAN 30 TAB √ ACC
SODIUM
8 SODIUM HYALURONATE INJ FORNAS E-KAT VIAL HYALURONATE INJ OA 15 VIAL √ ACC
ACC
KHUSUS
RANAP
9 CITICOLIN INJEKSI NON NON NON AMP CITICOLINE STROKE 30 amp √ STROKE
10 MECOBALAMIN INJ NON NON NON AMP MECOBALAMIN √ 9,400
DR. HERDIANA SPA

ACC CARI
HARGA
1 FERRIS DROP NON NON NON BTL FE ZAT BESI 15 BTL 19,000 RENDAH
2 OMEPRAZOLE SIRUP NON NON NON BTL OMEPRAZOLE 20MG/5MGERD, GASTRITIS 5 BTL blm 12,000 ACC
Salmeterol xinafoate
50 mcg, fluticasone
3 SERETIDE ANAK FORNAS E-KAT KRONIS BTL propionate 100 mcg ASMA 5 PCS √ 75,000 ACC
DR. SUEB SPB

SUBSTISUSI
AS.TRANEKS ACC
AMAT CARBAZO
1 ADONA AMPUL NON NON NON AMP CARBAZOCHROM NA ANTI HEMORAGIK 5 AMPUL INJEKSI 20,000 CHROME
SUDAH ADA
BURNAZIN
EKSTRAK AKAR SALEP HARGA
2 SALEP MEBO NON NON NON TUBE TUMBUHAN LUKA BAKAR 5 TUBE 24.600 527,000 TIDAK ACC
3 VENOSMIL KAPS NON NON NON KAPS ANTI HEMORAGIK 100 TAB 11,000 TIDAK ACC
DR. RATNA SPM

1 SILOXAN FORNAS NON NON BTL NATRIUM HYALURONATPOST OP 10 BTL √ 75,000 ACC
2 POSOP FORNAS NON BTL FLUOROMETHOLON 1 GRADANG/UVEITIS 15 BTL BELUM 123,125 ACC
3 FUKRISIN FORNAS NON BTL NATAMYCIN JAMUR 10 BTL 128,000 TDK ACC
ACC
CENDO
KARENA
LEBIH
4 EFRICEL FORNAS NON MD PHENYLEPHRINE HCL PRE OP 10 BTL BELUM 22,900 MURAH
5 TROPIN FORNAS NON BTL ATROPIN SULFAT UVEITIS 10 BTL BELUM 15,900 ACC
TIDAK ACC
SUDAH ADA KFT
ISOTIC
ADRETOR
harga
6 TIMOPHTAL FORNAS NON BTL TIMOLOL MALEAT 20 BTL 31.200/btl 83,000
ACC
UNTUK
PREDNISOLONE OPERASI
7 CENDO P-PRED NON NON MD ACETATE √
DR.DAULAT SPPD
dengan
catatan lantus
1 SANSULIN LOG G FORNAS E-KAT KRONIS PEN I-GLARGINE DM 2 100 PEN stop 135,000 BLM ACC
TIDAK ACC
KFT KRN
SUDAH DI
ACC
RIVAROXAB
AN YG
MASUK
2 ENDOXABAN NON NON NON TAB ENDOXABAN ANTIKOAGULAN 50 TAB 31,000 FORNAS
SUDAH
TERSEDIA TIDAK ACC
LANSO DAN 198,000 KFT
OME INJEKSI
DGN HARGA
3 PANTOPRAZOLE INJ NON NON NON VIAL PANTOPRAZOLE PPI 20 VIAL LBH MURAH
4 BISOPROLOL 2,5 MG FORNAS KRONIS TAB BISOPROLOL HT SUDAH TERSEDIA BISOPROLOL 5MG
di hold oleh kft

krn sudah ada
sefalosforin 83,000 TDK ACC
generasi 4
cefazolin,
generasi 3
CEFUROXIME ceftri dan cefo,
(sefalosforin generasi generasi 1
5 ANBACIM INJ NON NON VIAL ke 2 ) INJEKSI GVT 10 VIAL cefepime
6 SILODOSIN 4MG FORNAS TAB SILODOSIN PROSTAT 100 TAB belum ACC
7 VILDAGLIPTIN 50 MG FORNAS E KAT KRONIS TAB VILDAGLIPTIN 50 MG ANTIDIABETES ORAL belum ACC
8 LEVOTIROKSIN FORNAS E KAT KRONIS TAB LEVOTIROKSIN HIPOTIROID 100 tab √ ACC
DR. MARCEL SPPD
1 RIVAROXABAN (XARELTO) FORNAS NON TAB RIVAROXABAN DVT, PE 30 TAB √ 47,000 ACC
2 WIDA - KN 1 500 ML FORNAS NON KOLF NACL 0,9% + kcl 0.15% HIPOKALEMIA 10 KOLF BISA DIRACIK DI FARMASI
3 WIDA - KN 2 500 ML FORNAS NON KOLF NACL 0,9% + kcl 0.3% HIPOKALEMIA 10 KOLF BISA DIRACIK DI FARMASI
PARENTERAL
4 TRIOFURIN E 1000 500ML NON NON NON KOLF NUTRITION MALNUTRISI 10 KOLF 118,278 TDK ACC
5 JANUVIA NON NON NON KOLF SIFAGLIPTIN DPP4 - IL 20 KOLF 22,000 TDK ACC
STRONGER NEO
6 SNMC NON NON NON MINOOHAGEN C HEPATOPROTEKTOR 2 PCS √ 169,000 ACC
7. ASAM FOLAT 5 MG FORNAS EKAT KRONIS ASAM FOLAT PENY GINJAL KRONIS 200 TAB belum ACC
8 AMINOFUSIN L 600 NON KOLF LIVER FAILURE 5 BTL ACC
DR LAVELIA SPOG
PROLACTA DHA FOR 237000/60
1 MOTHER NON NON NON KAPS MINYAK IKAN VITAMIN BUMIL KAPS TDK ACC
2 MALTOFER NON NON NON TAB SF ANEMIA 3000/TAB TDK ACC
3 SANGOBION NON NON NON TAB SF ANEMIA 1600/KAPS TDK ACC
4 CALGAE NON NON NON TAB KALSIUM KALSIUM 6000/TAB TDK ACC
135000/30
5 EAZYCAL NON NON NON TAB KALSIUM KALSIUM KAPS TDK ACC
6 OVACARE NON NON NON TAB KESUBURAN KESUBURAN 9,600/TAB TDK ACC
7 OLIGOCARE NON NON NON TAB KESUBURAN KESUBURAN 10,000/TAB TDK ACC
DR. ANGGINA SP.THT

1 LIDOCAIN CREAM (EMLA) FORNAS NON TUBE LIDOCAIN ANASTESI OLES 10 TUBE belum 35,000 ACC
SUDAH
TERSEDIA DI
METHYLPREDNISOLON 16 FARMASI
2 MG FORNAS KRONIS TAB METHYLPREDNISOLON RADANG SEDIAAN 8 MG TDK ACC
SUDAH
TERSEDIA DI
FARMASI
3 BETASERC 24 MG FORNAS KRONIS TAB BETAHISTIN VERTIGO SEDIAAN 6 MG TDK ACC
ACC
CENDO
NATACE
INFEKSI JAMUR PD N (LEBIH
4 FUKRICIN EYE DROP FORNAS NON BTL NATAMYCIN MATA 6 BTL BELUM 128,000 MURAH)
BETAMETASON DAN
5 CELESTAMIN TAB NON NON NON TAB DEKLORPENIRAMIN ALERGI SAL NAFAS 80 TAB 4,500 TDK ACC
DR.MAULIANA SPPD
STOP
HUMALOG
1 RYZODEG FORNAS E-KAT KRONIS FLEXPE DIABETES MELITUS 50/50 135,000 ACC
2 GLUCOSAMIN NON NON NON TAB GLUCOSAMIN 500 MG OA 1500 TAB 1,500 TDK ACC
3 NTG INJEKSI FORNAS AMP GLYCERYL TRINITRATE √ ACC
DR. GUNTUR SP.THT

BETAMETASON DAN
1 CELESTAMIN SIR NON NON NON BTL DEKLORPENIRAMIN ALERGI SAL NAFAS 10 BTL 55,000 TDK ACC
PSEUDOEFEDRIN DAN
CLORPENIRAMIN
2 RHINOS JR SIRUP NON NON NON BTL MALEAT PILEK 10 BTL √ 47,000 TDK ACC
DR.DAMAR SPA
LIFE SAVING
1 SURVANTA / BERACTANT NON NON NON VIAL SURFAKTAN PEMATANGAN PARU 1 VIAL √ 6,000,000 ACC
ANTIHISTAMIN/
STIMULAN NAFSU
2 HEPTASAN NON NON NON TAB SIPROHEPTADINE MAKAN 20 TAB 1,000 TDK ACC
3 FERRIZ DROP NON NON NON BTL FE ANTIANEMIA 15 BTL BELUM 35,000 ACC
SUDAH
TERAPI HIPOKALEMIA 8 TAB TERSEDIA KSR 3,500 TDK ACC
4 ASPAR-K TAB 300 MG FORNAS E-KAT NON TAB KALIUM ANAK 600 MG
SUDAH
TERSEDIA
TERAPI REHIDRASI MINERAL
5 RESOMAL SACH NON NON NON SACH UNTUK GIBUR MIX 10,000 TDK ACC
6 KLORAL HIDRAT 10% FORNAS DEPRESI NAFAS BELUM ACC
DR. FIFI SPKK

1 IKHTIOL 3 % NON NON NON POT 1 BTL 8,500 TDK ACC
VITILIGO VULGARIS,
2 SORALEN SOLUTION 15 ML NON NON NON BTL METHOXSALEN 1% PSORIASIS 1 BTL 81,000 TDK ACC
TIDAK ACC
FARMASI
KRN
HARGA
3 PROTOPIC 0,1% 10 G NON NON NON TACROLIMUS OINT 0,1%INFLAMASI 5 TUBE 300,000 MAHAL
4 INERSON 15 G FORNAS E-KAT NON DEXOSIMETASONE DERMATITIS ATOPIK 50 TUBE 15,000 TDK ACC
TIDAK ACC
FARMASI
KRN
VITILIGO VULGARIS, HARGA
5 VITISKIN 50ML NON NON NON DERMATITIS ATOPIK 5 BTL 754,500 MAHAL
DR.AGUS SP KFR
1 FLAMAR GEL NON NON NON TUBE NA DIKLOFENAK BELUM ACC
MENGETAHUI, MENYETUJUI,
KASIE PENUNJANG
KA. INST FARMASI MEDIS KA. KOMITE FARMASI DAN TERAPI DIREKTUR RSUD TUGU KOJA
PEMAKAIAN/BLN
143 tab
3 amp
73 tab
26 vial
29 amp
40 AMP
10 pcs
3 AMP/6 BLN
18 BTL
23 MD
300 tab
53 tab
3 ampul
2 btl
350 PEN
2 AMP
JIKA ADA KASUS
REKAP PERMINTAAN OBAT LAYANAN SPESIALIS THN 2023
FORNAS/ KATALOG OBAT PERKIRAAN KETERANGAN

KRONIS / SUDAH HARGA PER ACC/
NO NAMA OBAT NON /NON
NON SAT KANDUNGAN INDIKASI KEBUTUHAN/B TERSEDIA DI SATUAN TIDAK
FORNAS KATALOG KRONIS LN FARMASI
DR.SALSA SPS
DR. NADIA SPA

NUTRISI BAYI BARU
1 INTRALIPID 20% BTL LAHIR KONDISI KHUSUS 5
2 ASAM AMINO 10% BTL 5
3 CAFFEIN SITRAT TAB 13
DR. SUEB SPB
DR. RATNA SPM
DR.DAULAT SPPD
PENGOBATAN CHF
1 SACUBITRIL VALSARTAN FOR NON NON GAGAL JANTUNG 5000 TAB 8,000 ACC
2 TICAGRELOR FOR NON NON ANTIPLATELET 100 TAB ACC
PENGGAN
TI
350,000 LOVENOX.
TP BLM
SYRIN ACC
3 DIVITI (FONDAPARINUX NA) FOR NON NON GE VTE 100 PEN
4 REDACID (CINAMOMUM) NON E KAT NON TAB FITOFARMAKA 100 TAB 7,000 TDK ACC
DR BAZAR SPN
1 PREGABALIN KAPS FOR EKAT NON 100 TAB 13.000 BLM ACC
DR. MARCEL SPPD
1 MOXIFLOXACIN TABLET FOR E KAT KRON TAB INFEKSI NOSOKOMIAL 30 970

2 CEFPIROM INJ 1 GR FOR E KAT VIAL SEPSIS 10 22,000
DR LAVELIA SPOG
TIDAK ADA
DR. ANGGINA SP.THT
DR.MAULIANA SPPD
DR. GUNTUR SP.THT
DR.DAMAR SPA
1 FERRO K DROP NON NON NON 10 BTL
2 KETOTIFEN SIRUP NON NON NON ASMA BRONKIAL 5 BTL 101,000
3 ALBENDAZOLE SIRUP FOR EKAT INFEKSI CACING 2 BTL 4,400
DR. FIFI SPKK

VITILIGO VULGARIS,
2 SORALEN SOLUTION 15 ML NON NON NON BTL METHOXSALEN 1% PSORIASIS 1 BTL 81,000 TDK ACC
TIDAK ACC
FARMASI
KRN
VITILIGO VULGARIS, HARGA
5 VITISKIN 50ML NON NON NON DERMATITIS ATOPIK 5 BTL 754,500 MAHAL
3 NEUROBION INJ 10 AMP 28,000 TIDAK ACC
4 hydroxizin hcl
DR.AGUS SP KFR
1 FLAMAR GEL NON NON NON TUBE NA DIKLOFENAK ACC
DIREKTUR
KASIE PENUNJANG RSUD TUGU
KA. INST FARMASI MEDIS KA. KOMITE FARMASI DAN TERAPI KOJA
NAIKIN ULANG
REKAP PERMINTAAN ALKES BMHP LAYANAN SPESIALIS THN 2022
OBAT
FORNAS/ KATALOG KRONIS / PERKIRAAN KETERANGAN HARGA
SUDAH
NON /NON NON KEBUTUHAN/B TERSEDIA DI PER ACC/
NO NAMA ALKES / BMHP FORNAS KATALOG KRONIS SAT KANDUNGAN INDIKASI LN FARMASI SATUAN TIDAK
DR. HERDIANA SPA
1 BURRET WITH CONTROLLER 10 PCS

PENGUMPULAN SAMPLE
URIN PADA ANAK
2 URINE COLLECTOR PEREMPUAN 20 PCS √
DR RETNO SPAN
SUCTION CLOSE NO 16, 18,
1 14 PASIEN ICU 10 PCS
2 MEDIFLIX SCALE PASIEN ICU
3 MEDIFLIX LINE PASIEN ICU
4 MEDIFLIX HFNC PASIEN ICU
5 SIKAT KANUL TRAKEOSTOMI PASIEN ICU

6 LIDI CUTTON STERIL PASIEN ICU
7 TRAKEOETOMI NO 6,7,7,5 PASIEN ICU
NEBULIZER KIT UNTUK
8 VENTILATOR PASIEN ICU
DR. IVAN SPB

1 CUTIMED SORRACH SWAB NON NON NON BTL PERAWATAN LUKA
2 OSTENIC GEL NON NON NON BTL PERAWATAN LUKA √
2,500,000/
3 PILLA PACK NON NON NON PCS POLIDOCANOL 30MG/ML IRIGASI HEMOROID 5PACK
CHEST TUBE THORACTOMY
4 NO 24, NO 28, NO 20 EMERGENCY SAL NAFAS
5
DR. RATNA SPM

1 FLOURESCEIN STRIP STERIL NON NON STRIP KERATIN 20 STRIP
2 HAND PIECE A1A OP MATA 12 PCS
3 KASET PACHO HIJAU OP MATA 13 PCS
JARUM HYDRO ORANYE
4 KECIL OP MATA 10 PCS
5 JARUM HYDRO ABU2 KECIL OP MATA 10 PCS
6 DOP MATA OP MATA 70 PCS √
DR LAVELIA SPOG
2 IUD NOVA - T NON NON NON PCS KONTRASEPSI KB 350,000
DR. ANGGINA SP.THT

1 XYLOCAIN SPRAY FORNAS NON NON BTL LIDOCAIN ANASTESI SEMPROT 5 BTL
DRG. YANTI
1 ZINC PHOSPATE CEMENT NON NON NON BTL
2 FLETCHER NON NON NON BTL
DR. FIFI SPKK

1 ZINC OXIDE 10% NON NON NON GRAM 500 GRAM
KORTIKOSTEROID SUDAH
2 NEEDLE 27 G PCS INTALESI 200 PCS TERSEDIA
KORTIKOSTEROID SUDAH
3 NEEDLE 30 G PCS INTALESI 201 PCS TERSEDIA
SUDAH
4 PARAFFIN WAX NON TERSEDIA
SUDAH
5 CUTTON BUD PANJANG TERSEDIA
DIREKTUR
KASIE PENUNJANG RSUD TUGU
KA. INST FARMASI MEDIS KA. KOMITE FARMASI DAN TERAPI KOJA
REKAP PERMINTAAN ALKES BMHP LAYANAN SPESIALIS THN 2023
OBAT
FORNAS/ KATALOG KRONIS / PERKIRAAN KETERANGAN HARGA
SUDAH
NON /NON NON KEBUTUHAN/B TERSEDIA DI PER ACC/
NO NAMA ALKES / BMHP FORNAS KATALOG KRONIS SAT KANDUNGAN INDIKASI LN FARMASI SATUAN TIDAK
DR. NADIA SPA
1 SPUIT BCG 0,05 ML 30
2 ALAT TINDIK TELINGA 1
DR. DAMAR SP.A

UNTUK MERUJUK
SIRKUIT VENTILATOR PASIEN NICU DI
1 HALMINTON PCS AMBULANCE 5√ 350000 ACC
DR.SALSA SPS
1 GEL EMG √
2 EKG PATCH √
DR RETNO SPAN
1 SPIDOL MARKER PCS PENANDA OPERASI 10 √ ACC
2 ELEKTRO SURGICAL PLATES PCS KAMAR OK 10 √ ACC
DR JACKY SPAN
NEBULIZER T PIERC KIT -
1 TRACHVENT PCS ICU 3 ACC
2 ABOCATH 18 PCS ICU 7 ACC
3 CATHETER MOUTH PCS ICU 7 ACC
DR AGUS SP.FISO
LUMBOSACRAL KORSET SIZE
1 S,M,L,XL,XXL 25
2 PAD TENS PCS FISIOTERAPI 17 √ ACC
IGD
PASIEN ANAK YG
DEHIDRASI SEHINGGA
INTRAOSSEUS NEEDLE 3 SULIT DIPASANG AKSES
1 UKURAN IV 5
PASIEN ANAK YG
DEHIDRASI SEHINGGA
INTRAOSSEUS EXTENTION SULIT DIPASANG AKSES
2 TUBE IV 5
PASIEN ANAK YG
DEHIDRASI SEHINGGA
SULIT DIPASANG AKSES
3 FIXATOR IV 5
DR. RATNA SPM

1 SOFT LENS BANDAGE PCS 6√ ACC
DR KEVIN
1 COUTER BOVIE PCS 3√
CSSD
5,700,000/
CRYSTAL SA (H2O2) LAR 120 20 CYCLE
1 L BTL CSSD 1 BTL TANK
218,670/
2 PLASMA INDIKATOR TAPE BOX 1 BOX ROLL
BIOLOGICAL INDICATOR
3 H2O2 PLASMA BOX PLASMA STERILIZATION 1 BOX 1,870,000
15 MM X 100 MM (2OO 364,000/
4 INDICATOR STRIP BOX LBR/BOX) 1 BOX BOX
RED LABEL WITH INDICATOR 1 BOX ISI 12 ROLL ( 1
5 FOR PLASMA BOX ROLL ISI 750 LABEL) 1 BOX 7,260,000
POUCHES TYVEX
6 STERILIZATION REEL ROLL GLOPACK 1 ROLL
AESCULAP STERILI OIL SPRAY PELUMAS INSTRUMEN
7 300 ML SPRAY PT B BRAUN, AESCULAP A BEDAH 4 BOTOL
DR. ANGGINA SP.THT
DRG. YANTI
1 RESIN KOMPOSIT Z350 XT 3
2 RESIN KOMPOSIT A3 BODY 3
3 RESIN KOMPOSIT A2 EMAIL 3
4 ETSA 3 M 5
APEX LOCATOR MORITA
5 ROOT ZX ii 1
SYIRIN
6 BULKFILL FLOWABLE GE 2
FREEGENOL TEMPORARY
7 PACK PASTA 1 PACK
8 RELYX ULTIMATE CLICKER PACK 2 WARNA (A3 DAN A1) 1 PACK
DR. FIFI SPKK
DR. IFAH SPP

1 MOUTH PIECE PCS ALAT RESPIRATOR 17 √ 5650 ACC
SUCI PERINA
1 KERTAS EKG REN CARE ROLL EKG 1 ROLL ACC
KA. INST FARMASI KASIE PENUNJANG MEDIS KA. KOMITE FARMASI DAN TERAPI DIREKTUR RSUD TUGU KOJA
G TIDAK KELUAR 6 BULAN BERTURUT-TURUT
NO NAMA OBAT JUN - DES 22

1 METISOPRINOL TAB hapus saja
2 SURVANTA ED lama, sewaktu-waktu perlu
3 ACTEMRA hapus saja
4 ATENOLOL TAB hapus saja, bilang dulu dr daulat, minta habiskan
5 AZITRO INFUS 5 VIAL/6 BLN tetap sediakan
6 EFEDRIN TAB hapus saja
7 FOSFOMICYN INJEKSI hapus saja
8 GRISEOFULVIN 125MG BARU ED hapus saja, tanya dr fifi
MORFIN TAB hapus saja

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1.

evaluasi pemakaian dan efek samping obat baru 2022

2. evaluasi obat yg tidak digunakan selama 3 bulan berturut turut

3. daftar permintaan obat baru non fornas

4. obat - obat yang bisa di hapus dari formularium RS

5. restriksi pemberian obat non fornas , non kronis

4 F Ketoprofen F: suppos supp 100 mg suprafenid 2 sup/hari, maks 3 hari

ANTIALERGI DAN OBAT UNTUK

4 ANTIDOT DAN OBAT LAIN UNTUK

3 F Karbamazepin F: tablet tab 200 mg Carbamazepine tablet 200 mg () 120 tab/bulan

2 F Ampisilin F: inj; 1g/vial, 250 mg/vial Ampicillin inj 1 g, 250 mg 10 hari

2 F eritromisin sirup F : botol sirup 200 mg/5ml eritromisin sirup 2 btl/kasus

6.2.7 Golongan Tetrasiklin

Untuk infeksi akibat bakteri

Sepsis dan infeksi berat

Dosis 1 - 3 g/hari sampai diperoleh

Hanya untuk wanita hamil

Diberikan atas persetujuan

tab 100 (10mg/kgBB)maks 6 bln

Dapat diberikan oleh Faskes Tk.1

6 F tenofovir disoproxil fumarate 300 F : tab salut selaput tenofovir tenofovir

7 F nevirapine 200 mg F : kaplet nevirapine nevirapine

11 NF favipiravir F : tablet tab 200 mg favipirafir

12 NF oseltamivir F : tablet tab 75 mg oseltamivir

13 NF remdesivir NF : botol infus 100 mg/ vial remdac

7 ANTIMIGRAIN DAN ANTIVERTIGO 6

1 F Levodopa + Karbidopa + F: tablet 100 mg + 25 mg + 200 mg Stalevo

OBAT YANG MEMPENGARUHI

3 F Klopidogrel F: tablet 75 mg Clopidogrel tablet 75 mg (generik)

"Bahan dasar terbuat dari babi."

Untuk pencegahan VTE (Venous

2 F Vitamin K F: tab; inj tab 10 mg; inj 2 mg/ml Phytomenadione -

10 PRODUK DARAH DAN PENGGANTI

10,1 FRAKSI PLASMA UNTUK

benzethonium chloride 0,3%,

5 F alkacide F : cairan 2% Alkacide -

6 alkazyme F : serbuk Alkazyme -

Tidak digunakan sebagai lini

Sebagai terapi tambahan pada

Tidak digunakan sebagai obat

15.1.2 Antidiabetik parenteral

1 F Insulin Analog Aspart F: Inj 100 IU/ml 3 cc Apidra flexpen

Dalam kondisi tertentu, Dokter di

HORMON KELAMIN DAN OBAT

15,3 HORMON TIROID DAN

2 F levothyroxin F: tab levothyroxin

3 F tiamazole F : Tablet 10 mg thyrozol Untuk bulan pertama maksimal

Tablet: Methylprednisolone tablet 4 mg; 8 4 mg : Maksimal 10 tab/kasus

1 F Amiodaron F: tab, injeksi tab 200 mg, injeksi 50 mg / ml Kendaron, tyarit

14 F Dextrose, sodium chloride F infus infus 500 ml d5 1/4 saline -

dextrose, sodium chloride, sodium

16 F sodium chloride, Potassium F : infus infus 500 ml kaen 4B -

Tiap 500 mL mengandung Asam

Komposisi: Bilberry dry extr 80

Ofloxacin 3 mg, dapar fosfat pada

Hanya untuk pasien glaukoma

Vitamin A palmitate 1,000 iu, CENDO OCULENT A OPHTHALMIC GEL 5 G

Ion Natrium & Kalium dengan

3 F fluoxetine F: tablet tab 20 mg fluoxetine

tab 10 mg; sirup 1 mg/ml; suspensi domperidon suspensi; Domperidone

Metoclopramide tablet 10 mg; inj. 10 mg/

tab 4 mg : maksimal 3 tab pasca