Buku Ykkbi 2019 Revisi

DAFTAR STANDAR OBAT
YAYASAN KESEJAHTERAAN KARYAWAN

BANK I
NDONESIA
TAHUN 2019
KATA PENGANTAR
Dengan menyebut nama Allah SWT Tuhan yang Maha Kuasa yang telah melimpahkan rahmat dan hidayah-Nya bersama
ini kami panjatkan rasa syukur atas telah selesainya penyusunan Daftar Standar Obat Yayasan Kesejahteraan Karyawan Bank
Indonesia (DSO YKKBI) tahun 2019.
Dunia kedokteran dan industri farmasi berkembang pesat. Perkembangan tersebut di antaranya adanya a). penemuan zat
aktif obat baru, b). perkembangan teknologi baru pengemasan obat yang memungkinkan aktivitas terapeutik obat diperlama
dengan cara pelepasan obat secara terus menerus selama periode tertentu dalam sekali pemberian sehingga meningkatkan
kepatuhan dan kenyamanan pasien serta memperkecil efek samping serta c). telah dirilisnya berbagai hasil kajian obat pasca
dilepas ke pasaran.
Sehubungan dengan hal tersebut YKKBI bekerjasama kembali dengan Departemen Farmakologi dan Terapeutik Fakultas
Kedokteran Universitas Indonesia (FKUI) dalam melakukan review DSO YKKBI tahun 2017 dan penyusunan DSO YKKBI tahun 2019.
Dengan telah disusunnya DSO YKKBI tahun 2019 kami mengharapkan agar pemberian obat bagi Penerima Tunjangan Kesehatan
Hari Tua (TKHT) dapat terus-menerus dilakukan secara bermutu, rasional, aman, efektif dan efisien dan tetap memperhatikan
faktor ketersediaan obat di Apotek.
Tak lupa kami mengucapkan terima kasih kepada semua pihak yang telah membantu dalam proses penyusunan DSO YKKBI
tahun 2019 ini.
Jakarta, Januari 2019
YAYASAN KESEJAHTERAAN KARYAWAN

BANK INDONESIA
DAFTAR ISI
DAFTAR ISI
KALSIFIKASI HAL KALSIFIKASI HAL

DAFTAR OBAT UMUM 4.11 Hemostatik 14
1. Alergi dan Sistem Imun 4.12 Anti Koagulan, Anti Platelet & Fibrinolitik 14
1.1 Anti Histamin & Anti Alergi 1 5. Preparat Kulit Topikal
2. Sistem Gastrointestinal 5.1 Anti Infeksi Topikal 15
2.1 Antasid & Anti Ulserasi 1 5.2 Anti Infeksi Topikal Dengan Kortikosteroid 15
2.2 Anti Inflamasi Gastrointestinal 3 5.3 Topikal Kortikosteroid 16
2.3 Anti Spasmodik 3 5.4 Preparat Acne 17
2.4 Anti Diare 3 5.5 Antiseptik 17
2.5 Laksatif, Pencahar 3 5.6 Kasa Steril Dengan Obat 17
2.6 Digestan 4 5.7 Topikal Anti Jamur dan Parasit 17
2.7 Kolagogum, Kolelitolitik 4 5.8 Preparat Psoriasis, Seboroik & Iktiosis 18
2.8 Preparat Anorektal 4 5.9 Topikal Anti Virus 18
3. Antibiotik 5.10 Topikal Anti Histamin /Anti Pruritus 18
3.1 Cefalosporin 5 5.11 Topikal Analgetik & Anti Inflamasi 18
3.2 Chloramphenicol 5 5.12 Topikal Anastesi 18
3.3 Makrolid 6 6. Preparat Mata, Telinga, Mulut/Tenggorokan
3.4 Penisilin 7 6.1 Anti Infeksi & Antiseptik Mata 18
3.5 Kuinolon 7 6.2 Kortikosteroid Mata 19
3.6 Tetrasiklin 7 6.3 Antiseptik & Kortikosteroid Mata 19
3.7 Anti Tuberkulosis 8 6.4 Obat Midriatik 19
3.8 Kombinasi Anti Bakterial 8 6.5 Obat Glaukoma 19
3.9 Antibiotik Lain 9 6.6 Preparat Mata Lain 20
4. Sistem Kardiovaskular dan Hematopoietik 6.7 Anti Infeksi & Antiseptik Telinga 20
4.1 Obat Jantung 9 6.8 Antiseptik & Kortikosteroid Telinga 20
4.2 Obat Anti Angina 9 6.9 Preparat Telinga Lain 21
4.3 ACE Inhibitor 9 6.10 Preparat Mulut / Tenggorokan 21
4.4 Beta Blocker 10 7. Sistem Urogenital
4.5 Antagonis Kalsium 11 7.1 Preparat Vagina 21
4.6 Antagonis Angiotensin II 12 7.2 Antiseptik Saluran Kemih 21
4.7 Anti Hipertensi Golongan Lain 12 7.3 Preparat Sistem Urogenital Lain 21
4.8 Diuretik 13 8. Hormon
4.9 Vasodilator Perifer & Aktivator Cerebral 13 8.1 Hormon Kortikosteroid 22
4.10 Obat Migrain & Obat Anti Vertigo 13 8.2 Hormon Kortikosteroid 22
DAFTAR ISI
DAFTAR ISI
KALSIFIKASI HAL KALSIFIKASI HAL

9. Sistem Endokrin dan Metabolik DAFTAR OBAT KONDISI KHUSUS
9.1 Oral Antidiabetic Agents 23 I. Anti Virus 41
9.2 Preparat Tiroid 25 II. Imunosupresi 41
9.3 Obat Dislipidemia 25 III. Preparat Anti dotum 42
9.4 Insulin 26 IV. Preparat Haematopoietik 42
10. Sistem Syaraf Pusat V. Cairan Intravena 42
10.1 Analgesik & Antipiretik 27 VI. Analgesik Anti Inflamasi 43
10.2 Analgesik Anti Inflamasi Non Steroid 27 VII. Anti Emetik 43
10.3 Minor Tranquilliser / Anxiolitik 29 VIII. Anti Neoplastik 43
10.4 Major Tranquillisers / Anti Psikotik 30 IX. Antikoagulan, Antiplatelet & Fibrinolitik 46
10.5 Hipnotik & Sedatif 30 X. Preparat Affecting Metabolisme Tulang 46
10.6 Anti Konvulsi 31 XI. Relaksan Otot 46
XII. Anti Psikosis 47
10.7 Anti Parkinson 32
XIII. Injeksi Mata 47
10.8 Anti Depresan 32
XIV. Suplemen 47
10.9 Nootropik & Neurotonik 32
XV. Topical Kortikosteroid 47
10.10 Anti Emetik 33
XVI. Anti Anemia 47
11. Sistem Muskuloskeletal
XVII. Anti Trombositopenia 47
11.1 Obat Relaksan Otot 33
XVIII. Anti Koagulan 47
11.2 Obat Gangguan Neuromuskular 33
XIX. Anti Angina 47
11.3 Preparat Gout 34
XX. Preparat Sistim Urogenital Lain 48
11.4 Preparat Muskuloskeletal Lain 34 XXI. Oral Antidiabetic Agents 48
12. Anti infeksi XXII. Sistem Respirasi 48
12.1 Anti Jamur 34 XXIII. Analgesik Sistem Syaraf Pusat 48
12.2 Anti Amuba 35 XXIV. Detoxifying Agent 48
12.3 Anti Parasit 35 XXV. Therapi of Chorn's Disease 48
12.4 Anti Virus 35 DAFTAR OBAT KHUSUS DENGAN PERSETUJUAN
13. Sistem Respirasi I. Anti Demensia 49
13.1 Anti Asma & PPOK 35 II. Anti Ulserasi 49
13.2 Obat Batuk & Pilek 36 III. Antibiotik 49
13.3 Dekongestan Nasal & Preparat Nasal Lain 38 IV. Cerebral Activator 49
14. Vitamin & Mineral V. Nootropik dan Neurotonik 50
14.1 Vitamin 39 VI. Preparat Osteoporosis 50
14.2 Multivitamin 39 VII. Suplemen 50
14.3 Elektrolit & Mineral 40 TATA CARA PENGGUNAAN OBAT 51
DAFTAR OBAT UMUM
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT
OBAT UMUM
UMUM
NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI
1. Alergi dan Sistem Imun

1.1 Anti Histamin & Anti Alergi
Celestamine Syrup 30 ml; 60 ml PT. Merck Sharp & Dohme Indonesia
Betamethasone + Tablet 0,25 mg + 2 mg PT. Merck Sharp & Dohme Indonesia
1.1.1
dexchlorpheniramine maleate Cortamine Syrup 60 ml PT. Interbat
Tablet 0,25 mg + 2 mg PT. Interbat
Cetirizine Drops 10 mg/ml PT. Indofarma Tbk
Syrup 5 mg/ml PT. Indofarma Tbk
Tablet 10 mg PT. Novell Pharmaceutical Laboratories
1.1.2 Cetirizine HCL
PT. Hexpharm Jaya
PT. Indofarma Tbk
Cetrin Tablet 10 mg PT. Hexpharm Jaya
Chlorpheniramine maleate Tablet 4 mg PT. Phapros Tbk
1.1.3 Chlorpheniramine maleate
Allohex Tablet 10 mg PT. Hexpharm Jaya
Claritin Syrup Syrup 5 mg PT. Bayer Indonesia
Loratadine Tablet 10 mg PT. Novell Pharmaceutical Laboratories
1.1.4 Loratadine PT. Hexpharm Jaya
PT. Indofarma Tbk
Rahistin Tablet 10 mg PT. Kimia Farma
Ultilar Tablet 10 mg PT. Promedrahardjo Farmasi Industri
1.1.5 Pheniramine maleate Avil Tablet 25 mg PT. Aventis Pharma
2. Sistem Gastrointestinal
2.1 Antasid & Anti Ulserasi
Antasida Doen Syrup 400 mg/5 ml/Botol PT. Kimia Farma
2.1.1 Al (OH)3 + mg(OH)2
Tablet 400 mg/Tablet PT. Kimia Farma
Polysilane Syrup 80 mg + 200 mg + Apotek
2.1.2 Dimeticone + Al (OH)3 + mg(OH)2
200 mg + 100 ml
Lansoprazole kapsul 30 mg PT. Novell Pharmaceutical Laboratories
2.1.3 Lansoprazole PT. Hexpharm Jaya
PT. Indofarma Tbk
1
OBAT UMUM
UMUM

Digest kapsul 30 mg PT. Hexpharm Jaya
2.1.3 Lansoprazole Laproton kapsul 30 mg PT. Tempo Rx Farma
Sopralan kapsul 30 mg PT. Mersifarma Tirmaku Mercusana
Acitral Suspensi 120 ml PT. Interbat
Tablet 200mg+200mg+20m PT. Interbat

g
Anflat Forte Suspensi 400 mg + 400 mg + PT. Hexpharm Jaya
100 mg
Tablet 400 mg + 400 mg + PT. Hexpharm Jaya
100 mg
2.1.4 mg (OH)2 + Al(OH)3 + Simethicone
Gestamag Suspensi 250 mg + 250 mg + PT. Metiska Farma
50 mg
Tablet 250 mg + 250 mg + PT. Metiska Farma
50 mg
Magtral Suspensi 250 mg + 250 mg + PT. Otto Pharmaceutical Industries
50 mg
Magtral Forte Suspensi 400 mg + 400 mg + PT. Otto Pharmaceutical Industries
100 mg
Omeprazole kapsul 20 mg PT. Novell Pharmaceutical Laboratories
PT. Hexpharm Jaya
2.1.5 Omeprazole PT. Indofarma Tbk
OMZ Injeksi 40 mg PT. Ferron Par Pharmaceuticals
Tamezol kapsul 20 mg PT. Hexpharm Jaya
Ranitidine Injeksi 50 mg/2 ml PT. Bernofarm Pharmaceutical
PT. Hexpharm Jaya
Tablet 150 mg PT. Bernofarm Pharmaceutical
2.1.6 Ranitidine HCL PT. Hexpharm Jaya
PT. Indofarma Tbk
Ulceranin Tablet 150 mg PT. Abbott Indonesia
Xeradin Tablet 150 mg PT. Metiska Farma
Rebamipide Tablet 100 mg PT. Yarindo Farmatama
2.1.7 Rebamipide
PT. Novell Pharmaceutical Laboratories
2
OBAT UMUM
UMUM

2.1.7 Rebamipide Repimide Tablet 100 mg PT. Novell Pharmaceutical Laboratories
Gitafat Suspensi 500 mg/5 ml PT. Tempo Rx Farma
Ulsafate Suspensi 500 mg/5 ml PT. Combiphar
2.1.8 Sucralfate
Tablet 500 mg PT. Combiphar
Ulsicral Suspensi 500 mg/5 ml PT. Ikapharmindo Putramas
2.2 Anti Inflamasi Gastrointestinal
Sulcolon Captab 500 mg PT. Bernofarm Pharmaceutical
2.2.1 Sulfasalazine
Sulfasalazine Tablet 500 mg PT. Bernofarm Pharmaceutical
2.3 Anti Spasmodik
Metamizole,Belladona, papaverin Spasminal Tablet 500 mg, 10 mg, 25 Apotek
2.3.1
HCl mg
Cliad Tablet 5 mg + 2,5 mg PT. Interbat
2.3.2 Chlordiaxepozide + ClidinIUm Br
Parios Kaplet 10 mg + 500 mg PT. Hexpharm Jaya
2.3.3 Hyoscin N Butylbromide Scobutrin Tablet 10 mg PT. Pertiwi Agung (Landson)
Scopamin Tablet 10 mg PT. Abbott Indonesia
Hyoscin N Butylbromide + Scopamin Plus Kaplet 10 mg + 500 mg PT. Abbott Indonesia
2.3.4
Paracetamol
2.4 Anti Diare
New Diatabs Tablet 600 mg Apotek
2.4.1 Colloidal Activated Actapulgite
Normudal Tablet 2 mg PT. Combiphar
2.4.2 Loperamide HCL
Opox Tablet 2 mg PT. Guardian Pharmatama
Lacbon Tablet 10 juta IU PT. Kimia Farma
Lacidofil kapsul 2 x 109 CFU probiotik PT. Dexa Medica
2.4.3 Lactobacillus
sachet 4 x 109 CFU probiotik PT. Dexa Medica
2.5 Laksatif, Pencahar

Bisacodyl Tablet 5 mg PT. Novell Pharmaceutical Laboratories
2.5.1 Bisacodyl Dulcolax Supp 10 mg PT. Aventis Farma
Tablet 5 mg PT. Aventis Farma
3
OBAT UMUM
UMUM

Lactulax Syrup 120 ml PT. Ikapharmindo Putramas
2.5.2 Lactulose 60 ml PT. Ikapharmindo Putramas
LaxasIUm Syrup 400 mg / 5ml PT. Pratapa Nirmala Fahrenheit
Na Lauryl Sulfoacetatte + Na Rectolax Enema 400 mg PT. Actavis Indonesia
2.5.3 Citrate + Sorbic Acid + Peg 400 +
Sorbitol
2.6 Digestan
Pancreatin + Activated Xepazym Kaplet 170 mg + 80 mg PT. Metiska Farma
2.6.1
Dimethylpolysiloxane
2.7 Kolagogum, Kolelitolitik
Estazor Tablet 250 mg PT. Pratapa Nirmala Fahrenheit
Urdafalk G kapsul 250 mg PT. Darya Varia Laboratoria Tbk
2.7.1 Ursodeoxycholic acid Urdex Tablet 250 mg PT. Dexa Medica
Ursodeoxycholic Acid kapsul 250 mg PT. Novell Pharmaceutical Laboratories
Ursolic kapsul 250 mg PT. Guardian Pharmatama
Salofalk Tablet 250 mg PT. Darya Varia Laboratoria Tbk
2.7.2 Mesalazine
500 mg PT. Darya Varia Laboratoria Tbk
2.8 Preparat Anorektal
Fluocortolone pivalate, Ultraproct N Oint 1 mg/20 mg PT. Bayer Indonesia
fluocortolone caproate ,
2.8.1
cinchocaine HCL, clemizole Supp 1 mg/40 mg PT. Bayer Indonesia
undecylate
Faktu Oint 100 mg/ 2.5 mg Apotek
2.8.2 Policresulen, cinchocaine HCL
Supp 50 mg/ 10 gr Apotek
Borraginol N Oint 0.09 mg PT. Takeda Indonesia
Supp 0.1 mg PT. Takeda Indonesia
2.8.3 Lithospermi rdx, Benzocaine, dll
Borraginol S Oint 0.1 mg PT. Takeda Indonesia
Supp 0.18 mg PT. Takeda Indonesia
4
OBAT UMUM
UMUM

3. Antibiotik
3.1 Cefalosporin
Cefadroxil kapsul 500 mg PT. Hexpharm Jaya
PT. Indofarma Tbk
3.1.1 Cefadroxil Monohydrate PT. Kimia Farma
Dexadrox kapsul 500 mg PT. Dexa Medica
Librocef kapsul 500 mg PT. Hexpharm Jaya
Cefabiotic kapsul 500 mg PT. Bernofarm Pharmaceutical
3.1.2 Cefalexin Monohydrate Syrup 125 mg/5 ml PT. Bernofarm Pharmaceutical
Cephalexin kapsul 500 mg PT. Indofarma Tbk
Cefixime kapsul 100 mg PT. Novell Pharmaceutical Laboratories
PT. Hexpharm Jaya
PT. Indofarma Tbk
200 mg PT. Novell Pharmaceutical Laboratories
PT. Bernofarm Pharmaceutical
Syrup 100 mg/5 ml PT. Novell Pharmaceutical Laboratories
3.1.3 Cefixime PT. Hexpharm Jaya
PT. Indofarma Tbk
Ceptik kapsul 200 mg PT. Interbat
100 mg PT. Interbat
Syrup 100 mg/5 ml PT. Interbat
Lanfix kapsul 200 mg PT. Pertiwi Agung (Landson)
100 mg PT. Pertiwi Agung (Landson)
Syrup 100 mg/5ml PT. Pertiwi Agung (Landson)
3.1.4 Cefuroxime Axetil Situroxim Tablet 500 mg PT. Puspa Pharma
3.2 Chloramphenicol
Chloramex kapsul 500 mg PT. Actavis Indonesia
Chloramphenicol kapsul 250 mg PT. Indofarma Tbk
3.2.1 Chloramphenicol Syrup 125 mg/5ml PT. Kimia Farma
Kalmicetine kapsul 250 mg PT. Kalbe Farma
Syrup 125 mg/5ml PT. Kalbe Farma
5
OBAT UMUM
UMUM

Opiphen kapsul 500 mg PT. Otto Pharmaceutical Industries
Thiamphenicol kapsul 500 mg PT. Phapros Tbk
Thiamycin kapsul 1000 mg PT. Interbat
250 mg PT. Interbat
3.2.2 Thiamphenicol
500 mg PT. Interbat
Syrup 125mg/5ml PT. Interbat
250mg/5ml PT. Interbat
Thianicol kapsul 500 mg PT. Hexpharm Jaya
3.3 Makrolid
Azithromycin Kaplet 500 mg PT. Novell Pharmaceutical Laboratories
PT. Kimia Farma
Tablet 500 mg PT. Otto Pharmaceutical Industries
Trozin Syrup 200 mg/5 ml PT. Tempo Rx Farma
3.3.1 Azithromycin
Tablet 500 mg PT. Tempo Rx Farma
Zitrolin Kaplet 500 mg PT. Otto Pharmaceutical Industries
Zycin Kaplet 250 mg PT. Interbat
500 mg PT. Interbat
Abbotic Granule 250 mg /5ml PT. Abbott Indonesia
Tablet 500 mg PT. Abbott Indonesia
Abbotic XL Tablet Release 500 mg PT. Abbott Indonesia
3.3.2 Clarithromycin
Clarithromycin Kaplet 500 mg PT. Novell Pharmaceutical Laboratories

Comtro Dry Syrup 125 mg / 5 ml PT. Combiphar
Erythrin Syrup 200 mg / 5 ml PT. Interbat
Tablet 500 mg PT. Interbat
3.3.3 Erythromycin HCL Erythromycin Syrup 200 mg / 5 ml PT. Indofarma Tbk
PT. Kimia Farma
Tablet 250 mg PT. Kimia Farma
Sitro Kaplet 300 mg PT. Interbat
3.3.4 Roxithromycin
Tablet 150 mg PT. Interbat
Rovadin Syrup 125 mg/ 5 ml PT. Otto Pharmaceutical Industries
3.3.5 Spiramycin Tablet 500 mg PT. Otto Pharmaceutical Industries
Spiramycin Tablet 500 mg PT. Novell Pharmaceutical Laboratories
6
OBAT UMUM
UMUM

3.4 Penisilin
Amoxicillin Kaplet 500 mg PT. Kimia Farma
kapsul 500 mg PT. Bernofarm Pharmaceutical
Opimox Kaplet 500 mg PT. Otto Pharmaceutical Industries
3.4.1 Amoxycillin Trihydrate Syrup 125 mg / 5 ml PT. Otto Pharmaceutical Industries
Topcillin Kaplet 500 mg PT. Hexpharm Jaya
Syrup 125 mg / 5 ml PT. Hexpharm Jaya
250 mg / 5 ml PT. Hexpharm Jaya
Clamixin Syrup 125 mg; 31,25 mg/5 PT. Otto Pharmaceutical Industries
ml
3.4.2 Amoxycillin + Clavulanic acid
Clamixin Forte Syrup 250 mg; 62,5 mg / PT. Otto Pharmaceutical Industries
5ml
Co Amoxiclav Tablet 625 mg PT. Indofarma Tbk
3.5 Kuinolon
Ciprofloxacin Tablet 500 mg PT. Novell Pharmaceutical Laboratories
3.5.1 Ciprofloxacin PT. Hexpharm Jaya
Girabloc Tablet 500 mg PT. Hexpharm Jaya
Siflox Tablet 500 mg PT. Mersifarma Tirmaku Mercusana
Lekuicin Fc Tablet 500 mg PT. Ferron Par Pharmaceuticals
Levofloxacin Tablet 500 mg PT. Novell Pharmaceutical Laboratories
3.5.2 Levofloxacin PT. Bernofarm Pharmaceutical
PT. Indofarma Tbk
PT. Kimia Farma
Flotavid Tablet 200 mg PT. Mersifarma Tirmaku Mercusana
Ofloxacin Tablet 200 mg PT. Novell Pharmaceutical Laboratories
3.5.3 Ofloxacin PT. Indofarma Tbk
PT. Indofarma Tbk
3.6 Tetrasiklin
Doxycycline kapsul 100 mg PT. Kimia Farma
3.6.1 Doxycycline Interdoxin kapsul 100 mg PT. Interbat
50 mg PT. Interbat
Page 7
OBAT UMUM
UMUM

3.7 Anti Tuberkulosis
Ethambutol Tablet 500 mg PT. Indofarma Tbk
PT. Kimia Farma
3.7.1 Ethambutol HCL Pulna Tablet 250 mg PT. Pertiwi Agung (Landson)
Pulna Forte Tablet 500 mg PT. Pertiwi Agung (Landson)
Tibigon Tablet 500 mg PT. Hexpharm Jaya
INHA Tablet 400 mg PT. Mersifarma Tirmaku Mercusana
3.7.2 Isoniazid + Vit B6
Inoxin Tablet 400 mg PT. Dexa Medica
Pyrazinamide Tablet 500 mg PT. Kimia Farma
3.7.3 Pyrazinamide
Siramid Kaplet 500 mg PT. Mersifarma Tirmaku Mercusana
Merimac Kaplet 450 mg PT. Mersifarma Tirmaku Mercusana
Rifampicin Kaplet 450 mg PT. Kimia Farma
3.7.4 Rifampicin kapsul 300 mg PT. Indofarma Tbk
450 mg PT. Indofarma Tbk
Tablet 600 mg PT. Indofarma Tbk
3.7.5 Rifampicin + INH Pro TB 2 Tablet salut 150 mg+150 mg PT. Phapros Tbk
Pro TB 4 Tablet salut 150 mg+400mg+75 PT. Phapros Tbk
mg+275mg
Rifampicin + INH + Pyrazinamide
3.7.6
+Ethambutol
Rifastar Kaplet 150 mg+400mg+75 PT. Indofarma Tbk
mg+275mg
3.7.7 Streptomycin Streptomycin Injeksi 50 mg PT. Phapros Tbk
3.8 Kombinasi Anti Bakterial
Cotrimoxazole Syrup 240 mg/5 ml PT. Indofarma Tbk
PT. Kimia Farma
Tablet 160 mg + 800 mg PT. Bernofarm Pharmaceutical
3.8.1 Co-Trimoxazole 80 mg + 400 mg PT. Bernofarm Pharmaceutical
PT. Indofarma Tbk
PT. Kimia Farma
Primazole Syrup 240 mg/5 ml PT. Hexpharm Jaya
8
OBAT UMUM
UMUM

3.9 Antibiotik Lain
Albiotin kapsul 150 mg PT. Hexpharm Jaya
300 mg PT. Hexpharm Jaya
Clindamycin kapsul 150 mg PT. Phapros Tbk
3.9.1 Clindamycin PT. Indofarma Tbk
Dacin kapsul 150 mg PT. Mersifarma Tirmaku Mercusana
300 mg PT. Mersifarma Tirmaku Mercusana
4. Sistem Kardiovaskular dan Hematopoietik
4.1 Obat Jantung
Kendarone Tablet 200 mg PT. Darya Varia Laboratoria Tbk
4.1.1 Amiodarone HCL
Rexidron Tablet 200 mg PT. Novell Pharmaceutical Laboratories
4.1.2 Digoxin Digoxin Tablet 0.25 mg Apotek
4.1.3 Propafenone HCL Rytmonorm Tablet 150 mg PT. Abbott Indonesia
4.2 Obat Anti Angina
Cedocard Tablet 10 mg PT. Darya Varia Laboratoria Tbk
20 mg PT. Darya Varia Laboratoria Tbk
4.2.1 Isosorbide Dinitrate 5 mg PT. Darya Varia Laboratoria Tbk
Isonat Tablet 10 mg PT. Kimia Farma
5 mg PT. Kimia Farma
Cardismo Tablet 20mg PT. Phapros Tbk
4.2.2 Isosorbide 5 - Mononitrate
Imocard Tablet 60 mg PT. Novell Pharmaceutical Laboratories
Nitral Tablet 0.5 mg PT. Actavis Indonesia
Sublingual
4.2.3 Glyceryl Trinitrat
Nitrokaf Retard kapsul 2.5 mg PT. Kimia Farma
Nitrokaf Retard Forte kapsul 5.0 mg PT. Kimia Farma
4.3 ACE Inhibitor
Captopril Tablet 12,5 mg PT. Kimia Farma
4.3.1 Captopril
Dexacap Tablet 25 mg PT. Dexa Medica
9
OBAT UMUM
UMUM

Interpril Tablet 10 mg PT. Interbat
5 mg PT. Interbat
Lisinopril Tablet 10 mg PT. Novell Pharmaceutical Laboratories
PT. Dexa Medica
4.3.2 Lisinopril
PT. Dexa Medica
Tensiphar Tablet 10 mg PT. Actavis Indonesia
5 mg PT. Actavis Indonesia
Prohytens Tablet 10 mg PT. Novell Pharmaceutical Laboratories
2,5 mg PT. Novell Pharmaceutical Laboratories
Ramipril Tablet 10 mg PT. Novell Pharmaceutical Laboratories
4.3.3 Ramipril
Tenapril Kaplet 10 mg PT. Dexa Medica
2,5 mg PT. Dexa Medica
5 mg PT. Dexa Medica
Tanapress Tablet 10 mg PT. Mitsubishi Tanabe Pharma Indonesia
4.3.4 Imidapril HCL
5 mg PT. Mitsubishi Tanabe Pharma Indonesia
4.4 Beta Blocker
Betablok Tablet 100 mg PT. Hexpharm Jaya
4.4.1 Atenolol 50 mg PT. Hexpharm Jaya
Internolol Tablet 50 mg PT. Interbat
Beta-One Tablet 2,5 mg PT. Kalbe Farma
5 mg PT. Kalbe Farma
Biscor Tablet 5 mg PT. Dexa Medica
4.4.2 Bisoprolol Fumarate Bisoprolol Tablet 5 mg PT. Novell Pharmaceutical Laboratories
Concor Tablet 1.25 mg PT. Merck Tbk
2.5 mg PT. Merck Tbk
5 mg PT. Merck Tbk
Bisoprolol Fumarate + Lodoz Tablet 2,5 mg PT. Merck Tbk
4.4.3
Hydrochlorthiazide 5 mg PT. Merck Tbk
Blorec Tablet 25 mg PT. Pratapa Nirmala Fahrenheit
4.4.4 Carvedilol V-Bloc Tablet 25 mg PT. Kalbe Farma
6,25 mg PT. Kalbe Farma
10
Page 10
OBAT UMUM
UMUM

4.4.5 Metoprolol Tartrate Loprolol Tablet 100 mg PT. Ikapharmindo Putramas
4.4.6 Propranolol HCL Propranolol HCL Tablet 40 mg PT. Kimia Farma
4.5 Antagonis KalsIUm
Amcor Tablet 10 mg PT. Merck Tbk
5 mg PT. Merck Tbk
Amlodipine Tablet 10 mg PT. Hexpharm Jaya
PT. Indofarma Tbk
PT. Kimia Farma
PT. Indofarma Tbk
4.5.1 Amlodipine Besylate
PT. Kimia Farma
Belvas Tablet 10 mg PT. Tempo Rx Farma
5 mg PT. Tempo Rx Farma
Comdipin Tablet 10 mg PT. Combiphar
5 mg PT. Combiphar
Hexavask Tablet 10 mg PT. Hexpharm Jaya
Cordilla SR Tablet 180 mg PT. Dexa Medica
Diltiazem Tablet 30 mg PT. Kimia Farma
Herbesser Tablet 30 mg PT. Mitsubishi Tanabe Pharma Indonesia
4.5.2 Diltiazem HCL 60 mg PT. Mitsubishi Tanabe Pharma Indonesia
Herbesser CD kapsul 100 mg PT. Mitsubishi Tanabe Pharma Indonesia
Herbesser SR kapsul 180 mg PT. Mitsubishi Tanabe Pharma Indonesia
Adalat Oros Tablet 30 mg PT. Bayer Indonesia
4.5.3 Nifedipine
Nifedipine Tablet 10 mg PT. Kimia Farma
Isoptin Kaplet 80 mg PT. Abbott Indonesia
4.5.4 Verapamil HCL Isoptin SR Kaplet 240 mg PT. Abbott Indonesia
Verapamil Tablet 80 mg PT. Kimia Farma
11
OBAT UMUM
UMUM

4.6 Antagonis Angiotensin II
Candesartan Tablet 16 mg PT. Novell Pharmaceutical Laboratories
Candepress Tablet 16 mg PT. Bernofarm Pharmaceutical
4.6.1 Candesartan Cilexetil
8 mg PT. Bernofarm Pharmaceutical
Canderin Tablet 16 mg PT. Dexa Medica
Candotens Tablet 16 mg PT. Novell Pharmaceutical Laboratories
Irbesartan Tablet 150 mg PT. Indofarma Tbk
4.6.2 Irbesartan
Irtan Tablet 150 mg PT. Ikapharmindo Putramas
300 mg PT. Ikapharmindo Putramas
4.6.3 Irbesartan + HCT Irtan Plus Tablet 300 mg,12.5 mg PT. Ikapharmindo Putramas
Angioten Tablet 50 mg PT. Kalbe Farma
Lifezar Tablet 100 mg PT. Darya Varia Laboratoria Tbk
4.6.4 Losartan 50 mg PT. Darya Varia Laboratoria Tbk
Losartan Tablet 50 mg PT. Hexpharm Jaya
Losartan K Tablet 50 mg PT. Novell Pharmaceutical Laboratories
4.6.5 Telmisartan Micardis Tablet 40 mg PT. Boehringer Ingelheim
80 mg PT. Boehringer Ingelheim
4.6.6 Telmisartan + Hydrochlorothiazide Micardis Plus Tablet 40 mg/12,5 mg PT. Boehringer Ingelheim
80 mg/12,5 mg PT. Boehringer Ingelheim
4.6.7 Valsartan Valsartan Tablet 160 mg PT. Novell Pharmaceutical Laboratories
4.7 Anti Hipertensi Golongan Lain
Catapres Tablet 0.075 mg PT. Boehringer Ingelheim
0.15 mg PT. Boehringer Ingelheim
4.7.1 Clonidine HCL Catapres liquid Ampul 0.15 mg PT. Boehringer Ingelheim
Clonidine Tablet 0.15 mg PT. Indofarma Tbk
PT. Kimia Farma
12
OBAT UMUM
UMUM

Cardura Tablet 1 mg PT. Pfizer Indonesia
4.7.2 Doxazosin Mesylate
2 mg PT. Pfizer Indonesia
4.7.3 Methyldopa Dopamet Tablet 250 mg PT. Actavis Indonesia
4.8 DIUretik
4.8.1 Acetazolamide Glaucon Tablet 250 mg PT. Cendo Pharmaceutical Industries
Furosemide Tablet 40 mg PT. Indofarma Tbk
PT. Kimia Farma
4.8.2 Furosemide
Lasix Ampul 10 mg / ml PT. Aventis Pharma
Tablet 40 mg PT. Aventis Pharma
4.8.3 Hydrochlorthiazide Hydrochlorthiazide Tablet 25 mg/Tablet PT. Kimia Farma
Letonal Tablet 100 mg PT. Abbott Indonesia
25 mg PT. Abbott Indonesia
Spirola Tablet 100 mg PT. Kalbe Farma
4.8.4 Spironolactone
Spironolactone Tablet 100 mg PT. Otto Pharmaceutical Industries
25 mg PT. Otto Pharmaceutical Industries
4.8.5 Indapamide Natrilix SR Tablet 1.5 mg PT. Servier Indonesia
4.9 Vasodilator Perifer & Aktivator Cerebral
Merron Tablet 25 mg PT. Mersifarma Tirmaku Mercusana
4.9.1 Cinnarizine Nariz Tablet 25 mg PT. Tempo Rx Farma
Perifas Tablet 25 mg PT. Otto Pharmaceutical Industries
Serolin Tablet 10 mg PT. Kalbe Farma
4.9.2 Nicergoline
4.9.3 Nimodipine Nimotop Tablet 30 mg PT. Bayer Indonesia
4.9.4 Pentoxyfylline Trental Tablet 400 mg PT. Aventis Pharma
4.9.5 Naftidropuryl Oxalate Praxilene Tablet 200 mg PT. Merck Tbk
4.10 Obat Migrain & Obat Anti Vertigo
Ergotamine Tartrate & Tablet 1 mg + 50 mg PT. Kimia Farma
4.10.1 Ergotamine Tartrate & Caffeine Caffeine
Ericaf Tablet 1mg + 100 mg PT. Tempo Rx Farma
Flunarizine Tablet 5 mg PT. Bernofarm Pharmaceutical
4.10.2 Flunarizine Silum Tablet 10 mg PT. Mersifarma Tirmaku Mercusana
13
OBAT UMUM
UMUM

UnalIUm Tablet 10 mg PT. Guardian Pharmatama
5 mg PT. Guardian Pharmatama
4.10.2 Flunarizine
XepalIUm Tablet 10 mg PT. Metiska Farma
5 mg PT. Metiska Farma
Vertikaf Tablet 24 mg PT. Kimia Farma
4.10.3 Betahistin Dihidroklorida
Betahistine Tablet 6 mg PT. Novell Pharmaceutical Laboratories
Kurtigo Tablet 6 mg PT. Ikapharmindo Putramas
Mertigo Tablet 6 mg PT. Dexa Medica
4.10.4 Betahistin Mesilat
Mertigo SR Tablet 12 mg PT. Dexa Medica
Vercure Tablet 6 mg PT. Tempo Rx Farma
Versilon Tablet 6 mg PT. Mersifarma Tirmaku Mercusana
4.11 Hemostatik
Asam Traneksamat Injeksi 500 mg/5 ml PT. Bernofarm Pharmaceutical
Tablet 500 mg PT. Bernofarm Pharmaceutical
Asamnex Tablet 500 mg PT. Metiska Farma
4.11.1 Tranexamic Acid Kalnex Injeksi 250 mg PT. Kalbe Farma
Tablet 500 mg PT. Kalbe Farma
Nexa Tablet 500 mg PT. Hexpharm Jaya
4.12 Anti Koagulan, Anti Platelet & Fibrinolitik
Aspilet Chewable Chewable 80 mg PT. Darya Varia Laboratoria Tbk
Cardio Aspirin Tablet 100 mg PT. Bayer Indonesia
4.12.1 Acetylsalicylic Acid Farmasal Tablet 100 mg PT. Pratapa Nirmala Fahrenheit
Nospirinal Tablet 80 mg PT. Novell Pharmaceutical Laboratories
Thrombo Aspilet Entry Coated 80 mg PT. Darya Varia Laboratoria Tbk
Antiplat Tablet 100 mg PT. Dexa Medica
4.12.2 Cilostazol Naletal Tablet 100 mg PT. Guardian Pharmatama
Clopidogrel Tablet 75 mg PT. Tempo Rx Farma
PT. Hexpharm Jaya
PT. Kimia Farma
14
OBAT UMUM
UMUM

4.12.3 Clopidogrel Medigrel Tablet 75 mg PT. Promedrahardjo Farmasi Industri
Placta Tablet 75 mg PT. Actavis Indonesia
Platogrix Tablet 75 mg PT. Aventis Pharma
Rinclo Tablet 75 mg PT. Yarindo Farmatama
Notisil Tablet 2 mg PT. Novell Pharmaceutical Laboratories
4.12.4 Warfarin Na
Simarc 2 Tablet 2 mg PT. Pratapa Nirmala Fahrenheit
Warfarin Tablet 1 mg PT. Eisai Indonesia
5. Preparat Kulit Topikal
5.1 Anti Infeksi Topikal
Gentamycin Cream 0,1%/Tube PT. Kimia Farma
5.1.1 Gentamycin Sulfate
Salticin Cream 0,001 PT. Interbat
Mupirocin Oint 5 gr PT. Novell Pharmaceutical Laboratories
Bactroban Cream 10 gr PT. Smith Kline Beecham Pharmaceutical
5 gr PT. Smith Kline Beecham Pharmaceutical
5.1.2 Mupirocin Oint 10 gr PT. Smith Kline Beecham Pharmaceutical
5 gr PT. Smith Kline Beecham Pharmaceutical
Pirotop Cream 10 gr PT. Surya Dermato Medica Laboratories
5 gr PT. Surya Dermato Medica Laboratories
Oint 10 gr PT. Surya Dermato Medica Laboratories
5.1.3 Silver Sulfadiazine Burnazin Cream 30 mg PT. Darya Varia Laboratoria Tbk
5.1.4 Chloramphenicol Kalmicetine Dermakolog Tube 20 mg PT. Kalbe Farma
5.2 Anti Infeksi Topikal Dengan Kortikosteroid
Betason N Cream 5 gr PT. Kimia Farma
Betamethasone + Neomycin
5.2.1 Oviskin N Cream 10 gr PT. Hexpharm Jaya
Sulfate
5 gr PT. Hexpharm Jaya
Digenta Cream 10 gr PT. Interbat
Betamethasone Dipropionate +
5.2.2
Gentamycin /Neomycin Scanderma Plus Cream 10 gr PT. Tempo Rx Farma
15
OBAT UMUM
UMUM

Nerilon Cream 0,001 PT. Interbat
5.2.3 Diflucortolone + Chlorquinadol
Fluprednidene, Neomycin, Gentacortin Tube 0,1% PT. Merck Tbk
5.2.4
Hydroxyquinoline
Betamethasone Dipropionate, Diprosalic Oint 5 gr PT. Merck Sharp & Dohme Indonesia
5.2.5
Salysilic Acid (Sol)
Thecort Cream 5 gr PT. Guardian Pharmatama
5.2.6 Miconazole Nitrat + Hydrocortison
5.3 Topikal Kortikosteroid
Betamethasone Cream 5 gr PT. Phapros Tbk
PT. Kimia Farma

Betamethasone
5.3.1 Betason Cream 10 gr PT. Kimia Farma
Valerate/dipropionat
Oviskin Cream 10 gr PT. Hexpharm Jaya
Skizon Cream 10 gr PT. Hexpharm Jaya
5 gr PT. Hexpharm Jaya
Desoximetasone Oint 15 gr PT. Novell Pharmaceutical Laboratories
5.3.2 Desoximetasone
Dexocort Cream 10 gr PT. Kimia Farma
Dermovel Cream 10 gr PT. Ferron Par Pharmaceuticals
5 gr PT. Ferron Par Pharmaceuticals
5.3.3 Mometasone furoate
Elox Cream 10 gr PT. Guardian Pharmatama
5 gr PT. Guardian Pharmatama
Kloderma Cream 10 gr PT. Surya Dermato Medica Laboratories
Gel 5 gr PT. Surya Dermato Medica Laboratories
5.3.4 Clobetasol propionate Oint 10 gr PT. Surya Dermato Medica Laboratories
Lotasbat Cream 10 gr PT. Interbat
Oint 10 gr PT. Interbat
16
OBAT UMUM
UMUM

5.4 Preparat Acne
Erymed Cream 20 gr PT. Surya Dermato Medica Laboratories
5.4.1 Erythromycin Gel 15 gr PT. Surya Dermato Medica Laboratories
Solution 30 ml PT. Surya Dermato Medica Laboratories
Vitacid Cream 0,00025 PT. Surya Dermato Medica Laboratories
0,0005 PT. Surya Dermato Medica Laboratories
5.4.2 Retinoic Acid 0,001 PT. Surya Dermato Medica Laboratories
Gel 0,00025 PT. Surya Dermato Medica Laboratories
Solution 50 ml PT. Surya Dermato Medica Laboratories
Nuface Cream 0.025% / 10 gr PT. Guardian Pharmatama
5.4.3 Tretionin
0.05% / 10 gr PT. Guardian Pharmatama
5.5 Antiseptik
5.5.1 Etakridin Rivanol Solution 0,1% Apotek
5.5.2 Hydrogen Perokside Hydrogen Perokside Solution 0,03 Apotek
5.5.3 KalIUm Permanganat KalIUm Permanganat Serbuk 5 gr Apotek
Iodine Povidon Lar Cairan 10 %, 30 ml PT. Kimia Farma
5.5.4 Povidone Iodine
10 %, 60 ml PT. Kimia Farma
5.5.5 Asam Salisilat 2 % Talk 98% Salisil Talk Bedak Tabur 50 mg PT. Ikapharmindo Putramas
5.6 Kasa Steril Dengan Obat
Daryant Tulle 10 x 10 cm 2m mg BP 1% PT. Darya Varia Laboratoria Tbk
5.6.1 Framycetin Sulfate 25mg BP 1%
Sofratulle Sheet 10 X 10 cm PT. Aventis Pharma
5.7 Topikal Anti Jamur dan Parasit
5.7.1 Cloritamazole Cotristen Cream 10 mg Apotek
Ketoconazole Cream 0,02 PT. Hexpharm Jaya
5.7.2 Ketoconazole
PT. Kimia Farma
Interzol SS 1% Cairan 0,001 PT. Interbat
Interzol SS 2% Cairan 0,002 PT. Interbat
5.7.2 Ketoconazole
Muzoral Cream 0,02 PT. Transfarma Medica Indah
Mycoral Cream 0,02 PT. Kalbe Farma
Myco-Z Oint 100.000 IU + 200mg PT. Taisho Pharmaceutical
5.7.3 Nystatin + Zinc Oxide
17
OBAT UMUM
UMUM

5.7.4 Terbinafine Interbi Cream 5 gr PT. Interbat
5.8 Preparat Psoriasis, Seboroik & Iktiosis
5.8.1 Calcipotriol Daivonex Oint 30 gr PT. Mensa Bina Sukses (Leo Pharma)
Daivobet Oint 15 gr PT. Mensa Bina Sukses (Leo Pharma)
5.8.2 Calcipotriol & Betamethasone
30 gr PT. Mensa Bina Sukses (Leo Pharma)
Carmed Cream 0,1 PT. Surya Dermato Medica Laboratories
0,2 PT. Surya Dermato Medica Laboratories
5.8.3 Urea
Moisderm Cream 0,1 PT. Interbat
0,2 PT. Interbat
5.9 Topikal Anti Virus
Acyclovir Cream 0,05 PT. Indofarma Tbk
PT. Kimia Farma
5.9.1 Acyclovir
Scanovir Cream 0,05 PT. Tempo Rx Farma
Zoter Cream 0,05 PT. Interbat
5.10 Topikal Anti Histamin /Anti Pruritus
Diphenhydramine HCL + Calamine Caladine Lotion 2% + 15% + 5% Apotek
5.10.1
+ Zinc Oxide
5.11 Topikal Analgetik & Anti Inflamasi
Infeld Gel 0,005 PT. Interbat
5.11.1 Piroxicam
Scandene Gel Gel 0.005 / 20 mg PT. Tempo Rx Farma
5.12 Topikal Anastesi
Lidocain HCL Injeksi 0,02 PT. Phapros Tbk
5.12.1 Lidocain HCL
Estesia Cream 2 gr Apotek
5.12.2 Lidocaine 25 mg + Prilocaine 25 mg
6. Preparat Mata, Telinga, Mulut/Tenggorokan

6.1 Anti Infeksi & Antiseptik Mata
6.1.1 Acyclovir Hervis Eye Oint 30 mg/g PT. Cendo Pharmaceutical Industries
Colme eye Eye drop 0,005 PT. Interbat
6.1.2 Chlorampenicol Fenicol Eye Oint 5 mg/ml PT. Cendo Pharmaceutical Industries
Minidose 0,005 PT. Cendo Pharmaceutical Industries
6.1.3 Levofloxacin HCL Cravit Eye drop 5 mg/ml PT. Ferron Par Pharmaceuticals
18
OBAT UMUM
UMUM

6.1.3 Levofloxacin HCL LFX Minidose 5 mg/ml PT. Cendo Pharmaceutical Industries
Stratol Eye drop 3.5 mg+6000 IU PT. Cendo Pharmaceutical Industries
Neomycin sulfate + polymyxin B
6.1.4 Eye Oint 3.5 mg+6000 IU PT. Cendo Pharmaceutical Industries
sulfate + phenylephrine HCL
Minidose 3.5 mg+6000 IU PT. Cendo Pharmaceutical Industries
6.1.5 Oxytetracyclin Terramycin Eye Oint 0,01 PT. Pfizer Indonesia
6.1.6 Sulfacetamide Na Cetamide Eye drop 150 mg/ml PT. Cendo Pharmaceutical Industries
6.1.7 Ciprofloxacin Interflox eye Eye drop 3 mg PT. Interbat
6.2 Kortikosteroid Mata
6.2.1 Betamethasone Na Phosphate Vosama Minidose 10 mg/ml PT. Cendo Pharmaceutical Industries
P. Pred Eye drop 10 mg PT. Cendo Pharmaceutical Industries
6.2.2 Prednisolone Acetate Miconized
Minidose 10 mg PT. Cendo Pharmaceutical Industries
6.3 Antiseptik & Kortikosteroid Mata
Polydex Eye drop 1 mg/ml; 3,5 mg/ml; PT. Cendo Pharmaceutical Industries
10000 IU/ml
Dexamethasone + Neomycin +
6.3.1
Polymixin B Minidose 2 mg/ml; 3,5 mg/ml; PT. Cendo Pharmaceutical Industries
10000 IU/ml
Tobradex Eye drop 5 ml Apotek

6.3.2 Dexamethasone + Tobramycin
Tobroson Minidose 1 mg/ml; 3 mg/ml PT. Cendo Pharmaceutical Industries
Framycetin Sulfate + Gramicidin + Fradex Minidose 5 mg/ml; 0,05 PT. Cendo Pharmaceutical Industries
6.3.3
Dexamethasone mg/ml; 1 mg/ml
Mycos Eye Oint 5 mg/ml; 2 mg/ml PT. Cendo Pharmaceutical Industries
6.3.4 Hydrocortison + Chloramphenicol
Minidose 5 mg/ml; 2 mg/ml PT. Cendo Pharmaceutical Industries
6.4 Obat Midriatik
6.4.1 Atropine sulfate Tropine Eye drop 10 mg/ml PT. Cendo Pharmaceutical Industries
Minidose 10 mg/ml PT. Cendo Pharmaceutical Industries
6.5 Obat Glaukoma
6.5.1 Brinzolamide Azopt Eye drop 5 ml Apotek
19
OBAT UMUM
UMUM

Glaoplus Minidose 0,05 mg/ml; 5 mg/ml PT. Cendo Pharmaceutical Industries
6.5.2 Latanoprost + timolol
Xalacom Drops 50 mcg+5mg PT. Pfizer Indonesia
Timol Eye drop 5 mg/ml PT. Cendo Pharmaceutical Industries
6.5.3 Timolol maleate
Minidose 5 mg/ml PT. Cendo Pharmaceutical Industries
6.5.4 Pilocarpine Carpine Minidose 20 mg/ml PT. Cendo Pharmaceutical Industries
6.5.5 Travoprost Travatan BAK Free Eye drop 0.004% Apotek
6.6 Preparat Mata Lain
Eyefresh Minidose 0.1%+0.3% PT. Cendo Pharmaceutical Industries
6.6.1 Dextran + Hydroxy Methylcellulose
Tears Naturale II Eye drop 0.1%+0.3% Apotek
6.6.2 Diclofenac Na Noncort Minidose 1 mg/ml PT. Cendo Pharmaceutical Industries
6.6.3 Carboxy methylcellulose Cenfresh Minidose 5 mg/ml PT. Cendo Pharmaceutical Industries
Hialid Eye drop 1 mg/ml PT. Ferron Par Pharmaceuticals
6.6.4 Na Hyaluronate
Hyalub Minidose 1 mg/ml PT. Cendo Pharmaceutical Industries
Napchon A Eye drop 0,25 mg/ml; 3 mg/ml Apotek
Naphazoline HCL + Pheniramine
6.6.5
Maleat Vernacel Minidose 0,25 mg/ml; 3 mg/ml PT. Cendo Pharmaceutical Industries
6.6.6 Pemirolast K Alegysal Eye drop 0,001 PT. Ferron Par Pharmaceuticals
Zn Sulfate + Antazolin Ph + Zinc Prima A Minidose 1,25 mg + 5 mg + 0,5 PT. Cendo Pharmaceutical Industries
6.6.7
Naphazoline HCL mg
6.7 Anti Infeksi & Antiseptik Telinga
6.7.1 Chlorampenicol + Lidocain Colme ear Ear drop 0,1 PT. Interbat
6.7.2 Ofloxacin Tarivid Otic Solution Ear drop 3% PT. Kalbe Farma
6.8 Antiseptik & Kortikosteroid Telinga
Fludrocortison + Neomycin + Otopain Ear drop 5mg+10.000IU PT. Interbat
6.8.1
Polymixin B dll
20
OBAT UMUM
UMUM

Neomycin + Polimixin B + Otozambon Ear drop 8 ml PT. Zambon Indonesia
6.8.2
Furalthallidone dll
6.9 Preparat Telinga Lain
6.9.1 Docusate Na Forumen Ear drop 5 mg/ml Apotek
6.9.2 Asam Asetat 2 % Asam Asetat 2 % Ear drop 0,02 Apotek
6.10 Preparat Mulut / Tenggorokan
6.10.1 Benzydamide HCL Tantum Verde Gargle 7,5 mg/5 ml Apotek
6.10.2 Miconazole Daktarin Oral Gel 20 mg/gr; 20gr Apotek
Betadine Gargle 0,01 Apotek
6.10.3 Povidone Iodine
Septika Larutan 60 ml PT. Ikapharmindo Putramas
Kenalog in Orabase Oral Base 0,001 PT. Taisho Pharmaceutical
6.10.4 Triamcinolone Acetonide
Ketricin OR Oral Base 0,001 PT. Ferron Par Pharmaceuticals
6.10.5 Chlorhexidine gluconate Minosep Gargle 0,001 Apotek
7. Sistem Urogenital
7.1 Preparat Vagina
Fladystin ovula 522.7 mg PT. Dexa Medica
Neo Gynoxa ovula 500 mg + 100.000 IU PT. Kalbe Farma
7.1.1 Metronidazole + Nystatin
Vagistin ovula 500 mg + 100.000 IU PT. Combiphar
7.1.2 Povidone Iodine Betadine FH Solution 0,1 Apotek

Nystatin Tab Vaginal 100000 IU PT. Phapros Tbk
7.1.3 Nystatin
500000 IU PT. Phapros Tbk
7.2 Antiseptik Saluran Kemih
Urinter kapsul 400 mg PT. Interbat
7.2.1 Pipemidic Acid
Urixin Tablet 400 mg PT. Abbott Indonesia
7.3 Preparat Sistem Urogenital Lain
7.3.1 Dutasterid Avodart Tablet 0,5 mg PT. Smith Kline Beecham Pharmaceutical
7.3.2 Tamsulosin Hydrochlorida Harnal ® D 0.2 mg Disp. Tablet 0.2 mg PT. Astellas Pharma Indonesia
21
OBAT UMUM
UMUM

Harnal ® OCAS 0.4 mg Tablet 0.4 mg PT. Astellas Pharma Indonesia
7.3.2 Tamsulosin Hydrochlorida
Prostam SR Tablet 0,4 mg – 0,8 mg PT. Novell Pharmaceutical Laboratories
Vesicare Tablet 10 mg PT. Astellas Pharma Indonesia
7.3.3 Solifenacin succinate
5 mg PT. Astellas Pharma Indonesia
7.3.4 Bethanecol Chloride Urocarb Tablet 10 mg Apotek
8. Hormon
8.1 Hormon Kortikosteroid
8.1.1 Medroxyprogesterone acetate Provera Tablet 10 mg PT. Pfizer Indonesia
8.2 Hormon Kortikosteroid
Danasone Tablet 0,5 mg PT. Hexpharm Jaya
Dexamethasone Injeksi 5 mg/ml PT. Bernofarm Pharmaceutical
Tablet 0,5 mg PT. Bernofarm Pharmaceutical
8.2.1 Dexamethason
PT. Kimia Farma
Kalmethasone Tablet 0,5 mg PT. Kalbe Farma
Scandexon Tablet 0,5 mg PT. Tempo Rx Farma
Methylprednisolone Injeksi 125mg PT. Bernofarm Pharmaceutical
PT. Hexpharm Jaya
PT. Hexpharm Jaya
8.2.2 Methylprednisolone
Metisol Tablet 4 mg PT. Hexpharm Jaya
Prednicort Kaplet 8 mg PT. Otto Pharmaceutical Industries
Tison Tablet 4 mg PT. Pertiwi Agung (Landson)
8.2.3 Prednisone Prednisone Tablet 5 mg PT. Phapros Tbk
Triamcinolone Tablet 4 mg PT. Novell Pharmaceutical Laboratories
8.2.4 Triamcinolone Triamcort Tablet 4 mg PT. Interbat
Trilac Injeksi 10 mg/ml PT. Novell Pharmaceutical Laboratories
22
OBAT UMUM
UMUM

40 mg/ml PT. Novell Pharmaceutical Laboratories
8.2.4 Triamcinolone
Trinolon Tablet 4 mg PT. Kimia Farma
8.2.5 Steroid tibolone Livial Tablet 2,5 mg Apotek
9. Sistem Endokrin dan Metabolik
9.1 Oral Antidiabetic Agents
Eclid Tablet 100 mg PT. Dexa Medica
9.1.1 Acarbose Glubose Tablet 100 mg PT. Ferron Par Pharmaceuticals
50 mg PT. Ferron Par Pharmaceuticals
Glucobay Tablet 50 mg PT. Bayer Indonesia
Daonil Tablet 5 mg PT. Aventis Pharma
Glibenclamide Tablet 5 mg PT. Phapros Tbk
9.1.2 Glibenclamide
PT. Indofarma Tbk
Glidanil Tablet 5 mg PT. Mersifarma Tirmaku Mercusana
Glucovance Tablet 1.25 mg + 250 mg PT. Merck Tbk
9.1.3 Glibenclamide + Metformin HCL 2.5 mg + 500 mg PT. Merck Tbk
5 mg + 500 mg PT. Merck Tbk
Diamicron Tablet 80 mg PT. Servier Indonesia
9.1.4 Gliclazide Diamicron MR Tablet 60 mg PT. Servier Indonesia
Glucodex Tablet 80 mg PT. Dexa Medica
Glimepiride Tablet 1 mg PT. Hexpharm Jaya
PT. Kimia Farma
PT. Indofarma Tbk
PT. Kimia Farma
9.1.5 Glimepiride PT. Kimia Farma
PT. Indofarma Tbk
PT. Kimia Farma
Diaversa Tablet 1 mg PT. Dexa Medica
23
OBAT UMUM
UMUM

9.1.5 Glimepiride Gliaride Tablet 2 mg PT. Otto Pharmaceutical Industries
3 mg PT. Otto Pharmaceutical Industries
Velacom Plus 1 Tablet 1 mg + 250 mg PT. Novell Pharmaceutical Laboratories
9.1.6 Glimepiride + Metformin HCL
Velacom Plus 2 Tablet 2 mg + 500 mg PT. Novell Pharmaceutical Laboratories
Glurenorm Tablet 30 mg PT. Boehringer Ingelheim
9.1.7 Gliquidone
Lodem Tablet 30 mg PT. Dexa Medica
Diabemin FC Tablet 500 mg PT. Dexa Medica
Diabemin XR Kaplet 500 mg PT. Dexa Medica
Gliformin Tablet 500 mg PT. Tempo Rx Farma
Glucophage Tablet 500 mg PT. Merck Tbk
850 mg PT. Merck Tbk
9.1.8 Metformin HCI Glucophage XR Tablet 1000 mg PT. Merck Tbk
Glumin Tablet 500 mg PT. Ferron Par Pharmaceuticals
Glumin XR Tablet 500 mg PT. Ferron Par Pharmaceuticals
750 mg PT. Ferron Par Pharmaceuticals
Metformin Tablet 500 mg PT. Hexpharm Jaya
Pioglitazone Tablet 15 mg PT. Yarindo Farmatama
30 mg PT. Yarindo Farmatama
9.1.9 Pioglitazone HCL Actos Tablet 15 mg PT. Takeda Indonesia
30 mg PT. Takeda Indonesia
Pionix Tablet 15 mg PT. Kalbe Farma
9.1.9 Pioglitazone HCL Prabetic Tablet 15 mg PT. Pratapa Nirmala Fahrenheit
30 mg PT. Pratapa Nirmala Fahrenheit
Prabetic Plus Tablet 15 mg + 500 mg PT. Pratapa Nirmala Fahrenheit
9.1.10 Pioglitazone HCL + Metformin
30 mg + 500 mg PT. Pratapa Nirmala Fahrenheit
9.1.11 Repaglinide Dexanorm Tablet 1 mg PT. Dexa Medica
9.1.12 Sitagliptine Januvia Tablet 100 mg PT. Merck Sharp & Dohme Indonesia
24
OBAT UMUM
UMUM

9.1.12 Sitagliptine Januvia Tablet 50 mg PT. Merck Sharp & Dohme Indonesia
9.1.13 Sitagliptine / + Metformine HCL Janumet Tablet 50 mg + 1000 mg PT. Merck Sharp & Dohme Indonesia
50 mg + 500 mg PT. Merck Sharp & Dohme Indonesia
9.2 Preparat Tiroid
Euthyrox Tablet 100 mcg PT. Merck Tbk
9.2.1 Levothyroxine Na
50 mcg PT. Merck Tbk
9.2.2 Thyroxine Na Thyrax Tablet 100 mcg Apotek
Thyrozol Tablet 10 mg PT. Merck Tbk
9.2.3 Thiamazole
5 mg PT. Merck Tbk
9.2.4 Propyl Thiouracyl Propylthiouracyl Tablet 100 mg Apotek
9.3 Obat Dislipidemia
Evothyl kapsul 100 mg PT. Guardian Pharmatama
Fenofibrate kapsul 100 mg PT. Hexpharm Jaya
9.3.1 Fenofibrate 300 mg PT. Hexpharm Jaya
Hyperchol kapsul 100 mg PT. Ikapharmindo Putramas
Gemfibrozil kapsul 300 mg PT. Indofarma Tbk
9.3.2 Gemfibrozil
Tablet 300 mg PT. Phapros Tbk
Simvastatin Tablet 10 mg PT. Hexpharm Jaya
PT. Kimia Farma
PT. Kimia Farma
9.3.3 Simvastatin 20 mg PT. Bernofarm Pharmaceutical
Esvat Tablet 10 mg PT. Dexa Medica
Sinova kapsul 10 mg PT. Combiphar
SVT Tablet 10 mg PT. Hexpharm Jaya
Atorvastatin Kaplet 10 mg PT. Hexpharm Jaya
25
OBAT UMUM
UMUM

Tablet 10 mg PT. Yarindo Farmatama
PT. Yarindo Farmatama
PT. Yarindo Farmatama
9.3.4 Atorvastatin Ca Avesco Kaplet 10 mg PT. Dipa Pharmalab Intersains
20 mg PT. Dipa Pharmalab Intersains
Litorcom Tablet 10 mg PT. Combiphar
20 mg PT. Combiphar
40 mg PT. Combiphar
Tavora Tablet 10 mg PT. Hexpharm Jaya
Recansa Tablet 10 mg PT. Aventis Pharma
20 mg PT. Aventis Pharma
9.3.5 Rosuvastatin Suvesco Kaplet 10 mg PT. Dipa Pharmalab Intersains
9.4 Insulin
Apidra Solostar Solostar Pen 100 IU / ml PT. Aventis Pharma
9.4.1 Rapid Analog Insulin Humalog Kwikpen PEN 100 IU/ ml PT. APL Zuellig Farma
Novorapid Flexpen 100 IU/ ml PT. Novo Nordisk Indonesia
9.4.2 Long Acting Analog Insulin Levemir Flexpen 100 IU/ ml PT. Novo Nordisk Indonesia
Humalog Mix 25 Kwikpen PEN 100 IU/ ml PT. APL Zuellig Farma
9.4.3 Mix Analog Insulin Humalog Mix 50 Kwikpen PEN 100 IU/ ml PT. APL Zuellig Farma
Novomix Flexpen 100 IU/ ml PT. Novo Nordisk Indonesia

Humulin R Kwikpen PEN 100 IU/ ml PT. APL Zuellig Farma
9.4.4 Human Insulin
Humulin R Vial PEN 100 IU/ ml PT. APL Zuellig Farma
26
OBAT UMUM
UMUM

Basaglar Kwikoen PEN 100 IU/ ml PT. APL Zuellig Farma
Ezelin Catride 100 IU/ml PT. Kalbe Farma
9.4.5 Insulin Glargine
Lantus Solostar Pen 100 IU / ml PT. Aventis Pharma
Lantus XR PEN 300 IU / ml PT. Aventis Pharma
10. Sistem Syaraf Pusat
10.1 Analgesik & Antipiretik
Asam Mefenamat Kaplet 500 mg PT. Hexpharm Jaya
Dogesic Kaplet 500 mg PT. Yarindo Farmatama
10.1.1 Mefenamic Acid Mefentan Tablet 500 mg PT. Hexpharm Jaya
Stanza Kaplet 500 mg PT. Hexpharm Jaya
Topgesik Kaplet 500 mg PT. Kimia Farma
Novalgin Syrup 250 mg / ml PT. Aventis Pharma
10.1.2 Metamizol Na
Tablet 500 mg PT. Aventis Pharma
Fasgo Syrup 160 mg PT. Hexpharm Jaya
Tablet 500 mg PT. Hexpharm Jaya
Fasgo Forte Kaplet 650 mg PT. Hexpharm Jaya
Paracetamol Tablet 500 mg PT. Bernofarm Pharmaceutical
PT. Kimia Farma
10.1.3 Paracetamol Propyretic Supp 160 mg PT. Combiphar
240 mg PT. Combiphar
80 mg PT. Combiphar
Sumagesic Tablet 600 mg PT. Darya Varia Laboratoria Tbk
Xepamol Syrup 250 mg; 60 ml PT. Metiska Farma
Tablet 500 mg PT. Metiska Farma
Tramadol kapsul 50 mg PT. Indofarma Tbk
PT. Kimia Farma
10.1.4 Tramadol
Dolgesik kapsul 50 mg PT. Mersifarma Tirmaku Mercusana
Orasic kapsul 50 mg PT. Otto Pharmaceutical Industries
Analtram Tablet 37,5 mg + 325 mg PT. Lapi Laboratories
10.1.5 Tramadol + Paracetamol Tramifen Kaplet 37,5 mg + 325 mg PT. Abbott Indonesia
Trapasin Tablet 37,5 mg + 325 mg PT. Combiphar
10.2 Analgesik Anti Inflamasi Non Steroid
10.2.1 Celecoxib Celebrex kapsul 100 mg PT. Pfizer Indonesia
27
OBAT UMUM
UMUM

10.2.1 Celecoxib Celebrex kapsul 200 mg PT. Pfizer Indonesia
Dexketoprofen Injeksi 50 mg/2 ml PT. Yarindo Farmatama
10.2.2 Dexketoprofen Trometamol Tablet 25 mg PT. Yarindo Farmatama
Fendex Tablet 25 mg PT. Pratapa Nirmala Fahrenheit
Exaflam Tablet 25 mg PT. Guardian Pharmatama
KalIUm diklofenak Tablet 50 mg PT. Hexpharm Jaya
Merflam Tablet 50 mg PT. Mersifarma Tirmaku Mercusana
10.2.3 Diclofenac K Nacoflar Tablet 25 mg PT. Phapros Tbk
50 mg PT. Phapros Tbk
Scanaflam Tablet 25 mg PT. Tempo Rx Farma
Diclofenac Na Tablet 25 mg PT. Phapros Tbk
Divoltar Tablet 50 mg PT. Hexpharm Jaya
Klotaren Tablet 25 mg PT. Kimia Farma
10.2.4 Diclofenac Na
Na Diklofenak Tablet 50 mg PT. Indofarma Tbk
NatrIUm Diklofenac Tablet 50 mg PT. Novell Pharmaceutical Laboratories
Tirmaclo Tablet 50 mg PT. Mersifarma Tirmaku Mercusana
Ketoprofen Injeksi 100 mg/2 ml PT. Bernofarm Pharmaceutical
Kaltrofen Supp 100 mg PT. Kalbe Farma
10.2.5 Ketoprofen Tablet 100 mg PT. Kalbe Farma
Lantiflam Tablet 100 mg PT. Pertiwi Agung (Landson)
50 mg PT. Pertiwi Agung (Landson)
Protofen Supp 100 mg PT. Kimia Farma
Tablet 100 mg PT. Kimia Farma
Cameloc Tablet 15 mg PT. Dexa Medica
10.2.6 Meloxicam 7,5 mg PT. Dexa Medica
Hexcam Tablet 15 mg PT. Hexpharm Jaya
28
OBAT UMUM
UMUM

10.2.6 Meloxicam Meloxicam Tablet 15 mg PT. Hexpharm Jaya
PT. Indofarma Tbk
PT. Kimia Farma
7,5 mg PT. Hexpharm Jaya
PT. Indofarma Tbk
PT. Kimia Farma
Kifaden Tablet 10 mg PT. Kimia Farma
Piroxicam kapsul 10 mg PT. Indofarma Tbk
10.2.7 Piroxicam 20 mg PT. Indofarma Tbk
Tablet 10 mg PT. Novell Pharmaceu cal Laboratories
PT. Kimia Farma
Etoricoxib Tablet 120 mg PT. Novell Pharmaceu cal Laboratories
60 mg PT. Novell Pharmaceu cal Laboratories
10.2.8 Etoricoxib
Etorvel Tablet 120 mg PT. Novell Pharmaceu cal Laboratories
10.3 Minor Tranquilliser / Anxioli k
Alprazolam Tablet 0,5 mg PT. Mersifarma Tirmaku Mercusana
PT. Kimia Farma
PT. Kimia Farma
10.3.1 Alprazolam Atarax Tablet 0,5 mg PT. Mersifarma Tirmaku Mercusana
Frixitas Tablet 0,25 mg PT. Novell Pharmaceu cal Laboratories
0,5 mg PT. Novell Pharmaceu cal Laboratories
Diazepam Tablet 2 mg PT. Phapros Tbk
PT. Kimia Farma
10.3.2 Diazepam
Stesolid Injeksi 10mg/2ml PT. Actavis Indonesia
Rectal Tube 10mg PT. Actavis Indonesia
29
OBAT UMUM
UMUM

5mg PT. Actavis Indonesia
Syrup 60ml PT. Actavis Indonesia
10.3.2 Diazepam Tablet 2 mg PT. Actavis Indonesia
Valdimex Tablet 5 mg PT. Mersifarma Tirmaku Mercusana
Merlopam Tablet 0,5 mg PT. Mersifarma Tirmaku Mercusana
10.3.3 Lorazepam
10.4 Major Tranquillisers / Anti Psikotik
Cepezet Tablet 100 mg PT. Mersifarma Tirmaku Mercusana
10.4.1 Chlorpromazine HCL
Chlorpromazine Tablet 100 mg PT. Kimia Farma
Govotil Tablet 2 mg PT. Guardian Pharmatama
10.4.2 Haloperidol Haloperidol Tablet 5 mg PT. Indofarma Tbk
Lodomer Tablet 2 mg PT. Mersifarma Tirmaku Mercusana
Noprenia Syrup 5 mg/ 5 ml PT. Novell Pharmaceutical Laboratories
10.4.3 Risperidon
Risperidone Tablet 2 mg PT. Mersifarma Tirmaku Mercusana
Rizodal Tablet 1 mg PT. Guardian Pharmatama
Clorilex Tablet 100 mg PT. Mersifarma Tirmaku Mercusana
10.4.4 Clozapine
Clozapine Tablet 100 mg PT. Mersifarma Tirmaku Mercusana
10.4.4 Clozapine
Nuzip Tablet 100 mg PT. Guardian Pharmatama
10.5 Hipnotik & Sedatif
Alena 1 Tablet 1 mg PT. Novell Pharmaceutical Laboratories
10.5.1 Estazolam
Alena 2 Tablet 2 mg PT. Novell Pharmaceutical Laboratories
30
OBAT UMUM
UMUM

Esilgan Tablet 1 mg PT. Takeda Indonesia
10.5.1 Estazolam
2 mg PT. Takeda Indonesia
Zolmia Tablet 10 mg PT. Pratapa Nirmala Fahrenheit
10.5.2 Zolpidem Tartrate Zolta Tablet 10 mg PT. Novell Pharmaceutical Laboratories
Zudem Kaplet 10 mg PT. Guardian Pharmatama
10.6 Anti Konvulsi
Bamgetol Kaplet 200 mg PT. Mersifarma Tirmaku Mercusana
10.6.1 Carbamazepine Tegretol Tablet 200 mg PT. Novartis Indonesia
Tegretol CR Tablet 200 mg PT. Novartis Indonesia
10.6.2 Clonazepam Riklona Tablet 2 mg PT. Mersifarma Tirmaku Mercusana
Lamictal Tablet 100 mg PT. Glaxo Welcome Indonesia
10.6.3 Lamotrigine
50 mg PT. Glaxo Welcome Indonesia
Alpentin kapsul 100 mg PT. Actavis Indonesia
10.6.4 Gabapentin Gabapentin kapsul 300 mg PT. Novell Pharmaceutical Laboratories
Opipentin Tablet 300 mg PT. Otto Pharmaceutical Industries
Sipentin kapsul 300 mg PT. Mersifarma Tirmaku Mercusana
Ikaphen Kapsul kapsul 100 mg PT. Ikapharmindo Putramas
10.6.5 Phenytoin Na Kutoin kapsul 100 mg PT. Mersifarma Tirmaku Mercusana
Phenytoin Na Injeksi 50 mg PT. Phapros Tbk
Ikalep Syrup 250 mg/5 ml PT. Ikapharmindo Putramas
10.6.6 Valproic Na
Tablet 250 mg PT. Ikapharmindo Putramas
Lepsio Syrup 250 mg/5 ml PT. Dexa Medica
10.6.7 Valproic Acid Valproic Acid Syrup 250 mg/5 ml PT. Novell Pharmaceutical Laboratories
Vellepsy Syrup 250 mg/5 ml PT. Novell Pharmaceutical Laboratories
Barzepin Tablet 300 mg PT. Novell Pharmaceutical Laboratories
Prolepsi Kaplet 300 mg PT. Mersifarma Tirmaku Mercusana
10.6.8 Oxcarbazepin
Trileptal Tablet 300 mg PT. Novartis Indonesia
600 mg PT. Novartis Indonesia
10.6.9 Divalproex SodIUm Divalproex SodIUm Kaplet 250 mg PT. Yarindo Farmatama
31
OBAT UMUM
UMUM

10.6.9 Divalproex SodIUm Divalproex SodIUm Tablet 250 mg PT. Novell Pharmaceutical Laboratories
10.7 Anti Parkinson
Levodopa + carbidopa + Stalevo Tablet 100mg/25mg/200mg PT. Novartis Indonesia
10.7.1
entacapone
Sifrol Tablet 0,125 mg PT. Boehringer Ingelheim
0,25 mg PT. Boehringer Ingelheim
10.7.2 Pramipexole HCL
Sifrol ER Tablet 0,375 mg PT. Boehringer Ingelheim
0,75 mg PT. Boehringer Ingelheim
Hexymer Tablet 2 mg/1000 PT. Mersifarma Tirmaku Mercusana
10.7.3 Trihexyphenidyl
2 mg/200 PT. Mersifarma Tirmaku Mercusana
Leparson Tablet 125 mg + 28,5 mg PT. Dexa Medica
10.7.4 Levodopa + Benserazide HCL Madopar Dispersible Tablet 125mg + 30 mg PT. Roche Indonesia
Dispersible
10.8 Anti Depresan
10.8.1 Amitriptyline Amitriptyline Tablet 25 mg PT. Indofarma Tbk
Elizac kapsul 20 mg PT. Mersifarma Tirmaku Mercusana
Kalxetin kapsul 10 mg PT. Kalbe Farma
10.8.2 Fluoxetine HCL 20 mg PT. Kalbe Farma
Nopres Kaplet 20 mg PT. Dexa Medica
Noxetine Tablet 20 mg PT. Novell Pharmaceutical Laboratories
10.8.3 Imipramine HCL Imipramin HCL Tablet 25 mg Apotek
Fridep Tablet 50 mg PT. Mersifarma Tirmaku Mercusana
10.8.4 Sertraline HCL Nudep Kaplet 50 mg PT. Guardian Pharmatama
Sernade Tablet 50 mg PT. Novell Pharmaceutical Laboratories
10.9 Nootropik & Neurotonik
Ethigobal Injeksi 500 mcg PT. Guardian Pharmatama
kapsul 500 mcg PT. Guardian Pharmatama
Lanabal Tablet 500 mcg PT. Pertiwi Agung (Landson)
Mecobalamine kapsul 250 mcg PT. Novell Pharmaceutical Laboratories
10.9.1 Mecobalamine
500 mcg PT. Novell Pharmaceutical Laboratories
Metifer kapsul 500 mcg PT. Ikapharmindo Putramas
Mobafer Tablet 500 mcg PT. Dexa Medica
Rincobal kapsul 500 mcg PT. Yarindo Farmatama
32
OBAT UMUM
UMUM

10.10 Anti Emetik
Domperidone Syrup 5 mg / 5 ml PT. Hexpharm Jaya
PT. Hexpharm Jaya
10.10.1 Domperidone PT. Indofarma Tbk
Domedon Tablet 10 mg PT. Tempo Rx Farma
Vomina Syrup 5 mg /5 ml PT. Hexpharm Jaya
10.10.2 Dimenhydrinate Dimenhydrinate Tablet 50 mg PT. Kimia Farma
Ondansetron Injeksi 4 mg/2 ml PT. Indofarma Tbk
8 mg/ 4 ml PT. Indofarma Tbk
PT. Indofarma Tbk
10.10.3 Ondansetron
PT. Indofarma Tbk
Vometraz Tablet 4 mg PT. Dexa Medica
Metoclopramide Tablet 10 mg PT. Kimia Farma
Nausile Syrup 5 mg / 5 ml PT. Promedrahardjo Farmasi Industri
10.10.4 Metoclopramide HCL Tablet 10 mg PT. Promedrahardjo Farmasi Industri
Piralen Syrup 5 mg / 5 ml PT. Otto Pharmaceutical Industries
Tomit Tablet 10 mg PT. Interbat
11. Sistem Muskuloskeletal
11.1 Obat Relaksan Otot
Eperisone HCL Tablet 50 mg PT. Novell Pharmaceutical Laboratories
Myobat Tablet 50 mg PT. Interbat
11.1.1 Eperisone HCL
Myori Tablet 50 mg PT. Tempo Rx Farma
Perilax Tablet 50 mg PT. Dexa Medica
11.2 Obat Gangguan Neuromuskular
11.2.1 Pyridostigmine Br Mestinon Tablet 120 mg PT. Transfarma Medica Indah
33
OBAT UMUM
UMUM

11.3 Preparat Gout
Allopurinol Tablet 100 mg PT. Hexpharm Jaya
PT. Kimia Farma
11.3.1 Allopurinol PT. Bernofarm Pharmaceutical
Alodan Tablet 100 mg PT. Hexpharm Jaya
Sinoric Tablet 100 mg PT. Mersifarma Tirmaku Mercusana
L-CISIN® Tablet 0,5 mg PT. Lapi Laboratories
11.3.2 Colchicine
Recolfar Tablet 0,5 mg PT. Pratapa Nirmala Fahrenheit
11.4 Preparat Muskuloskeletal Lain
Glucosamine Tablet 250 mg PT. Hexpharm Jaya
11.4.1 Glucosamine
Glucosamine MPL Tablet 500 mg Apotek
12. Anti infeksi
12.1 Anti Jamur
Cryptal Tablet 200 mg PT. Pratapa Nirmala Fahrenheit
50 mg PT. Pratapa Nirmala Fahrenheit
12.1.1 Fluconazole
Fluconazole Tablet 150 mg PT. Kimia Farma
Kifluzol Kaplet 150 mg PT. Kimia Farma
Forcanox kapsul 100 mg PT. Guardian Pharmatama
12.1.2 Itraconazole Itraconazole Tablet 100 mg PT. Bernofarm Pharmaceutical
Spyrocon kapsul 100 mg PT. Interbat
Anfuhex Tablet 200 mg PT. Hexpharm Jaya
Dexazol Tablet 200 mg PT. Dexa Medica
12.1.3 Ketoconazole Ketoconazole Tablet 200 mg PT. Hexpharm Jaya
PT. Kimia Farma
Muzoral Tablet 200 mg PT. Transfarma Medica Indah
Enystin Suspensi 100.000 IU PT. Kalbe Farma
Kandistatin Suspensi 100000 IU PT. Metiska Farma
12.1.4 Nystatin
Nyndia Suspensi 100000 IU PT. Guardian Pharmatama
Nystatin Suspensi 100000 IU PT. Bernofarm Pharmaceutical
34
OBAT UMUM
UMUM

12.2 Anti Amuba
Fladex Supp 1 gr PT. Dexa Medica
Metronidazole Tablet 500 mg PT. Bernofarm Pharmaceutical
12.2.1 Metronidazole
PT. Kimia Farma
Trogyl Suspensi 60 ml PT. Otto Pharmaceutical Industries
12.3 Anti Parasit
12.3.1 Mebendazole Vermox Tablet 500 mg Apotek
12.3.2 Pyrantel Pamoate Pyrantel Tablet 125 mg PT. Kimia Farma
12.4 Anti Virus
Acyclovir Tablet 200 mg PT. Novell Pharmaceutical Laboratories
PT. Indofarma Tbk
PT. Kimia Farma
12.4.1 Acyclovir
PT. Indofarma Tbk
PT. Kimia Farma
Poviral Kaplet 400 mg PT. Hexpharm Jaya
Zorel Tablet 200 mg PT. Dexa Medica
Iclofar Tablet 500 mg PT. Pratapa Nirmala Fahrenheit
Inclovir Tablet 500 mg PT. Interbat
12.4.2 Valacyclovir HCL
Valacyclovir Tablet 500 mg PT. Bernofarm Pharmaceutical
Valvir Tablet 500 mg PT. Ethica Industri Farmasi
13. Sistem Respirasi
13.1 Anti Asma & PPOK
Aminophylline Injeksi 25 mg/ml Apotek
13.1.1 Aminophylline
Tablet 100 mg Apotek
Bronsolvan Tablet 150 mg PT. Hexpharm Jaya
13.1.2 Anhydrous Theophylline Theobron kapsul 130 mg PT. Interbat
Syrup 130 mg/ 15ml PT. Interbat
Obucort Swinghaler 200 mcg PT. Otsuka Indonesia
Pulmicort Respules 0,25 mg PT. Astra Zeneca Indonesia
13.1.3 Budesonide
0,5 mg PT. Astra Zeneca Indonesia
Turboheler 200 mcg PT. Astra Zeneca Indonesia
35
Page 35
OBAT UMUM
UMUM

Salbutamol Syrup 2 mg/5 ml PT. Indofarma Tbk
Tablet 2 mg PT. Phapros Tbk
Slabron Tablet 2 mg PT. Hexpharm Jaya
13.1.4 Salbutamol Sulfate Suprasma Inhaler 100 mcg PT. Dexa Medica
Velutine Nebule 2,5 mg/4 ml PT. Novell Pharmaceutical Laboratories
Ventolin Syrup 2 mg PT. Glaxo Welcome Indonesia
Tablet 2 mg PT. Glaxo Welcome Indonesia
Nebule 0,1% PT. Glaxo Welcome Indonesia
Teosal Syrup 1 mg + 130 mg Apotek
13.1.5 Salbutamol Sulfate + Theophylline
Tablet 1 mg + 150 mg Apotek
Flutias Inhaler 125 mcg PT. Kalbe Farma
Seretide Diskus Diskus 100 mcg PT. Glaxo Welcome Indonesia
250 mcg PT. Glaxo Welcome Indonesia
13.1.6 Salmeterol, Fluticasone Propionate
Seretide Inhaler Canister 125 mcg PT. Glaxo Welcome Indonesia
Spiriva Respimat Liquid for 5 mcg/dose (1x2 PT. Boehringer Ingelheim
13.1.7 TiotropIUm Br
inhalation puff)
Flixotide Inhaler Canister 50 mcg PT. Glaxo Welcome Indonesia
13.1.8 Fluticasone Propionate
Flixotide Nebules Nebule 0,5 mg PT. Glaxo Welcome Indonesia
13.1.9 Salbutamol Sulfate + Guaifenesin Ventolin Expectorant Syrup 1 mg PT. Glaxo Welcome Indonesia
13.2 Obat Batuk & Pilek

Ambroxol Syrup 15 mg/5 ml PT. Indofarma Tbk
PT. Kimia Farma
PT. Indofarma Tbk
13.2.1 Ambroxol PT. Kimia Farma
Ambroxol HCL Syrup 15 mg/5 ml PT. Bernofarm Pharmaceutical
30 mg / 5 ml PT. Bernofarm Pharmaceutical
Mucera Syrup 15 mg/5 ml PT. Otto Pharmaceutical Industries
36
OBAT UMUM
UMUM

Mucera Forte Syrup 30 mg / 5 ml PT. Otto Pharmaceutical Industries
Mucoxol Syrup 30 mg / 5 ml PT. Tempo Rx Farma
13.2.1 Ambroxol Tablet 30 mg PT. Tempo Rx Farma
Transmuco Syrup 15 mg/5 ml PT. Hexpharm Jaya
13.2.2 Bromhexine HCL Bisolvon Sol Solution 10 mg/ 5 ml PT. Aventis Farma
Codein Tablet 10 mg PT. Kimia Farma
13.2.3 Codein HCL 20 mg PT. Kimia Farma
Codikaf Tablet 10 mg PT. Kimia Farma
Codipront kapsul 30 mg + 10 mg PT. Kimia Farma
13.2.4 Codein + Phenyltoloxamine
Syrup 11,11 mg + 3,67 mg PT. Kimia Farma
Codipront Expectorant kapsul 30 mg + 10 mg + 150 PT. Kimia Farma
mg
Codein + Phenyltoloxamine +
13.2.5 Syrup 11,11 mg + 3,67 mg PT. Kimia Farma
Guaiphenesin
+ 55,55 mg + 55,55
mg
Benacol DTM Syrup 60 ml PT. Kalbe Farma
Dexthromethorphan,
13.2.6 Diphenhydramine,Phenylephrine,
Ikadryl DMP Tablet 15 mg PT. Ikapharmindo Putramas
Guaifenesin
Rhinos SR kapsul 5 mg + 60 mg PT. Dexa Medica

13.2.7 Loratadine + Pseudoephedrine
Benacol Expectorant Cough Syrup 100 ml PT. Kalbe Farma
Glycerin guaicolate + AmmonIUm 60 ml PT. Kalbe Farma
13.2.8
Cl + Na Sitrate Ikadryl Syrup 100 ml PT. Ikapharmindo Putramas
60 ml PT. Ikapharmindo Putramas
Acetylcystein kapsul 200 mg PT. Novell Pharmaceutical Laboratories
13.2.9 N-Acetylcystein Tablet 200 mg PT. Indofarma Tbk
Fluimucil Dry Syrup 100 mg/5 ml PT. Zambon Indonesia
37
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OBAT UMUM
UMUM

Fluimucil Granule sachet 200mg/sachet PT. Zambon Indonesia
13.2.9 N-Acetylcystein
Fluimucil Pediatric sachet 100mg/sachet PT. Zambon Indonesia
Fluzep Tablet 500 mg, 12,5 mg, 2 PT. Otto Pharmaceutical Industries
mg, 15 mg, 50 mg
Paratusin Tablet 500 mg, 50 mg, 15 PT. Darya Varia Laboratoria Tbk
Paracetamol +
mg, 15 mg, 2 mg
13.2.10 Phenylpropanolamine + CTM +
DMP
Pro-Inz Tablet 500 mg, 50 mg, 15 PT. Hexpharm Jaya
mg, 15 mg, 2 mg
13.2.11 Pseudoephedrine HCL Rhinos Neo Drops 7.5 m /0.8 ml PT. Dexa Medica
Alerfed Syrup 1.25 mg + 30 mg PT. Guardian Pharmatama
Tablet 2.5 mg + 60 mg PT. Guardian Pharmatama
Tripolidine HCL +
13.2.12 Librofed Syrup 2.5 mg + 30 mg PT. Hexpharm Jaya
pseudoephedrine HCL
Mertisal Tablet 2.5 mg + 30 mg PT. Mersifarma Tirmaku Mercusana
Trifed Tablet 2.5 mg + 60 mg PT. Interbat
Comtusi Syrup 1,65 mg + 33.3 / 60 PT. Combiphar
ml
13.2.13 Oksomemazin + Gliserilguaiakolat 1,65 mg + 33.3 /100 PT. Combiphar
ml
Comtusi Forte kapsul 1,65 mg + 33.3 PT. Combiphar
Paracetamol + Nodrof Flu Antitussive Tablet 500 mg + 12.5 mg PT. Tempo Rx Farma
13.2.14
Phenylpropanolamine Nodrof Flu Expectorant Tablet 500 mg + 12.5 mg PT. Tempo Rx Farma
13.3 Dekongestan Nasal & Preparat Nasal Lain
13.3.1 Mometasone furoate Nasonex Nasal Nasal Spray 140 mcg PT. Transfarma Medica Indah
iliadin Nasal Drop 0,00025 PT. Merck Tbk. Consumer Health
13.3.2 Oxymethazoline
Nasal Spray 0,0005 PT. Merck Tbk. Consumer Health
Nasacort AQ Nasal Spray 55mcg/dose PT. Aventis Farma
13.3.3 Triamcinole Acetonide
60 mcg PT. Transfarma Medica Indah
38
OBAT UMUM
UMUM

14. Vitamin & Mineral
14.1 Vitamin
14.1.1 Synthetic vitamin A acetate Vitamin A Soft Kapsul 100.000 IU Apotek
14.1.2 Vitamin B Kompleks Vitamin B.Complex Tablet 2 mg/Tablet PT. Kimia Farma
Asam Askorbat(Vit C) Tablet 250 mg PT. Kimia Farma
14.1.3 Vitamin C Ascorbic Acid(Vit.C) Tablet 500 mg PT. Kimia Farma

Vitamin C Tablet 100 mg PT. Kimia Farma
Vitamin K Ampul 10 mg PT. Phapros Tbk
14.1.4 Vitamin K
14.1.5 CalcIUm Lactate CalcIUm Lactat Tablet 500 mg PT. Kimia Farma
Calporosis D Kaplet 500 mg + 100 IU PT. Mersifarma Tirmaku Mercusana
800 mg + 200 IU PT. Mersifarma Tirmaku Mercusana
14.1.6 CalcIUm + Vit D
Cavit D3 Tablet 500 mg + 133 IU PT. Merck Tbk. Consumer Health
Oscifit Kaplet 500 mg + 133 IU PT. Promedrahardjo Farmasi Industri
Anemolat Tablet 1 mg PT. Phapros Tbk
14.1.7 Folic Acid Folac Tablet 0.4 mg PT. Otto Pharmaceutical Industries
Starfolat Tablet 0.4 mg PT. Dexa Medica
Neurobion Tablet 100 mg,200 PT. Merck Tbk. Consumer Health
14.1.8 Vit B1 , B 6 , B12
mg,200mcg
14.2 Multivitamin
Lycalvit Tablet 100mg PT. Interbat
Vit A 3, Vitamin B1, Vitamin B2 ,
Vitamin B6, Vitamin B12, Vitamin C
14.2.1 , Vitamin D, nicotinamide, Ca
pantothenate , Ca gluconate,
lysine HCl, phosphorus
39
Page 39
OBAT UMUM
UMUM

Emibion kapsul 250 mg PT. Guardian Pharmatama
Fe gluconate, folic acid,
Hasil lab 3 bulan terakhir, Hb < 11
14.2.2 manganese sulfate, copper sulfate,
Sangobion kapsul 250 mg PT. Merck Tbk. Consumer Health
vit B12, vit C , sorbitol
Hasil lab 3 bulan terakhir, Hb < 11
14.3 Elektrolit & Mineral
Oralit sachet 200 ml Apotek
Glucose Anhydrous, NaCl, Na
14.3.1
Bicarbonate, CaCl2 Pedialyte Solution 500 ml Apotek
14.3.2 KCl KSR Tablet 600 mg PT. Merck Tbk

14.3.3 K L-Aspartate ASPAR K Tablet 300 mg PT. Mitsubishi Tanabe Pharma Indonesia
14.3.4 Na,Cl NaCl 0.9% Kolf 0,009 Apotek
14.3.5 MagnesIUm Sulfat MagnesIUm Sulfat Serbuk 30 mg Apotek
40
DAFTAR OBAT KHUSUS
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT KONDISI
OBAT KHUSUS

I. Anti Virus
I.1 Adefovir dipivoxil Hepsera Tablet 10 mg PT. Glaxo Welcome Indonesia
I.2 Daklastafir Mydekal 60 mg Tablet 60 mg PT. Kimia Farma
Baraclude Tablet 0.5 mg PT. Taisho Pharmaceutical
I.3 Entecavir
1 mg PT. Taisho Pharmaceutical
I.4 Interferon alfa-2b Rebif Syringe 22 mcg PT. Merck Tbk
3TC Tablet 150 mg PT. Glaxo Welcome Indonesia
I.5 Lamivudin
Heplav Tablet 100 mg PT. Kimia Farma
Pegasys PFS 135 mcg/ 0,5 ml PT. Roche Indonesia
I.6 Peginterferon alfa-2a
180 mcg/0,5 ml PT. Roche Indonesia
Peg Intron Injeksi 100 mcg Apotek
I.7 Peginterferon alfa-2b 50 mcg Apotek
80 mcg Apotek
I.8 Ribavirin Copegus Tablet 200mg PT. Roche Indonesia
MyHep Tablet 400 mg PT. Kimia Farma
I.9 Sofosbufir
Sobuvir Coated Tablet 400 mg PT. Bernofarm Pharmaceutical
I.10 Telbivudine Sebivo Tablet 600 mg PT. Novartis Indonesia
Hepamed Kaplet 300 mg PT. Dipa Pharmalab Intersains
I.11 Tenofovir Disoproxil Fumarate
Ricovir Tablet 300 mg PT. Kimia Farma
I.12 Thymosin alfa-1 Zadaxin Injeksi 1,6 mg/vial PT. Tempo Rx Farma
II. Imunosupresi
II.1 Azathioprine Imuran Tablet 50 mg Apotek
Neoral Tablet 100 mg PT. Novartis Indonesia
II.2 Ciclosporin 25 mg PT. Novartis Indonesia
Afinitor Tablet 10 mg PT. Novartis Indonesia
II.3 Eferolimus
II.4 Mycophenolate mofetil Cellcept Tablet 500 mg PT. Roche Indonesia
Prograf kapsul 0,5 mg PT. Astellas Pharma Indonesia
II.5 Tacrolimus
1 mg PT. Astellas Pharma Indonesia
41
OBAT KHUSUS

III. Preparat Anti dotum
III.1 Deferiprone Ferriprox Tablet (blank) Apotek
III.2 Desferrioxamine Mesylate Desferal Injeksi 500 mg PT. Novartis Indonesia
IV. Preparat Haematopoietik
Epotrex Injeksi 10.000 IU PT. Novell Pharmaceutical Laboratories
2.000 IU PT. Novell Pharmaceutical Laboratories
IV.1 Epoetin alfa
4.000 IU PT. Novell Pharmaceutical Laboratories
Hemapo Injeksi 3000 IU PT. Kalbe Farma
Recormon PFS 10000 IU PT. Roche Indonesia
2000 IU PT. Roche Indonesia
IV.2 Epoetin beta
Eprex Syringe 10.000 IU PT. Johnson & Johnson Indonesia
2.000 IU PT. Johnson & Johnson Indonesia
IV.3 Epoetin-alfa
Leucogen Injeksi 300 mcg PT. Kalbe Farma
IV.4 Filgrastim
Leukokine Injeksi 300 mcg PT. Novell Pharmaceutical Laboratories
V. Cairan Intravena
Human Albumin BioteInfus 20%,100 ml PT. Kimia Farma
Octalbin Infus 20%,100 ml PT. Kalbe Farma
25%,100ml PT. Kalbe Farma
25%,50ml PT. Kalbe Farma
Plasbumin Infus 20 ml PT. Dipa Pharmalab Intersains
V.1 Human Albumin
20%,100 ml PT. Dipa Pharmalab Intersains
25%,50ml PT. Dipa Pharmalab Intersains
Nacl 538 mg, Na Lactate 448 mg, Dianeal Pd-2 Infus Apotek
V.2 Cacl2 25.7 mg, mgcl2 5.08 mg,
Dextrose
42
OBAT KHUSUS

VI. Analgesik Anti Inflamasi
VI.1 Infliximab Remicade Injeksi 100 mg PT. Mitsubishi Tanabe Pharma Indonesia
Osflex 1 Syringe 10 mg/ml PT. Novell Pharmaceutical Laboratories
VI.2 Na Hyaluronate 5 Syringe 10 mg/ml PT. Novell Pharmaceutical Laboratories
Umarone Injeksi 10 mg/ml PT. Pratapa Nirmala Fahrenheit
VI.3 Parecoxib Na Dynastat Injeksi 40mg PT. Pfizer Indonesia
VII. Anti Emetik
Degrani Injeksi 1 mg/ml PT. Pratapa Nirmala Fahrenheit
3 mg/3 ml PT. Pratapa Nirmala Fahrenheit
Granisetron Injeksi 1 mg/ml PT. Yarindo Farmatama
3 mg/3 ml PT. Yarindo Farmatama
VII.1 Granisetron HCL
Granisetron HCL Injeksi 1 mg/ml PT. Otto Pharmaceutical Industries
3 mg/3 ml PT. Otto Pharmaceutical Industries
Gravomit Injeksi 1 mg/ml PT. Ferron Par Pharmaceuticals
3 mg/3 ml PT. Ferron Par Pharmaceuticals
VIII. Anti Neoplastik
VIII.1 5-Fluorouracil Curacil Injeksi 500 mg PT. Kalbe Farma
VIII.2 Abiraterone Acetate Zytiga Tablet 250 mg PT. Johnson & Johnson Indonesia
Arimidex Tablet 1 mg PT. Astra Zeneca Indonesia
VIII.3 Anastrozole
Bracer Tablet 1 mg PT. Ferron Par Pharmaceuticals
VIII.4 Asparaginase Leunase Solution 10.000 KU Apotek
VIII.5 Bendamustin Ribomustin Injeksi 100 mg PT. Johnson & Johnson Indonesia
VIII.6 Bevasizumab Avastin Injeksi 100 mg/4 ml PT. Roche Indonesia
Bicastra Tablet 50 mg PT. Ferron Par Pharmaceuticals
VIII.7 Bicalutamide
Diproca Tablet 50 mg PT. Dipa Pharmalab Intersains
VIII.8 Bleomycin Bleocin Injeksi 15 mg PT. Kalbe Farma
VIII.9 Bortezomib Velcade Injeksi 3.5 mg PT. Johnson & Johnson Indonesia
VIII.10 Busulfan Myleran Tablet (blank) Apotek
VIII.11 CalcIUm Folinat Leucovorin Ca Injeksi 50 mg PT. Kalbe Farma
VIII.12 Capecitabine Xeloda Tablet 500mg PT. Roche Indonesia
VIII.13 Carboplatin Carboplatin Injeksi 150 mg PT. Kalbe Farma
VIII.13 Carboplatin Carboplatin Injeksi 450 mg PT. Kalbe Farma
43
OBAT KHUSUS

VIII.14 Chlorambucyl Leukeran Tablet 2 mg Apotek
Cisplatin Injeksi 10 mg PT. Kalbe Farma
VIII.15 Cisplatin
Cyclovid Injeksi 1000 mg PT. Novell Pharmaceutical Laboratories
VIII.16 Cyclofosfamid
Endoxan Injeksi 1000 mg PT. Transfarma Medica Indah
200 mg PT. Transfarma Medica Indah
VIII.17 Cytarabin DBL Cytarabin Injeksi 1g Apotek
VIII.18 Dacarbacyn Dacarbazine Medac Injeksi 200 mg/vial PT. Dipa Pharmalab Intersains
VIII.19 Dactinomicyn Cosmegen Injeksi 500 mcg Apotek
VIII.20 Daunorubicyn Daunocin Injeksi 20 mg/4 ml PT. Novell Pharmaceutical Laboratories
Brexel Injeksi 20 mg PT. Kalbe Farma
VIII.21 Docetaxel
Dochemo Injeksi 20 mg PT. Novell Pharmaceutical Laboratories
Doxorubicin Injeksi 10 mg PT. Kalbe Farma
VIII.22 Doxorubicin HCL
Doxotil Injeksi 10 mg PT. Dipa Pharmalab Intersains
Ciazil Injeksi 10 mg PT. Dipa Pharmalab Intersains
VIII.23 Epirubicyn
Epirubicin Injeksi 10 mg PT. Kalbe Farma
VIII.24 Eribulin Mesylate Halaven Injeksi 0.44 mg PT. Eisai Indonesia
Tarceva Tablet 100 mg PT. Roche Indonesia
VIII.25 Erlotinib
150 mg PT. Roche Indonesia
VIII.26 Etopocid Etopul Injeksi 5 ml PT. Novell Pharmaceutical Laboratories
VIII.27 Exemestane Aromasin Tablet 25 mg PT. Pfizer Indonesia
VIII.28 Gefitinib Iressa Tablet 250 mg PT. Astra Zeneca Indonesia
44
OBAT KHUSUS

Gemcikal Injeksi 1000 mg PT. Kalbe Farma
VIII.29 Gemcitabine HCL
Gemfix Injeksi 1000 mg PT. Novell Pharmaceutical Laboratories
Zoladex Syringe 10,8 mg PT. Astra Zeneca Indonesia
VIII.30 Goserelin Acetate
3,6 mg PT. Astra Zeneca Indonesia
VIII.31 Hydroxyurea Hydroxyurea Medac kapsul 500 mg PT. Dipa Pharmalab Intersains
Holoxan Vial 1 gr PT. Transfarma Medica Indah
VIII.32 Ifosfamid
2 gr PT. Transfarma Medica Indah
VIII.33 Imatinib Mesylate Glivec Tablet 100 mg PT. Novartis Indonesia
VIII.34 Lapatinib ditosylate Tykerb 250 mg Tablet 250 mg PT. Novartis Indonesia
Femaplex Tablet 2,5 mg PT. Dipa Pharmalab Intersains
VIII.35 Letrozole Lebrest Tablet 2.5 mg PT. Ferron Par Pharmaceuticals
Letraz Tablet 2.5 mg PT. Kalbe Farma
Divalin Injeksi 3.75 mg PT. Darya Varia Laboratoria Tbk
Endrolin Injeksi 3.75 mg PT. Kalbe Farma
VIII.36 Leuprorelin Tapros Injeksi 1,88 mg PT. Takeda Indonesia
11.25 mg PT. Takeda Indonesia
3.75 mg PT. Takeda Indonesia
VIII.37 Medroxyprogesterone acetate Provera Tablet 100 mg PT. Pfizer Indonesia
Tracetate Syrup 40 mg/ml PT. Pratapa Nirmala Fahrenheit
VIII.38 Megestrol Acetate
Tablet 160 mg PT. Pratapa Nirmala Fahrenheit
VIII.39 Melfalan Alkeran Tablet 2 mg Apotek
VIII.40 Mercaptopurin Purinethol Tablet 50 mg Apotek
VIII.41 Mesna Uromitexan Injeksi 400 mg PT. Transfarma Medica Indah
VIII.42 Methotrexate Methotrexate Injeksi 50 mg PT. Kalbe Farma
VIII.43 Mitomisin D Mitomisin D Injeksi 2 mg Apotek
Sandostatin LAR Ampul 625 mg/2,5 ml PT. Novartis Indonesia
VIII.44 Octreotide
Sandostatin SC Ampul 0.1 mg/ml PT. Novartis Indonesia
Oxaliplatin Medac Injeksi 100 mg PT. Dipa Pharmalab Intersains
VIII.45 Oxaliplatin 50 mg PT. Dipa Pharmalab Intersains
Oxitel Injeksi 50 mg PT. Novell Pharmaceutical Laboratories
45
OBAT KHUSUS

VIII.45 Oxaliplatin Rexta Injeksi 50 mg PT. Kalbe Farma
Fonkopac Injeksi 300 mg/50 mL PT. Ferron Par Pharmaceuticals
Paclon Injeksi 100 mg/16,7 ml PT. Novell Pharmaceutical Laboratories
VIII.46 Paclitaxel 30 mg/5 ml PT. Novell Pharmaceutical Laboratories
Paxus Injeksi 100 mg/16,7 ml PT. Kalbe Farma
30 mg/5 ml PT. Kalbe Farma
VIII.47 Procarbazin Matulane kapsul 50 mg Apotek
VIII.48 Sorafenib Tosylate Nexavar Tablet 200 mg PT. Bayer Indonesia
VIII.49 Tamoxifen Tamofen Tablet 10 mg PT. Kalbe Farma
VIII.50 Temozolomide Temodal Tablet 20 mg ; 100 mg Apotek
VIII.51 Trastuzumab Herceptin Injeksi 440 mg/ 20 ml PT. Roche Indonesia
VIII.52 Ustekinumab Stelara Syringe 90 mg PT. Johnson & Johnson Indonesia
VIII.53 Vinblastin DBL Vinblastin Injeksi 10 mg Apotek
Vincristine- Kalbe Injeksi 1 mg PT. Kalbe Farma
VIII.54 Vinkristin
Navelbine Injeksi 10 mg PT. Transfarma Medica Indah
VIII.55 Vinoralbine
IX. Antikoagulan, Antiplatelet & Fibrinolitik
Lovenox Syringe 10.000 IU / ml ; 0,2 ml PT. Aventis Pharma
IX.1 Enoxaparin Na 10.000 IU / ml ; 0,4 ml PT. Aventis Pharma
10.000 IU / ml ; 0,6 ml PT. Aventis Pharma
Arixtra Injeksi 7,5 mg/0,6 ml PT. Mitsubishi Tanabe Pharma Indonesia
IX.2 Fondaparinux sodIUm
Syringe 2,5 mg/0,5 ml PT. Mitsubishi Tanabe Pharma Indonesia
IX.3 Human antithrombin III Kybernin P Injeksi 50 IU/ml Apotek
IX.4 Streptokinase Fibrion Vial 1.500.000IU PT. Dexa Medica
X. Preparat Affecting Metabolisme Tulang
X.1 Raloxifene Evista Tablet 1 x 60 mg PT. APL Zuellig Farma
Aclasta Infus 5mg/100ml PT. Novartis Indonesia
X.2 Zoledronic acid
Zometa Injeksi 4 mg/100 ml PT. Novartis Indonesia
XI. Relaksan Otot
BTXA Injeksi 100 IU Apotek
XI.1 ClostridIUm botulinum toxin type A
46
OBAT KHUSUS

XII. Anti Psikosis
Ariski Tablet 10 mg PT. Actavis Indonesia
XII.1 Aripiprazole
XIII. Injeksi Mata
XIII.1 Afliberceft Eylea Injeksi 100 mcl PT. Bayer Indonesia
XIII.2 Ranibizumab Patizra Injeksi 10 mg/ml PT. Novartis Indonesia
XIV. Suplemen
XIV.1 Ca polystylene sulfonate Kalitake sachet 5 gr PT. Dipa Pharmalab Intersains
XV. Topical Kortikosteroid
XV.1 Hydrocortison butyrat Dermacoid Scalp Lotion 0,1% PT. Combiphar
XV.2 Momethasone Elocon Lotion 0,001 PT. Transfarma Medica Indah
XVI. Anti Anemia
XVI.1 Epoetin beta + Methoxy polyethylene Mircera PFS 50 mcg/ 0.3ml PT. Roche Indonesia
glycol 75 mcg/ 0.3ml PT. Roche Indonesia
100 mcg/ 0.3ml PT. Roche Indonesia
XVII. Anti Trombositopenia
XVII.1 Anagrelid Agrylin Tablet 0,5 mg PT. Pratapa Nirmala Fahrenheit
XVII.2 Eltrombopag Olamine Rebozet Tablet 25 mg PT. Novartis Indonesia
XVIII. Anti Koagulan
XVIII.1 Dabigatran etexilate Pradaxa kapsul 110 mg PT. Boehringer Ingelheim
XVIII.2 Heparin inj Inviclot Injeksi 5000 IU PT. Pratapa Nirmala Fahrenheit
XVIII.3 Rivaroxaban Xarelto Tablet 10 mg PT. Bayer Indonesia
15 mg PT. Bayer Indonesia
20 mg PT. Bayer Indonesia
XIX. Anti Angina
Angintriz MR Tablet 35 mg PT. Novell Pharmaceutical Laboratories
XIX.1 Trimetazidine Miozidine Tablet 35 mg PT. Pratapa Nirmala Fahrenheit
Trimetazidine Tablet 35 mg PT. Novell Pharmaceutical Laboratories
47
OBAT KHUSUS

XX. Preparat Sistim Urogenital Lain
XX.1 Hyaluronate Cytistat Injeksi 40 mg / 50 ml Apotek
XXI. Oral Antidiabetic Agents
Forxiga Tablet 10 mg PT. Astra Zeneca Indonesia
XXI.1 Dapaglifozin
5 mg PT. Astra Zeneca Indonesia
XXI.2 Linagliptin Trajenta Tablet 5 mg PT. Boehringer Ingelheim
Trajenta Duo FCT Tablet 2.5 mg + 1000 mg PT. Boehringer Ingelheim
XXI.3 Linagliptin + Metformin HCL 2.5 mg + 500 mg PT. Boehringer Ingelheim
2.5 mg + 850 mg PT. Boehringer Ingelheim
XXI.4 Liraglutide Victoza Flexpen 6 mg/ml PT. Novo Nordisk Indonesia
XXII. Sistem Respirasi
Breathy Nasal Drop NaCl 0,9% PT. Novell Pharmaceutical Laboratories
XXII.1 Sea water microdifusion
Nasalin Spray Bootle 0.7 ml PT. Dexa Medica
XXIII. Analgesik Sistem Syaraf Pusat
Durogesic Patch 12 Mcg PT. Johnson & Johnson Indonesia
XXIII.1 Fentanyl 25 Mcg PT. Johnson & Johnson Indonesia
50 mcg PT. Johnson & Johnson Indonesia
Jurnista Tablet 16 mg PT. Johnson & Johnson Indonesia
XXIII.2 Hydromorphone HCL
8 mg PT. Johnson & Johnson Indonesia
MST Continus Tablet 10 mg Apotek
100 mg Apotek
XXIII.3 Morphin Sulfate
30 mg Apotek
60 mg Apotek
XXIV. Detoxifying Agent
XXIV.1 Sevelamer Renvela Tablet 800 mg PT. Aventis Pharma
XXV. Therapi of Chorn's Disease
XXV.1 Budesonide Budenofalk kapsul 3 mg PT. Darya Varia Laboratoria Tbk
48
DAFTAR OBAT KONDISI KHUSUS
DENGAN PERSETUJUAN
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT KONDISI KHUSUS DENGAN PERSETUJUAN
NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI keterangan
I. Anti Demensia
Alzim Tablet 5 mg PT. Pratapa Nirmala Fahrenheit R/ Dokter Spesialis Neurologi,
I.1 Donepezil Donacept Tablet 5 mg PT. Novell Pharmaceutical Laboratories melampirkan hasil pemeriksaan
fungsi luhur terbaru (1 tahun
Donepezil Tablet 5 mg PT. Novell Pharmaceutical Laboratories
terakhir) dan / atau jawaban Dokter
I.2 Rivastigmin Exelon Patch Patch 18 mg/10 cm2 PT. Novartis Indonesia
Spesialis Neurologi pada surat
5.9 mg/5 cm2 PT. Novartis Indonesia rujukan dari Dokter Umum
II. Anti Ulserasi
II.1 Esomeprazole NexIUm Injeksi 40 mg PT. Astra Zeneca Indonesia
R/ Dokter Spesialis Penyakit Dalam.
Pada kasus GERD dan/atau Ulkus
Tablet 40 mg PT. Astra Zeneca Indonesia
Peptikum, melampirkan hasil
pemeriksaan Endoskopi, pemberian
20 mg PT. Astra Zeneca Indonesia
selama 6-8 minggu
III. Antibiotik
III.1 Linezolid Zyvox Tablet 600 mg PT. Pfizer Indonesia R/ Dokter Spesialis, melampirkan
jawaban Dokter Spesialis pada surat
III.2 Pefloxacin Dexaflox Kaplet 400 mg PT. Dexa Medica rujukan dari Dokter Umum yang
merujuk
IV. Cerebral Activator
Citicholine Injeksi 250 mg/2 ml PT. Hexpharm Jaya
Citicoline Kaplet 1000 mg PT. Novell Pharmaceutical Laboratories R/ Dokter Spesialis Neurologi. Pada
500 mg PT. Novell Pharmaceutical Laboratories kasus CVD Akut, lampirkan hasil
Tablet 500 mg PT. Hexpharm Jaya pemeriksaan CT Scan Kepala atau
IV. 1 Citicoline
PT. Indofarma Tbk MRI Kepala terbaru (6 bulan
Lancolin Tablet 500 mg PT. Pertiwi Agung (Landson) terakhir) atau resume medis rawat
Takelin Kaplet 1000 mg PT. Mersifarma Tirmaku Mercusana inap terakhir, diberikan 3-6 bulan
Tablet 500 mg PT. Mersifarma Tirmaku Mercusana
49
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT KONDISI KHUSUS DENGAN PERSETUJUAN
NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI keterangan

V. Nootropik dan Neurotonik
Piracetam Injeksi 1 gr PT. Bernofarm Pharmaceutical
3 gr PT. Bernofarm Pharmaceutical
Kaplet 1200 mg PT. Hexpharm Jaya
R/ Dokter Spesialis Neurologi. Pada
PT. Hexpharm Jaya
kasus CVD Akut, lampirkan hasil
pemeriksaan CT Scan Kepala atau
V.1 Piracetam PT. Bernofarm Pharmaceutical
MRI Kepala terbaru (6 bulan
terakhir) atau resume medis rawat
inap terakhir, diberikan 3-6 bulan
Mersitropil Kaplet 1200 mg PT. Mersifarma Tirmaku Mercusana
Syrup 30-50 mg/kg PT. Mersifarma Tirmaku Mercusana
VI. Preparat Osteoporosis
Alovell Tablet 10 mg PT. Novell Pharmaceutical Laboratories
VI.1 Alendronate Pada kasus osteoporosis di daerah
Vertebrae/Femur/Radius /Ulna,
Kolkatriol kapsul 0.25 mcg PT. Phapros Tbk lampirkan hasil pemeriksaan BMD <
Kolkatriol Forte kapsul 0.5 mcg PT. Phapros Tbk -2.5 dan/atau pada pemeriksaan
VI.2 Calcitriol
radiologi terdapat fraktur
Triocol kapsul 0.25 mcg PT. Guardian Pharmatama
VII. Suplemen
Aminefron Tablet 630 mg PT. Dexa Medica
Pada kasus CKD, lampirkan hasil lab
terbaru (3 bulan terakhir). Nilai
VII.1 Essential Ketoacids
Aminoral Kaplet 630 mg PT. Ethica Industri Farmasi kreatinin > 2 atau proteinuri (++)
atau GFR < 29 mL/min/1.73m²
50
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA
TATA CARA PEMBERIAN OBAT DAN PENGGUNAAN

DAFTAR STANDAR OBAT (DSO) YKKBI
1. Daftar Standar Obat Yayasan (DSO YKKBI) merupakan pedoman dan menjadi acuan bagi provider YKKBI yang terdiri dari Dokter Umum, Dokter
Gigi, Dokter Spesialis/Subspesialis dan Dokter Gigi Spesialis Langganan untuk penulisan resep dan pelayanan obat oleh apotek langganan kepada
Penerima TKHT.
2. DSO YKKBI terdiri dari tiga bagian, yaitu :
a. Daftar Obat Umum : Bagian yang dapat diresepkan oleh Dokter Umum dan Dokter Spesialis tanpa melampirkan keterangan dan
data medis
b. Daftar Obat Khusus : Bagian yang hanya dapat diresepkan oleh Dokter Spesialis. Pada saat penulisan jenis obat ini untuk pertama
kali, Dokter Spesialis harus memberikan keterangan medis tertulis (resume medis) yang menjadi indikasi dan
selanjutnya Apotek Langganan mengajukan Surat Permintaan Persetujuan kepada YKKBI melalui AdMedika.
Apotek berkewajiban menyimpan keterangan medis tertulis tersebut beserta hasil persetujuannya. Dan
lampirkan untuk penagihan dalam masa 6 (enam) bulan pertama. Apabila terdapat peresepan kembali
sesudah 6 (enam) bulan pertama dimaksud Dokter Spesialis harus kembali memberikan keterangan medis
tertulis (resume medis) yang baru.
b. Daftar Obat Kondisi : Bagian yang hanya dapat diresepkan oleh Dokter Spesialis pada kondisi khusus sesuai kriteria yang telah
Khusus dengan ditetapkan. Apotek Langganan mengajukan Surat Permintaan Persetujuan kepada YKKBI melalui Admedika
Persetujuan dengan melampirkan berbagai keterangan / data medis yang diperlukan (hasil pemeriksaan penunjang
radiologi/laboratorium sesuai dengan kondisi medis yang ditentukan).
3. Apotek Langganan harus melakukan pelayanan obat kepada penerima BKP secara profesional sesuai ketentuan yang ditetapkan dalam perjanjian
kerjasama dengan YKKBI.
4. Apotek harus memberikan informasi dan penjelasan secara baik dan lengkap tentang jenis obat, aturan pemakaian dan jumlah obat resep serta
copy resep yang diberikan pada saat obat diserahkan kepada Penerima TKHT.
5. Dokter Langganan melakukan penulisan resep obat berdasarkan DSO YKKBI dan ketentuan yang ditetapkan YKKBI serta memperhatikan jenis obat
yang sudah didapat atau sedang diminum pasien.
6. Penulisan resep obat harus berdasarkan indikasi medis yang jelas, rasional dan menganut prinsip cost effectiveness.
51
7. Jenis obat yang tercantum pada penulisan resep, adalah sebagai berikut :
a. Resep Dokter Umum : Jumlah jenis obat maksimal terdiri dari 5 (lima) item;
b. Resep Dokter Spesialis: Jumlah jenis obat maksimal terdiri dari 7 (tujuh) item;
yang didalamnya sekurang-kurangnya tercantum 1 (satu) jenis obat generik (OGB)
8. Apotek Langganan harus mampu menyediakan obat-obatan yang sudah ditetapkan pada DSO YKKBI.
Dalam hal penyediaan jenis obat tertentu sesuai DSO tidak dapat dilakukan karena terdapat hal-hal di luar kendali Apotek (seperti obat tidak
diproduksi lagi, terdapat gangguan distribusi dll) maka Apotek harus memberi informasi mengenai kondisi tersebut kepada YKKBI sebelum stock
obat dimaksud habis.
9. Apotek Langganan harus melakukan konfirmasi dengan Dokter Langganan untuk keperluan klarifikasi jenis obat pada resep apabila diperlukan.
10. Apotek Langganan dapat melayani pengambilan resep obat rutin yang belum sampai waktunya, apabila pengambilan obat dilakukan maksimal 5
(lima) hari sebelum tanggal habis obat tersebut.
11. Pengambilan resep obat rutin pada kondisi sebagaimana pada angka 10 diatas, maka Apotek dapat memberikan obat pada resep dengan
mengurangi jumlah obat dengan jumlah hari jatuh temponya obat tersebut tanpa memberikan copy resepnya.
12. Pengambilan obat untuk pemakaian lebih dari 30 (tiga puluh) hari, harus melampirkan Surat Permintaan Persetujuan kepada YKKBI melalui
AdMedika
13. Pemberian obat untuk penggantian obat yang hilang karena suatu sebab apapun tidak menjadi beban YKKBI.
14. Jumlah obat untuk penanganan penyakit akut dapat diberikan sebanyak-banyaknya untuk pemakaian selama 7 (tujuh) hari.
15. Jumlah obat untuk penanganan penyakit kronik dapat diberikan sebanyak-banyaknya untuk pemakaian selama 30 (tiga puluh) hari.
16. Dokter dapat memberikan resep obat dengan 'iter' apabila diperlukan dan tidak melebihi dari 3x iter.
Penerima TKHT dapat mengajukan persetujuan untuk pengambilan obat dipercepat (sebelum jumlah obat yang dimilikinya habis) untuk keperluan
tertentu (ibadah haji dan umroh, bepergian ke luar negeri dll) untuk keperluan maksimal selama 90 hari dan hanya untuk obat-obatan penyakit
kronik serta vitamin. Terhadap hal tersebut Apotek mengajukan Surat Permintaan Persetujuan kepada YKKBI dengan melampirkan berkas
pendukung yaitu copy paspor/visa dan/atau copy tiket pesawat.
17. Apotek Langganan akan menginformasikan kepada Dokter Langganan apabila obat pada resep tidak tersedia karena hal-hal di luar kendali (obat
tidak diproduksi lagi, terdapat gangguan distribusi dll). Pada kondisi tersebut Apotek Langganan berhak menggantinya dengan jenis obat lain yang
tercantum dalam DSO dengan bahan aktif sama.
18. Bagi Penerima TKHT yang dirawat oleh lebih dari satu Dokter, maksimal memperoleh 10 (sepuluh) jenis obat rutin untuk penanganan penyakit
kronik. Apabila jumlah jenis obat yang didapatkan Penerima TKHT lebih dari 10 (sepuluh) item, maka kelebihannya (obat ke-11 dan selanjutnya)
tidak menjadi beban YKKBI.
52
19. Dokter Umum/Spesialis Langganan tidak diperkenankan menuliskan resep obat :

a. Di luar daftar standar obat (DSO) YKKBI.
b. Berupa obat tradisional/herbal, Food Supplement, penunjang nutrisi/nutrisi enteral.
c. Untuk penanganan penyakit di luar tanggungan yayasan, yaitu Penyakit Autisme/ADHD, HIV/AIDS, penanggulangan masalah hubungan
seksual (disfungsi seksual) dan penyakit menular seksual (PMS/STD) dan untuk penanggulangan NAPZA.
20. YKKBI menanggung biaya obat dan vitamin/multivitamin/elektrolit sebagai berikut :
a. Sesuai dengan standar pemberian dosis obat yang diakui secara umum.
b. Jenis obat Anti Histamin, Analgetik (pengurang nyeri) dan/atau obat penurun asam lambung (PPI dan H2Antagonis) sebanyak-banyaknya
untuk pemakaian selama 15 (lima belas) hari dalam 1 (satu) bulan.
c. Vitamin sebagaimana tercantum dalam bagian 14.1 dapat diberikan maksimal 2 macam dan masing-masing sebanyak-banyaknya 15 (lima
belas) kap/tab/inj untuk keperluan / penggunaan 30 (tiga puluh) hari
d. Multivitamin sebagaimana tercantum dalam bagian 14.2 dan eletrolit dan mineral sebagaimana tercantum dalam bagian 14.3 dapat diberikan
masing-masing maksimal 1 macam dan masing-masing sebanyak-banyaknya 15 (lima belas) tab/sachet/sol/kolf untuk keperluan /
penggunaan 30 (tiga puluh) hari
e. Apotek langganan mengajukan surat Permintaan Persetujuan melalui AdMedika dalam hal :
i. Pemberian jenis 'vitamin untuk pengobatan' yang masuk dalam ‘daftar obat kondisi khusus' sesuai kriteria yang telah ditetapkan yayasan
ii. Pemberian vitamin/multivitamin/elektrolit dan mineral lebih dari 15 (lima belas) kap/tab/sachet/sol untuk keperluan / penggunaan 30
(tiga puluh) hari
21. Apabila Penerima TKHT memperoleh resep dari Dokter Langganan atau Nonlangganan yang mencantumkan jenis obat di luar DSO, maka :
a. Bahan aktif obat yang sama tersedia pada DSO, maka obat diganti dengan obat copy drug pada DSO yang lebih murah. Apabila Penerima TKHT
tetap ingin mendapatkan obat seperti yang tercantum pada resep, maka Ybs dapat membelinya terlebih dahulu. Apotek akan mengeluarkan
kuitansi atas nama YKKBI dan selanjutnya Penerima TKHT dapat mengajukan reimbursement untuk mendapatkan penggantian biaya sesuai
ketentuan.
b. Bahan aktif obat yang sama tidak tersedia pada DSO, maka :
i. Apotek harus menghubungi dokter yang memberikan resep untuk konfirmasi penyesuaian obat yang sama dengan obat me-too pada
DSO (mempunyai fungsi dan kelas terapi yang sama).
ii. Apabila Penerima TKHT tetap ingin mendapatkan obat seperti yang tercantum pada resep, maka Ybs dapat membelinya terlebih dahulu.
Apotek akan mengeluarkan kuitansi atas nama YKKBI dan selanjutnya Penerima TKHT dapat mengajukan reimbursement untuk mendapat
penggantian biaya sesuai dengan ketentuan yang berlaku.
22. Pada kondisi tertentu, Apotek langganan dapat memberikan obat dalam kemasan tertentu sepanjang tidak mengurangi mutu dan khasiat obat.
53
INDEKS ZAT AKTIF
INDEX ZAT AKTIF INDEKS ZAT AKTIF
No ZAT AKTIF HAL NO ZAT AKTIF HAL NO ZAT AKTIF HAL

1 5-Fluorouracil 43 28 Atorvastatin Ca 26 55 Calcipotriol 18
2 Abiraterone Acetate 43 29 Atropine sulfate 19 56 Calcipotriol & Betamethasone 18
3 Acarbose 23 30 Azathioprine 41 57 Calcitriol 50
4 Acetazolamide 13 31 Azithromycin 6 58 Calcium + Vit D 39
5 Acetylsalicylic Acid 14 32 Bendamustin 43 59 Calcium Folinat 43
6 Acyclovir 18,35 33 Benzydamide HCL 21 60 Calcium Lactate 39
7 Adefovir dipivoxil 41 34 Betahistin Dihidroklorida 14 61 Candesartan Cilexetil 12
8 Afliberceft 47 35 Betahistin Mesilat 14 62 Capecitabine 43
9 Al (OH)3 + Mg(OH)2 1 36 Betamethasone + dexchlorpheniramine 1 63 Captopril 9
maleate
10 Alendronate 50 37 Betamethasone + Neomycin Sulfate 15 64 Carbamazepine 31
11 Allopurinol 34 38 Betamethasone Dipropionate + 15 65 Carboplatin 43
Gentamycin /Neomycin
12 Alprazolam 29 39 Betamethasone Dipropionate, Salysilic 16 66 Carboxy methylcellulose 20
Acid (Sol)
13 Ambroxol 36 40 Betamethasone Na Phosphate 19 67 Carvedilol 10
14 Aminophylline 35 41 Betamethasone Valerate/dipropionat 16 68 Cefadroxil Monohydrate 5
15 Amiodarone HCL 9 42 Bethanecol Chloride 22 69 Cefalexin Monohydrate 5

16 Amitriptyline 32 43 Bevasizumab 43 70 Cefixime 5
17 Amlodipine Besylate 11 44 Bicalutamide 43 71 Cefuroxime Axetil 5
18 Amoxycillin + Clavulanic acid 7 45 Bisacodyl 3 72 Celecoxib 27,28
19 Amoxycillin Trihydrate 7 46 Bisoprolol Fumarate 10 73 Cetirizine HCL 1
20 Anagrelid 47 47 Bisoprolol Fumarate + 10 74 Chlorambucyl 4
Hydrochlorthiazide
21 Anastrozole 43 48 Bleomycin 43 75 Chlorampenicol 18
22 Anhydrous Theophylline 35 49 Bortezomib 43 76 Chlorampenicol + Lidocain 20
23 Aripiprazole 47 50 Brinzolamide 19 77 Chloramphenicol 5
24 Asam Asetat 2 % 21 51 Bromhexine HCL 37 78 Chlordiaxepozide + Clidinium Br 3
25 Asam Salisilat 2 % Talk 98% 17 52 Budesonide 35,48 79 Chlorhexidine gluconate 21
26 Asparaginase 43 53 Busulfan 43 80 Chlorpheniramine maleate 1
27 Atenolol 10 54 Ca polystylene sulfonate 47 81 Chlorpromazine HCL 30

82 Ciclosporin 41 106 Dacarbacyn 44 130 Etopocid 44
83 Cilostazol 14 107 Dactinomicyn 44 131 Etoricoxib 29
84 Cinnarizine 13 108 Daklastafir 41 132 Exemestane 44
85 Ciprofloxacin 7, 19 109 Dapaglifozin 48 133 Fe gluconate, folic acid, manganese 40
sulfate, copper sulfate, vit B12, vit C ,
sorbitol
86 Cisplatin 43 110 Daunorubicyn 44 134 Fenofibrate 25
87 Citicoline 49 111 Deferiprone 42 135 Fentanyl 48
88 Clarithromycin 6 112 Desferrioxamine Mesylate 42 136 Filgrastim 2
89 Clindamycin 9 113 Desoximetasone 16 137 Fluconazole 34
90 Clobetasol propionate 16 114 Dexamethason 22 138 Fludrocortison + Neomycin + Polymixin B 20
dll
91 Clonazepam 31 115 Dexamethasone + Neomycin + Polymixin 19 139 Flunarizine 13
B
92 Clonidine HCL 12 116 Dexamethasone + Tobramycin 19 140 Fluocortolone pivalate, fluocortolone 4
caproate , cinchocaine HCL, clemizole
undecylate
93 Clopidogrel 15 117 Dexketoprofen Trometamol 28 141 Fluoxetine HCL 32
94 Cloritamazole 17 118 Dexthromethorphan, 37 142 Fluprednidene, Neomycin, 16
Diphenhydramine,Phenylephrine, Hydroxyquinoline
Guaifenesin
95 Clostridium botulinum toxin type A 46 119 Dextran + Hydroxy Methylcellulose 20 143 Fluticasone Propionate 36
96 Clozapine 30 120 Diazepam 29 144 Folic Acid 39
97 Codein + Phenyltoloxamine 37 121 Diclofenac K 28 145 Fondaparinux sodium 46
98 Codein + Phenyltoloxamine + 37 122 Diclofenac Na 20, 28 146 Framycetin Sulfate 17
Guaiphenesin
99 Codein HCL 37 123 Diflucortolone + Chlorquinadol 16 147 Framycetin Sulfate + Gramicidin + 19
Dexamethasone
100 Colchicine 34 124 Digoxin 9 148 Furosemide 13
101 Colloidal Activated Actapulgite 3 125 Diltiazem HCL 11 149 Gabapentin 31
102 Co-Trimoxazole 8 126 Essential Ketoacids 50 150 Gefitinib 4
103 Cyclofosfamid 44 127 Estazolam 30 151 Gemcitabine HCL 45
104 Cytarabin 44 128 Etakridin 17 152 Gemfibrozil 25
105 Dabigatran etexilate 47 129 Ethambutol HCL 8 153 Gentamycin Sulfate 15

154 Glibenclamide 23 184 Indapamide 13 214 Lidocaine 25 mg + Prilocaine 25 mg 18
155 Glibenclamide + Metformin HCL 23 185 Infliximab 43 215 Linagliptin 48
156 Gliclazide 23 186 Insulin Glargine 27 216 Linagliptin + Metformin HCL 48
157 Glimepiride 23 187 Interferon alfa-2b 41 217 Linezolid 49
158 Glimepiride + Metformin HCL 24 188 Irbesartan 12 218 Liraglutide 48
159 Gliquidone 24 189 Irbesartan + HCT 12 219 Lisinopril 10
160 Glucosamine 34 190 Isoniazid + Vit B6 8 220 Lithospermi rdx, Benzocaine, dll 4
161 Glucose Anhydrous, NaCl, Na 40 191 Isosorbide 5 - Mononitrate 9 221 Long Acting Analog Insulin 26
Bicarbonate, CaCl2
162 Glycerin guaicolate + Ammonium Cl + Na 37 192 Isosorbide Dinitrate 9 222 Loperamide HCL 3
Sitrate
163 Glyceryl Trinitrat 9 193 Itraconazole 34 223 Loratadine 1
164 Goserelin Acetate 45 194 K L-Aspartate 40 224 Loratadine + Pseudoephedrine 37
165 Granisetron HCL 43 195 Kalium Permanganat 17 225 Lorazepam 30
166 Haloperidol 30 196 KCl 40 226 Losartan 12
167 Heparin inj 47 197 Ketoconazole 17,34 227 Magnesium Sulfat 40
168 Human Albumin 42 198 Ketoprofen 28 228 Mebendazole 35
169 Human antithrombin III 46 199 Lactobacillus 3 229 Mecobalamine 32
170 Human Insulin 26 200 Lactulose 4 230 Medroxyprogesterone acetate 22
171 Hyaluronate 48 201 Lamivudin 41 231 Mefenamic Acid 27
172 Hydrochlorthiazide 13 202 Lamotrigine 31 232 Megestrol Acetate 45
173 Hydrocortison + Chloramphenicol 19 203 Lansoprazole 1 233 Melfalan 45
174 Hydrocortison butyrat 47 204 Lapatinib ditosylate 45 234 Meloxicam 28
175 Hydrogen Perokside 17 205 Latanoprost + timolol 20 235 Mercaptopurin 45
176 Hydromorphone HCL 48 206 Letrozole 45 236 Mesalazine 4
177 Hydroxyurea 45 207 Leuprorelin 45 237 Mesna 45
178 Hyoscin N Butylbromide 3 208 Levodopa + Benserazide HCL 32 238 Metamizol Na 27
179 Hyoscin N Butylbromide + Paracetamol 3 209 Levodopa + carbidopa + entacapone 32 239 Metamizole,Belladona, papaverin HCl 13
180 Ifosfamid 45 210 Levofloxacin 7 240 Metformin HCI 24

181 Imatinib Mesylate 45 211 Levofloxacin HCL 18, 19 241 Methotrexate 45
182 Imidapril HCL 10 212 Levothyroxine Na 25 242 Methyldopa 13
183 Imipramine HCL 32 213 Lidocain HCL 18 243 Methylprednisolone 22

244 Metoclopramide HCL 33 270 Nystatin 21 296 Pioglitazone HCL + Metformin 24
245 Metoprolol Tartrate 11 271 Nystatin + Zinc Oxide 17 297 Pipemidic Acid 21
246 Metronidazole 35 272 Octreotide 45 298 Piracetam 50
247 Metronidazole + Nystatin 21 273 Ofloxacin 7, 19 299 Piroxicam 18, 29
248 Mg (OH)2 + Al(OH)3 + Simethicone 2 274 Oksomemazin + Gliserilguaiakolat 38 300 Policresulen, cinchocaine HCL 4
249 Miconazole 21 275 Omeprazole 2 301 Povidone Iodine 21
250 Miconazole Nitrat + Hydrocortison 16 276 Ondansetron 33 302 Pramipexole HCL 32
251 Mitomisin D 45 277 Oxaliplatin 45 303 Prednisolone Acetate Miconized 19
252 Mix Analog Insulin 26 278 Oxcarbazepin 31 304 Prednisone 22
253 Mometasone furoate 38 279 Oxymethazoline 38 305 Procarbazin 46
254 Momethasone 47 280 Oxytetracyclin 19 306 Propafenone HCL 9
255 Morphin Sulfate 48 281 Paclitaxel 46 307 Propranolol HCL 11
256 Mupirocin 15 282 Pancreatin + Activated 4 308 Propyl Thiouracyl 25
Dimethylpolysiloxane
257 Mycophenolate mofetil 41 283 Paracetamol 27 309 Pseudoephedrine HCL 38
258 Na Hyaluronate 20 284 Paracetamol + Phenylpropanolamine 38 310 Pyrantel Pamoate 35
259 Na Lauryl Sulfoacetatte + Na Citrate + 4 285 Paracetamol + Phenylpropanolamine + 38 311 Pyrazinamide 8

Sorbic Acid + Peg 400 + Sorbitol CTM + DMP
260 Na,Cl 40 286 Parecoxib Na 43 312 Pyridostigmine Br 33
261 N-Acetylcystein 37 287 Pefloxacin 49 313 Raloxifene 46
262 Nacl 538 mg, Na Lactate 448 mg, Cacl2 42 288 Peginterferon alfa-2a 41 314 Ramipril 10
25.7 mg, mgcl2 5.08 mg, Dextrose
263 Naftidropuryl Oxalate 13 289 Peginterferon alfa-2b 41 315 Ranibizumab 7
264 Naphazoline HCL + Pheniramine Maleat 20 290 Pemirolast K 20 316 Ranitidine HCL 2
265 Neomycin + Polimixin B + 21 291 Pentoxyfylline 13 317 Rapid Analog Insulin 26

Furalthallidone dll
266 Neomycin sulfate + polymyxin B sulfate 19 292 Pheniramine maleate 1 318 Rebamipide 2, 3
+ phenylephrine HCL
267 Nicergoline 13 293 Phenytoin Na 31 319 Repaglinide 24
268 Nifedipine 11 294 Pilocarpine 20 320 Retinoic Acid 17
269 Nimodipine 13 295 Pioglitazone HCL 24 321 Ribavirin 41

322 Rifampicin 8 349 Sucralfate 3 376 Triamcinolone Acetonide 21
323 Rifampicin + INH 8 350 Sulfacetamide Na 19 377 Trihexyphenidyl 32
324 Rifampicin + INH + Pyrazinamide 8 351 Sulfasalazine 3 378 Trimetazidine 47
+Ethambutol
325 Risperidon 30 352 Synthetic vitamin A acetate 39 379 Tripolidine HCL + pseudoephedrine HCL 38
326 Rivaroxaban 47 353 Tacrolimus 41 380 Urea 18

327 Rivastigmin 49 354 Tamoxifen 46 381 Ursodeoxycholic acid 4
328 Rosuvastatin 26 355 Tamsulosin Hydrochlorida 21,22 382 Ustekinumab 46
329 Roxithromycin 6 356 Telbivudine 41 383 Valacyclovir HCL 35
330 Salbutamol Sulfate 36 357 Telmisartan 12 384 Valproic Acid 31
331 Salbutamol Sulfate + Guaifenesin 36 358 Telmisartan + Hydrochlorothiazide 12 385 Valproic Na 31
332 Salbutamol Sulfate + Theophylline 36 359 Temozolomide 46 386 Valsartan 12
333 Salmeterol, Fluticasone Propionate 36 360 Tenofovir Disoproxil Fumarate 1 387 Verapamil HCL 11
334 Sea water microdifusion 48 361 Terbinafine 18 388 Vinblastin 46
335 Sertraline HCL 32 362 Thiamazole 25 389 Vinkristin 46
336 Sevelamer 48 363 Thiamphenicol 6 390 Vinoralbine 46
337 Silver Sulfadiazine 15 364 Thymosin alfa-1 41 391 Vit A + Vit C + Vit D3 + Vit E + Vit B Comp 39
338 Simvastatin 25 365 Thyroxine Na 25 392 Vit A 3, Vitamin B1, Vitamin B2 , Vitamin 39
B6, Vitamin B12, Vitamin C , Vitamin D,
nicotinamide, Ca pantothenate , Ca
gluconate, lysine HCl, phosphorus
339 Sitagliptine 24,25 366 Timolol maleate 20 393 Vit B1 , B 6 , B12 39

340 Sitagliptine / + Metformine HCL 25 367 Tiotropium Br 36 394 Vitamin B Kompleks 39
341 Sofosbufir 41 368 Tramadol 27 395 Vitamin C 39
342 Solifenacin succinate 22 369 Tramadol + Paracetamol 27 396 Vitamin K 39

343 Sorafenib Tosylate 46 370 Tranexamic Acid 14 397 Warfarin Na 15
344 Spiramycin 6 371 Trastuzumab 46 398 Zn Sulfate + Antazolin Ph + Naphazoline 20
HCL
345 Spironolactone 13 372 Travoprost 20 399 Zoledronic acid 46
346 Steroid tibolone 23 373 Tretionin 17 400 Zolpidem Tartrate 31
347 Streptokinase 46 374 Triamcinole Acetonide 38
348 Streptomycin 8 375 Triamcinolone 22,23
INDEKS MERK
INDEX MERK INDEKS MERK
NO MERK HAL NO MERK HAL NO MERK HAL

1 Stratol 19 34 Amoxicillin 7 67 Baraclude 41
2 3TC 41 35 Analtram 27 68 Barzepin 31
3 Abbotic 6 36 Anemolat 39 69 Basaglar Kwikoen 27
4 Abbotic XL 6 37 Anflat Forte 2 70 Belvas 11
5 Acetylcystein 37 38 Anfuhex 34 71 Benacol DTM 37
6 Acitral 2 39 Angintriz MR 47 72 Benacol Expectorant Cough 37
7 Aclasta 46 40 Angioten 12 73 Betablok 10
8 Actos 24 41 Antasida Doen 1 74 Betadine 21
9 Acyclovir 18, 35 42 Antiplat 14 75 Betadine FH 21
10 Adalat Oros 11 43 Apidra Solostar 26 76 Betahistine 14
11 Afinitor 41 44 Arimidex 43 77 Betamethasone 16
12 Agrylin 47 45 Ariski 47 78 Beta-One 10
13 Albiotin 9 46 Arixtra 46 79 Betason 16
14 Alegysal 20 47 Arixtra 46 80 Betason N 15
15 Alena 1 30 48 Aromasin 44 81 Bicastra 3
16 Alena 2 30 49 Asam Asetat 2 % 21 82 Bisacodyl 3
17 Alerfed 38 50 Asam Askorbat(Vit C) 39 83 Biscor 10
18 Alkeran 48 51 Asam Mefenamat 27 84 Bisolvon Sol 37
19 Allohex 1 52 Asam Traneksamat 14 85 Bisoprolol 10
20 Allopurinol 34 53 Asamnex 14 86 Bleocin 3
21 Alodan 34 54 Ascorbic Acid(Vit.C) 39 87 Blorec 10
22 Alovell 50 55 ASPAR K 40 88 Borraginol N 4
23 Alpentin 31 56 Aspilet Chewable 14 89 Borraginol S 4
24 Alprazolam 29 57 Atarax 27 90 Bracer 3
25 Alzim 49 58 Atorvastatin 25 91 Breathy 48
26 Ambroxol 36 59 Avastin 43 92 Brexel 44
27 Ambroxol HCL 36 60 Avesco 26 93 Bronsolvan 35
28 Amcor 11 61 Avil 1 94 BTXA 46
29 Aminefron 50 62 Avodart 21 95 Budenofalk 48
30 Aminophylline 35 63 Azithromycin 6 96 Burnazin 15
31 Aminoral 50 64 Azopt 19 97 Caladine 18
32 Amitriptyline 32 65 Bactroban 15 98 Calcium Lactat 39
33 Amlodipine 11 66 Bamgetol 31 99 Calporosis D 39

100 Cameloc 28 133 Ciazil 4 166 Cravit 18
101 Candepress 12 134 Ciprofloxacin 7 167 Cryptal 34
102 Canderin 12 135 Cisplatin 44 168 Curacil 43
103 Candesartan 12 136 Citicholine 49 169 Cyclovid 44
104 Candotens 12 137 Citicoline 49 170 Cytistat 48
105 Captopril 9 138 Clamixin 7 171 Dacarbazine Medac 44
106 Carboplatin 43 139 Clamixin Forte 7 172 Dacin 9
107 Cardio Aspirin 14 140 Clarithromycin 6 173 Daivobet 18
108 Cardismo 9 141 Claritin Syrup 1 174 Daivonex 18
109 Cardura 13 142 Cliad 3 175 Daktarin 21
110 Carmed 18 143 Clindamycin 9 176 Danasone 22
111 Carpine 20 144 Clonidine 12 177 Daonil 23
112 Catapres 12 145 Clopidogrel 14 178 Daryant Tulle 17
113 Catapres liquid 12 146 Clorilex 30 179 Daunocin 44
114 Cavit D3 39 147 Clozapine 30 180 DBL Cytarabin 44
115 Cedocard 9 148 Co Amoxiclav 7 181 DBL Vinblastin 46
116 Cefabiotic 5 149 Codein 37 182 Degrani 43
117 Cefadroxil 5 150 Codikaf 37 183 Dermacoid 7
118 Cefixime 5 151 Codipront 37 184 Dermovel 16
119 Celebrex 27,28 152 Codipront Expectorant 37 185 Desferal 42
120 Celestamine 1 153 Colme ear 20 186 Desoximetasone 16
121 Cellcept 41 154 Colme eye 18 187 Dexacap 9
122 Cenfresh 20 155 Comdipin 11 188 Dexadrox 5
123 Cepezet 30 156 Comtro 6 189 Dexaflox 49
124 Cephalexin 5 157 Comtusi 38 190 Dexamethasone 22
125 Ceptik 5 158 Comtusi Forte 38 191 Dexanorm 24
126 Cetamide 19 159 Concor 10 192 Dexazol 34
127 Cetirizine 1 160 Copegus 41 193 Dexketoprofen 28
128 Cetrin 1 161 Cordilla SR 11 194 Dexocort 16
129 Chloramex 5 162 Cortamine 1 195 Diabemin FC 24
130 Chloramphenicol 5 163 Cosmegen 44 196 Diabemin XR 24
131 Chlorpheniramine maleate 1 164 Cotrimoxazole 8 197 Diamicron 23
132 Chlorpromazine 30 165 Cotristen 17 198 Diamicron MR 23

199 Dianeal Pd-2 42 232 Endoxan 44 265 Femaplex 45
200 Diaversa 28 233 Endrolin 45 266 Fendex 28
201 Diazepam 29 234 Enystin 34 267 Fenicol 18
202 Diclofenac Na 28 235 Eperisone HCL 33 268 Fenofibrate 25
203 Digenta 15 236 Epirubicin 44 269 Ferriprox 42
204 Digest 2 237 Epotrex 42 270 Fibrion 46
205 Digoxin 9 238 Eprex 42 271 Fladex 35
206 Diltiazem 11 239 Ergotamine Tartrate & Caffeine 13 272 Fladystin 21
207 Dimenhydrinate 33 240 Ericaf 13 273 Flixotide Inhaler 36
208 Diproca 43 241 Erymed 17 274 Flixotide Nebules 36
209 Diprosalic 16 242 Erythrin 6 275 Flotavid 7
210 Divalin 45 243 Erythromycin 6 276 Fluconazole 34
211 Divalproex Sodium 31,32 244 Esilgan 31 277 Fluimucil 37
212 Divoltar 28 245 Estazor 4 278 Fluimucil Granule 38
213 Dochemo 44 246 Estesia 18 279 Fluimucil Pediatric 38
214 Dogesic 27 247 Esvat 25 280 Flunarizine 13
215 Dolgesik 27 248 Ethambutol 8 281 Flutias 36
216 Domedon 33 249 Ethigobal 32 282 Fluzep 38
217 Domperidone 33 250 Etopul 44 283 Folac 39
218 Donacept 49 251 Etoricoxib 29 284 Fonkopac 46
219 Donepezil 49 252 Etorvel 29 285 Forcanox 34
220 Dopamet 13 253 Euthyrox 25 286 Forumen 21
221 Doxorubicin 44 254 Evista 46 287 Forxiga 48
222 Doxotil 44 255 Evothyl 25 288 Fradex 19
223 Doxycycline 7 256 Exaflam 28 289 Fridep 32
224 Dulcolax 3 257 Exelon Patch 49 290 Frixitas 29
225 Durogesic 48 258 Eyefresh 20 291 Furosemide 13
226 Dynastat 43 259 Eylea 47 292 Gabapentin 31
227 Eclid 23 260 Ezelin 24 293 Gemcikal 45
228 Elizac 32 261 Faktu 4 294 Gemfibrozil 25
229 Elocon 47 262 Farmasal 14 295 Gemfix 45
230 Elox 16 263 Fasgo 27 296 Gentacortin 16
231 Emibion 40 264 Fasgo Forte 27 297 Gentamycin 15

298 Gestamag 2 331 Hepsera 41 364 INHA 8
299 Girabloc 7 332 Herbesser 11 365 Inoxin 8
300 Gitafat 3 333 Herbesser CD 11 366 Interbi 18
301 Glaoplus 20 334 Herbesser SR 11 367 Interdoxin 7
302 Glaucon 13 335 Herceptin 46 368 Interflox eye 19
303 Gliaride 24 336 Hervis 18 369 Internolol 10
304 Glibenclamide 23 337 Hexavask 11 370 Interpril 10
305 Glidanil 23 338 Hexcam 28 371 Interzol SS 1% 17
306 Gliformin 24 339 Hexymer 32 372 Interzol SS 2% 17
307 Glimepiride 23 340 Hialid 20 373 Inviclot 47
308 Glivec 45 341 Holoxan 45 374 Iodine Povidon Lar 17
309 Glubose 23 342 Humalog Kwikpen 26 375 Irbesartan 12
310 Glucobay 23 343 Humalog Mix 25 Kwikpen 26 376 Iressa 44
311 Glucodex 23 344 Humalog Mix 50 Kwikpen 26 377 Irtan 12
312 Glucophage 24 345 Human Albumin Biotest 42 378 Irtan Plus 12
313 Glucophage XR 24 346 Humulin R Kwikpen 26 379 Isonat 9
314 Glucosamine 34 347 Humulin R Vial 100 IU 26 380 Isoptin 11
315 Glucosamine MPL 34 348 Hyalub 20 381 Isoptin SR 11
316 Glucovance 23 349 Hydrochlorthiazide 13 382 Itraconazole 34
317 Glumin 24 350 Hydrogen Perokside 17 383 Janumet 25
318 Glumin XR 24 351 Hydroxyurea Medac 45 384 Januvia 24
319 Glurenorm 24 352 Hyperchol 25 385 Jurnista 8
320 Govotil 30 353 Iclofar 35 386 Kalitake 47
321 Granisetron 43 354 Ikadryl 37 387 Kalium diklofenak 28
322 Granisetron HCL 43 355 Ikadryl DMP 37 388 Kalium Permanganat 17
323 Gravomit 43 356 Ikalep 31 389 Kalmethasone 22
324 Halaven 44 357 Ikaphen Kapsul 31 390 Kalmicetine 5
325 Haloperidol 30 358 Iliadin 38 391 Kalmicetine Dermakolog 15
326 Harnal ® D 0.2 mg Disp. 21 359 Imipramin HCL 32 392 Kalnex 14
327 Harnal ® OCAS 0.4 mg 22 360 Imocard 9 393 Kaltrofen 28
328 Hemapo 42 361 Imuran 41 394 Kalxetin 32
329 Hepamed 41 362 Inclovir 35 395 Kandistatin 34
330 Heplav 41 363 Infeld 18 396 Kenalog in Orabase 21

397 Kendarone 9 430 Letonal 13 463 Medigrel 15
398 Ketoconazole 17 431 Letraz 45 464 Mefentan 27
399 Ketoprofen 28 432 Leucogen 42 465 Meloxicam 27
400 Ketricin OR 21 433 Leucovorin Ca 43 466 Merflam 28
401 Kifaden 29 434 Leukeran 44 467 Merimac 8
402 Kifluzol 34 435 Leukokine 42 468 Merlopam 30
403 Kloderma 16 436 Leunase 43 469 Merron 13
404 Klotaren 28 437 Levemir 26 470 Mersitropil 50
405 Kolkatriol 50 438 Levofloxacin 7 471 Mertigo 14
406 Kolkatriol Forte 50 439 LFX 19 472 Mertigo SR 14
407 KSR 40 440 Librocef 5 473 Mertisal 38
408 Kurtigo 14 441 Librofed 38 474 Mestinon 33
409 Kutoin 31 442 Lidocain HCL 18 475 Metformin 24
410 Kybernin P 46 443 Lifezar 12 476 Methotrexate 45
411 Lacbon 3 444 Lisinopril 10 477 Methylprednisolone 22
412 Lacidofil 3 445 Litorcom 26 478 Metifer 32
413 Lactulax 4 446 Livial 23 479 Metisol 22
414 Lamictal 31 447 Lodem 24 480 Metoclopramide 33
415 Lanabal 32 448 Lodomer 30 481 Metronidazole 35
416 Lancolin 49 449 Lodoz 10 482 Micardis 12
417 Lanfix 5 450 Loprolol 11 483 Micardis Plus 12
418 Lansoprazole 1 451 Loratadine 1 484 Minosep 21
419 Lantiflam 28 452 Losartan 12 485 Miozidine 47
420 Lantus 27 453 Losartan K 12 486 Mircera 47
421 Lantus XR 27 454 Lotasbat 16 487 Mitomisin D 45
422 Laproton 2 455 Lovenox 46 488 Mobafer 32
423 Lasix 13 456 Lycalvit 39 489 Moisderm 18
424 Laxasium 4 457 Madopar Dispersible 32 490 MST Continus 48
425 L-CISIN® 34 458 Magnesium Sulfat 40 491 Mucera 37
426 Lebrest 45 459 Magtral 2 492 Mucera Forte 37
427 Lekuicin Fc 7 460 Magtral Forte 2 493 Mucoxol 37
428 Leparson 32 461 Matulane 46 494 Mupirocin 15
429 Lepsio 31 462 Mecobalamine 32 495 Muzoral 17, 34

496 Mycoral 17 529 Nitrokaf Retard 9 562 Otopain 20
497 Mycos 19 530 Nitrokaf Retard Forte 9 563 Otozambon 21
498 Myco-Z 17 531 Nodrof Flu Antitussive 38 564 Oviskin 15
499 MyDekla 60 mg 41 532 Nodrof Flu Expectorant 38 565 Oviskin N 15
500 MyHep 41 533 Noncort 20 566 Oxaliplatin Medac 45
501 Myleran 43 534 Noprenia 30 567 Oxitel 45
502 Myobat 33 535 Nopres 32 568 P. Pred 19
503 Myori 33 536 Normudal 3 569 Paclon 46
504 Na Diklofenak 28 537 Nospirinal 14 570 Paracetamol 27
505 NaCl 0.9% 40 538 Notisil 15 571 Paratusin 38
506 Nacoflar 28 539 Novalgin 27 572 Parios 3
507 Naletal 14 540 Novomix 26 573 Patizra 47
508 Napchon A 20 541 Novorapid 26 574 Paxus 6
509 Nariz 13 542 Noxetine 32 575 Pedialyte 40
510 Nasacort AQ 38 543 Nudep 32 576 Peg Intron 41
511 Nasalin 48 544 Nuface 17 577 Pegasys 41
512 Nasonex Nasal 38 545 Nuzip 30 578 Perifas 13
513 Natrilix SR 13 546 Nyndia 34 579 Perilax 33
514 Natrium Diklofenac 28 547 Nystatin 21 580 Phenytoin Na 31
515 Nausile 33 548 Obucort 35 581 Pioglitazone 24
516 Navelbine 46 549 Octalbin 42 582 Pionix 24
517 Neo Gynoxa 21 550 Ofloxacin 7 583 Piracetam 50
518 Neoral 41 551 Omeprazole 2 584 Piralen 33
519 Nerilon 16 552 OMZ 2 585 Pirotop 15
520 Neurobion 39 553 Ondansetron 33 586 Piroxicam 29
521 Neurovit E 39 554 Opimox 7 587 Placta 15
522 New Diatabs 3 555 Opipentin 31 588 Plasbumin 42
523 Nexa 14 556 Opiphen 6 589 Platogrix 15
524 Nexavar 46 557 Opox 3 590 Polydex 19
525 Nexium 49 558 Oralit 40 591 Polysilane 1
526 Nifedipine 11 559 Orasic 27 592 Poviral 35
527 Nimotop 13 560 Oscifit 39 593 Prabetic 24
528 Nitral 9 561 Osflex 43 594 Prabetic Plus 24

595 Pradaxa 47 628 Remicade 43 661 Scopamin Plus 3
596 Praxilene 13 629 Renvela 48 662 Sebivo 41
597 Prednicort 22 630 Repimide 3 663 Septika 21
598 Prednisone 22 631 Rexidron 9 664 Seretide Diskus 36
599 Primazole 8 632 Rexta 46 665 Seretide Inhaler 36
600 Pro TB 2 8 633 Rhinos Neo 38 666 Sernade 32
601 Pro TB 4 8 634 Rhinos SR 37 667 Serolin 13
602 Prograf 41 635 Ribomustin 43 668 Siflox 7
603 Prohytens 10 636 Ricovir 41 669 Sifrol 32
604 Pro-Inz 38 637 Rifampicin 8 670 Sifrol ER 32
605 Prolepsi 31 638 Rifastar 8 671 Silum 13
606 Propranolol HCL 11 639 Riklona 31 672 Simarc 2 15
607 Propylthiouracyl 25 640 Rinclo 15 673 Simvastatin 25
608 Propyretic 27 641 Rincobal 32 674 Sinoric 34
609 Prostam SR 22 642 Risperidone 30 675 Sinova 25
610 Protofen 28 643 Rivanol 17 676 Sipentin 31
611 Provera 22 644 Rizodal 30 677 Siramid 8
612 Pulmicort 35 645 Rovadin 6 678 Sitro 6
613 Pulna 8 646 Rytmonorm 9 679 Situroxim 5
614 Pulna Forte 8 647 Salbutamol 36 680 Skizon 16
615 Purinethol 45 648 Salisil Talk 17 681 Slabron 36
616 Pyrantel 35 649 Salofalk 4 682 Sobuvir 41
617 Pyrazinamide 8 650 Salticin 15 683 Sofratulle 17
618 Rahistin 1 651 Sandostatin LAR 45 684 Sopralan 2
619 Ramipril 10 652 Sandostatin SC 45 685 Spasminal 3
620 Ranitidine 2 653 Sangobion 40 686 Spiramycin 6
621 Rebamipide 3 654 Scanaflam 28 687 Spiriva Respimat 36
622 Rebif 41 655 Scandene Gel 18 688 Spirola 13
623 Rebozet 47 656 Scanderma Plus 15 689 Spironolactone 13
624 Recansa 26 657 Scandexon 22 690 Spyrocon 34
625 Recolfar 34 658 Scanovir 18 691 Stalevo 32
626 Recormon 42 659 Scobutrin 3 692 Stanza 27
627 Rectolax 4 660 Scopamin 3 693 Starfolat 39

694 Stelara 6 727 Thyrozol 25 760 Ulsicral 3
695 Stesolid 29 728 Tibigon 8 761 Ultilar 1
696 Streptomycin 8 729 Timol 20 762 Ultraproct N 4
697 Sulcolon 3 730 Tirmaclo 28 763 Umarone 43
698 Sulfasalazine 3 731 Tison 22 764 Unalium 14
699 Sumagesic 27 732 Tobradex 19 765 Urdafalk G 4
700 Suprasma 36 733 Tobroson 19 766 Urdex 4
701 Suvesco 26 734 Tomit 33 767 Urinter 21
702 SVT 25 735 Topcillin 7 768 Urixin 21
703 Takelin 49 736 Topgesik 27 769 Urocarb 22
704 Tamezol 2 737 Tracetate 45 770 Uromitexan 45
705 Tamofen 46 738 Trajenta 48 771 Ursodeoxycholic Acid 4
706 Tanapress 10 739 Trajenta Duo FCT 48 772 Ursolic 4
707 Tantum Verde 21 740 Tramadol 27 773 Vagistin 21
708 Tapros 45 741 Tramifen 27 774 Valacyclovir 35
709 Tarceva 44 742 Transmuco 37 775 Valdimex 30
710 Tarivid Otic Solution 20 743 Trapasin 27 776 Valproic Acid 31
711 Tavora 26 744 Travatan BAK Free 20 777 Valsartan 12
712 Tears Naturale II 20 745 Trental 13 778 Valvir 35
713 Tegretol 31 746 Triamcinolone 21, 22 779 V-Bloc 10
714 Tegretol CR 31 747 Triamcort 22 780 Velacom Plus 1 24
715 Temodal 46 748 Trifed 38 781 Velacom Plus 2 24
716 Tenapril 10 749 Trilac 22 782 Velcade 43
717 Tensiphar 10 750 Trileptal 31 783 Vellepsy 31
718 Teosal 36 751 Trimetazidine 7 784 Velutine 36
719 Terramycin 19 752 Trinolon 23 785 Ventolin 36
720 Thecort 16 753 Triocol 50 786 Ventolin Expectorant 36
721 Theobron 35 754 Trogyl 35 787 Verapamil 11
722 Thiamphenicol 6 755 Tropine 19 788 Vercure 14
723 Thiamycin 6 756 Trozin 6 789 Vermox 35
724 Thianicol 6 757 Tykerb 250 mg 45 790 Vernacel 20
725 Thrombo Aspilet 41 758 Ulceranin 2 791 Versilon 14
726 Thyrax 25 759 Ulsafate 3 792 Vertikaf 14

793 Vesicare 22 804 Warfarin 15 815 Zoladex 45
794 Victoza 48 805 Xalacom 20 816 Zolmia 31
795 Vincristine- Kalbe 46 806 Xarelto 47 817 Zolta 31
796 Vitacid 17 807 Xeloda 43 818 Zometa 6
797 Vitamin A 39 808 Xepalium 14 819 Zorel 35
798 Vitamin B.Complex 39 809 Xepamol 27 820 Zoter 18
799 Vitamin C 39 810 Xepazym 4 821 Zudem 31
800 Vitamin K 39 811 Xeradin 2 822 Zycin 6
801 Vometraz 33 812 Zadaxin 41 823 Zytiga 43
802 Vomina 33 813 Zinc Prima A 20 824 Zyvox 49
803 Vosama 19 814 Zitrolin 6
YKKBI
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DAFTAR STANDAR OBAT

YAYASAN KESEJAHTERAAN KARYAWAN

Jakarta, Januari 2019

YAYASAN KESEJAHTERAAN KARYAWAN

KALSIFIKASI HAL KALSIFIKASI HAL

KALSIFIKASI HAL KALSIFIKASI HAL

NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI

1. Alergi dan Sistem Imun

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Tablet 200mg+200mg+20m PT. Interbat

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2.5 Laksatif, Pencahar

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Clarithromycin Kaplet 500 mg PT. Novell Pharmaceutical Laboratories

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PT. Kimia Farma

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6. Preparat Mata, Telinga, Mulut/Tenggorokan

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Tobradex Eye drop 5 ml Apotek

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7.1.2 Povidone Iodine Betadine FH Solution 0,1 Apotek

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Novomix Flexpen 100 IU/ ml PT. Novo Nordisk Indonesia

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13.2 Obat Batuk & Pilek

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Rhinos SR kapsul 5 mg + 60 mg PT. Dexa Medica

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14.1.3 Vitamin C Ascorbic Acid(Vit.C) Tablet 500 mg PT. Kimia Farma

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14.3.2 KCl KSR Tablet 600 mg PT. Merck Tbk

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