PEMERINTAH KOTA PALEMBANG

DINAS KESEHATAN
PUSKESMAS MULTIWAHANA
Jl. Musi Raya Nomor 1 RT.013 RW.005 Kel. Sialang Kec. Sako Palembang
Komp. Perkantoran Kecamatan Sako
Email : pkm_multiwahana@yahoo.com Telp. 082175338955

FORMULARIUM OBAT UNTUK PELAYANAN DASAR KESEHATAN

DI PUSKESMAS MULTIWAHANA

BENTUK
NO KELAS TERAPI DOSIS SEDIAAN
SEDIAAN
1 Analgesik Non Narkotik dan Anti Inflamasi
1.1 Asam Mefenamat Tablet 500MG
1.2 Ibuprofen Tablet/Sirup 400MG/tablet,100mg/5ml
1.3 Natrium Diklofenak Tablet 25MG/50MG
1.4 Parasetamol Tablet/Sirup/Drop 500MG/tab,120MG/5ml,
100MG/ml
2 Anti Piral
2.1 Allopurinol Tablet 100MG
3 Anastetik Lokal
3.1 Lidocain 2% Ampul 2%
3.2 Etil Klorida spray Botol 100ML
4 OBAT TOPIKAL
a Anti Inflamasi
4.1 Betametason Krim 0.10%
4.2 Hidrocortison Krim 2.50%
b Anti Bakteri
4.1 Perak Sulfadiazin Krim 1%
4.2 Gentamicin Salep Kulit Salep 0.1%
c Anti Fungi
4.1 Nistatin Tablet vagina 100.000iu
4.2 Miconazol Krim 2%
4.3 Anti Fungi doen (AAV) Salep
4.4 Griseofulvin Tablet 125mg/tab
4.5 Ketokonazole Tablet 200mg/tab
d Anti Scabies
4.1 Permetrin (Scabimite) Krim 5%
4.2 Salep 2-4 Salep
e Lain-Lain
4.1 Bedak Salicil Serbuk 2%
5 Psikofarmaka
a Anti Ansietas
5.1 Diazepam Injeksi,Tablet 5MG/ML,2MG
5.2 Klobazam Tablet 10mg
b Nyeri Neuropatik
5.1 Amtriptiline Tablet 25MG
c Anti Psikosis
5.1 Clozapine Tablet 25MG
5.2 Halloperidol Tablet 1,5MG,5MG
5.3 Halloperidol INJEKSI
5.4 Klorpromazine Tablet 100MG
5.5 Risperidon Tablet 2MG
d Anti Epilepsi
5.1 Fenobarbital Tablet,Injeksi 30MG,
e Anti Parkinson/Dementia
5.1 Triheksifenidil Tablet 2MG
6 VERTIGO
 6.1 Betahistin mesilate Tablet 6MG
7 Diuretika
7.1 Furosemide Tablet 40MG
7.2 Hidroklorotiazide Tablet 25MG
8 Anti Helmintika
8.1 Albendazole Tablet,Suspensi 400MG/tablet,200mg/5ml
8.2 Pirantel Pamoat Tablet 125MG
9 Anti Bakteri
a Beta Laktam
9.1 Amoksisillin Tablet 500MG
9.2 Amoksisillin sirup/drop sirup, Drop 125mg/5ml ,100mg/ml
9.3 Sefadroksil Capsul,sirup 500mg/capsul,125mg/5ml
b Makrolid
9.1 Eritromicin Tablet,sirup 500MG/Tablet,200MG/5ml
c Tetrasiklin
9.1 Doksisiklin kapsul 100mg/tab
d Kuinolon
9.1 Siprofloksasin Tablet 500MG
e Khlorampheniol
9.1 Klorampheniol Capsul 250MG
f Sulfametoksazol+Trimetoprim
9.1 Kotrimoksazol Tablet,suspensi 480MG,960MG,240MG/5ML
10 Anti Tuberkulosis
Obat anti tuberkulosis
10.1 Paket
Kategori I
Obat anti tuberkulosis
10.2 Paket
Kategori 2
Obat anti tuberkulosis
10.3 Paket
Kategori Anak
11 Anti Amubasis
11.1 Metronidazol Tablet 500MG
12 Anti Virus
12.1 Asiklovir Tablet, 200 MG,400 MG
12.2 Asiklovir Krim 5%
13 Obat yang mempengaruhi darah (koagulasi)
13.1 Fitomenadion Tablet,injeksi 10 MG,2 MG/ml
14 Anti Anemia
14.1 Ferro sulfat +asam folat Tablet
14.2 Vitamin B12 Tablet 50MG
15 Anti Histamin Dan Anti Alergi
15.1 Cetirizin sirup Sirup 5 mg/5 ml
15.2 Cetirizin Tablet 10 MG
15.3 Klorfeniramini maleat Tablet 4 MG
15.4 Loratadin Tablet 10 MG
16 Anti Diabetika
16.1 Glimepiride Tablet 1 MG, 2 MG
16.2 Glibenklamide Tablet 5 MG
16.3 Metformin Tablet 500 MG
17 Kortikosteroid
17.1 Prednison Tablet 5 MG
18 Anti Angina
18.1 Isosorbid dinitrat Tablet 5 MG
19 Anti Hipertensi
a Golongan ACE Inhibitor
19.1 Katopril Tablet 12,5 MG ,25 MG
b Golongan Beta Blocker
 19.1 Propanolol Tablet 10 MG
c Golongan Calsium Channel Bloker
19.1 Amlodipin Basilat Tablet 5MG,10MG
19.2 Hidroklorotiazide Tablet 25MG
20 Anti Agregasi Platelet
20.1 Asam asetyl salisilat Tablet 80MG,100MG
21 Penurun Kolesterol
21.1 Simvastatin Tablet 10MG,20MG
22 Anti Ulkus
22.1 Antasida Doen Tablet,sirup 400mg/tab. 5ml/sirup
22.3 Omeprazole Capsul 20mg/caps
22.4 Ranitidine Tablet 15omg/tab
23 Anti Emetika
23.1 Domperidon Tablet,sirup 10mg/tab.5mg/5mlsirup
23.2 Metoklorperamide Tablet 10mg/tab
24 Anti Spasmodik
24.1 Hiosin butilbromida Tablet 10mg
25 Obat untuk Diare
25.1 Attalpulgit Tablet 630mg/tab
25.2 Loperamide Tablet 2mg/tab
26 Larutan Elektrolit, Nutrisi
26.1 Garam Oralit Serbuk 200mg
27 Anti Asma
27.1 Salbutamol Tablet 2MG/tab
28 Ekspektoran
28.1 n-Asetil sistein Capsul 200mg/cap
29 Katartik
29.1 Bisakodil Tablet 5mg/tab
29.2 Bisakodil Suppos 5mg,10mg
30 Obat Untuk Mata
30.1 Gentamicin Salep,Drop 0,1%
31 Obat UntukTelinga
31.1 Fenol Glyserol Drop 10%
31.2 Khloramphenicol Drop 1%
32 Anti Hemaroid
32.1 Anti Hemaroid Suppose 2gram
33 Obat Gigi Dan Mulut
33.1 Eugenol Cairan
33.2 Kalsium Hidroksida Bubuk,Pasta
KlorfenolKamper
33.3 Cairan
Mentol (CHKM)
33.4 Formokresol Cairan
33.5 Composit Resin
SemenSeng Fosfat
33.6 serbuk dan cair
serbuk dan cair
Temporar stoping
33.7 serbuk dan cair
Fletcher
Devitalisasi pasta (Non
33.8 Pasta
arsen)
Glass Ionomer ART
33.9 (Atraumatik serbuk dan cair
Restrorative Theament)
Povidone Iodida obat
33.10 Cairan 1%
kumur
34 Anti Septik
34.1 Hidrogen Peroksida Cairan 3%
34.2 Povidone Iodida Cairan
35 Desinfektan
 35.1 Lysol Cairan
35.2 Etanol 70% Cairan 70%
36 Paranteral
36.1 NatriumCklorida Infus 0,9%
36.2 Ringer Lactat Infus
36.3 Glucosa Infus 5%,10%
37 Serum
37.1 Serum Anti Tetanus Injeksi
38 Vaksin
38.1 Vaksin BCG Injeksi Serbuk
38.2 Vaksin MR Injeksi Serbuk
Vaksin DPT +Hepatitis
38.3 Injeksi
B
38.4 Vaksin Polio Injeksi
38.5 Vaksin DT Injeksi
38.6 Vaksin TD Injeksi
38.7 Vaksin IPV Injeksi
38.8 Vaksin Polio Injeksi
39 Vitamin dan Mineral
39.1 Asam Ascorbat Tablet 50mg,250mg
39.2 Kalsium Lactat Tablet 500mg
39.3 Piridoksin Tablet 10mg
39.4 Retinol Capsul 100.000iu,200.000iu
40 ANTIALERGI DAN ANAFILAKSIS
40.1 Dexametashone Injeksi 5mg/ml
40.2 Dipehenhidramin Injeksi 10mg/ml
40.3 Efineprin (Adrenalin) Injeksi 1mg/ml
41 OBAT KEJANG PADA PRE-EKLAMSIA DAN EKLAMSIA
41.1 Magnesium Sulfat Injeksi 20% iv
41.2 Magnesium Sulfat Injeksi 40% iv
42 Kontrasepsi
42.1 Copper T
42.2 Implan
42.3 Pil KB
42.4 Obat Suntik KB
42.5 IUD

Ditetapkan di : Palembang
Tanggal : 09 Januari 2023
KEPALA PUSKESMAS MULTIWAHANA

DIAN HAYATI