formularium mawaddah-dh2015

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1 FORMULARIUM OBAT RUMAH SAKIT MAWADDAH MEDIKA TAHUN 2010 KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga 1 2 3 4 5 6 1 Analgesik, Antipiretik, Antiinflamasi NonSteroid, Antipirai 1.1 Analgesik Narkotika 1 Kodein 1.1.1 Tab 10mg, kaleng generik KF 2 Fentanyl 1.1.2 inj. 50 mcg/ml @10ml Fentanyl janssen-cilag 3 Morphin HCl 1.1.3A Tab, 10 mg MST Mahakam 1.1.3B Inj. 10 mg/ml generik KF 4 Petidin 1.1.4A injc i.m/s.k/i.v KF 1.1.4B 50mg/ml Bentuk sediaan, kekuatan obat

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Page 1: formularium mawaddah-dH2015

1

FORMULARIUM OBAT

RUMAH SAKIT MAWADDAH MEDIKA

TAHUN 2010

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga

1 2 3 4 5 6

1 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika

1 Kodein 1.1.1 Tab 10mg, kaleng generik KF

2 Fentanyl 1.1.2 inj. 50 mcg/ml @10ml Fentanyl janssen-cilag

3 Morphin HCl 1.1.3A Tab, 10 mg MST Mahakam

1.1.3B Inj. 10 mg/ml generik KF

4 Petidin 1.1.4A injc i.m/s.k/i.v KF

1.1.4B 50mg/ml

Bentuk sediaan, kekuatan obat

Page 2: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

1.2 Analgesik Non-Narkotik

1 Asam asetilsalisilat 1.2.1 Tab 100mg Aspilet Medifarma

(asetosal)

2 Asam mefenamat 1.2.2A Tab 500 mg grafik gracia

1.2.2B Cargesic Sanprima

1.2.2C Opistan Otto

1.2.2D Pondex Dexa

3 Ibuprofen 1.2.3A Tab 200mg generik

1.2.3B Proris Pharos

1.2.3C syr.100mg/5ml Proris Pharos

1.2.3D Supp. 125 mg Proris Pharos

4 Kalium Diklofenac 1.2.4A tab 50mg,25mg Exaflam Guardian

1.2.4B tab 50mg X-flam Combiphar

5 Ketoprofen 1.2.5A Supp 100mg Kaltrofen Kalbe

1.2.5B Tab 100mg Pronalges pharos

1.2.5C Kaltrofen kalbe

6 Ketorolac 1.2.6A inj. 30mg/ml generik

1.2.6B trolac inj Berno

1.2.6C Matolac Mahakam

7 Meloxicam 1.2.7A Tab 15mg generik

Page 3: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

1.2.7B osteloc sanbe

1.2.7C Tab 7,5 mg generik

1.2.7D loxil gracia

8 Metampiron 1.2.8A Tab 500mg Antalgin

1.2.8B Analsik Sanbe

(+Dzp 2mg)

1.2.8C Zyparon novell

9 Metamizole sodium 1.2.9A Tablet 500mg Antalgin

1.2.9B Injc. 500mg/ml Norages Mepro

1.2.9C @2ml Novalgin Sanovi-aventis

1.2.9D PRAGESOL NOVELL

10 Natrium diklofenak 1.2.10A Tab 50mg Voltadex Dexamedika

1.2.10B Tab 25 mg Renadinac Fahrenheit

1.2.10C gel Scantaren Scanpasific

11 Paracetamol 1.2.11A Tab 500mg Mirasic Sanprima

1.2.11B Sanmol Sanbe

1.2.11C Syr 120mg/5ml Sanmol Sanbe

1.2.11D Pyridol Pyridam

1.2.11E Mirasic Sanprima

1.2.11F drop 60mg/0,6ml Sanmol drops sanbe

1.2.11G Supp 240mg Propyretic 240 Combi

1.2.11H Supp 160mg Propyretic 160 Combi

1.2.11I SANMOL INFUS SANMOL SANBE

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

1.2.11J MORESIC DROP MORETIC DROP GRACIA

12 Piroksikam 1.2.12A tab 20 mg generik

1.2.12B gel Pirofel Sanbe

13 Tinoridine HCl 1.2.13 tab 50 mg Nonflamin Takeda

14 Tramadol 1.2.14A inj 50mg/ml generik

1.2.14B tab 37,5mg+ Patral mahakam

1.2.14C paracetamol 32,5mg

15 Kombinasi :

Antalgin 250mg 1.2.15 inj 15ml/vial Xillomidon Dura

Pyramidon 50mg

Lidocain HCl 15mg

1.3 Antipirai

1 Allopurinol 1.3.1A Tab 100mg generik

1.3.1B reucid otto

2 Anestetik

2.1 Anestetik Lokal

1 Bupivacain HCl 2.1.1A inj 5mg+ dextrose80mg RECAIN MAHAKAM

amp, 4ml

2 Etil klorida 2.1.2 spray, botol 100ml

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

3 Lidokain 2.1.3A inj 2% lidocain

2.1.3B inj 2% (HCl) Pehacain Phapros

+epinefrin 1:80000

2.1.3C inj 2%+dextrosa 5% Lidodex Berno

2.2 Anastetik Umum dan Oksigen

1 Halotan 2.2.1 cairan inhalasi Halotan Dexa

250ml

2 isoflurane 2.2.2 cairan inhalasi isofluran Dexa

3 Ketamin 2.2.3 inj iv 100mg/ml Ketamin

@20ml KTM Guardian

4 Nitrogen Oksigen 2.2.4 gas tabung 15kg

5 Oksigen 2.2.5 gas dlm tabung

6 Propofol 2.2.6 inj 10mg/ml, amp20ml Safol Novell

2.3 Prosedur Peri Operatif, Obat untuk

1 Atropin sulfat 2.3.1 inj 0,25mg/ml@1ml sulfas atropin ethica

2 Diazepam 2.3.2A tab 5mg Valisanbe Sanbe

Page 6: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

2.3.2B tab 2mg Valisanbe Sanbe

2.3.2C inj 5mg/ml Valisanbe Sanbe

2.3.2D rectal 5mg/2,5ml Stesolid Actavis

3 Midazolam 2.3.3A inj 5mg/5ml Dormicum Roche

2.3.3B inj 15mg/3ml Dormicum Roche

3 Anti Alergi dan Obat untuk Anafilaksis

1 Dexametasone 3.1A inj 5mg/ml@1ml Kalmethasone Hexapharma

3.1B Indexon Interbat

3.1C Cortidex Sanbe

3.1D tab 0,5mg Kalmethasone Hexapharma

3.1E Scandexon Tempo

3.1F Carbidu Sampharindo

Kombinasi dengan 3.1G Tab Mexon sampharindo

difenhidramin

2 Difenhidramin 3.2A Inj 10mg/ml generik

3.2B Inj 15mg/vial Duradryl Dura

3 Epinefrin (adrenalin) 3.3 Inj 0,1% Generik

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

4 Klorfeniramin 3.4 Tab 4mg pehachlor

5 Pheniramine maleat 3.5A Tab 25mg avil sanofi

3.5B inj.50mg/2ml avil sanofi

6 Loratadine 3.6A tab 10mg generik

3.6B clarihis lapi

7 Ceterizin 3.7A tab 10mg Zenris Pyridam

3.7B generik

3.7C drops Tiriz Lapi

8 Metil Prednisolon 3.8A tab 8mg generik

3.8B Lameson lapi

3.8C inj 125mg/ml Lameson lapi

3.8D generik

9 Ciproheptadin 3.9 kap 4mg Pronicy Kalbe

10 Mebhidroline Naphadisilat 3.10 tab 50mg interhistin interbat

4 Antidot dan obat lain

Untuk Keracunan

4.1 Khusus

1 Atropin 4.1.1 inj 0,25mg/ml sulfas atropin ethica

Page 8: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

2 Kaksium glukonat 4.1.2 100mg/ml Ca Gluconas Ethica

3 Natrium bikarbonat 4.1.3A tab 500mg generic

4.1.3B inf fl. 25 Meq Meylon Otsuka

4 Naloxone HCl 4.1.4 inj.0,4mg/ml Nokoba Fahrenheit

5 Neostigmin metylsulfat 4.1.5 inj 0,5mg/ml Prostigmin Transfarma

4.2 Umum

1 Magnesium sulfat 4.2.1A inj 20%25ml MgSo4 20% Otsu

4.2.1B inj 40%25ml MgSo4 40% Otsu

5 Antiepilepsi - Antikonvulsi

1 Carbamazepin 5.1 tab 200mg generik

2 Diazepam 5.2 rectal 5mg/2,5ml Stesolid Actavis

3 Fenitoin 5.3A inj 50mg/ml phenytoin ikapharmino

5.3B cap 100mg phenytoin ikapharmino

4 Fenobarbital 5.4A tab 30mg generik KF

5.4B inj 50mg Phental iv Combi

Page 9: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

5 Gabapentin 5.5A cap 300mg Gabexal Sandoz

5.5B generic

6 Antiinfeksi

6.1 Antelmintik

6.1.1 Antelmintik Intestinal

1 Pirantel 6.1.1.1A tab 125mg Pyrantin

6.1.1.1B susp 125mg/5ml Combantrin Pfizer

6.2 Antibakteri

6.2.1 Beta Laktam

1 Amoksisilin trihidrat 6.2.1.1A tab 500mg novax caps gracia

6.2.1.1B Zemoxil Zenith

6.2.1.1C Brodamox Sampharindo

6.2.1.1D dry syr 125mg/5ml fosicolos gracia

6.2.1.1E Zemoxil Zenith

6.2.1.1F drops 100mg/ml Amoxan Sanbe

6.2.1.1G serb inj 1000mg Amoxan Sanbe

2 Ampisilin 6.2.1.2A cap 500mg Brodapen Sampharindo

Page 10: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

6.2.1.2B serb inj 1000mg Viccilin Meiji

3 Ampicillin + Sulbactam 6.2.1.3 serb inj 500+250mg Pycin 750 Berno

4 6.2.1.4A kap 500+125mg co amoxiclav

6.2.1.4B clanexi sanbe

5 Cefadroksil 6.2.1.5A caps 500mg Pyricef Piridam

6.2.1.5B generik

6.2.1.5C dry syr 125mg/5ml Pyricef Piridam

6.2.1.5D generik

6 Sefaklor 6.2.1.6 caps 500mg Capabiotik Yarindo

7 Sefaleksin 6.2.1.7 caps 500mg Cefabiotic Berno

8 Sefiksim 6.2.1.8A caps 100mg NUCEF GUARDION

6.2.1.8B dry syr 100mg/5ml PROFIM PROMED

9 Sefotaksim 6.2.1.9A serb inj 1gr generik

6.2.1.9B FOBET MAHAKAM

6.2.1.9C lapixim lapi

10 Seftazidim 6.2.1.10 serb inj 1gr CEFDIM PROMED

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 11: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

11 Seftriakson 6.2.1.11A serb inj 1gr generik

6.2.1.11B GRACEF GRACIA

6.2.1.11C cephaflox guardian

12 Sephalotin 6.2.1.12 serb inj 1gr Moraxine Yarindo

13 Meropenem 6.2.1.13A serb inj 1 gr Meropex Berno

6.2.1.13B generik

14 SEFTISOXIM 6.2.1.13C serb inj 1 gr e-zox nulab

generik novell

6.2.2 Antibakteri Lain

6.2.2.1 Tetrasiklin

1 Doksisiklin 6.2.2.1.1A caps 100mg generik ogb dexa

6.2.2.1.1B doxacin otto

2 Tetrasiklin 6.2.2.1.2 caps 500mg Suprabiotik Zenith

6.2.2.2 Kloramfenikol

1 Kloramfenikol 6.2.2.2.1A caps 250mg Lanacetin landsen

6.2.2.2.1B susp 125mg/5ml coromycetin coronetcrown

2 Tiamfenikol 6.2.2.2.2A caps 500mg Promixin Pyridam

6.2.2.2.2B Dexicol Dexa

6.2.2.2.2C dry syr 125mg/5ml Phenobiotic Berno

Page 12: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

6.2.2.2.2D fosicolos gracia

6.2.2.3 Sulfa - Trimetoprim

1 (dewasa)kombinasi : 6.2.2.3.1A Tablet Sanprima Sanbe

sulfametoksazol 400mg + 6.2.2.3.1B miratrim sampharindo

trimetoprim 80mg

2 sulfa 800mg+ 6.2.2.3.2A Tablet Lapikot forte Lapi

trimetoprim 160mg 6.2.2.3.2B Primadex forte Dexamedika

3 Kotrimoksazol suspensi 6.2.2.3.3A susp Sanprima Sanbe

komb : sulfametoksazol 6.2.2.3.3B Primadex Dexamedica

200mg + trimetoprim 40mg/5ml 6.2.2.3.3C Miratrim Sampharindo

6.2.2.4 Makrolit

1 Clindamisin 6.2.2.4.1 caps 150mg & 300mg generik

2 Eritromisin 6.2.2.4.2A caps 500mg generik

6.2.2.4.2B erisanbe sanbe

6.2.2.4.2C erisanbe chewable sanbe

6.2.2.4.2D syr 200mg/5ml generik

3 Spiramisin 6.2.2.4.3A tab 500mg generik

6.2.2.4.3B varoc pyridam

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

4 Azytromicin 6.2.2.4.4A caps 500mg zibramax guardian

6.2.2.4.4B generik

6.2.2.5 Amiglikosida

1 Gentamisin 6.2.2.5.1A inj 40mg/ml Sagestam Sanbe

6.2.2.5.1B inj 80mg/ml ottogenta otto

6.2.2.6 Kuinolon

1 Levofloksasin 6.2.2.6.1A tab 500mg Cravox Lapi

6.2.2.6.1B generik

6.2.2.6.1C lar infus 500mg/100ml generik

6.2.2.6.1D Cravox Lapi

2 Ofloksasin 6.2.2.6.2 tab 200&400mg generik

3 Siprofloksasin 6.2.2.6.3A tab 500mg generik

6.2.2.6.3B Baquior forte sanbe

6.2.2.6.3C Lapiflox Lapi

6.2.2.6.3D lar infus 500mg/100ml generik

6.2.2.6.3E Lapiflox inf Lapi

6.2.2.7 Penggunaan khusus

1 Sulfasalazin 6.2.2.7.1 tab 500mg Sulcolon Berno

Page 14: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

2 Metronidazol 6.2.2.7.2A tab 500mg Metrolet Harsen

6.2.2.7.2B Trychodazole Sanbe

6.2.2.7.2C syr 125mg/5ml Metrolet Harsen

6.2.2.7.2D promuba mepro

6.2.2.7.2E supp 500mg Flagyl Sanovi

6.2.2.7.2F ovul + nistatin 100000iu Vagistin Combiphar

6.2.2.7.2G lar infus 500mg/100ml Trychodazole Sanbe

6.2.2.7.2H generic

3 Colistin sulfat 6.2.2.7.2 Tab 250000 iu Colistine Actavis

6.3 Antiinfeksi Khusus

6.3.1 Antituberkulosis

1 Etambutol 6.3.1.1 tab 500mg generik

2 Isoniazid 6.3.1.2 tab 300mg generik

3 Pirazinamid 6.3.1.3 tab 500mg generik

4 Rifampicin 6.3.1.4 caps 450mg generik

Page 15: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

5 Kombinasi (OAT TB dots): 6.3.1.5

untuk dewasa kap : INH 75,Rifam 150, OAT fase intensif Indofarma

Pza 400, ethambutol 275

kap: INH 150, Rifam 150 OAT fase lanjutan Indofarma

untuk pediatri INH100, rifam75,Pza200 OAT fase intensif Indofarma

INH 100, Rifam 75 OAT fase lanjutan Indofarma

6 Kombinasi : 6.3.1.6

Ethambutol, INH, B6 caps Bacbutinh

Niazitol

7 INH50+Rifam75+PZA150 6.3.1.7 caps Rimcure paed Sandoz

8 INH50+ Rifam75 6.3.1.8 Rimtazid paed Sandoz

6.3 Antifungi

1 Itrakonazol 6.3.1 caps 100mg Itzol Lapi

2 Ketokonazol 6.3.2 tab 200mg generik

3 Mikonazol 6.3.3 cream generik

4 Nistatin 6.3.4A ovul + metronidazol vagistin Combi

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

6.3.4B drops Kandistatin lapi

6.5 Antimalaria

1 Sulfadoxin 500mg, 6.5.1A tab Fansidar Roche

primetamin 25 mg 6.5.1B

6.6 Antivirus

6.6.1 Antiherpes

1 Asiklovir 6.6.1A tab 200mg generik

6.6.1B tab 400mg generik

6.6.1C cream 5% generik

7 Antimigren dan neuroprotector

1 Ergotamin cafein 7.1 tab 1mg generik

2 7.2 kap Nogren Pyridam

3 Piracetam 7.3A tab 800mg&1200mg generik

7.3B latropril Lapi

7.3C inj 1gr/5ml generik

7.3D Neurotam kalbe

7.3E inj 3gr/5ml generik

Kombinasi paracetamol 300mg, acetosal, cafein

Page 17: formularium mawaddah-dH2015

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

4 Sitikolin/citikolin 7.4A tab 500mg Neociti Lapi

7.4B inj 250mg/2ml Nicholin Takeda

7.4C Neociti Lapi

5 Pyritinol HCL 7.5 syr 100ml Encephabol Merck

6 Mecobalamin 7.6A inj. Amp 500mcg Kalmeco Kalbefarma

7.6B tab 500mg Kalmeco Kalbefarma

8 Darah, Obat yang Mempengaruhi

8.1 Antianemi

1 Asam folat 8.8.1.1 tab 1mg Folacom combi

2Besi III sulfat (sulfas ferosus)

8.8.1.2A tab salut 300mg Natabion Pyridam

8.8.1.2B Artoferum

8.8.1.2C syr. 50mg/50ml, @150ml Maltofer Combi

3 Vit B1, B6, B12 8.8.1.3A tab Neurobion 5000 Merc

8.8.1.3B Neurobat Interbat

8.8.1.3C Neurosanbe Sanbe

8.8.1.3D Neurodex dexamedika

8.8.1.3E Sakaneuron sakafarma

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

8.8.1.3F inj. Amp 3ml Neurosanbe 5000 Sanbe

8.8.1.3G Neurobion 5000 merck

8.2 Koagulasi, obat

yang mempengaruhi

1 Asam traneksamat 8.8.2.1A inj 250mg/5ml Kalnex Kalbe

8.8.2.1B Transamin Otto/daichi

8.8.2.1C tab 500mg Transamin Otto/Daichi

2 Fitomenadion (vit K) 8.8.2.2A tab salut 10mg, kaleng generik

8.8.2.2B inj 10mg/ml Neo K Combi

3 Heparin Na 8.8.2.3A gel Thrombopop Gel tunggal idaman

8.8.2.3B Antithromb Mecosin

4 Lidocain 8.8.2.4 inj 2% generic Bernofafm

9 Diuretik

1 Furosemida 9.1A tab 40mg generik

9.1B inj 10mg/ml Lasix Sanofiaventis

2 Hidroklortiazid (HCT) 9.2 tab 25mg generik

3 Manitol 9.3 lar infus 20%@500ml manitol Otsu

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

4 Spironolacton 9.4 tab 25mg carpiaton Fahrenheit

10 Hepatoprotector dan Cholelitiolisis

1 Lesitin 10.1A caps 300mg Lesichol Landson

10.1B Lesipar Lapi

2 L-ornitin, L-aspartat 10.2A inj 5mg/10ml Hepa-Merz Combi

10.2B sachet 3g Hepa-Merz granul Combi

3 Ursodeoxycholic 10.3 caps 250mg Urdafalk darya-varia

4 hepatoprotector 10.4A tab Hepa-Q Pyridam

fitofarmaka 10.4B HP pro

11 Hormon, Obat Endokrin Lain dan

Kontraseptik

11.1 Antidiabetes

11.1.1 Antiabetes, Oral

1 Glibenclamida 11.1.1 tab 5mg generik

2 Glimepiride 11.1.2 tab 2mg Amaril Sanofiaventis

Gluvas Dexa

3 Glikuidon 11.1.3A tab 30mg Glurenorm Boehringer

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

11.1.3B generik

4 Metformin 11.1.4A tab 500mg generik

11.1.4B Eraphage guardian

5 Gliklasid 11.1.5 tab 80mg generik

11.1.2 Antidiabetes, Parenteral

1 Isulin reguler 11.2.1 inj 100iu/ml @10ml Actrapid Novo

11.2 Hormon Kelamin dan obat yang

mepengaruhi Fertilitas

11.2.1 Progestrogen

1 Noretisteron 11.2.1A tab 5mg Regumen Caprifarmindo

11.2.1B Norelut N dexa

2 Alil Esternol 11.2.2A tab 5mg Preabor Caprifarmindo

11.2.2B Premastone Kalbe

3 Ethinilestradiol 11.2.3 tab 50mcg Lynoral Schering

11.2.2 Clomiphen Sitrat

11.2.2.1A tab 50mg Blesifen Caprifarmindo

11.2.2.1B Profertil Kalbe

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

11.3 Kontraseptik

11.3.1 Oral

1 Levonogestrel, 11.3.1A tab 28 Microgynon ling- Bayer-Schering

ethinilestradiol,placebo 11.3.1B karan biru

11.3.2 Injeksi

1 medroksiprogesteron 11.3.2.1A vial, 50mg/ml, 3mL Depo progestin Harsen

acetat 11.3.2.1B vial, 150mg/ml, 1ml Depo Neo Triyasa nagamas

2 Medroksiprogesteron 11.3.2.2A vial, 0,5 ml Cyclofem Tunggal

acetat 50mg+10 estradiol- 11.3.2.2B Idaman Abdi

cypionate

11.3.3 Intra Uterin 11.3.3 T-shaped dg copper wire Nova-T CU Bayer-Schering

dan silver core

11.4 Hormon Tiroid dan Antitiroid

1 Propiltiorasil 11.4.1 tab 100mg generik

11.4 Kortikosteroid

1 Deksametason 11.4.1A inj 5mg/ml @1ml Kalmethasone Kalbe

11.4.1B Indexon Interbat

11.4.1C Cortidex Sanbe

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KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

11.4.1D tab 0,5mg Kalmethasone Kalbe

11.4.1E scandexon scan pasific

11.4.1F carbidu sampharindo

2 Metil prednisolon 11.4.2A tab 4mg generik

11.4.2B lameson Lapi

11.4.2C inj 125mg/2ml lameson Lapi

3 Prednison 11.4.3 tab 5mg generik

4 Triamsinolon 11.4.4A inj 10mg/ml Falmicort Dexa

11.4.4B oral base, tube Kenalog Taisho

12 Kardiovaskuler, Obat

12.1 Antiangina

1 Atenolol 12.1.1 tab 100mg generik

2 Diltiazem HCL 12.1.2A tab 30mg generik

12.1.2B inj 5mg/ml

3 Isosorbit dinitrat 12.1.3A tab 5mg generik

12.1.3B Cedocard Darya-Varya

12.1.3C inj 10mg/10ml Farsorbid Fahrenheit

4 Nitrogliserin 12.1.4 inj 1mg/ml generik

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5 Propanolol 12.1.5 tab 10mg generik

12.2 Antiaritmia

1 Amiodaron HCT 12.2.1 tab 200mg dan inj Tiaryt Fahrenheit

2 Kuinidin 12.2.2 tab 100mg generik

3 Lisinopril 12.2.3 tab 10mg Noperten Dexa

4 Propanolol 12.2.4 tab 10mg generik

5 Trimetazidine diHCl 12.2.5 tab 35mg Trizedon MR servier

6 Verapamil 12.2.6 tab 80mg generik

12.3 Lain-lain

1 Amlodipin Besilat 12.3.1A tab 5mg generik

12.3.1B tab 10mg generik

12.3.1C lapiten Guardian

2 Losartan 12.3.2 tab 50mg Angioten Kalbe

3 Valsartan 12.3.3 tab 80mg Valsartan-Ni Dexa Medica

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12.4 Antihipertensi

1 Bisoprolol 12.4.1 tab 5mg generik

2 Captopril 12.4.2A tab 25mg generik

12.4.2B tab 12,5mg generik

3 Klonidin 12.4.3 tab 0,15mg generik

4 Metildopa 12.4.4 tab salut 250mg generik

5 Nifedipin 12.4.5A tab 10mg generik

12.4.5B Nifedin Sanbe

12.6 Anticoagulan, antiplatelet

1 Clopidogrel 12.6.1A tab 75mg Pidofix Lapi

12.6.1B generic

2 Cilostazol 12.6.2 tab 50mg Pletaal Otsuka

3 Streptokinase 12.6.3 inj 1.5 juta iu/vial Streptase Dexa

12.7 Trombolitik

1 Pentoksifilin 12.7.1 tab 400mg Reotal SR Kalbe

12.8 Gagal jantung, obat

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obat

1 Digoksin 12.8.1A tab 0,25mg generik

12.8.1B fargoxin fahrenheit

2 Furosemid 12.8.2A tab 40mg generik

12.8.2B inj 10mg/ml @2ml Lasix Sanofiaventis

12.9 Syok, obat untuk

11.9.1 Syok kardiogenik

1 Dopamin 12.9.1.1 inj 40mg/ml generik

2 Dobutamin 12.9.1.2 inj 250mg Dobutamin Combi

3 Epineprin (adrenalin) 12.9.1.3 inj 0,1% generik

4 Norepinefrin 12.9.1.4 inj 0,1% generik

(noradrenalin)

11.9.2 Syok karena Anestesi

1 Ephedrin 12.9.2.1 inj 50mg/ml generik

12.10 Antihiperlipidemia

1 Gemfibrozil 12.10.1A caps 300mg generik

12.10.1B Lapibroz Lapi

2 Simvastatin 12.10.2A tab 10mg generik

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12.10.2B Cholestat kalbe

13 Kulit, obat topikal untuk

13.1. Antibakteri

1 Framisetin 13.1 casa steril 1% sofratulle Sanovi

2 Natrium fusidat 13.2 cream 20mg/gr Fuson Pyridam

3 Perak sulfadiazin 13.3 cream 1% Burnazin Darya

4 Gentamisin sulfat 13.4A cream 1mg/gr generik

13.4B sagestam sanbe

13.4C Genoint erela

5 Gentian violet lar 1% 13.5 larutan 1% Genoint erela

6 neomycin sulfat + 13.6 cream Ociderm-N Pyridam

fluocinolon acetonide

7 Chloramphenicol+ 13.7 cream Chloramphecort KF

hidrocortison

13.2 Antifungi

1 Ketokonazol 13.2.1 cream Mycoderm Otto

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2 Miconazol 13.2.2A cream 2% generik

13.2.2B dactarin powder

3 Nystatin,zinc oxide 13.2.3 cream Myco-z taisho

4 Gentian Violet 13.2.4 larutan 1%

13.4 Antiinflamasi dan Antipruritik

1 Betametason 13.4.1A cream Betason cream KF

13.4.1B Benoson Berno

13.4.1C cream + neomycin Benoson N Berno

13.4.1D cream + miconazole Benoson M Berno

2 Clobetasol 13.4.2 cream 0,05% Kloderma SDM

3 Desoksimetason 13.4.3 cream 0,25% Pyderma Pyridam

4 Hidrokortison 13.4.4 cream 2,5% generik

5 Triamsinolon 13.4.5 cream oral base Kanalog Taiso

13.5 Antiskabies dan antipedikulosis

1 Lindane 1%, 13.5 cream Scabicid KF

ursic acid 1%

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13.6 Keratolitik dan keratoplastik

1 Urea 13.6.1 cream 20% Moistderm interbat

13.7 Extrac placenta

13.7A gel 10gr Bioplacenton Kalbe

13.7B Bismecon Mecosin

13.8 Hyaluronic acid 13.8 cream 15gr Bionect Combiphar

13.9 Lain-lain

1 Centella asiatica phytosom 13.9.1

& vit E cream Lanakeloid Landson

2 Asam sulfonat+ 13.9.2 solution 10ml Albothyl Pharos

formaldehid

3 Herbal ointment 13.9.3 cream Meibo Combi

14 Larutan irigasi

water for irigation 14.1 larutan 1L otsuka

15 Larutan Elektrolit,Nutrisi dan lain-lain

15.1 Oral

1 Garam oralit 15.1.1A Pedyalite Abbot

15.1.1B Renalyte fahrenheit

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15.1.1C Oralyte

2 Kalium klorida 15.1.2A tab siap larut 600mg KSR Merck

15.1.2B syr. Larutan 3%, 100mL KCl 3%

3 Natrium bikarbonat 15.1.3A tab 500mg generik

15.1.3B inf. 25 Meq, 25mL Meylon Otsuka

15.2 Parenteral

1 Plasme expander 15.2.1A lar infus 6%, botol 500ml Wida HES 130 Widatra

(HES) 15.2.1B Wida HES 200 Widatra

15.2.1C Tetra HES 130 Claris

2 Glukosa 15.2.2A lar infus 5%, botol 500ml D 5% otsu, widatra

15.2.2B lar infus 10%, botol 500ml D 10% otsu,widatra

15.2.2C lar infus 40%, botol 25ml D 40% Otsu

3 Kalsium glukonat 15.2.3 inj 10% @10ml Ca Gluconat Ethica

4 Kalium Klorida 15.2.4 inj 25ml/vial KCl 7,46% Otsu

5 Human Albumin 15.2.5 lar infus 20 % @50ml Octalbin Kalbe

(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi:

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Glukose 5%. + NaCl 0,45%

-lar infs btl 500ml 15.2.6 Wida D5 1/2 NS Widatra

7 Lar. Nutrisi DOEN VI kombinasi :

Glukose 5% + NaCl 0,225% 15.2.7 -lar infs btl 500ml Wida D5 1/4 NS Widatra

8 Natrium bikarbonat 15.2.8 lar inf 25Meq, 25mL Meylon Otsu

9 Natrium klorida 0,9%

lar inf. 500ml 15.2.9A Wida NS Widatra

15.2.9B Otsu NS Otsu

lar.inf 100ml 15.2.9C Otsu NS pegy Otsu

10 Ringer laktat 15.2.10 RL Widatra

11 kombinasi:

Dextrose 5% + NaCl 0,9% 15.2.11A D5 NS Otsu

-lar infs btl 500ml 15.2.11B Infusan RD5% Widatra

12 kombinasi :

Nacl 0,18 % b/v 15.2.12 Otsu D10 1/5 NS Otsu

glukosa 10 %

-lar infs btl 500ml

13 kombinasi :

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NaCl 2,34gr 15.2.13 KA EN 3A Otsu

KCl 0.75gr

Na Lactate 2,24gr

Dextrose anhydrat 27gr

-lar infs btl 500ml

14 kombinasi :

NaCL 1,75gr 15.2.14 KA EN 3B Otsu

KCl 1,5gr

Na Lactate 2,24gr

Dextrose anhydrat 27gr

-lar infs btl 500ml

15 kombinasi :

dextrose anhydrat 37,5 g

NaCl 2,25 g

-lar infs btl 500ml 15.2.15 KA EN 1B Otsu

16 Kombinasi :

Glukosa 12,5 g

NaCl 1 g 15.2.16 Wida 1/2 DaD Widatra

KCl 0,65 g

Na Lactat 1,55 g

17 kombinasi :

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Amino Acids 100mg

Nitrogen 15,7mg 15.2.17 Kalbamin Kalbe

Na 2m EQ.

Acetate 120m EQ

-lar infs btl 500ml

18 kombinasi :

Asam Amino 2,72% 15.2.18 Pan Amin G Otsu

Sorbitol 15%

-lar infs btl 500ml

19 Kombinasi :

Dextrose Anhydrose 100gr 15.2.19 KA EN MG3 otsu

Sodium Chlorid 1,75gr

Potasium Chloride 1,50gr

Sodium lactat 2,24gr

-lar infs btl 500ml

15.3 Lain-lain

1 Air untuk injeksi 15.3.1 Water For Injc Otsu

16 Mata, obat untuk

16.1 Sistemik

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1 Manitol 16.1.1 lar infus 20%, botol 500ml Manitol Kalbe

16.2 Topikal

16.2.1 Anestetik Lokal

1 Tetrakain 16.2.1.1 tetes mata 0,5% Pantocain cendo

16.2.2 Antimikroba

1 Gentamisin 16.2.2.1A tetes mata 0,3% Gent oint erela

16.2.2.1B salep mata 0,3% Gent oint erela

2 Kloramfenikol 16.2.2.2 salep mata 1% erlamicetin erela

16.2.3 Anti inflamasi

1 Kombinasi : 16.2.3.1 tetes mata

Polimiksina sulfat 6.000 IU Statrol Cendo

Neomisin Sulfat 3,5mg

Deksametason Na Fosfat 1,3mg

-tts mata btl 5ml

2 Kombinasi : tetes mata

Polimiksina sulfat 6.000 IU 16.2.3.2A Alletrol Erela

Neomisin sulfat 3,5mg 16.2.3.2B Oregan GMP

Deksametason Na fosfat 1mg 16.2.3.2C Xitrol Cendo

-tts mata btl 5ml

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16.2.4 lain-lain

1 Antazolin phospat, 16.2.4.1 tetes mata Vasacon-A Cendo

hypomeloza

17 Oksitosik dan relaksan uterus

17.1 Oksitosik

1 Metilergometrin 17.1.1A table salut 0,125mg generik

tablet 0,125 17.1.1B Pospargin Kalbe

17.1.1C inj 0,200mg/ml Methergin Novartis

2 Oksitosin 17.1.2 inj 10 IU/ml Syntocinon Novartis

3 Mesoprostol 17.1.3 tab 200mg Cytotec Pharmacia

17.2 Relaksan Uterus

1 Magnesium sulfat 17.2.1A inj 20% @25ml Mg SO4 20% Otsu

17.2.1B inj 40% @25ml Mg SO4 40% Otsu

2 Isoksuprin HCL 17.2.2A tabl 20mg Duvadilan Solvay farma

17.2.2B inj. 5mg/ml @2ml Duvadilan Solvay farma

18 Psikofarmaka

18.1 Antiansietas dan Antiinsomnia

1 Alprazolam 18.1.1A tab 0,25 mg Alganax Guardian

18.1.1B tab 0,5mg Alganax Guardian

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2 Clobazam 18.1.2 tab 10mg generik

3 Diazepam 18.1.3A tab 2mg Valisanbe sanbe

18.1.3B tab 5mg valisanbe sanbe

18.1.3C Supp 5mg/2,5ml Stesolid Actavis

4 phenobarbital 18.1.4A tab 30 mg generik

18.1.4B inj Phental iv Combi

18.2. Antidepresi dan Antimania

1 Amitriptilin 18.2.1 Tab 25 mg generik

2 Klorpromazin HCL 18.2.2 tab 100mg Cepezet Mersi

18.3 Antipsikosis

1 Halloperidol 18.3.1 tab 25mg generik

2 Klorpromazin 18.3.2 tab salut 100mg cepezet Mersi

19 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus

1 Antasida DOEN I kombinasi : 19.1.1 tab generik

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg) Sanbe

Magtral

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Stomacain Combiphar

2 Antasida DOEN II susp, kombinasi : 19.1.2

Al (OH)3 200mg/5ml + Mg (OH)2 Mylacid Emba

200mg/5ml Bufantacyd Bufa

(+cimeticon)

Carsida Sampharindo

3 Famotidin 19.1.3 tab 20mg generik

4 Lanzoprazol 19.1.4 caps 30mg generik

5 Omeprazol 19.1.5A caps 20mg generik

19.1.5B inj. OMZ Ferron

6 Ranitidin 19.1.6A tab 150mg generik

19.1.6B Acran sanbe

19.1.6C inj 25mg/2ml generik

19.1.6D Indoran Indofarma

19.1.6E Acran sanbe

7 Simetidin 19.1.7A tab 200mg generik

19.1.7B inj. 200mg,amp Ulsikur Hexapharma

8 Sulkrafat 19.1.8A tab 500mg Ulsafate Combiphar

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19.1.8B syr 100ml Propepsa Gracia

9 Polymigel 19.1.9 tab Srocain-P Eisai

19.2 Enzim

1 Pankreatin,diastease 19.2.1 kap lybrozim

2 kombinasi : pankreatin 19.2.2 kap lybrozim plus

diastase, cimetikon

3 Pankreatin,activated 19.2.3 kaplet Tripanzym Sanbe

dimetilpolisiloxan

19.3 Antiemetik

1 Betahistin mesilat 19.3.1 tab 6mg Mertigo Dexa

Merislon Mersi

2 Dimenhidrinat 19.3.2A tab 50mg generik

19.3.2B Mantino samparindo

3 Loperamid 19.3.3A tab 2mg lopamid Harsen

19.3.3B Lodia Sanbe

4 Metoklopramid 19.3.4A tab 5mg Nilatika sampharindo

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19.3.4B Damaben Capri

19.3.4C inj 5mg/ml Tomit interbat

19.3.4D Damaben Capri

5 Ondansetron 19.3.5A inj 4mg/2ml generik

19.3.5B ODR Lapi

19.3.5C Insetron Indofarma

19.3.5D tab 4mg vometraz Dexamedika

6 Domperidon 19.3.6A tab 1mg generik

19.3.6B Dom Lapi

19.3.6C Omedon Mutifa

19.3.6D syr 5mg/5ml Dom Lapi

19.3.6E Omedon mutifa

19.3.6F generik

7 Chlordiazepoxid 5mg+ 19.3.7 tab Braxidin Sanbe

dclonidium 2,5mg

8 Pantoprazol inj 19.3.8 inj 40mg Topazole Lapi

9 Pyratiazine chloroteo- 19.3.9 tablet Anvomer B6 Dexamedika

phylinate 40mg+B6 30mg

19.3 Antihemoroid

1 Kombinasi : 19.3.1 kapsul 100mg Lanaven Lansond

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Soybean purified extract

2 Antihemoroid kombinasi : 19.3.2

bismutsubgalat150mg Supp generik

heksaklorofen

3 Lidocain HCl +Al subacetat 19.3.3

hidrocortison acetat, ointmen Haemocain Gelenium

Zinc oxide

4 Lithospermi radix, prednisolon, 19.3.4

lidocain,benzocain,cetrimide ointmen Borraginol S Takeda

19.4 Antispasmodik

1 Atropin Sulfat 19.4.1 inj. 0,25mg/ml @iml Atropin Ethica

2 Hyoscine-N-butil bromide 19.4.2A tab. 10mg

Spasminal (+methampiron)

Buscopan Boehringer

19.4.2B inj 20mg/mL Gitas Interbat

3 Papaverin 19.4.3.A tab 40mg generik

19.4.3B inj im 40mg/ml generik

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19.5 Diare, obat untuk

1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr + 19.5.1 Oralit OGB

trinatrium sitrat dihidrat 0,58gr +

glukosa anhidrat 4gr

2 Kombinasi : 19.5.2A tab Corosorb Coronetcrown

Kaolin 550mg + 19.5.2B susp Novadiar Corsa

pectin 200mg 19.5.2C Omegdiar

3 Lactobacillus 19.5.3A serbuk L-bio Lapi

19.5.3B Lacto B pharos

19.5.3C Cap Lacidofil Dexa

19.5.3D Lacbon Pharmasolindo

4 Zinc 19.5.4A serbuk/sachet Orezinc

19.5.4B tablet Zincare Kalbe

19.6 Kataritik

1 Bisakodil 19.6.1A supp 5mg Dulcolax Paed Boehringer

19.6.1B supp 10mg Dulcolax Paed Boehringer

19.6.1C tab 5mg Dulcolax Paed Boehringer

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2 Gliserin

Kombinasi : 19.6.2A susp botol 60ml Laxadine Gelenium

Parafin + Glicerin + 19.6.2B cairan supp. fleet enema combiphar

fenolftalen

3 Lactulosa 19.6.3 syr Lactulax Ikapharmindo

4 Fosfosoda 19.6.4 susp Fleet Fosfosoda Combi

19.7 Antiinflamasi, obat untuk

1 Sulfasalazin 19.7.1 tablet 500mg Sulcolon Bernofarm

20 Saluran Kencing dan Prostat, obat yang mempengaruhi

20.1 Saluran kencing

20.1A tetes Kalkurenal darya faia

20.1B Batugin elixir KF

20.1C Caps Nefrolit

20.2 Renal insufisiensi

1 20.2.1 Kap 650mg Tonar Sandoz

L-tyrosin,L-lysin,dst

2 valeric acid, butiric acid, 20.2.2 Tab Prorenal Novell

lycin monoacetat, tryptopan,

tyrosin, histidin

α ketoisoleusin, L-hitidin

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20.3 Prostat (anti BPH)

1 Finasteride 20.3.1 tab 5mg Prostide Pharos

21 Saluran napas, Obat untuk

21.1 Antiasma

1 Aminofilin 21.1.1A tablet 200mg generik KF

21.1.1B inj. 24mg/ml @10ml generik KF

2 Deksametason 21.1.2A tab 0,5mg scandexon Scanpasific

21.1.2B carbidu Sampharindo

21.1.2C inj. 5mg/ml Indexon Interbat

21.1.2D Kalmetason Kalbe

21.1.2E Cortidex Sanbe

3 Efedrin 21.1.3 tab 0,5mg generik

4 Epinefrin (adrenalin) 21.1.4 inj 0,1% generik

5 Fluticason propionat 21.1.5 nebules 0,5mg/2,5ml Flixotide Glaxo

6 Salbutamol 21.1.6A tab 2mg generik

21.1.6B Ventolin Glaxo

21.1.6C syr 2mg/5ml Lasal Lapi

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21.1.6D syrup per 5ml : Lasal expectoran Lapi

salbutamol 2mg+Gg 75mg

21.2.6E inh.(aerosol) 100mcg/dosis Ventolin Glaxo

21.2.6F nebules 2,5mg Ventolin Glaxo

7 kombinasi salbutamol 21.2.7 nebules 2,5ml combiven Boehringer

dan ipratropium Br

8 Terbutalin sulfat 21.2.8 inj. 0,5mg/ml bricasma astra zeneca

9 Teofilin 21.2.9 tab 150 mg generik

21.2 Antitusif

1 Dekstrometorfan 21.2.1A tab 15mg generik

21.2.1B Romiler Behringer

2 Dextrometorfan 10mg + 21.2.2 syr per 5ml @ 60ml Alco plusDMP syr Interbat

pseudoefedrin 30mg +

bromfeniramin maleat2mg

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3 kombinasi : 21.2.3 syr 60ml Guamin

prometazin, Gg

4 Kodein 21.2.4 Tab 20 mg kF

5 Doveri 21.2.5 Tablet KF

21.3 Ekspektoran

1 Ambroxol 21.3.1A Tab 30mg Mirapect Sampharindo

21.3.1B generik

2 Bromheksin 21.3.2A Syr 4mg/5ml Bisolvon elixir Boehringer

21.3.2B inj. 4mg/2ml Bisolvon Boehringer

Bromheksin 4mg+ 21.3.2C Syr /5ml ,@60mL Bisolvon extra Boehringer

Guafenesin 100mg

3 Gliseril guaiakolat 21.3.3 Tab 100mg generik

4 Obat batuk hitam (OBH) 21.3.4 syr botol 100 ml

5 Kombinasi :

Paracet,Gg,efedrin 21.3.5A Tab. coparcetin sampharindo

chlorfeniramin 21.3.5B Hufagrip forte hufa

21.3.5C Syr 60ml coparcetin sampharindo

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6 Kombinasi

Paraset, pseudoefedrin, 21.3.6 Tab Demacolin coronetcrown

chlorfeniramin,cafein

7 kombinasi : 21.3.7

DMP,GG,PPA, Kap Dextral Molex

chlorpheniramin Dextral forte Molex

8 Kombinasi :

DMP,GG,Diphenhidramin 21.3.8 Kap grantusif grahafarma

9 kombinasi : 21.3.9 Syr 60 ml Miradryl Sampharindo

diphenhidramin,

amonium Cl, Na sitrat

10 kombinasi :

diphen, Gg, mentol 21.3.10 Syr. 60ml Coredryl GMP

11 Kombinasi:

ipekak,guefenesin 21.3.11 Syr 60ml Miradryl sampharindo

12 oxomemezin +Gg 21.3.12 syr 60ml oxopect syr mahakam

13 Kombinasi : 21.3.13 drops per ml, @ 15ml Nipe drop Transfarma

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acetaminofen 120, Medika indah

fenilefrin HCl 1mg,

isothipendil HCl 1mg

21.4 Decongestan dan anti rinitis

1 Fluticason furoat 21.4.1 Nasal spray 27,5mcg/spray Avamys Glaxo

2 pseudoefedrin 60mg + 21.4.2A Tab Valved GMP

tripolidin 2,5mg 21.4.2B tremenza sanbe

syr per 5ml:

21.4.2C pseudoefedrin 30mg Valved GMP

tripolidin 1,25mg

3 Pseudoefedrin 15mg+ 21.4.3A syr per 5ml Rhinos Junior Dexa

clorfeniramin maleat 1mg 21.4.3B drop 7,5mg/0,8ml Rhinos Neo Dexa

4 Pseudoefedrin 60mg+ 21.4.4 Tab Rhinos SR Dexa

loratadin 5mg

22 Sistem Imun, Obat yang

Mempengaruhi

22.1 Serum dan Imunoglobin

1 Serum anti bisa ular 22.1.1 inj im/iv 5ml Biofarma

Page 47: formularium mawaddah-dH2015

47

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

2 Serum antitetanus (A.T.S) 22.1.2 inj 1500 IU ATS Biofarma

3 Imunoglubin Anti Tetanus (Human 22.1.3

Tetanus Imunoglobin) inj. 250 IU Tetagam P Dexa

22.2 Vaksin

1 Vaksin B.C.G 22.2.1 serb inj +pelarut 2 ml

2 Vaksin campak 22.2.2 serbuk inj +pelarut 5ml

3 Vaksin polio 22.2.3 tetes

4 Vaksin jerap difteri tatanus 22.2.4 inj 5ml

pertusis (DPT)

5 Vaksin jerap tetanus (tetanus 22.2.5 inj 5ml

adsorbed toxoid)

23 Telinga, Hidung dan Tenggorokan

23.1 Antibakteri

1 Kombinasi : 23.1.1 tetes telinga Otopain Interbat

Polimiksin BSO4 10.000 IU

Neomisina SO4 3,75mg

Page 48: formularium mawaddah-dH2015

48

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

Lidokain HCl 40mg

Fludrokkortison Asetat 1mg

- btl 10ml

23.2 Lain -Lain

1 23.2.1 tetes telinga waxol Alpharma

2 Oksimetazolin 23.2.2 tetes hidung Illiadin kinder Merck

24 Vitamin dan Mineral

1 Asam Folat 24.1 tab 1mg Folacom Combi

2 Calcitriol 24.2 Tab 0,25mcg Osteofem Kalbe

3 Calsium lactat 24.3A Kap Caltron Pyridam

24.3.B Kalk KF

24.3C Calsifar Ifars

4 Ca laktat,Ca phospat, 24.4A Kap Elkana Sanbe

vit C, vit D 24.4B Syr Elkana Sanbe

5 Ca glukonas 24.5 inj 100mg/ml Ca glukonat Ethica

6 Vitamin A 24.6A sugar coated 6000IU generik KF

24.6B sugar coated 20000IU generik KF

Page 49: formularium mawaddah-dH2015

49

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

24..6C inj. Im. Amp generik

7 Vit B kompleks 24.7A Tab Alinamin F Takeda

24.7B Neurosanbe sanbe

24.7C neurobion 5000 merc

24.7D neurodex

24.7E sakaneuron akafarma

24.7F tab, kaleng generik

24.7G tab, + methampiron neuromec Sampharindo

24.7H inj. Amp Alinamin F Takeda

24.7I Neurosanbe sanbe

24.7J neurobion 5000 merc

24.7K inj im, vial generik

24.7L Neurotropic

8 Vitamin B1 24.8A Tab, kaleng generik

24.8B inj. Amp generik

9 Vitamin B6 24.9 Tab, kaleng Liconam

10 Vitamin C dan kombinasi

- Vit C 24.10A tab, kaleng generik

24.10B inj, amp 200mg generik

Page 50: formularium mawaddah-dH2015

50

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

- B1,B2,B6,B12,vit C500mg 24.10C kaps Becom C Sanbe

Ca pantotenat 20mg

- vit C 750mg,vit E30iu, B1, 24.10D kaps Becom Zet Sanbe

B2,B6,B12, as folat,Zn, niacin

11 Vitamin D +calsium 24.11 Kap Calsic-D Sampharindo

12 Vitamin E dan Kombinasi 24.12A Kapl 100 IU Santa E Sanbe

24.12B Original E Capri

13 Vitamin K 24.13A tab salut gula 10mg generik KF

24.13B inj 10mg/ml Neo K Combi

14 Vitamin Ibu Hamil dan Menyusui 24.14A Formom Pyridam

24.14B Kap. Lycalvit Interbat

24.14C Etabion Errita

24.14D Elkana sanbe

24.14E Caviplex erela

24.14F Prolacta mother novell

24.14G Moloco B-12 darya faria

15 Glukosamine dan 24.15A Kaplet Osteor plus pyridam

24.15B Efferfescen Cartos pryridam

Page 51: formularium mawaddah-dH2015

51

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

16 Multivitamin Anak 24.16A syr Apyalis Lapi

24.16B Vitacur lapi

24.16C Asedas Pyridam

24.16D Hufavit kalk Hufa

24.16E Elkana Sanbe

24.16F Drop Apyalis Lapi

17 Multivitamin inj 24.17 inj, vial Cernevit Kalbe

(vit A,B,C,D, lecitin)

25 Suplemen dan terapi Adjuvan lain

1 Astaxantin 25.1 caps Axanthin Ethica

2 Echinacea, Zn,Se,vit c 25.2A kap Imunos lapi

25.2B syr Stimuno Pyridam

3 Extrac curcuma 25.3 sugar coated tab Curcuma soho

4 Suplemen unt DHF 25.4A sachet Trolit

25.4B caps Psidii Dexa

5 syr unt campuran puyer 25.5 syrplus syr Berno

26 Relaksan Otot Perifer dan

Penghabat Kolinesterase

Page 52: formularium mawaddah-dH2015

52

KLS N A M A O B A T kode obat Nama Dagang Pabrik Harga Bentuk sediaan, kekuatan

obat

28.1 Penghambat Neuromuskuler 26.28.1

1 Athracurium besilat inj amp 10mg/2,5ml Notrixum Novell

2 Pancuronium Br 26.28.2 inj 2mg/ml, amp 2ml Pavulon Schering

3 Suksametonium

(suksinil kolin HCl) 26.28.3 injc 200mg/10ml vial Scholin Transfarma

Page 53: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T Nama Dagang

1 2 3 4

c Analgesik, Antipiretik, Antiinflamasi NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng generik

2 Fentanyl inj. 50 mcg/ml @10ml Fentanyl

2 Morphin HCl Tab, 10 mg MSTInj. 10 mg/ml generik

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik

1 Asam asetilsalisilat Tab 100mg Aspilet(asetosal)

2 Asam mefenamat Tab 500 mg MefinalCargesicOpistanPondex

3 Ibuprofen Tab 200mg generikProris

syr.100mg/5ml ProrisSupp. 125 mg Proris

4 Kalium Diklofenac tab 50mg,25mg Exaflamtab 50mg X-flam

5 Ketoprofen Supp 100mg KaltrofenTab 100mg Pronalges

Kaltrofen

6 Ketorolac inj. 30mg/ml generiktrolac inj

7 Meloxicam Tab 15mg generikosteloc

Bentuk Sediaan,kekuatan dan

kemasan

Page 54: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

Tab 7,5 mg generik

8 Metampiron Tab 500mg AntalginAnalsik

(+Dzp 2mg)

9 Metamizole sodium Tablet 500mg AntalginInjc. 500mg/ml Norages@2ml Novalgin

10 Natrium diklofenak Tab 50mg VoltadexTab 25 mg Renadinacgel Scantaren

11 Paracetamol Tab 500mg MirasicSanmol

Syr 120mg/5ml SanmolPyridolMirasic

drop 60mg/0,6ml Sanmol dropsSupp 240mg Propyretic 240Supp 160mg Propyretic 160

12 Piroksikam tab 20 mg generikgel Pirofel

13 Tinoridine HCl tab 50 mg Nonflamin

14 Tramadol inj 50mg/ml generiktab 37,5mg+ Patralparacetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vial XillomidonPyramidon 50mgLidocain HCl 15mg

6.2 Antibakteri

6.2.1 Beta Laktam1 Amoksisilin trihidrat tab 500mg Amoxan

ZemoxilBrodamox

Page 55: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

dry syr 125mg/5ml AmoxanZemoxil

drops 100mg/ml Amoxan

serb inj 1000mg Amoxan

2 Ampisilin cap 500mg Brodapenserb inj 1000mg Viccilin

3 Ampicillin + Sulbactam serb inj 500+250mg Pycin 750

4 kap 500+125mg co amoxiclavclanexi

5 Cefadroksil caps 500mg Pyricefgenerik

dry syr 125mg/5ml Pyricefgenerik

6 Sefaklor caps 500mg Capabiotik

7 Sefaleksin caps 500mg Cefabiotic

8 Sefiksim caps 100mg Cefiladry syr 100mg/5ml Cefila

9 Sefotaksim serb inj 1gr generikTaxegram

lapixim

10 Seftazidim serb inj 1gr Yadim

11 Seftriakson serb inj 1gr generikcephaflox

12 Sephalotin serb inj 1gr Moraxine

13 Meropenem serb inj 1 gr Meropexgenerik

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 56: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

1 Doksisiklin caps 100mg generikdoxacin

3 Tetrasiklin caps 500mg Suprabiotik

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg Lanacetin

susp 125mg/5ml coromycetin

2 Tiamfenikol caps 500mg PromixinDexicol

dry syr 125mg/5ml PhenobioticBiothicol

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet Sanprima

sulfametoksazol 400mg + miratrimtrimetoprim 80mg

2 sulfa 800mg+ Tablet Lapikot fortetrimetoprim 160mg Primadex forte

3 Kotrimoksazol suspensi susp Sanprimakomb : sulfametoksazol Primadex200mg + trimetoprim 40mg/5ml Miratrim

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg generik

2 Eritromisin caps 500mg generikerisanbe

erisanbe chewable

syr 200mg/5ml generik

3 Spiramisin tab 500mg generikvaroc

4 Azytromicin caps 500mg zibramaxgenerik

Page 57: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml Sagestam

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg Cravox

generik

lar infus 500mg/100ml generikCravox

2 Ofloksasin tab 200&400mg generik

3 Siprofloksasin tab 500mg generikBaquior forte

Lapiflox

lar infus 500mg/100ml generikLapiflox inf

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg Sulcolon

2 Metronidazol tab 500mg MetroletTrychodazole

syr 125mg/5ml Metroletpromuba

supp 500mg Flagyl

ovul + nistatin 100000i Vagistin

lar infus 500mg/100ml Trychodazolegeneric

3 Colistin sulfat Tab 250000 iu Colistine

10 Darah, Obat yang Mempengaruhi

8.1 Antianemi1 Asam folat tab 1mg Folacom

2 Besi III sulfat (sulfas ferosus) tab salut 300mg Natabion

Page 58: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

Artoferumsyr. 50mg/50ml, @150 Maltofer

3 Vit B1, B6, B12 tab Neurobion 5000Neurobat

Neurosanbe Neurodex

Sakaneuron

inj. Amp 3ml Neurosanbe 5000Neurobion 5000

8.2 Koagulasi, obat yang mempengaruhi

1 Asam traneksamat inj 250mg/5ml KalnexTransamin

tab 500mg Transamin

2 Fitomenadion (vit K) tab salut 10mg, kaleng generikinj 10mg/ml Neo K

3 Heparin Na gel Thrombopop GelAntithromb

4 Lidocain inj 2% generic

13 Kulit, obat topikal untuk

13.1. Antibakteri1 Framisetin casa steril 1% sofratulle

2 Natrium fusidat cream 20mg/gr Fuson

3 Perak sulfadiazin cream 1% Burnazin

4 Gentamisin sulfat cream 1mg/gr generiksagestamGenoint

5 Gentian violet lar 1% larutan 1% Genoint

Page 59: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

6 neomycin sulfat + cream Ociderm-Nfluocinolon acetonide

7 Chloramphenicol+ cream Chloramphecorthidrocortison

13.2 Antifungi1 Ketokonazol cream Mycoderm

2 Miconazol cream 2% generikdactarin powder

3 Nystatin,zinc oxide cream Myco-z

4 Gentian Violet larutan 1%

13.4 Antiinflamasi dan Antipruritik1 Betametason cream Betason cream

Benoson cream + neomycin Benoson Ncream + miconazole Benoson M

2 Clobetasol cream 0,05% Kloderma

3 Desoksimetason cream 0,25% Pyderma

4 Hidrokortison cream 2,5% generik

5 Triamsinolon cream oral base Kanalog

13.5 Antiskabies dan antipedikulosis 1 Lindane 1%, cream Scabicid

ursic acid 1%

13.6 Keratolitik dan keratoplastik1 Urea cream 20% Moistderm

13.7 Extrac placentagel 10gr Bioplacenton

Bismecon

13.8 Hyaluronic acid cream 15gr Bionect

Page 60: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

13.9 Lain-lain1 Centella asiatica phytosom

& vit E cream Lanakeloid

2 Asam sulfonat+ solution 10ml Albothylformaldehid

3 Herbal ointment cream Meibo

15.2 Parenteral1 Plasme expander lar infus 6%, botol 500 Wida HES 130

(HES) Wida HES 200Tetra HES 130

2 Glukosa lar infus 5%, botol 500 D 5%lar infus 10%, botol 50 D 10%lar infus 40%, botol 25 D 40%

3 Kalsium glukonat inj 10% @10ml Ca Gluconat

4 Kalium Klorida inj 25ml/vial KCl 7,46%

5 Human Albumin lar infus 20 % @50ml Octalbin(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45% -lar infs btl 500ml Wida D5 1/2 NS

9 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225% -lar infs btl 500ml Wida D5 1/4 NS

10 Natrium bikarbonat lar inf 25Meq, 25mL Meylon

11 Natrium klorida 0,9%lar inf. 500ml Wida NS

Otsu NSlar.inf 100ml Otsu NS pegy

12 Ringer laktat RL

13 kombinasi:

Page 61: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

Dextrose 5% + NaCl 0,9% D5 NS -lar infs btl 500ml Infusan RD5%

14 kombinasi :Nacl 0,18 % b/v Otsu D10 1/5 NSglukosa 10 % -lar infs btl 500ml

15 kombinasi :NaCl 2,34gr KA EN 3AKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

16 kombinasi :NaCL 1,75gr KA EN 3BKCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

17 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml KA EN 1B

18 Kombinasi :Glukosa 12,5 gNaCl 1 g Wida 1/2 DaDKCl 0,65 gNa Lactat 1,55 g

19 kombinasi :Amino Acids 100mgNitrogen 15,7mg KalbaminNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

20 kombinasi :Asam Amino 2,72% Pan Amin GSorbitol 15%

Page 62: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

-lar infs btl 500ml

21 Kombinasi :Dextrose Anhydrose 100gr KA EN MG3Sodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi Water For Injc

23 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombinasi : tab generik

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)Magtral

Stomacain

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 Mylacid200mg/5ml Bufantacyd

(+cimeticon)Carsida

3 Famotidin tab 20mg generik

4 Lanzoprazol caps 30mg generik

5 Omeprazol caps 20mg generikinj. OMZ

6 Ranitidin tab 150mg generikAcran

inj 25mg/2ml generikIndoranAcran

7 Simetidin tab 200mg generikinj. 200mg,amp Ulsikur

Page 63: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

8 Sulkrafat tab 500mg Ulsafatesyr 100ml Propepsa

9 Polymigel tab Srocain-P

19.2 Enzim1 Pankreatin,diastease kap lybrozim

2 kombinasi : pankreatin kap lybrozim plusdiastase, cimetikon

3 Pankreatin,activated kaplet Tripanzymdimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat tab 6mg Mertigo

Merislon

2 Dimenhidrinat tab 50mg generikMantino

3 Loperamid tab 2mg lopamidLodia

4 Metoklopramid tab 5mg NilatikaDamaben

inj 5mg/ml TomitDamaben

5 Ondansetron inj 4mg/2ml generikODR

Insetrontab 4mg vometraz

6 Domperidon tab 1mg generikDom

Omedonsyr 5mg/5ml Dom

Omedongenerik

Page 64: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

7 Chlordiazepoxid 5mg+ tab Braxidindclonidium 2,5mg

8 Pantoprazol inj inj 40mg Topazole

9 Pyratiazine chloroteo- tablet Anvomer B6phylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : kapsul 100mg Lanaven

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mg Supp generikheksaklorofen

3 Lidocain HCl +Al subacetathidrocortison acetat, ointmen HaemocainZinc oxide

4 Lithospermi radix, prednisolon,lidocain,benzocain,cetrimide ointmen Borraginol S

19.4 Antispasmodik1 Atropin Sulfat inj. 0,25mg/ml @iml Atropin

2 Hyoscine-N-butil bromide tab. 10mgSpasminal (+methampiron)

Buscopaninj 20mg/mL Gitas

3 Papaverin tab 40mg generikinj im 40mg/ml generik

19.6 Kataritik1 Bisaksupp 5mg Dulcolax Paed Boehringer

supp 10mg Dulcolax Paed Boehringer

tab 5mg Dulcolax Paed Boehringer

2 Gliserin

Page 65: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

Kombisusp botol 60ml Laxadine GeleniumParafcairan supp. fleet enema combipharfenolftalen

3 Lactusyr Lactulax Ikapharmindo

4 Fosf susp Fleet Fosfosoda Combi

19.7 Antiinflamasi, obat untuk1 Sulfatablet 500mg Sulcolon Bernofarm

20 Saluran Kencing dan Prostat, obat yang mempengaruhi20.1 Saluran kencing

tetes KalkurenalBatugin elixir

Caps Nefrolit20.2 Renal insufisiensi

1 Kap 650mg TonarL-tyrosin,L-lysin,dst

2 valeric acid, butiric acid, Tab Prorenallycin monoacetat, tryptopan,tyrosin, histidin

20.3 Prostat (anti BPH)1 Finasteride tab 5mg Prostide

24 Vitamin dan Mineral1 Asam Folat tab 1mg Folacom

2 Calcitriol Tab 0,25mcg Osteofem

3 Calsium lactat Kap CaltronKalk

Calsifar

4 Ca laktat,Ca phospat, Kap Elkana vit C, vit D Syr Elkana

5 Ca glukonas inj 100mg/ml Ca glukonat

6 Vitamin A sugar coated 6000IU generiksugar coated 20000IU generik

α ketoisoleusin, L-hitidin

Page 66: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

inj. Im. Amp generik

7 Vit B kompleks Tab Alinamin FNeurosanbe

neurobion 5000neurodex

sakaneurontab, kaleng generik

tab, + methampiron neuromec

inj. Amp Alinamin FNeurosanbe

neurobion 5000inj im, vial generik

Neurotropic

8 Vitamin B1 Tab, kaleng generikinj. Amp generik

9 Vitamin B6 Tab, kaleng Liconam

10 Vitamin C dan kombinasi- Vit C tab, kaleng generik

inj, amp 200mg generik

- B1,B2,B6,B12,vit C500mg kaps Becom C Ca pantotenat 20mg- vit C 750mg,vit E30iu, B1, kaps Becom Zet B2,B6,B12, as folat,Zn, niacin

11 Vitamin D +calsium Kap Calsic-D

12 Vitamin E dan Kombinasi Kapl 100 IU Santa EOriginal E

13 Vitamin K tab salut gula 10mg generikinj 10mg/ml Neo K

14 Vitamin Ibu Hamil dan Menyusui FormomKap. Lycalvit

EtabionElkana

Page 67: formularium mawaddah-dH2015

NO N A M A O B A T Nama DagangBentuk

Sediaan,kekuatan dan kemasan

CaviplexProlacta mother

Moloco B-12

15 Glukosamine dan Kaplet Osteor plusEfferfescen Cartos

16 Multivitamin Anak syr ApyalisVitacurAsedas

Hufavit kalkElkana

Drop Apyalis

17 Multivitamin inj inj, vial Cernevit(vit A,B,C,D, lecitin)

25 Suplemen dan terapi Adjuvan lain1 Astaxantin caps Axanthin

2 Echinacea, Zn,Se,vit c kap Imunossyr Stimuno

2 Extrac curcuma sugar coated tab Curcuma

Page 68: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Pabrik

5

KF

janssen-cilag

MahakamKF

KF

Medifarma

SanbeSanprima

OttoDexa

PharosPharosPharos

GuardianCombiphar

Kalbepharoskalbe

Berno

sanbe

Page 69: formularium mawaddah-dH2015

Pabrik

Sanbe

MeproSanovi-aventis

DexamedikaFahrenheitScanpasific

SanprimaSanbeSanbe

PyridamSanprima

sanbeCombiCombi

Sanbe

Takeda

mahakam

Dura

SanbeZenith

Sampharindo

Page 70: formularium mawaddah-dH2015

Pabrik

SanbeZenithSanbe

Sanbe

SampharindoMeiji

Berno

sanbe

Piridam

Piridam

Yarindo

Berno

lapilapi

Sanbelapi

Yarindo

guardian

Yarindo

Berno

Page 71: formularium mawaddah-dH2015

Pabrik

otto

Zenith

landsencoronetcrown

PyridamDexaBernoSanbe

Sanbesampharindo

LapiDexamedika

SanbeDexamedicaSampharindo

sanbesanbe

pyridam

guardian

Page 72: formularium mawaddah-dH2015

Pabrik

Sanbe

Lapi

Lapi

sanbeLapi

Lapi

Berno

HarsenSanbe

HarsenmeproSanovi

Combiphar

Sanbe

Actavis

combi

Pyridam

Page 73: formularium mawaddah-dH2015

Pabrik

Combi

MercInterbatSanbe

dexamedikasakafarma

Sanbemerck

KalbeOtto/daichi

Otto/Daichi

Combi

tunggal idamanMecosin

Bernofafm

Sanovi

Pyridam

Darya

sanbeerela

erela

Page 74: formularium mawaddah-dH2015

Pabrik

Pyridam

KF

Otto

taisho

KFBernoBernoBerno

SDM

Pyridam

Taiso

KF

interbat

KalbeMecosin

Combiphar

Page 75: formularium mawaddah-dH2015

Pabrik

Landson

Pharos

Combi

WidatraWidatraClaris

otsu, widatraotsu,widatra

Otsu

Ethica

Otsu

Kalbe

Widatra

Widatra

Otsu

WidatraOtsuOtsu

Widatra

Page 76: formularium mawaddah-dH2015

Pabrik

OtsuWidatra

Otsu

Otsu

Otsu

Otsu

Widatra

Kalbe

Otsu

Page 77: formularium mawaddah-dH2015

Pabrik

otsu

Otsu

Sanbe

Combiphar

EmbaBufa

Sampharindo

Ferron

sanbe

Indofarmasanbe

Hexapharma

Page 78: formularium mawaddah-dH2015

Pabrik

CombipharGracia

Eisai

Sanbe

DexaMersi

samparindo

HarsenSanbe

sampharindoCapri

interbatCapri

LapiIndofarma

Dexamedika

LapiMutifaLapi

mutifa

Page 79: formularium mawaddah-dH2015

Pabrik

Sanbe

Lapi

Dexamedika

Lansond

Gelenium

Takeda

Ethica

Spasminal (+methampiron)Boehringer

Interbat

Page 80: formularium mawaddah-dH2015

Pabrik

darya faiaKF

Sandoz

Novell

Pharos

Combi

Kalbe

PyridamKF

Ifars

SanbeSanbe

Ethica

KFKF

Page 81: formularium mawaddah-dH2015

Pabrik

Takedasanbemerc

akafarma

Sampharindo

Takedasanbemerc

Sanbe

Sanbe

Sampharindo

SanbeCapri

KFCombi

PyridamInterbatErritasanbe

Page 82: formularium mawaddah-dH2015

Pabrik

erelanovell

darya faria

pyridampryridam

Lapilapi

PyridamHufa

SanbeLapi

Kalbe

Ethica

lapiPyridam

soho

Page 83: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T Nama Dagang

1 2 3 41 Analgesik, Antipiretik, Antiinflamasi

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik1 Asam asetilsalisilat Tab 100mg

(asetosal)2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

7 Meloxicam Tab 15mg

Tab 7,5 mg

8 Metampiron Tab 500mg

Bentuk Sediaan,kekuatan dan

kemasan

Page 84: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

3 Antialergi dan obat untuk anafilaksis

1 Dexametasone inj 5mg/ml@1ml KalmethasoneIndexonCortidex

tab 0,5mg KalmethasoneScandexon

Carbidu

Kombinasi dengan Tab Mexondifenhidramin

Page 85: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

2 Difenhidramin Inj 10mg/ml generikInj 15mg/vial Duradryl

3 Epinefrin (adrenalin) Inj 0,1% Generik

4 Klorfeniramin Tab 4mg pehachlor

5 Pheniramine maleat Tab 25mg avilinj.50mg/2ml avil

6 Loratadine tab 10mg generikclarihis

7 Ceterizin tab 10mg Zenrisgenerik

drops Tiriz

8 Metil Prednisolon tab 8mg generikLameson

inj 125mg/ml Lamesongenerik

9 Ciproheptadin kap 4mg Pronicy

10 Mebhidroline Naphadisilat tab 50mg interhistin

4 Antidot dan obat lain

4.1 Khusus1 Atropin inj 0,25mg/ml sulfas atropin

2 Kaksium glukonat 100mg/ml Ca Gluconas

3 Natrium bikarbonat tab 500mg genericinf fl. 25 Meq Meylon

4 Naloxone HCl inj.0,4mg/ml Nokoba

5 Neostigmin metylsulfat inj 0,5mg/ml Prostigmin

4.2 Umum1 Magnesium sulfat inj 20%25ml MgSo4 20%

inj 40%25ml MgSo4 40%

inf fl. 25 Meq Meylon

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

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4 Naloxone HCl inj.0,4mg/ml Nokoba

5 Neostigmin metylsulfat inj 0,5mg/ml Prostigmin

4.2 Umum1 Magnesium sulfat inj 20%25ml MgSo4 20%

inj 40%25ml MgSo4 40%

6 Antiinfeksi6.1 Antelmintik

6.1.1 Antelmintik Intestinal

1 Pirantel tab 125mg Pyrantinsusp 125mg/5ml Combantrin

6.2 Antibakteri

6.2.1 Beta Laktam1 Amoksisilin trihidrat tab 500mg Amoxan

ZemoxilBrodamox

dry syr 125mg/5ml AmoxanZemoxil

drops 100mg/ml Amoxan

serb inj 1000mg Amoxan

2 Ampisilin cap 500mg Brodapenserb inj 1000mg Viccilin

3 Ampicillin + Sulbactam serb inj 500+250mg Pycin 750

4 kap 500+125mg co amoxiclavclanexi

5 Cefadroksil caps 500mg Pyricefgenerik

dry syr 125mg/5ml Pyricefgenerik

6 Sefaklor caps 500mg Capabiotik

7 Sefaleksin caps 500mg Cefabiotic

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 87: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

8 Sefiksim caps 100mg Cefiladry syr 100mg/5ml Cefila

9 Sefotaksim serb inj 1gr generikTaxegram

lapixim

10 Seftazidim serb inj 1gr Yadim

11 Seftriakson serb inj 1gr generikcephaflox

12 Sephalotin serb inj 1gr Moraxine

13 Meropenem serb inj 1 gr Meropexgenerik

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg generikdoxacin

3 Tetrasiklin caps 500mg Suprabiotik

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg Lanacetin

susp 125mg/5ml coromycetin

2 Tiamfenikol caps 500mg PromixinDexicol

dry syr 125mg/5ml PhenobioticBiothicol

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet Sanprima

sulfametoksazol 400mg + miratrimtrimetoprim 80mg

2 sulfa 800mg+ Tablet Lapikot fortetrimetoprim 160mg Primadex forte

3 Kotrimoksazol suspensi susp Sanprimakomb : sulfametoksazol Primadex200mg + trimetoprim 40mg/5ml Miratrim

Page 88: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg generik

2 Eritromisin caps 500mg generikerisanbe

erisanbe chewable

syr 200mg/5ml generik

3 Spiramisin tab 500mg generikvaroc

4 Azytromicin caps 500mg zibramaxgenerik

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml Sagestam

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg Cravox

generik

lar infus 500mg/100ml generikCravox

2 Ofloksasin tab 200&400mg generik

3 Siprofloksasin tab 500mg generikBaquior forte

Lapiflox

lar infus 500mg/100ml generikLapiflox inf

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg Sulcolon

2 Metronidazol tab 500mg MetroletTrychodazole

syr 125mg/5ml Metroletpromuba

supp 500mg Flagyl

Page 89: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

ovul + nistatin 100000iu Vagistin

lar infus 500mg/100ml Trychodazolegeneric

3 Colistin sulfat Tab 250000 iu Colistine

8 Darah, Obat yang Mempengaruhi

8.1 Antianemi1 Asam folat tab 1mg Folacom

2 tab salut 300mg NatabionArtoferum

syr. 50mg/50ml, @150m Maltofer

3 Vit B1, B6, B12 tab Neurobion 5000Neurobat

Neurosanbe Neurodex

Sakaneuron

inj. Amp 3ml Neurosanbe 5000Neurobion 5000

8.2 Koagulasi, obat yang mempengaruhi

1 Asam traneksamat inj 250mg/5ml KalnexTransamin

tab 500mg Transamin

2 Fitomenadion (vit K) tab salut 10mg, kaleng generikinj 10mg/ml Neo K

3 Heparin Na gel Thrombopop GelAntithromb

4 Lidocain inj 2% generic

13 Kulit, obat topikal untuk

13.1. Antibakteri1 Framisetin casa steril 1% sofratulle

Besi III sulfat (sulfas ferosus)

Page 90: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

2 Natrium fusidat cream 20mg/gr Fuson

3 Perak sulfadiazin cream 1% Burnazin

4 Gentamisin sulfat cream 1mg/gr generiksagestamGenoint

5 Gentian violet lar 1% larutan 1% Genoint

6 neomycin sulfat + cream Ociderm-Nfluocinolon acetonide

7 Chloramphenicol+ cream Chloramphecorthidrocortison

13.2 Antifungi1 Ketokonazol cream Mycoderm

2 Miconazol cream 2% generikdactarin powder

3 Nystatin,zinc oxide cream Myco-z

4 Gentian Violet larutan 1%

13.4 Antiinflamasi dan Antipruritik1 Betametason cream Betason cream

Benoson cream + neomycin Benoson Ncream + miconazole Benoson M

2 Clobetasol cream 0,05% Kloderma

3 Desoksimetason cream 0,25% Pyderma

4 Hidrokortison cream 2,5% generik

5 Triamsinolon cream oral base Kanalog

13.5 Antiskabies dan antipedikulosis 1 Lindane 1%, cream Scabicid

ursic acid 1%

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

13.6 Keratolitik dan keratoplastik1 Urea cream 20% Moistderm

13.7 Extrac placentagel 10gr Bioplacenton

Bismecon

13.8 Hyaluronic acid cream 15gr Bionect

13.9 Lain-lain1 Centella asiatica phytosom

& vit E cream Lanakeloid

2 Asam sulfonat+ solution 10ml Albothylformaldehid

3 Herbal ointment cream Meibo

14 Diuretik

1 Furosemida tab 40mg generikinj 10mg/ml Lasix

2 Hidroklortiazid (HCT) tab 25mg generik

15 Hormon, Obat Endokrin Lain dan Kontraseptik

11.1 Antidiabetes11.1.1 Antiabetes, Oral

1 Glibenclamida tab 5mg

2 Glimepiride tab 2mg

3 Glikuidon tab 30mg

4 Metformin tab 500mg

6 Gliklasid tab 80mg

11.1.2 Antidiabetes, Parenteral1 Isulin reguler inj 100iu/ml @10

11.2 Hormon Kelamin dan obat yang mepengaruhi Fertilitas

Page 92: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

11.2.1 Progestrogen1 Noretisteron tab 5mg

2 Alil Esternol tab 5mg

3 Ethinilestradiol tab 50mcg

11.2.2 Clomiphen Sitrattab 50mg

11.3 Kontraseptik11.3.1 Oral

1 Levonogestrel, tab 28ethinilestradiol,placebo

11.3.2 Injeksi1 medroksiprogesteron vial, 50mg/ml, 3

acetat vial, 150mg/ml, 1

2 Medroksiprogesteron vial, 0,5 mlacetat 50mg+10 estradiol-cypionate

11.3.3 Intra Uterin T-shaped dg coppdan silver core

11.4 Hormon Tiroid dan Antitiroid1 Propiltiorasil tab 100mg

11.4 Kortikosteroid1 Deksametason inj 5mg/ml @1ml

tab 0,5mg

2 Metil prednisolon tab 4mg

inj 125mg/2ml

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

3 Prednison tab 5mg

4 Triamsinolon inj 10mg/mloral base, tube

11.3.3 Intra Uterin T-shaped dg copper wir Nova-T CUdan silver core

1 Propiltiorasil tab 100mg generik

1 Deksametason inj 5mg/ml @1ml KalmethasoneIndexonCortidex

tab 0,5mg Kalmethasonescandexon

carbidu

2 Metil prednisolon tab 4mg generiklameson

inj 125mg/2ml lameson

3 Prednison tab 5mg generik

4 Triamsinolon inj 10mg/ml Falmicortoral base, tube Kenalog

16 Kardiovaskuler, Obat

12.1 Antiangina1 Atenolol tab 100mg

2 Diltiazem HCL tab 30mginj 5mg/ml

3 Isosorbit dinitrat tab 5mg

inj 10mg/10ml

4 Nitrogliserin inj 1mg/ml

5 Propanolol tab 10mg

12.2 Antiaritmia

Page 94: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

1 Amiodaron HCT tab 200mg dan in

2 Kuinidin tab 100mg

3 Lisinopril tab 10mg

4 Propanolol tab 10mg

5 Trimetazidine diHCl tab 35mg

6 Verapamil tab 80mg

12.3 Lain-lain1 Amlodipin Besilat tab 5mg

tab 10mg

2 Losartan tab 50mg

3 Valsartan tab 80mg

12.4 Antihipertensi1 Bisoprolol tab 5mg

2 Captopril tab 25mgtab 12,5mg

3 Klonidin tab 0,15mg

4 Metildopa tab salut 250mg

5 Nifedipin tab 10mg

12.6 Anticoagulan, antiplatelet1 Clopidogrel tab 75mg

2 Cilostazol tab 50mg

3 Streptokinase inj 1.5 juta iu/vial

12.7 Trombolitik1 Pentoksifilin tab 400mg

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

12.8 Gagal jantung, obat1 Digoksin tab 0,25mg

2 Furosemid tab 40mginj 10mg/ml @2m

12.9 Syok, obat untuk11.9.1 Syok kardiogenik

1 Dopamin inj 40mg/ml

2 Dobutamin inj 250mg

3 Epineprin (adrenalin) inj 0,1%

4 Norepinefrin inj 0,1%(noradrenalin)

11.9.2 Syok karena Anestesi1 Ephedrin inj 50mg/ml

12.10 Antihiperlipidemia1 Gemfibrozil caps 300mg

3 Simvastatin tab 10mg

Kulit, obat topikal untuk13.1. Antibakteri

1 Framisetin casa steril 1%

2 Natrium fusidat cream 20mg/gr

3 Perak sulfadiazin cream 1%

4 Gentamisin sulfat cream 1mg/gr

5 Gentian violet lar 1% larutan 1%

6 neomycin sulfat + creamfluocinolon acetonide

Page 96: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

7 Chloramphenicol+ creamhidrocortison

13.2 Antifungi1 Ketokonazol cream

2 Miconazol cream 2%

3 Nystatin,zinc oxide cream

4 Gentian Violet larutan 1%

13.4 Antiinflamasi dan Antipruritik1 Betametason cream

cream + neomycicream + miconaz

2 Clobetasol cream 0,05%

3 Desoksimetason cream 0,25%

4 Hidrokortison cream 2,5%

5 Triamsinolon cream oral base

13.5 Antiskabies dan antipedikulosis 1 Lindane 1%, cream

ursic acid 1%

13.6 Keratolitik dan keratoplastik1 Urea cream 20%

13.7 Extrac placentagel 10gr

13.8 Hyaluronic acid cream 15gr

13.9 Lain-lain1 Centella asiatica phytosom

& vit E cream

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

2 Asam sulfonat+ solution 10mlformaldehid

3 Herbal ointment cream19 Larutan Elektrolit,Nutrisi dan lain-lain

15.1 Oral1 Garam oralit

3 Kalium klorida tab siap larut 60syr. Larutan 3%,

4 Natrium bikarbonat tab 500mginf. 25 Meq, 25m

15.2 Parenteral1 Plasme expander lar infus 6%, bot

(HES)

2 Glukosa lar infus 5%, botlar infus 10%, bolar infus 40%, bo

3 Kalsium glukonat inj 10% @10ml

4 Kalium Klorida inj 25ml/vial

5 Human Albumin lar infus 20 % @(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45% -lar infs btl 500ml

9 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0, -lar infs btl 5

10 Natrium bikarbonat lar inf 25Meq, 2

11 Natrium klorida 0,9%lar inf. 500ml

lar.inf 100ml

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

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12 Ringer laktat

13 kombinasi:Dextrose 5% + NaCl 0,9% -lar infs btl 500ml

14 kombinasi :Nacl 0,18 % b/vglukosa 10 % -lar infs btl 500ml

15 kombinasi :NaCl 2,34grKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

16 kombinasi :NaCL 1,75grKCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

17 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml

18 Kombinasi :Glukosa 12,5 gNaCl 1 gKCl 0,65 gNa Lactat 1,55 g

19 kombinasi :Amino Acids 100mgNitrogen 15,7mgNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

20 kombinasi :

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Bentuk Sediaan,kekuatan dan

kemasan

Asam Amino 2,72%Sorbitol 15% -lar infs btl 500ml

21 Kombinasi :Dextrose Anhydrose 100grSodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi

23 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombi tab

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 200mg/5ml

3 Famotidin tab 20mg

4 Lanzoprazol caps 30mg

5 Omeprazol caps 20mginj.

6 Ranitidin tab 150mg

inj 25mg/2ml

7 Simetidin tab 200mginj. 200mg,amp

8 Sulkrafat tab 500mg

Page 100: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

syr 100ml

9 Polymigel tab

19.2 Enzim1 Pankreatin,diastease kap

2 kombinasi : pankreatin kapdiastase, cimetikon

3 Pankreatin,activated kapletdimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat tab 6mg

2 Dimenhidrinat tab 50mg

3 Loperamid tab 2mg

4 Metoklopramid tab 5mg

inj 5mg/ml

5 Ondansetron inj 4mg/2ml

tab 4mg

6 Domperidon tab 1mg

syr 5mg/5ml

7 Chlordiazepoxid 5mg+ tabdclonidium 2,5mg

8 Pantoprazol inj inj 40mg

Page 101: formularium mawaddah-dH2015

NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

9 Pyratiazine chloroteo- tabletphylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : kapsul 100mg

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mg Suppheksaklorofen

3 Lidocain HCl +Al subacetathidrocortison acetat, ointmenZinc oxide

4 Lithospermi radix, prednisolon,lidocain,benzocain,cetr ointmen

19.4 Antispasmodik1 Atropin Sulfat inj. 0,25mg/ml @i

2 Hyoscine-N-butil bromi tab. 10mgSpasminal (+methampiron)

inj 20mg/mL

3 Papaverin tab 40mginj im 40mg/ml

19.5 Diare, obat untuk1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr +trinatrium sitrat dihidrat 0,58gr +glukosa anhidrat 4gr

2 Kombinasi : tabKaolin 550mg + susppectin 200mg

3 Lactobacillus serbuk

Cap

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

4 Zinc serbuk/sachettablet

19.6 Kataritik1 Bisakodil supp 5mg

supp 10mg

tab 5mg

2 GliserinKombinasi : susp botol 60mlParafin + Glicerin + cairan supp.fenolftalen

3 Lactulosa syr

4 Fosfosoda susp

19.7 Antiinflamasi, obat untuk1 Sulfasalazin tablet 500mg

21 Saluran napas, Obat untuk21.1 Antiasma

1 Aminofilin tablet 200mg generikinj. 24mg/ml @10ml generik

2 Deksametason tab 0,5mg scandexoncarbidu

inj. 5mg/ml IndexonKalmetason

Cortidex

3 Efedrin tab 0,5mg generik

4 Epinefrin (adrenalin) inj 0,1% generik

5 Fluticason propionat nebules 0,5mg/2,5ml Flixotide

6 Salbutamol tab 2mg generikVentolin

syr 2mg/5ml Lasal

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

syrup per 5ml : Lasal expectoransalbutamol 2mg+Gg 75mg

inh.(aerosol) 100mcg/do Ventolin

nebules 2,5mg Ventolin

7 kombinasi salbutamol nebules 2,5ml combivendan ipratropium Br

8 Terbutalin sulfat inj. 0,5mg/ml bricasma

9 Teofilin tab 150 mg generik

21.2 Antitusif1 Dekstrometorfan tab 15mg generik

Romiler

2 Dextrometorfan 10mg + syr per 5ml @ 60ml Alco plusDMP syrpseudoefedrin 30mg +bromfeniramin maleat2mg

3 kombinasi : syr 60ml Guaminprometazin, Gg

4 Kodein Tab 20 mg

5 Doveri Tablet

21.3 Ekspektoran1 Ambroxol Tab 30mg Mirapect

generik

2 Bromheksin Syr 4mg/5ml Bisolvon elixirinj. 4mg/2ml Bisolvon

Bromheksin 4mg+ Syr /5ml ,@60mL Bisolvon extraGuafenesin 100mg

3 Gliseril guaiakolat Tab 100mg generik

4 Obat batuk hitam (OBH) syr botol 100 ml

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Bentuk Sediaan,kekuatan dan

kemasan

5 Kombinasi :Paracet,Gg,efedrin Tab. coparcetinchlorfeniramin Hufagrip forte

Syr 60ml coparcetin

6 KombinasiParaset, pseudoefedrin, Tab Demacolinchlorfeniramin,cafein

7 kombinasi :DMP,GG,PPA, Kap Dextralchlorpheniramin Dextral forte

8 Kombinasi :DMP,GG,Diphenhidramin Kap grantusif

9 kombinasi : Syr 60 ml Miradryldiphenhidramin, amonium Cl, Na sitrat

10 kombinasi :diphen, Gg, mentol Syr. 60ml Coredryl

11 Kombinasi:ipekak,guefenesin Syr 60ml Miradryl

12 oxomemezin +Gg syr 60ml oxopect syr

13 Kombinasi : drops per ml, @ 15ml Nipe dropacetaminofen 120, fenilefrin HCl 1mg,isothipendil HCl 1mg

21.4 Decongestan dan anti rinitis1 Fluticason furoat Nasal spray 27,5mcg/sp Avamys

2 pseudoefedrin 60mg + Tab Valvedtripolidin 2,5mg tremenza

syr per 5ml: pseudoefedrin 30mg Valvedtripolidin 1,25mg

3 Pseudoefedrin 15mg+ syr per 5ml Rhinos Juniorclorfeniramin maleat 1mg drop 7,5mg/0,8ml Rhinos Neo

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NO N A M A O B A T Nama Dagang

Bentuk Sediaan,kekuatan dan

kemasan

4 Pseudoefedrin 60mg+ Tab Rhinos SRloratadin 5mg

Page 106: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Pabrik

5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

generikosteloc sanbegenerik

Antalgin

Page 107: formularium mawaddah-dH2015

Pabrik

Analsik Sanbe(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

paracetamol 32,5mg

Xillomidon Dura

HexapharmaInterbatSanbe

HexapharmaTempo

Sampharindo

sampharindo

Page 108: formularium mawaddah-dH2015

Pabrik

Dura

sanofisanofi

lapi

Pyridam

Lapi

lapilapi

Kalbe

interbat

ethica

Ethica

Otsuka

Fahrenheit

Transfarma

Otsu

Otsu

Otsuka

Page 109: formularium mawaddah-dH2015

Pabrik

Fahrenheit

Transfarma

Otsu

Otsu

Pfizer

SanbeZenith

Sampharindo

SanbeZenithSanbe

Sanbe

SampharindoMeiji

Berno

sanbe

Piridam

Piridam

Yarindo

Berno

Page 110: formularium mawaddah-dH2015

Pabrik

lapilapi

Sanbelapi

Yarindo

guardian

Yarindo

Berno

otto

Zenith

landsencoronetcrown

PyridamDexaBernoSanbe

Sanbesampharindo

LapiDexamedika

SanbeDexamedicaSampharindo

Page 111: formularium mawaddah-dH2015

Pabrik

sanbesanbe

pyridam

guardian

Sanbe

Lapi

Lapi

sanbeLapi

Lapi

Berno

HarsenSanbe

HarsenmeproSanovi

Page 112: formularium mawaddah-dH2015

Pabrik

Combiphar

Sanbe

Actavis

combi

Pyridam

Combi

MercInterbatSanbe

dexamedikasakafarma

Sanbemerck

KalbeOtto/daichi

Otto/Daichi

Combi

tunggal idamanMecosin

Bernofafm

Sanovi

Page 113: formularium mawaddah-dH2015

Pabrik

Pyridam

Darya

sanbeerela

erela

Pyridam

KF

Otto

taisho

KFBernoBernoBerno

SDM

Pyridam

Taiso

KF

Page 114: formularium mawaddah-dH2015

Pabrik

interbat

KalbeMecosin

Combiphar

Landson

Pharos

Combi

Sanofiaventis

generik

Amaril SanofiaventisGluvas Dexa

Glurenorm Boehringergenerik

generikEraphage guardian

generik

Actrapid Novo

Page 115: formularium mawaddah-dH2015

Pabrik

Regumen CaprifarmindoNorelut N dexa

Preabor CaprifarmindoPremastone Kalbe

Lynoral Schering

Blesifen CaprifarmindoProfertil Kalbe

Microgynon ling-Bayer-Scheringkaran biru

Depo progestin HarsenDepo Neo Triyasa nagamas

Cyclofem TunggalIdaman Abdi

Nova-T CU Bayer-Schering

generik

Kalmethasone KalbeIndexon InterbatCortidex Sanbe

Kalmethasone Kalbescandexon scan pasific

carbidu sampharindo

generiklameson Lapilameson Lapi

Page 116: formularium mawaddah-dH2015

Pabrik

generik

Falmicort DexaKenalog Taisho

Bayer-Schering

KalbeInterbatSanbe

Kalbescan pasific

sampharindo

LapiLapi

DexaTaisho

generik

generik

generikCedocard Darya-VaryaFarsorbid Fahrenheit

generik

generik

Page 117: formularium mawaddah-dH2015

Pabrik

Tiaryt Fahrenheit

generik

Noperten Dexa

generik

Trizedon MR servier

generik

generikgeneriklapiten Guardian

Angioten Kalbe

Valsartan-Ni Dexa Medica

generik

generikgenerik

generik

generik

generikNifedin Sanbe

Pidofix Lapigeneric

Pletaal Otsuka

Streptase Dexa

Reotal SR Kalbe

Page 118: formularium mawaddah-dH2015

Pabrik

generikfargoxin fahrenheit

generikLasix Sanofiaventis

generik

Dobutamin Combi

generik

generik

generik

generikLapibroz Lapi

generikCholestat kalbe

sofratulle Sanovi

Fuson Pyridam

Burnazin Darya

generiksagestam sanbeGenoint erela

Genoint erela

Ociderm-N Pyridam

Page 119: formularium mawaddah-dH2015

Pabrik

Chloramphecort KF

Mycoderm Otto

generikdactarin powder

Myco-z taisho

Betason cream KFBenoson Berno

Benoson N BernoBenoson M Berno

Kloderma SDM

Pyderma Pyridam

generik

Kanalog Taiso

Scabicid KF

Moistderm interbat

Bioplacenton KalbeBismecon Mecosin

Bionect Combiphar

Lanakeloid Landson

Page 120: formularium mawaddah-dH2015

Pabrik

Albothyl Pharos

Meibo Combi

Pedyalite AbbotRenalyte fahrenheitOralyte

KSR MerckKCl 3%

generikMeylon Otsuka

Wida HES 130 WidatraWida HES 200 WidatraTetra HES 130 Claris

D 5% otsu, widatraD 10% otsu,widatraD 40% Otsu

Ca Gluconat Ethica

KCl 7,46% Otsu

Octalbin Kalbe

Wida D5 1/2 NS Widatra

Wida D5 1/4 NS Widatra

Meylon Otsu

Wida NS WidatraOtsu NS Otsu

Otsu NS pegy Otsu

Page 121: formularium mawaddah-dH2015

Pabrik

RL Widatra

D5 NS OtsuInfusan RD5% Widatra

Otsu D10 1/5 NS Otsu

KA EN 3A Otsu

KA EN 3B Otsu

KA EN 1B Otsu

Wida 1/2 DaD Widatra

Kalbamin Kalbe

Page 122: formularium mawaddah-dH2015

Pabrik

Pan Amin G Otsu

KA EN MG3 otsu

Water For Injc Otsu

generikSanmag (+dzp 2mg) Sanbe

MagtralStomacain Combiphar

Mylacid EmbaBufantacyd Bufa(+cimeticon)

Carsida Sampharindo

generik

generik

generikOMZ Ferron

generikAcran sanbe

generikIndoran IndofarmaAcran sanbe

generikUlsikur Hexapharma

Ulsafate Combiphar

Page 123: formularium mawaddah-dH2015

Pabrik

Propepsa Gracia

Srocain-P Eisai

lybrozim

lybrozim plus

Tripanzym Sanbe

Mertigo DexaMerislon Mersi

generikMantino samparindo

lopamid HarsenLodia Sanbe

Nilatika sampharindoDamaben Capri

Tomit interbatDamaben Capri

generikODR Lapi

Insetron Indofarmavometraz Dexamedika

generikDom Lapi

Omedon MutifaDom Lapi

Omedon mutifagenerik

Braxidin Sanbe

Topazole Lapi

Page 124: formularium mawaddah-dH2015

Pabrik

Anvomer B6 Dexamedika

Lanaven Lansond

generik

Haemocain Gelenium

Borraginol S Takeda

Atropin Ethica

Spasminal (+methampiron)Buscopan Boehringer

Gitas Interbat

generikgenerik

Oralit OGB

Corosorb CoronetcrownNovadiar CorsaOmegdiar

L-bio LapiLacto B pharosLacidofil DexaLacbon Pharmasolindo

Page 125: formularium mawaddah-dH2015

Pabrik

OrezincZincare Kalbe

Dulcolax Paed Boehringer

Dulcolax Paed Boehringer

Dulcolax Paed Boehringer

Laxadine Geleniumfleet enema combiphar

Lactulax Ikapharmindo

Fleet Fosfosoda Combi

Sulcolon Bernofarm

KFKF

ScanpasificSampharindo

InterbatKalbeSanbe

Glaxo

Glaxo

Lapi

Page 126: formularium mawaddah-dH2015

Pabrik

Lapi

Glaxo

Glaxo

Boehringer

astra zeneca

Behringer

Interbat

kF

KF

Sampharindo

BoehringerBoehringer

Boehringer

Page 127: formularium mawaddah-dH2015

Pabrik

sampharindohufa

sampharindo

coronetcrown

MolexMolex

grahafarma

Sampharindo

GMP

sampharindo

mahakam

TransfarmaMedika indah

Glaxo

GMPsanbe

GMP

DexaDexa

Page 128: formularium mawaddah-dH2015

Pabrik

Dexa

Page 129: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 31 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @10ml

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik1 Asam asetilsalisilat Tab 100mg

(asetosal)2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

Bentuk Sediaan,kekuatan dan kemasan

Page 130: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

7 Meloxicam Tab 15mg

Tab 7,5 mg

8 Metampiron Tab 500mg

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

1.3 Antipirai1 Allopurinol Tab 100mg

Page 131: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Antialergi dan obat untuk anafilaksis

1 Dexametasone inj 5mg/ml@1ml

tab 0,5mg

Kombinasi dengan Tabdifenhidramin

2 Difenhidramin Inj 10mg/mlInj 15mg/vial

3 Epinefrin (adrenalin) Inj 0,1%

4 Klorfeniramin Tab 4mg

5 Pheniramine maleat Tab 25mginj.50mg/2ml

6 Loratadine tab 10mg

7 Ceterizin tab 10mg

drops

8 Metil Prednisolon tab 8mg

inj 125mg/ml

9 Ciproheptadin kap 4mg

10 Mebhidroline Naphadisilat tab 50mg

5 Antiepilepsi - Antikonvulsi

1 Carbamazepin tab 200mg

2 Diazepam rectal 5mg/2,5ml

Page 132: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Fenitoin inj 50mg/mlcap 100mg

4 Fenobarbital tab 30mginj 50mg

5 Gabapentin cap 300mg

6 Antiinfeksi

6.1 Antelmintik6.1.1 Antelmintik Intestinal

1 Pirantel tab 125mgsusp 125mg/5ml

6.2 Antibakteri6.2.1 Beta Laktam

1 Amoksisilin trihidrat tab 500mg

dry syr 125mg/5ml

drops 100mg/ml

serb inj 1000mg

2 Ampisilin cap 500mgserb inj 1000mg

3 Ampicillin + Sulbactam serb inj 500+250mg

4 kap 500+125mg

5 Cefadroksil caps 500mg

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 133: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

dry syr 125mg/5ml

6 Sefaklor caps 500mg

7 Sefaleksin caps 500mg

8 Sefiksim caps 100mgdry syr 100mg/5ml

9 Sefotaksim serb inj 1gr

10 Seftazidim serb inj 1gr

11 Seftriakson serb inj 1gr

12 Sephalotin serb inj 1gr

13 Meropenem serb inj 1 gr

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg

3 Tetrasiklin caps 500mg

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg

susp 125mg/5ml

2 Tiamfenikol caps 500mg

dry syr 125mg/5ml

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet

Page 134: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

sulfametoksazol 400mg +trimetoprim 80mg

2 sulfa 800mg+ Tablettrimetoprim 160mg

3 Kotrimoksazol suspensi suspkomb : sulfametoksazol200mg + trimetoprim 40mg/5ml

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg

2 Eritromisin caps 500mg

syr 200mg/5ml

3 Spiramisin tab 500mg

4 Azytromicin caps 500mg

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg

lar infus 500mg/100ml

2 Ofloksasin tab 200&400mg

3 Siprofloksasin tab 500mg

lar infus 500mg/100ml

Page 135: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg

2 Metronidazol tab 500mg

syr 125mg/5ml

supp 500mg

ovul + nistatin 100000iu

lar infus 500mg/100ml

3 Colistin sulfat Tab 250000 iu

6.3 Antiinfeksi Khusus6.3.1 Antituberkulosis

1 Etambutol tab 500mg

2 Isoniazid tab 300mg

3 Pirazinamid tab 500mg

4 Rifampicin caps 450mg

5 Kombinasi (OAT TB dots):untuk dewasa kap : INH 75,Rifam 150,

Pza 400, ethambutol 275

kap: INH 150, Rifam 150

untuk pediatri INH100, rifam75,Pza200

INH 100, Rifam 75

6 Kombinasi : Ethambutol, INH, B6 caps

Page 136: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

7 INH50+Rifam75+PZA150 caps8 INH50+ Rifam75

6.3 Antifungi1 Itrakonazol caps 100mg

2 Ketokonazol tab 200mg

3 Mikonazol cream

4 Nistatin ovul + metronidazol

drops

6.5 Antimalaria1 Sulfadoxin 500mg, tab

primetamin 25 mg

6.6 Antivirus6.6.1 Antiherpes

1 Asiklovir tab 200mgtab 400mgcream 5%

10.2 Koagulasi, obat yang mempengaruhi

1 Asainj 250mg/5ml KalnexTransamin

tab 500mg Transamin

2 Fitotab salut 10mg, kaleng generikinj 10mg/ml Neo K

3 Hepgel Thrombopop GelAntithromb

4 Lidoinj 2% generic

11 Produk Darah dan Pengganti Plasma

Page 137: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

11.1 Produk DarahFaktor VII (konsentrat) serb injc 250IU/vial

serb injc 250IU/vial

Fraksi protein plasma lar infus kadar protein 5%@250ml(termasuk fibrinogen)

19 Larutan Elektrolit,Nutrisi dan lain-lain

15.1 Oral1 Garam oralit

3 Kalium klorida tab siap larut 600mgsyr. Larutan 3%, 100mL

4 Natrium bikarbonat tab 500mginf. 25 Meq, 25mL

15.2 Parenteral1 Plasme expander lar infus 6%, botol 500ml

(HES)

Page 138: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Glukosa lar infus 5%, botol 500mllar infus 10%, botol 500mllar infus 40%, botol 25ml

3 Kalsium glukonat inj 10% @10ml

4 Kalium Klorida inj 25ml/vial

5 Human Albumin lar infus 20 % @50ml(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45% -lar infs btl 500ml

9 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225% -lar infs btl 500ml

10 Natrium bikarbonat lar inf 25Meq, 25mL

11 Natrium klorida 0,9%lar inf. 500ml

lar.inf 100ml

12 Ringer laktat

13 kombinasi:Dextrose 5% + NaCl 0,9% -lar infs btl 500ml

14 kombinasi :Nacl 0,18 % b/vglukosa 10 % -lar infs btl 500ml

15 kombinasi :NaCl 2,34grKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

Page 139: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

16 kombinasi :NaCL 1,75grKCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

17 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml

18 Kombinasi :Glukosa 12,5 gNaCl 1 gKCl 0,65 gNa Lactat 1,55 g

19 kombinasi :Amino Acids 100mgNitrogen 15,7mgNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

20 kombinasi :Asam Amino 2,72%Sorbitol 15% -lar infs btl 500ml

21 Kombinasi :Dextrose Anhydrose 100grSodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi

23 Saluran Cerna, Obat untuk

Page 140: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombinasi : tab

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 200mg/5ml

3 Famotidin tab 20mg

4 Lanzoprazol caps 30mg

5 Omeprazol caps 20mginj.

6 Ranitidin tab 150mg

inj 25mg/2ml

7 Simetidin tab 200mginj. 200mg,amp

8 Sulkrafat tab 500mgsyr 100ml

9 Polymigel tab

19.2 Enzim1 Pankreatin,diastease kap

2 kombinasi : pankreatin kapdiastase, cimetikon

3 Pankreatin,activated kapletdimetilpolisiloxan

Page 141: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

19.3 Antiemetik1 Betahistin mesilat tab 6mg

2 Dimenhidrinat tab 50mg

3 Loperamid tab 2mg

4 Metoklopramid tab 5mg

inj 5mg/ml

5 Ondansetron inj 4mg/2ml

tab 4mg

6 Domperidon tab 1mg

syr 5mg/5ml

7 Chlordiazepoxid 5mg+ tabdclonidium 2,5mg

8 Pantoprazol inj inj 40mg

9 Pyratiazine chloroteo- tabletphylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : kapsul 100mg

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mg Suppheksaklorofen

Page 142: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Lidocain HCl +Al subacetathidrocortison acetat, ointmenZinc oxide

4 Lithospermi radix, prednisolon,lidocain,benzocain,cetrimide ointmen

19.4 Antispasmodik1 Atropin Sulfat inj. 0,25mg/ml @iml

2 Hyoscine-N-butil bromide tab. 10mgSpasminal (+methampiron)

inj 20mg/mL

3 Papaverin tab 40mginj im 40mg/ml

19.5 Diare, obat untuk1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr +trinatrium sitrat dihidrat 0,58gr +glukosa anhidrat 4gr

2 Kombinasi : tabKaolin 550mg + susppectin 200mg

3 Lactobacillus serbuk

Cap

4 Zinc serbuk/sachettablet

19.6 Kataritik1 Bisakodil supp 5mg

supp 10mg

Page 143: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

tab 5mg

2 GliserinKombinasi : susp botol 60mlParafin + Glicerin + cairan supp.fenolftalen

3 Lactulosa syr

4 Fosfosoda susp

19.7 Antiinflamasi, obat untuk1 Sulfasalazin tablet 500mg

21 Saluran napas, Obat untuk21.1 Antiasma

1 Aminofilin tablet 200mginj. 24mg/ml @10ml

2 Deksametason tab 0,5mg

inj. 5mg/ml

3 Efedrin tab 0,5mg

4 Epinefrin (adrenalin) inj 0,1%

5 Fluticason propionat nebules 0,5mg/2,5ml

6 Salbutamol tab 2mg

syr 2mg/5ml

syrup per 5ml : salbutamol 2mg+Gg 75mg

Page 144: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

inh.(aerosol) 100mcg/dosis

nebules 2,5mg

7 kombinasi salbutamol nebules 2,5mldan ipratropium Br

8 Terbutalin sulfat inj. 0,5mg/ml

9 Teofilin tab 150 mg

21.2 Antitusif1 Dekstrometorfan tab 15mg

2 Dextrometorfan 10mg + syr per 5ml @ 60mlpseudoefedrin 30mg +bromfeniramin maleat2mg

3 kombinasi : syr 60mlprometazin, Gg

4 Kodein Tab 20 mg

5 Doveri Tablet

21.3 Ekspektoran1 Ambroxol Tab 30mg

2 Bromheksin Syr 4mg/5mlinj. 4mg/2ml

Bromheksin 4mg+ Syr /5ml ,@60mLGuafenesin 100mg

3 Gliseril guaiakolat Tab 100mg

4 Obat batuk hitam (OBH) syr botol 100 ml

5 Kombinasi :

Page 145: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Paracet,Gg,efedrin Tab.chlorfeniramin

Syr 60ml

6 KombinasiParaset, pseudoefedrin, Tabchlorfeniramin,cafein

7 kombinasi :DMP,GG,PPA, Kapchlorpheniramin

8 Kombinasi :DMP,GG,Diphenhidramin Kap

9 kombinasi : Syr 60 mldiphenhidramin, amonium Cl, Na sitrat

10 kombinasi :diphen, Gg, mentol Syr. 60ml

11 Kombinasi:ipekak,guefenesin Syr 60ml

12 oxomemezin +Gg syr 60ml

13 Kombinasi : drops per ml, @ 15mlacetaminofen 120, fenilefrin HCl 1mg,isothipendil HCl 1mg

21.4 Decongestan dan anti rinitis1 Fluticason furoat Nasal spray 27,5mcg/spray

2 pseudoefedrin 60mg + Tabtripolidin 2,5mg

syr per 5ml: pseudoefedrin 30mgtripolidin 1,25mg

Page 146: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Pseudoefedrin 15mg+ syr per 5mlclorfeniramin maleat 1mg drop 7,5mg/0,8ml

4 Pseudoefedrin 60mg+ Tabloratadin 5mg

Page 147: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang Pabrik

4 5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

Page 148: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikosteloc sanbegenerik

AntalginAnalsik Sanbe

(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

Xillomidon Dura

generikRinolic GMPAlluric Kalbefarma

Page 149: formularium mawaddah-dH2015

Nama Dagang Pabrik

Kalmethasone HexapharmaIndexon InterbatCortidex Sanbe

Kalmethasone HexapharmaScandexon Tempo

Carbidu Sampharindo

Mexon sampharindo

generikDuradryl Dura

Generik

pehachlor

avil sanofiavil sanofi

generikclarihis lapi

Zenris Pyridamgenerik

Tiriz Lapi

generikLameson lapiLameson lapigenerik

Pronicy Kalbe

interhistin interbat

generik

Stesolid Actavis

Page 150: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikKutoin mersifarma

generik KFPhental iv Combi

Gabexal Sandozgeneric

PyrantinCombantrin Pfizer

Amoxan SanbeZemoxil Zenith

Brodamox Sampharindo

Amoxan SanbeZemoxil ZenithAmoxan Sanbe

Amoxan Sanbe

Brodapen SampharindoViccilin Meiji

Pycin 750 Berno

co amoxiclavclanexi sanbe

Pyricef Piridamgenerik

Page 151: formularium mawaddah-dH2015

Nama Dagang Pabrik

Pyricef Piridamgenerik

Capabiotik Yarindo

Cefabiotic Berno

Cefila lapiCefila lapi

generikTaxegram Sanbe

lapixim lapi

Yadim Yarindo

generikcephaflox guardian

Moraxine Yarindo

Meropex Bernogenerik

generikdoxacin otto

Suprabiotik Zenith

Lanacetin landsencoromycetin coronetcrown

Promixin PyridamDexicol Dexa

Phenobiotic BernoBiothicol Sanbe

Sanprima Sanbe

Page 152: formularium mawaddah-dH2015

Nama Dagang Pabrik

miratrim sampharindo

Lapikot forte LapiPrimadex forte Dexamedika

Sanprima SanbePrimadex DexamedicaMiratrim Sampharindo

generik

generikerisanbe sanbe

erisanbe chewable sanbe

generik

generikvaroc pyridam

zibramax guardiangenerik

Sagestam Sanbe

Cravox Lapigenerik

generikCravox Lapi

generik

generikBaquior forte sanbe

Lapiflox Lapi

generik

Page 153: formularium mawaddah-dH2015

Nama Dagang Pabrik

Lapiflox inf Lapi

Sulcolon Berno

Metrolet HarsenTrychodazole Sanbe

Metrolet Harsenpromuba mepro

Flagyl Sanovi

Vagistin Combiphar

Trychodazole Sanbegeneric

Colistine Actavis

generik

generik

generik

generik

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

Bacbutinh

Page 154: formularium mawaddah-dH2015

Nama Dagang Pabrik

Niazitol

Rimcure paed SandozRimtazid paed Sandoz

Itzol Lapi

generik

generik

vagistin Combi

Kandistatin lapi

Fansidar Roche

generikgenerikgenerik

KalbeOtto/daichi

Otto/Daichi

Combi

tunggal idamanMecosin

Bernofafm

Page 155: formularium mawaddah-dH2015

Nama Dagang Pabrik

Koate DVI Dipa

Pedyalite AbbotRenalyte fahrenheitOralyte

KSR MerckKCl 3%

generikMeylon Otsuka

Wida HES 130 WidatraWida HES 200 WidatraTetra HES 130 Claris

Page 156: formularium mawaddah-dH2015

Nama Dagang Pabrik

D 5% otsu, widatraD 10% otsu,widatraD 40% Otsu

Ca Gluconat Ethica

KCl 7,46% Otsu

Octalbin Kalbe

Wida D5 1/2 NS Widatra

Wida D5 1/4 NS Widatra

Meylon Otsu

Wida NS WidatraOtsu NS Otsu

Otsu NS pegy Otsu

RL Widatra

D5 NS OtsuInfusan RD5% Widatra

Otsu D10 1/5 NS Otsu

KA EN 3A Otsu

Page 157: formularium mawaddah-dH2015

Nama Dagang Pabrik

KA EN 3B Otsu

KA EN 1B Otsu

Wida 1/2 DaD Widatra

Kalbamin Kalbe

Pan Amin G Otsu

KA EN MG3 otsu

Water For Injc Otsu

Page 158: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikSanmag (+dzp 2mg) Sanbe

MagtralStomacain Combiphar

Mylacid EmbaBufantacyd Bufa(+cimeticon)

Carsida Sampharindo

generik

generik

generikOMZ Ferron

generikAcran sanbe

generikIndoran IndofarmaAcran sanbe

generikUlsikur Hexapharma

Ulsafate CombipharPropepsa Gracia

Srocain-P Eisai

lybrozim

lybrozim plus

Tripanzym Sanbe

Page 159: formularium mawaddah-dH2015

Nama Dagang Pabrik

Mertigo DexaMerislon Mersi

generikMantino samparindo

lopamid HarsenLodia Sanbe

Nilatika sampharindoDamaben Capri

Tomit interbatDamaben Capri

generikODR Lapi

Insetron Indofarmavometraz Dexamedika

generikDom Lapi

Omedon MutifaDom Lapi

Omedon mutifagenerik

Braxidin Sanbe

Topazole Lapi

Anvomer B6 Dexamedika

Lanaven Lansond

generik

Page 160: formularium mawaddah-dH2015

Nama Dagang Pabrik

Haemocain Gelenium

Borraginol S Takeda

Atropin Ethica

Spasminal (+methampiron)Buscopan Boehringer

Gitas Interbat

generikgenerik

Oralit OGB

Corosorb CoronetcrownNovadiar CorsaOmegdiar

L-bio LapiLacto B pharosLacidofil DexaLacbon Pharmasolindo

OrezincZincare Kalbe

Dulcolax Paed Boehringer

Dulcolax Paed Boehringer

Page 161: formularium mawaddah-dH2015

Nama Dagang Pabrik

Dulcolax Paed Boehringer

Laxadine Geleniumfleet enema combiphar

Lactulax Ikapharmindo

Fleet Fosfosoda Combi

Sulcolon Bernofarm

generik KFgenerik KF

scandexon Scanpasificcarbidu SampharindoIndexon Interbat

Kalmetason KalbeCortidex Sanbe

generik

generik

Flixotide Glaxo

generikVentolin Glaxo

Lasal Lapi

Lasal expectoran Lapi

Page 162: formularium mawaddah-dH2015

Nama Dagang Pabrik

Ventolin Glaxo

Ventolin Glaxo

combiven Boehringer

bricasma astra zeneca

generik

generikRomiler Behringer

Alco plusDMP syr Interbat

Guamin

kF

KF

Mirapect Sampharindogenerik

Bisolvon elixir BoehringerBisolvon Boehringer

Bisolvon extra Boehringer

generik

Page 163: formularium mawaddah-dH2015

Nama Dagang Pabrik

coparcetin sampharindoHufagrip forte hufa

coparcetin sampharindo

Demacolin coronetcrown

Dextral MolexDextral forte Molex

grantusif grahafarma

Miradryl Sampharindo

Coredryl GMP

Miradryl sampharindo

oxopect syr mahakam

Nipe drop TransfarmaMedika indah

Avamys Glaxo

Valved GMPtremenza sanbe

Valved GMP

Page 164: formularium mawaddah-dH2015

Nama Dagang Pabrik

Rhinos Junior DexaRhinos Neo Dexa

Rhinos SR Dexa

Page 165: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 31 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @10ml

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik1 Asam asetilsalisilat Tab 100mg

(asetosal)2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

7 Meloxicam Tab 15mg

Tab 7,5 mg

8 Metampiron Tab 500mg

Bentuk Sediaan,kekuatan dan kemasan

Page 166: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

1.3 Antipirai1 Allopurinol Tab 100mg

6 Antiinfeksi6.1 Antelmintik

6.1.1 Antelmintik Intestinal1 Pirantel tab 125mg

susp 125mg/5ml

6.2 Antibakteri

Page 167: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.2.1 Beta Laktam1 Amoksisilin trihidrat tab 500mg

dry syr 125mg/5ml

drops 100mg/ml

serb inj 1000mg

2 Ampisilin cap 500mgserb inj 1000mg

3 Ampicillin + Sulbactam serb inj 500+250mg

4 kap 500+125mg

5 Cefadroksil caps 500mg

dry syr 125mg/5ml

6 Sefaklor caps 500mg

7 Sefaleksin caps 500mg

8 Sefiksim caps 100mgdry syr 100mg/5ml

9 Sefotaksim serb inj 1gr

10 Seftazidim serb inj 1gr

11 Seftriakson serb inj 1gr

12 Sephalotin serb inj 1gr

13 Meropenem serb inj 1 gr

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 168: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg

3 Tetrasiklin caps 500mg

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg

susp 125mg/5ml

2 Tiamfenikol caps 500mg

dry syr 125mg/5ml

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet

sulfametoksazol 400mg +trimetoprim 80mg

2 sulfa 800mg+ Tablettrimetoprim 160mg

3 Kotrimoksazol suspensi suspkomb : sulfametoksazol200mg + trimetoprim 40mg/5ml

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg

2 Eritromisin caps 500mg

erisanbe chewable

syr 200mg/5ml

3 Spiramisin tab 500mg

4 Azytromicin caps 500mg

Page 169: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg

lar infus 500mg/100ml

2 Ofloksasin tab 200&400mg

3 Siprofloksasin tab 500mg

lar infus 500mg/100ml

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg

2 Metronidazol tab 500mg

syr 125mg/5ml

supp 500mg

ovul + nistatin 100000iu

lar infus 500mg/100ml

3 Colistin sulfat Tab 250000 iu

6.3 Antiinfeksi Khusus6.3.1 Antituberkulosis

1 Etambutol tab 500mg

2 Isoniazid tab 300mg

3 Pirazinamid tab 500mg

Page 170: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

4 Rifampicin caps 450mg

5 Kombinasi (OAT TB dots):untuk dewasa kap : INH 75,Rifam 150,

Pza 400, ethambutol 275

kap: INH 150, Rifam 150

untuk pediatri INH100, rifam75,Pza200

INH 100, Rifam 75

6 Kombinasi : Ethambutol, INH, B6 caps

7 INH50+Rifam75+PZA150 caps8 INH50+ Rifam75

6.3 Antifungi1 Itrakonazol caps 100mg

2 Ketokonazol tab 200mg

3 Mikonazol cream

4 Nistatin ovul + metronidazol

drops

6.5 Antimalaria1 Sulfadoxin 500mg, tab

primetamin 25 mg

6.6 Antivirus6.6.1 Antiherpes

1 Asiklovir tab 200mgtab 400mgcream 5%

10 Darah, Obat yang Mempengaruhi

8.1 Antianemi1 Asam folat tab 1mg

Page 171: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2Besi III sulfat (sulfas ferosus)

tab salut 300mg

syr. 50mg/50ml, @150ml

3 Vit B1, B6, B12 tab

inj. Amp 3ml

8.2 Koagulasi, obat yang mempengaruhi

1 Asam traneksamat inj 250mg/5ml

tab 500mg

2 Fitomenadion (vit K) tab salut 10mg, kalenginj 10mg/ml

3 Heparin Na gel

4 Lidocain inj 2%

14 Diuretik

1 Furosemida tab 40mginj 10mg/ml

2 Hidroklortiazid (HCT) tab 25mg

3 Manitol lar infus 20%@500ml

4 Spironolacton tab 25mg

Page 172: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

15.3 Hormon Kelamin dan obat yang mepengaruhi Fertilitas

11.2.1 Progestrogen1 Noretisteron tab 5mg

2 Alil Esternol tab 5mg

3 Ethinilestradiol tab 50mcg

11.2.2 Clomiphen Sitrattab 50mg

11.3.1 Oral1 Levonogestrel, tab 28

ethinilestradiol,placebo

11.3.2 Injeksi1 medroksiprogesteron vial, 50mg/ml, 3mL

acetat vial, 150mg/ml, 1ml

2 Medroksiprogesteron vial, 0,5 mlacetat 50mg+10 estradiol-cypionate

11.3.3 Intra Uterin T-shaped dg copper wiredan silver core

1 Propiltiorasil tab 100mg

1 Deksametason inj 5mg/ml @1ml

Page 173: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

tab 0,5mg

2 Metil prednisolon tab 4mg

inj 125mg/2ml

3 Prednison tab 5mg

4 Triamsinolon inj 10mg/mloral base, tube

19 Larutan Elektrolit,Nutrisi dan lain-lain

15.1 Oral1 Garam oralit

3 Kalium klorida

4 Natrium bikarbonat

15.2 Parenteral1 Plasme expander

(HES)

2 Glukosa

3 Kalsium glukonat

4 Kalium Klorida

5 Human Albumin

6 Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45%

Page 174: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

-lar infs btl 500ml

9 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225%

10 Natrium bikarbonat

11 Natrium klorida 0,9%lar inf. 500ml

lar.inf 100ml

12 Ringer laktat

13 kombinasi:Dextrose 5% + NaCl 0,9% -lar infs btl 500ml

14 kombinasi :Nacl 0,18 % b/vglukosa 10 % -lar infs btl 500ml

15 kombinasi :NaCl 2,34grKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

16 kombinasi :NaCL 1,75grKCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

17 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml

18 Kombinasi :Glukosa 12,5 gNaCl 1 g

Page 175: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

KCl 0,65 gNa Lactat 1,55 g

19 kombinasi :Amino Acids 100mgNitrogen 15,7mgNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

20 kombinasi :Asam Amino 2,72%Sorbitol 15% -lar infs btl 500ml

21 Kombinasi :Dextrose Anhydrose 100grSodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi

Page 176: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

21 Oksitosik dan relaksan uterus

17.1 Oksitosik1 Metilergometrin

tablet 0,125

2 Oksitosin

3 Mesoprostol

17.2 Relaksan Uterus1 Magnesium sulfat

Page 177: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Isoksuprin HCL

23 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombinasi :

Al(OH)3 200mg + Mg (OH)2 200mg

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 200mg/5ml

3 Famotidin

4 Lanzoprazol

5 Omeprazol

6 Ranitidin

Page 178: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

7 Simetidin

8 Sulkrafat

9 Polymigel

19.2 Enzim1 Pankreatin,diastease

2 kombinasi : pankreatindiastase, cimetikon

3 Pankreatin,activated dimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat

2 Dimenhidrinat

3 Loperamid

4 Metoklopramid

5 Ondansetron

6 Domperidon

Page 179: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

7 Chlordiazepoxid 5mg+dclonidium 2,5mg

8 Pantoprazol inj

9 Pyratiazine chloroteo-phylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi :

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mgheksaklorofen

3 Lidocain HCl +Al subacetathidrocortison acetat, Zinc oxide

4 Lithospermi radix, prednisolon,lidocain,benzocain,cetrimide

19.4 Antispasmodik1 Atropin Sulfat

2 Hyoscine-N-butil bromide

3 Papaverin

19.5 Diare, obat untuk1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr +trinatrium sitrat dihidrat 0,58gr +glukosa anhidrat 4gr

Page 180: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Kombinasi : Kaolin 550mg +pectin 200mg

3 Lactobacillus

4 Zinc

19.6 Kataritik1 Bisakodil

2 GliserinKombinasi :Parafin + Glicerin + fenolftalen

3 Lactulosa

4 Fosfosoda

19.7 Antiinflamasi, obat untuk1 Sulfasalazin

Page 181: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

27 Vitamin dan Mineral

1 Asam Folat tab 1mg

2 Calcitriol Tab 0,25mcg

3 Calsium lactat Kap

4 Ca laktat,Ca phospat, Kap vit C, vit D Syr

5 Ca glukonas inj 100mg/ml

6 Vitamin A sugar coated 6000IUsugar coated 20000IUinj. Im. Amp

7 Vit B kompleks Tab

tab, kaleng

tab, + methampiron

inj. Amp

inj im, vial

8 Vitamin B1 Tab, kalenginj. Amp

9 Vitamin B6 Tab, kaleng

10 Vitamin C dan kombinasi

Page 182: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

- Vit C tab, kalenginj, amp 200mg

- B1,B2,B6,B12,vit C500mg kaps Ca pantotenat 20mg- vit C 750mg,vit E30iu, B1, kaps B2,B6,B12, as folat,Zn, niacin

11 Vitamin D +calsium Kap

12 Vitamin E dan Kombinasi Kapl 100 IU

13 Vitamin K tab salut gula 10mginj 10mg/ml

14 Vitamin Ibu Hamil dan MenyusuiKap.

15 Glukosamine dan KapletEfferfescen

16 Multivitamin Anak syr

Drop

17 Multivitamin inj inj, vial(vit A,B,C,D, lecitin)

Page 183: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang PabrikHarga

4 5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

generikosteloc sanbegenerik

Antalgin

Page 184: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Analsik Sanbe(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

Xillomidon Dura

generik

PyrantinCombantrin Pfizer

Page 185: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Amoxan SanbeZemoxil Zenith

Brodamox Sampharindo

Amoxan SanbeZemoxil ZenithAmoxan Sanbe

Amoxan Sanbe

Brodapen SampharindoViccilin Meiji

Pycin 750 Berno

co amoxiclavclanexi sanbe

Pyricef Piridamgenerik

Pyricef Piridamgenerik

Capabiotik Yarindo

Cefabiotic Berno

Cefila lapiCefila lapi

generikTaxegram Sanbe

lapixim lapi

Yadim Yarindo

generikcephaflox guardian

Moraxine Yarindo

Meropex Bernogenerik

Page 186: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

generikdoxacin otto

Suprabiotik Zenith

Lanacetin landsencoromycetin coronetcrown

Promixin PyridamDexicol Dexa

Phenobiotic BernoBiothicol Sanbe

Sanprima Sanbemiratrim sampharindo

Lapikot forte LapiPrimadex forte Dexamedika

Sanprima SanbePrimadex DexamedicaMiratrim Sampharindo

generik

generikerisanbe sanbe

erisanbe chewable sanbe

generik

generikvaroc pyridam

zibramax guardiangenerik

Page 187: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Sagestam Sanbe

Cravox Lapigenerik

generikCravox Lapi

generik

generikBaquior forte sanbe

Lapiflox Lapi

generikLapiflox inf Lapi

Sulcolon Berno

Metrolet HarsenTrychodazole Sanbe

Metrolet Harsenpromuba mepro

Flagyl Sanovi

Vagistin Combiphar

Trychodazole Sanbegeneric

Colistine Actavis

generik

generik

generik

Page 188: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

generik

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

BacbutinhNiazitol

Rimcure paed SandozRimtazid paed Sandoz

Itzol Lapi

generik

generik

vagistin Combi

Kandistatin lapi

Fansidar Roche

generikgenerikgenerik

Folacom combi

Page 189: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Natabion PyridamArtoferumMaltofer Combi

Neurobion 5000 MercNeurobat Interbat

Neurosanbe SanbeNeurodex dexamedika

Sakaneuron sakafarma

Neurosanbe 5000 SanbeNeurobion 5000 merck

Kalnex KalbeTransamin Otto/daichi

Transamin Otto/Daichi

generikNeo K Combi

Thrombopop Geltunggal idamanAntithromb Mecosin

generic Bernofafm

generikLasix Sanofiaventis

generik

manitol Otsu

carpiaton Fahrenheit

Page 190: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Regumen CaprifarmindoNorelut N dexa

Preabor CaprifarmindoPremastone Kalbe

Lynoral Schering

Blesifen CaprifarmindoProfertil Kalbe

Microgynon ling-Bayer-Scheringkaran biru

Depo progestin HarsenDepo Neo Triyasa nagamas

Cyclofem TunggalIdaman Abdi

Nova-T CU Bayer-Schering

generik

Kalmethasone KalbeIndexon Interbat

Page 191: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Cortidex Sanbe

Kalmethasone Kalbescandexon scan pasific

carbidu sampharindo

generiklameson Lapilameson Lapi

generik

Falmicort DexaKenalog Taisho

Pedyalite AbbotRenalyte fahrenheitOralyte

tab siap larut 6 KSR Mercksyr. Larutan 3%, KCl 3%

tab 500mg generikinf. 25 Meq, 25m Meylon Otsuka

lar infus 6%, botWida HES 130 WidatraWida HES 200 WidatraTetra HES 130 Claris

lar infus 5%, bot D 5% otsu, widatralar infus 10%, bo D 10% otsu,widatralar infus 40%, bo D 40% Otsu

inj 10% @10ml Ca Gluconat Ethica

inj 25ml/vial KCl 7,46% Otsu

lar infus 20 % @ Octalbin Kalbe(tidak stock)

Page 192: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Wida D5 1/2 NSWidatra

-lar infs btl 5Wida D5 1/4 NSWidatra

lar inf 25Meq, 2 Meylon Otsu

Wida NS WidatraOtsu NS Otsu

Otsu NS pegy Otsu

RL Widatra

D5 NS OtsuInfusan RD5% Widatra

Otsu D10 1/5 NS Otsu

KA EN 3A Otsu

KA EN 3B Otsu

KA EN 1B Otsu

Wida 1/2 DaD Widatra

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Nama Dagang PabrikHarga

Kalbamin Kalbe

Pan Amin G Otsu

KA EN MG3 otsu

Water For Injc Otsu

Page 194: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

table salut 0,12 generikPospargin Kalbe

inj 0,200mg/ml Methergin Novartis

inj 10 IU/ml Syntocinon Novartis

tab 200mg Cytotec Pharmacia

inj 20% @25ml Mg SO4 20% Otsuinj 40% @25ml Mg SO4 40% Otsu

Page 195: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

tabl 20mg DuvadilanSolvay farmainj. 5mg/ml @2m DuvadilanSolvay farma

tab generikAl(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)Sanbe

MagtralStomacain Combiphar

Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 Mylacid Emba

Bufantacyd Bufa(+cimeticon)

Carsida Sampharindo

tab 20mg generik

caps 30mg generik

caps 20mg generikinj. OMZ Ferron

tab 150mg generikAcran sanbe

Page 196: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

inj 25mg/2ml generikIndoran IndofarmaAcran sanbe

tab 200mg generikinj. 200mg,amp Ulsikur Hexapharma

tab 500mg Ulsafate Combipharsyr 100ml Propepsa Gracia

tab Srocain-P Eisai

kap lybrozim

kap lybrozim plus

kaplet Tripanzym Sanbe

tab 6mg Mertigo DexaMerislon Mersi

tab 50mg generikMantino samparindo

tab 2mg lopamid HarsenLodia Sanbe

tab 5mg Nilatika sampharindoDamaben Capri

inj 5mg/ml Tomit interbatDamaben Capri

inj 4mg/2ml generikODR Lapi

Insetron Indofarmatab 4mg vometraz Dexamedika

tab 1mg generikDom Lapi

Page 197: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Omedon Mutifasyr 5mg/5ml Dom Lapi

Omedon mutifagenerik

tab Braxidin Sanbe

inj 40mg Topazole Lapi

tablet Anvomer B6Dexamedika

kapsul 100mg Lanaven Lansond

Supp generik

ointmen Haemocain Gelenium

ointmen Borraginol S Takeda

inj. 0,25mg/ml @ Atropin Ethica

tab. 10mgSpasminal (+methampiron)

Buscopan Boehringerinj 20mg/mL Gitas Interbat

tab 40mg generikinj im 40mg/ml generik

Oralit OGB

Page 198: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

tab CorosorbCoronetcrownsusp Novadiar Corsa

Omegdiar

serbuk L-bio LapiLacto B pharos

Cap Lacidofil DexaLacbon Pharmasolindo

serbuk/sachet Orezinctablet Zincare Kalbe

supp 5mg Dulcolax PaedBoehringer

supp 10mg Dulcolax PaedBoehringer

tab 5mg Dulcolax PaedBoehringer

susp botol 60ml Laxadine Geleniumcairan supp. fleet enema combiphar

syr Lactulax Ikapharmindo

susp Fleet Fosfosoda Combi

tablet 500mg Sulcolon Bernofarm

Page 199: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Folacom Combi

Osteofem Kalbe

Caltron PyridamKalk KF

Calsifar Ifars

Elkana SanbeElkana Sanbe

Ca glukonat Ethica

generik KFgenerik KFgenerik

Alinamin F TakedaNeurosanbe sanbe

neurobion 5000 mercneurodex

sakaneuron akafarmagenerik

neuromec Sampharindo

Alinamin F TakedaNeurosanbe sanbe

neurobion 5000 mercgenerik

Neurotropic

generikgenerik

Liconam

Page 200: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

generikgenerik

Becom C Sanbe

Becom Zet Sanbe

Calsic-D Sampharindo

Santa E SanbeOriginal E Capri

generik KFNeo K Combi

Formom PyridamLycalvit InterbatEtabion ErritaElkana sanbe

Caviplex erelaProlacta mother novell

Moloco B-12 darya faria

Osteor plus pyridamCartos pryridam

Apyalis LapiVitacur lapiAsedas Pyridam

Hufavit kalk HufaElkana SanbeApyalis Lapi

Cernevit Kalbe

Page 201: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 31 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai1.1 Analgesik Narkotika

Fentanilinjc i.m/I.v 0,05mg/ml

Kodein tabl 10mg tabl 15mg tabl 20mg

Morfininjc i.m/i.v 10mg/ml

Tabl 10mgTabl 30mg

Petidininjc i.m/s.k/i.v 5omg/ml

Sufentanil 125%

1.2 Analgesik Non-NarkotikAsam asetilsalisilat (asetosal) tabl 80mg

tabl 100mg

Asam mefenamat capl 500mg

Fenilbutason tabl 200mg

Ibuprofen tabl 2oomgtabl 2oomgSyrp

Indometasin caps 25mg

Kalium Diklofenac tabl 25mg dan 50 mg

Ketoprofen tabl 100mg, Injc, Sup Supp

Bentuk Sediaan,kekuatan dan kemasan

Page 202: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Tabl 100mg, Injc, Sup

Ketorolac injc 10mg/1ml dan 30mg/1ml

Meloxicam tabl 7,5mg,15mg

Tabl 7,5mg,15mg dan supp

Metampiron tabl 500mg dan Inj

Metamizole sodium injc i.m/ i.v 500mginjc i.m/ i.v 500mg

Natrium diklofenak tabl 25mg dan 50 mg

Paracetamol tabl 500mg

Syr 120/5ml dan drops

Piroksikam tabl 10,gtabl 20mg

Tramadol caps 50mg, Injc

Kombinasi : Tramadol dan Parasetamol

Kombinasi :Antalgin 250mgPyramidon 50mgLidocain HCl 15mg Injc,15ml/ Vial

Tinoridine Hcl

Tambahan :

Page 203: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Antialergi dan obat untuk anafilaksisCetirizin tabl 10mg

Flunarizine Tabl 10mg

Cinnarizine Tabl 10mg

Dexametasone injc 5mg/ml @1ml

tabl 0.5mg

Difenhidramin injc i.m 10mg/mlinjc 15mg/vial

Epinefrin (adrenalin) injc s.k/i.m 0,1% @1ml

Klorfeniramin tabl 4mg

Pheniramine maleat Tabl 4mg

Loratadine tabl 10mg

Loratadine + Pseudoefedrin

Mebhydroline tabl 50mg

Desoksimethasone Krim

Tambahan :

6.2 Antibakteri6.2.1 Beta Laktam

Amoksisilin trihidrat tabl ecored 500mg

Page 204: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

syr kering 125mg/5ml

serb injc 1000mg

Ampisilin kapl 500mg

syr kering 125mg/5ml 60ml

serb injc 1000mgserb inj 250mg

Ampicillin + Sulbactam Serb Injc 500+250mgSerb Injc 750+500

Benzatin benzilpenisilin injc 1.2 juta IU/vial @20mlinjc 2.4 juta IU/vial @20ml

Dikloksasilin kaps 125mgkaps 250mgkaps 500mg

Fenoksimetil penisilin (Penicillin V) tabl 250mgtabl 500mg

Kombinasi Amoksisilin 500mg kapl co Amoxiclav 625mgdan clavulanat 125mg

Syrp kering

Procain benzilpenisilin serb injc i.m 3juta IU/vial

Sefadroksil caps 500mg

sirup kering 125mg/5ml 60ml

Sefaklor caps 500mg

Sefaleksin caps 500mg

Sefazolin injc 1gr

Page 205: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Sefiksim caps 100mg

sirup kering 100mg/5ml

Sefotaksim serb injc 1gr

Seftazidim serb injc 1gr

Seftriakson serb injc 1gr

Sefuroksim serb injc 750mg/vial

Tambahan :

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

Doksisiklin caps 100mg

Oksitetrasiklin salep mata 1%@3.5grsalep kulit 3%@5gr

Page 206: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Tetrasiklin caps 250mgcaps 500mg

6.2.2.2 KloramfenikolKloramfenikol caps 250mg

salep mata 1%@5grsusp 125mg/5ml@60mltetes mata 0,5%@5mltetes telinga 3%@5mlserb injc i.v 1000mg/ml

Tiamfenikol caps 500mg

6.2.2.3 Sulfa - TrimetoprimKotrimoksazol DOEN I(dewasa)kombinasi : tabl kotrimoksazolsulfametoksazol 400mg +trimetoprim 80mgKotrimoksazol DOEN II(pediatrik) kombinasi tabl kotrimoksazol paedsulfametoksazol 200mg +trimetoprim 20mg

Kotrimoksazol suspensikomb : sulfametoksazol syr kotrimoksazol@60ml200mg + trimetoprim 40mg/5ml

Sulfadiazin tabl 500mg

Sulfametoksazol tabl 400mg

Trimetoprim tabl 200mg

6.2.2.4 MakrolitEritrimisin caps 500mg

syr 200mg/5ml

Klindamisin caps 150mg dan 300mg

Linkomisin caps 250mg dan 500mg

Spiramisin tabl 250mg dan 500mg

6.2.2.5 AmiglikosidaGentamisin injc 40mg/ml

injc 80mg/mlsalep kulit 0.1%@5gr

tetes mata 0.3%@5mlsalep mata

Page 207: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Fradiomicin + gramicidinTambahan :

6.2.2.6 KuinolonLevofloksasin tabl 500mg

Levofloksasin

Lart Infus

Ofloksasin tabl 200mg dan 400mg

Siprofloksasin tabl 250mg dan 500mg

tetes mata 0.3%@10mlinfus 2%@100ml

Tambahan :

6.2.2.7 Penggunaan khususSulfasalazin tabl 500mg

Metronidazol tabl 250mgtabl 500mg

sirup

lar infus 5mg/ml@100ml

Tambahan :

Page 208: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.3 Antiinfeksi Khusus6.3.1 Antilepra

Dapson tabl 100mg

Klofazimin (micronized) caps dlm minyak 1oomg

Rifampicin kaps 300mgkaps 450mgkaps 600mg

6.3.2 AntituberkulosisEtambutol tabl 250mg

tabl 500mg

Isoniazid tabl 100mg tabl 300mg

Pirazinamid tabl 500mg

Rifampicin kaps 300mgkaps 450mgkaps 600mg

Streptomicin serb injc 1000mg/vialsarb injc 1500mg/vialserb injc 5000mg/vial

Kombinasi : Rifampicin, INH, Pyrazinamid, Ethambuthol

Tambahan :

10 Darah, Obat yang Mempengaruhi10.1 Antianemi

Asam folat tabl 1mgtabl 5mg

Besi II sulfat (sulfas ferosus) tabl salut 300mg

Sianokobalamin (vit B12) dan injc 500mcg/ml@1mlkombinasinya

Page 209: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Tabl

Tambahan :

10.2 Koagulasi, obat yang mempengaruhi

Asam traneksamat injc 250mg/5ml dan 500 mg

tabl 500mg

Fitomenadion (vit K) tabl salut 10mginjc 10mg/ml

Heparin Na injc i.v/s.k 5000 IU/ml@5mlGel

Protamin sulfat injc 10mg/ml

Warfarin tabl 1mg tabl 2mg

11 Produk Darah dan Pengganti Plasma11.1 Produk Darah

Faktor VII (konsentrat) serb injc 250IU/vialserb injc 250IU/vial

Fraksi protein plasma lar infus kadar protein 5%@250ml(termasuk fibrinogen)

11.2 Pengganti Plasma dan Plasma Expander

Dextran 70 lar infus 6%@500mllar infus 6%@500ml

Hydroxyl ethyl starch lar infus 6%@500mllar infus 6%@500ml

Page 210: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

lar infus 10%@500mllar infus 10%@500ml

14 DiuretikAmilorida tabl 5mg

Furosemida tabl 40mg

injc i.v/i.m 10mg/ml@2ml

Hidroklortiazid (HCT) tabl 25mg

Manitol lar infus 20%@500mllar infus 20%@500ml

Spironolacton tabl 25mg dan 10mg

15.5 KortikosteroidDeksametason injc 5mg/ml @1ml

tabl 0.5mg

Metil prednisolon tabl 4mg, 8mg, 16 mg

injc 125mg/2ml

Prednison tabl 5mg

Tambahan :

16 Kardiovaskuler, Obat16.1 Antiangina

Atenolol tabl 50mg

Page 211: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

tabl 100mg tabl 100mg

Diltiazem HCL tabl 30mg

injc 50mg/amp (hanya untuk kondisi darurat)

injc 50mg/amp

Isosorbit dinitrat tabl sublingual 5mg

injc 10mg/10mlinjc 10mg/10ml

Nitrogliserin injc 1mg/ml

Propanolol tabl 10mg (HCL)tabl 40mg

16.2 AntiaritmiaDisopriramida kaps 100mg (fosfat)

Kuinidin tabl 100mg (sulfat)tabl 200mg (sulfat)

Lisinopril tabl 5mgtabl 5mg

tabl 10mg dan 20 mg

Propanolol tal 10mg, 40mg

Amiodaron HCT Tab 200mg dan Injc

Verapamil tabl 80mg

injc 2,5mg/ml (HCL) @2ml

Tambahan :

Page 212: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

16.3 Lain-lainAmlodipin Besilat tabl 5mg dan 10mg

tabl 5mg

Amlodipin maleat tabl 5mg dan 10mg

Losarartan

Valsartan tabl 80mg dan 160 mg

Tambahan :

16.4 AntihipertensiAtenolol tabl 50mg

tabl 50mg tabl 100mgtabl 100mg

Bisoprolol tabl 5mg

Kaptopril tabl 12,5mgtabl 25mgtabl 5omg

Klonidin tabl 0.15mg injc i.m 0,15mg/ml(HCL)@1ml

Metildopa tabl salut 250mgtabl 250mg

Nifedipin tabl 10mgtabl 10mg

tabl 20mg

tabl 3omg

Ramipril tabl 2,5mgtabl 2,5mg

Page 213: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

tabl 5mgtabl 5mg

Reserpin tabl 0,10mgtabl 0,25mg

16.5 Lain-lain Imidapril tabl 5mg

tabl 10mg

Tetrazosin HCL tabl 1mg

16.6 Antitrombolitik Clopidogrel tabl 75mg

tabl 75mg

16.7 TrombolitikPentoksifilin tabl 400mg

tabl 400mg

Pentoksifilin injc 300mg/15ml injc 300mg/15ml

Streptokinase serb injc 1,5 juta IU/vialserb injc 1,5 juta IU/vial

16.8 Gagal jantung, obatDigoksin tabl 0,25mg

injc 0,25mg/ml

Furosemid tabl 40mg

injc i.v/i.m 10mg/ml@2ml

Tambahan :

16.9 Syok, obat untuk16.9.1 Syok kardiogenik

Dopamin injc 40mg/ml (HCL)

Page 214: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Dobutamin injc 250mg

Epineprin (adrenalin) injc i.v 1% (HCl/bitatrat) @1mlinjc 0,1% (HCl) @1ml

Tambahan :

16.9.2 Syok karena AnestesiEphedrin injc 50mg/ml (HCL)

16.10 AntihiperlipidemiaGemfibrozil kaps 300mg

kaps 600mg

Pravastatin tabl 10mgtabl 20mg

Simvastatin tabl 5mgtabl 10mg

Atorvastatin tab 10mg dan 20mg

Tambahan :

19 Larutan Elektrolit,Nutrisi dan lain-lain 19.1 Oral

Garam oralit Lart

Human Albumin lar infs 20%,btl 50m

lar infs 25% btl 100ml

lar infs 25% btl 20ml

Kalium klorida tabl siap larut 300mgtabl siap larut 600mg

Natrium bikarbonat tabl 500mg

19.2 ParenteralDextran 70 lar infs 6%, btl 500ml

Page 215: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Glukosa lar infs 5%, btl 500ml lar infs 10%, btl 500ml lar infs 40% @25ml lar infs 5%, btl 100mllar infs 5%, btl 1000ml

Kalsium glukonat injc i.v 10%@10ml

Kalium Klorida injc 25ml/vial

Kombinasi infs per liter : lar infs btl 250ml Asam AminoEsensial 18/250ml, lar infs btl 250ml Histidin 69g/250ml

Lar Nutrisi DOEN I, kombinasi :Asam amino 50gr/L lar infs, btl 500ml D-sorbitol 100gr/L lar infs, btl 500ml Asam askorbat 0,4gr/LInositol 0,5gr/LNikotinamida(Niasianida) 0,06gr/LPiridoksin HCL (vit.B6) 0,04gr/LRibloflavin Na-fosfat 2,5mg/mlRutosid (Rutin) 0,4gr/lMineral

Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45% 5%Glukose + 0,45% NaCl -lar infs btl 500ml Infusan D5 + 1/2 Ns

Lar. Nutrisi DOEN V kombinasi :Glukose 2,5%. + NaCl 0,45% 2,5%Dextrose + 0,45%NaCl -lar infs btl 500ml otsu-D2,5 1/2Ns

Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225% 5%Gukose + NaCl 0,225% -lar infs btl 500ml infusan D5 + 1/4 Ns

Natrium bikarbonat injc i.v 8,4% vial 25mlinjc i.v 8,4% vial 25ml

injc i.v 8,4% vial 100ml

Natrium klorida lar infs 0,9% btl 500ml lar infs 0,9% btl 500ml

lar infs 0,9% btl 1000ml lar infs 0,9% btl 1000ml

Ringer laktat lar infs btl 500ml Lar infs btl 500ml

kombinasi:Dextrose 5% + NaCl 0,9%

Page 216: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

-lar infs btl 500ml

kombinasi :NaCl 2,34grKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

kombinasi :NaCL 1,75grKCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

kombinasi :Amino AcidsXylitolVitaminMineral -lar infs btl 500ml

kombinasi :Fruktose 60grGlukose 33grXylitol 30gr lar infs btl 500ml

kombinasi :Na. 100m EQ. K 18m EQCa. 4m EQ. Mg 6m EQ.Cl. 90m EQ. Acetate 38m EQ.Sorbitol 50gr -lar infs btl 500ml

kombinasi :As. Amino Rantai Cabang Kadar TinggiAs. Amino Aromatik Kadar RendahNaCl (tdk ada tirosin) -lar infs btl 500ml

kombinasi :Amino Acids 100mgNitrogen 15,7mgNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

kombinasi :Asam Amino 2,72%Sorbitol 15%

Page 217: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

-lar infs btl 500ml

Kombinasi :Dextrose Anhydrose 100grSodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

-lar infs btl 1000ml

Maltose -lar infs 10% btl 500ml

19.3 Lain-lain Air untuk injeksi vial 25ml

Tambahan :

22 Psikofarmaka22.1 Antiansietas dan Antiinsomnia

Alprazolam tabl 0.25mg

tabl 0,5mg

tabl 1mg

Clobazam tabl 10mg

Diazepam tabl 5mg

tabl 2mg

injc 5mg @2ml

Rectal

22.2 Antidepresi dan AntimaniaAmitriptilin

Litium karbonat tabl 200mg

Klorpromazin HCL tabl salut 25mgtabl salut 100mg

Page 218: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

injc 25mg/ml @2ml

22.3 Antiobsesi KompulsiKlomiparin tabl 25mg(HCL)

22.4 AntipsikosisFlufenazin tabl 2,5mg(HCL)

Haloperidol tabl 0,5mg, 1.5mg, 2mg,5mg

injc 5mg/ml

Klorpromazin tabl salut 25mg (HCl), 100mg

injc 25mg/ml ampl @2ml (HCl)

injc i.m 5mg/ml (HCl) @2ml

Perfenazin tabl 2mg(HCL)tabl 4mgtabl 8mg

Resperidon tabl 1mg, 2mg, 3mg

Trifuoperazin talb 1mg, 5mg

Tambahan :

24 Saluran napas, Obat untuk24.1 Antiasma

Aminofilin tabl scored 150mgtabl scored 200mg injc 24mg/ml @10ml

Deksametason tabl 0,5mginjc i.v 5mg/ml l(sbg natrium fosfat) @1ml

Efedrin tabl 25mg (HCl)

Epinefrin (adrenalin) injc 0,1% (sbg HCl/bitartrat)

Page 219: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Salbutamol tabl 2mg (sbg sulfat)tabl 4mg (sbg sulfat) inh. (aerosol) 100mcg/dosis(sbg sulfat) tbg 200 dosis

nebules 2,5mg

Terbutalin sulfat tabl 2,5mg

syr 1,5mg/5ml @60ml

injc 0,5mg/ml @1ml

Teofilin tabl 150mg

Tambahan :

24.2 AntitusifDekstrometorfan tabl 15mg (HBr)

syr 10mg/5ml (HBr)@60ml

Prometazin tabl 25mg

Kodein tabl 10mg (HCl/fosfat)

Sirop timi majemuk cairan btl 100ml

Tambahan :

24.3 EkspektoranAmbroxol tabl 30mg

syr 15mg/ml @60ml

Bromheksin tabl 8mg

Syrp

Page 220: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Gliseril guaiakolat tabl 100mg

Obat batuk hitam (OBH) syr btl 100mlsyr btl 200ml

Anti Influenza Tab

Syrp dan Drops

kombinasiOxomenazine & guafenezine Syrp Oxomenazine & gg

KombinasiParaset, PPA, CTM, dmp Tabl

Tambahan :

27 Vitamin dan MineralVitamin c dan kombinasi

Vitamin E dan Kombinasi

Vitamin D dan kombinasiGlukosamine dan kondroitin

Curcuma

Page 221: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Ubidecaronate dan levocarnitin

Fitomenadion (Vit K) injc 10mg/mltabl salut gula 10mg

Kalsium glukonat injc 100mg/ml @10ml

Vit B kompleks tabl

Imunomudulator Tabl dan Syrup

Tambahan :

Page 222: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang PabrikHarga

4 5

KF

KF

KF

MST BMF

MST BMF

Aspilet Medi

miniaspi Mersi

Cardioaspirin Bayer

Thromboaspilet Medifarma

Mefinal Sanbe

Argesid Promed

Datan Pyridam

Mefinter Interbat

Lapistan Lapi

Mefix Meproharma

Benostan Bernopharma

Proris Pharos

Bufect Sanbe

Bufect Sanbe

Exaflam Guardian

Eflagen Sanbe

Cataflam Novartis

Kaltrofen Kalbe

Fetik Interbat

Page 223: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Ketros Pharos

Remopain Dexa

Ketopain Soho

Torasic Kalbe

Ketrobat Interbat

Lantipain Landson

Trolac Berno

Toramin Otto

Ketoflam Indopharma

Dolac Ethica

Arimed Promed

Meloxim Interbat

Movix Lapi

Moxam Pharos

Novalgin Novartis

Antrain Interbat

Norages Mepro

Novalgin Novartis

Pragesol Novell

Flamar Sanbe

Dolofenak Merck

Voltaren Novartis

Voltadex Dexamedika

Pamol Interbat

Sanmol Sanbe

Sanmol Sanbe

Pamol Interbat

Sistenol Dexa

Pyridol Pyridam

Tradosik Sanbe

Tramal Pharos

Zaldiar Pharos

Xillomidon Dura

NonFlamin Takeda

Page 224: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Ozen Pharos

Ryzo SohoRyzen UCB Pharma

Unalium Guardian

Vertizin Bernopharma

Kalmethasone Kalbe

Indexon Interbat

Cortidex Sanbe

Kalmethasone Kalbe

Duradryl Dura

Avil Sanofiaventis

Alloris Sanbe

Inclarin Interbat

Clarihis Lapi

Pylor Piridam

Aldisa SR Sanbe

Rhinos SR Dexa

Interhistin interbat

Inerson

Amoxan Sanbe

Intermoxil Interbat

Mestamox Mestika

Lapimox Lapi

Page 225: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Amoxan Sanbe

Opimox Otto

Kalmoxcillin Kalbe

Intermoxyl Interbat

Amobiotic Bernopharma

Sanpicillin Sanbe

Sanpicillin Sanbe

Kalpicillin Kalbe

Viccilin meiji

Picyn Bernopharma

Picyn Bernopharma

Clavamox Kalbe

Claneksi Sanbe

Aclam Lapi

Clabat Interbat

Claneksi Sanbe

PPC Meiji

Pyricef Piridam

Vroxil Promed

Cefat Sanbe

Lapicef Lapi

Ancefa Mepro

Cefat Sanbe

Pyricef Piridam

Chloracef Ethica

Cefabiotik Bernopharma

Page 226: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Cefspan Kalbe

Ceptik Interbat

Sporetik Sanbe

Fixiphar Pharos

Comsporin Combipharma

Cefspan Kalbe

Sporetik Sanbe

Combicef Combipharma

Taxegram Sanbe

Kalfoxim Kalbe

Rycef Interbat

Procefa Promed

Lapixim Lapi

Ethiclaf Ethica

Soclaf Soho

Tirdicef Bernopharma

Efotax Mepro

Extimon Interbat

Zibac Fahrenheit

Zidifec Sanbe

Lacedim Lapi

Sodim Soho

Broadced Kalbe

Tyason Combipharma

Starxon Interbat

Terfacef Sanbe

Bioxon Otto

Cefxon Lapi

Cephaflox Guardian

Criax Mepro

Foricef Promed

Ecotrixon Bernopharma

Intrix Pharos

Oxtercid Interbat

Anbacym Sanbe

Page 227: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Tetrasanbe Sanbe

Erlamcetin Erela

Colsancetin Sanbe

Thiamicim

Biothicol

Comthicol

Sanprima sanbe

Primadex Dexamedica

Sanprima sanbe

Primadex Dexamedica

Erysanbe Sanbe

Erytrin Interbat

Lando Landson

Prolic

Promixin

Varoc

Provamed

Sagestam Sanbe

Sagestam Sanbe

Gentacortin

Page 228: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Fg troches Meiji

Cravit Kalbe

Prolecin Promed

Cravox Lapi

Lekuicin

Lecrav Pyridam

Volquin

Nislev Pharos

Cravit Kalbe

Levores Novellpharma

Tarivid Kalbe

Floksid Promed

Interflox Interbat

Volinol Pyridam

Baquior Sanbe

Quinobioic Pharos

Tequinol Otto

Wiaflox Landson

Sulcolon Berno

Fladex Dexa

Promuba Mepro

Fladex Dexa

Fortagil

Diazol BBMI

Page 229: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Tibigon Hexaparm

Tibitol Mersi

Rimstar Sandoz

Rifastar Indopharma

Natabion Pyridam

Emibion Guardian

Cernevit Kalbe

Neurobat Interbat

Neurosanbe 5000 Sanbe

Biocombin Mepro

Bioneuron Pharos

Page 230: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Neurosanbe 5000 Sanbe

Neurodex dexa

neuraxon Pyridam

Neurobion merck

Neuromed mepro

Kalnex Kalbe

Transamin

Intermic Interbat

Kalnex Kalbe

Transamin

Intermic Interbat

Neo K

Inficlot

Thrombopop Gel

Simarck 2 Fahrenheit

Koate DVI Dipa

Otsutrans 70 Otsu

Widahes Wida

Fima Hes Kalbe

Page 231: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Hestar Claris

Hemohes Bbmi

Farsix Fahrenheit

Naclex Pharos

Lasix Sanofiaventis

Farsix Fahrenheit

Nacclex Pharos

Manitol Kalbe

Manitol Otsu

Spirola Kalbe

Carpiaton Fahrenhait

Letonal Otto

Kalmethasone Kalbe

Indexon Interbat

Cortidex Sanbe

Kalmethasone Kalbe

Hexilon Kalbe

Prolon Promed

Hexilon Kalbe

Betablock Kalbe

Famormin Fahrenhait

Page 232: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Berablok Kalbe

Tensinorm Medikon

Herbeser Tanabe

Herbesser Tanabe

farmabess Fahrenhait

Farsobit Fahrenhait

Cedocard Daryavaria

Isoket Pharos

Cedocard Darya Varia

Interpril Interbat

Noperten Dexa

Interpril Interbat

Noperten Dexa

Tiaryt Fahrenheit

Kendaron Daryavaria

Cordaron

Cardiover Landsond

Page 233: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Amlodipin

Intervask Interbat

Cardisan Sanbe

Tensivask Dexa

Amdixal Sand

Diovan

Betablok Kalbe

Betablok Kalbe

Bisovel Novel

Concor Merck

Catapres Boehringer

Catapres Boehringer

Dopamet Actavis

Farmalat Farenhait

Adalat oros Bayer

Adalat oros Bayer

Cardace Aven

Ramixal Sand

Page 234: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Tanapril Dexa

Ramixal Sand

Tanapres tanabe

Tanapres tanabe

Hytrin Abboth

CPG Kalbe

Vacio Dexa

Reotal Kalbe

Reotal Kalbe

Streptase Dexa

Fargoxin Fahrenhait

Fargoxin Fahrenhait

Farsix Fahrenheit

Naclex Pharos

Lasix Sanofiaventis

Farsix Fahrenheit

Nacclex Pharos

Dopac Kalbe

Cetadop Ethica

Indop Fahrenheit

Page 235: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Cardiject Danpac

Inotrop Fahrenhait

Ethica

Pravinat Interbat

Stator dexa

Renalyt Fahrenheit

Octalbin Kalbe

Cealb Graf

Octalbin Kalbe

Cealb Graf

Plasbumin Dipa

KSR Merck

Page 236: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

D 5% BBMI

D 10% BBMI

D 40% Otsu

Ca Gluconat Ethica

KCl 7,46% Otsu

EAS Pfrimmer Kalbe

Aminofusin

L-601 Kalbe

Wida

Sanbe

Wida

Sanbe

Wida

Sanbe

Meylon Otsu

OGB

Ecosol Bbmi

Na Cl 0,9%

Ecosol Na Cl 0,9%

Bbmi

Ecosol RL Bbmi

D5 NS Otsu

Page 237: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Infusan RD sanbe

KA EN 3A Otsu

Tridex 27A Sanbe

KA EN 3B Otsu

Tridex 27B Sanbe

Aminoleban Otsu

Comafusin

Hepar Kalbe

Tutofusin Kalbe

Tutofusin Kalbe

Aminofusin

Hepar Kalbe

Amiparen Otsu

Kalbamin Kalbe

Pan Amin G Otsu

Page 238: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

KN MG3 otsu

KN MG3 Otsu

Martos Otsu

Water For Injc Otsu

Zypras Kalbe

Zypras Kalbe

Frisium Aven

Valisanbe Sanbe

Valdimex Mersipharma

Valisanbe Sanbe

Valisanbe Sanbe

ValiumStesolid Actavis

Stesolid Actavis

Cepezet Mersi

Page 239: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Cepezet Mersi

Anafranil Novartis

Lodomer Mersi

Cepezet Mersi

Cepezet Mersi

Persidal Mersi

Stelazin Pharos

Page 240: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Ventolin Glaxo

Ventolin Glaxo

Neiret Otto

Tismalin Metiska

Neiret Otto

Neiret Otto

Thebron Interbat

Romilar

Propec

Epexol

Mucohexin Sanbe

Bisolvon

Vectrine Dexa

Page 241: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Nostel Pyridam

Tremenza Sanbe

Trifed

Lapfed Lapi

Rhinos Dexa

Alco Interbat

Comtusi Combi

Oxoril Mepro

Chough en Mestilat

Flutamol Pyridam

Becom C Sanbe

Zegavit

Elkana

Asthin Soho

Lycoxy Dexa

Lanturol Landson

Lesichol Landson

Proxidan Mepro

Caltron Pyridam

Osteor plus

Osteocom Lapi

Ostriol

Risteon

Osteocal Nicolas

Osmin

Biocurliv Soho

Page 242: formularium mawaddah-dH2015

Nama Dagang PabrikHarga

Corsel Fahrenheit

Kavitin Kalbe

Ca Glukonat Ethica

Alinamin F Takeda

Imbost

Imudator

Starmuno Kalbe

Nu fit Guardian

Imunos

Page 243: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 31 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @10ml

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik1 Asam asetilsalisilat Tab 100mg

(asetosal)2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

7 Meloxicam Tab 15mg

Tab 7,5 mg

Bentuk Sediaan,kekuatan dan kemasan

Page 244: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

8 Metampiron Tab 500mg

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

1.3 Antipirai1 Allopurinol Tab 100mg

Page 245: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Antialergi dan obat untuk anafilaksis

1 Dexametasone inj 5mg/ml@1ml

tab 0,5mg

Kombinasi dengan Tabdifenhidramin

2 Difenhidramin Inj 10mg/mlInj 15mg/vial

3 Epinefrin (adrenalin) Inj 0,1%

4 Klorfeniramin Tab 4mg

5 Pheniramine maleat Tab 25mginj.50mg/2ml

6 Loratadine tab 10mg

7 Ceterizin tab 10mg

drops

8 Metil Prednisolon tab 8mg

inj 125mg/ml

9 Ciproheptadin kap 4mg

Page 246: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

10 Mebhidroline Naphadisilat tab 50mg

5 Antiepilepsi - Antikonvulsi

1 Carbamazepin tab 200mg

2 Diazepam rectal 5mg/2,5ml

3 Fenitoin inj 50mg/mlcap 100mg

4 Fenobarbital tab 30mginj 50mg

5 Gabapentin cap 300mg

6.2 Antibakteri

6.2.1 Beta Laktam1 Amoksisilin trihidrat tab 500mg

dry syr 125mg/5ml

drops 100mg/ml

serb inj 1000mg

Page 247: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Ampisilin cap 500mgserb inj 1000mg

3 Ampicillin + Sulbactam serb inj 500+250mg

4 kap 500+125mg

5 Cefadroksil caps 500mg

dry syr 125mg/5ml

6 Sefaklor caps 500mg

7 Sefaleksin caps 500mg

8 Sefiksim caps 100mgdry syr 100mg/5ml

9 Sefotaksim serb inj 1gr

10 Seftazidim serb inj 1gr

11 Seftriakson serb inj 1gr

12 Sephalotin serb inj 1gr

13 Meropenem serb inj 1 gr

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg

3 Tetrasiklin caps 500mg

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg

susp 125mg/5ml

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 248: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Tiamfenikol caps 500mg

dry syr 125mg/5ml

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet

sulfametoksazol 400mg +trimetoprim 80mg

2 sulfa 800mg+ Tablettrimetoprim 160mg

3 Kotrimoksazol suspensi suspkomb : sulfametoksazol200mg + trimetoprim 40mg/5ml

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg

2 Eritromisin caps 500mg

erisanbe chewable

syr 200mg/5ml

3 Spiramisin tab 500mg

4 Azytromicin caps 500mg

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg

lar infus 500mg/100ml

2 Ofloksasin tab 200&400mg

Page 249: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Siprofloksasin tab 500mg

lar infus 500mg/100ml

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg

2 Metronidazol tab 500mg

syr 125mg/5ml

supp 500mg

ovul + nistatin 100000iu

lar infus 500mg/100ml

3 Colistin sulfat Tab 250000 iu

Page 250: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Page 251: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

7 Antimigren

1 Ergotamin cafein tab 1mg

2 kap

3 Piracetam tab 800mg&1200mg

inj 1gr/5ml

inj 3gr/5ml

2 Sitikolin/citikolin tab 500mg

inj 250mg/2ml

3 Pyritinol HCL syr 100ml

Kombinasi paracetamol 300mg, acetosal, cafein

Page 252: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

4 Mecobalamin inj. Amp 500mcgtab 500mg

10 Darah, Obat yang Mempengaruhi

8.1 Antianemi1 Asam folat tab 1mg

2Besi III sulfat (sulfas ferosus)

tab salut 300mg

syr. 50mg/50ml, @150ml

3 Vit B1, B6, B12 tab

inj. Amp 3ml

8.2 Koagulasi, obat yang mempengaruhi

1 Asam traneksamat inj 250mg/5ml

tab 500mg

2 Fitomenadion (vit K) tab salut 10mg, kalenginj 10mg/ml

3 Heparin Na gel

Page 253: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

4 Lidocain inj 2%Anti Alergi dan Obat untuk Anafilaksis

1 Dexametasone inj 5mg/ml@1ml

tab 0,5mg

Kombinasi dengan Tabdifenhidramin

2 Difenhidramin Inj 10mg/mlInj 15mg/vial

3 Epinefrin (adrenalin) Inj 0,1%

4 Klorfeniramin Tab 4mg

5 Pheniramine maleat Tab 25mginj.50mg/2ml

6 Loratadine tab 10mg

23

7 Ceterizin tab 10mg

drops

8 Metil Prednisolon tab 8mg

inj 125mg/ml

9 Ciproheptadin kap 4mg

10 Mebhidroline Naphadisilat tab 50mg

19. saluran c cerna DAN OBAT UNTUK

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombinasi : tab

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

Page 254: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 200mg/5ml

3 Famotidin tab 20mg

4 Lanzoprazol caps 30mg

5 Omeprazol caps 20mginj.

6 Ranitidin tab 150mg

inj 25mg/2ml

7 Simetidin tab 200mginj. 200mg,amp

8 Sulkrafat tab 500mgsyr 100ml

9 Polymigel tab

19.2 Enzim1 Pankreatin,diastease kap

2 kombinasi : pankreatin kapdiastase, cimetikon

3 Pankreatin,activated kapletdimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat tab 6mg

Page 255: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Dimenhidrinat tab 50mg

3 Loperamid tab 2mg

4 Metoklopramid tab 5mg

inj 5mg/ml

5 Ondansetron inj 4mg/2ml

tab 4mg

6 Domperidon tab 1mg

syr 5mg/5ml

7 Chlordiazepoxid 5mg+ tabdclonidium 2,5mg

8 Pantoprazol inj inj 40mg

9 Pyratiazine chloroteo- tabletphylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : kapsul 100mg

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mg Suppheksaklorofen

3 Lidocain HCl +Al subacetathidrocortison acetat, ointmenZinc oxide

27 4 Lithospermi radix, prednisolon,lidocain,benzocain,cetrimide ointmen

Page 256: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

19.4 Antispasmodik1 Atropin Sulfat inj. 0,25mg/ml @iml

2 Hyoscine-N-butil bromide tab. 10mgSpasminal (+methampiron)

inj 20mg/mL

3 Papaverin tab 40mginj im 40mg/ml

19.5 Diare, obat untuk1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr +trinatrium sitrat dihidrat 0,58gr +glukosa anhidrat 4gr

2 Kombinasi : tabKaolin 550mg + susppectin 200mg

3 Lactobacillus serbuk

Cap

4 Zinc serbuk/sachettablet

19.6 Kataritik1 Bisakodil supp 5mg

supp 10mg

tab 5mg

2 GliserinKombinasi : susp botol 60mlParafin + Glicerin + cairan supp.fenolftalen

22 3 Lactulosa syr

Page 257: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

4 Fosfosoda susp

19.7 Antiinflamasi, obat untuk1 Sulfasalazin tablet 500mg

Page 258: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Page 259: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang Pabrik

4 5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

generikosteloc sanbegenerik

Page 260: formularium mawaddah-dH2015

Nama Dagang Pabrik

AntalginAnalsik Sanbe

(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

Xillomidon Dura

generikRinolic GMPAlluric Kalbefarma

Page 261: formularium mawaddah-dH2015

Nama Dagang Pabrik

Kalmethasone HexapharmaIndexon InterbatCortidex Sanbe

Kalmethasone HexapharmaScandexon Tempo

Carbidu Sampharindo

Mexon sampharindo

generikDuradryl Dura

Generik

pehachlor

avil sanofiavil sanofi

generikclarihis lapi

Zenris Pyridamgenerik

Tiriz Lapi

generikLameson lapiLameson lapigenerik

Pronicy Kalbe

Page 262: formularium mawaddah-dH2015

Nama Dagang Pabrik

interhistin interbat

generik

Stesolid Actavis

generikKutoin mersifarma

generik KFPhental iv Combi

Gabexal Sandozgeneric

Amoxan SanbeZemoxil Zenith

Brodamox Sampharindo

Amoxan SanbeZemoxil ZenithAmoxan Sanbe

Amoxan Sanbe

Page 263: formularium mawaddah-dH2015

Nama Dagang Pabrik

Brodapen SampharindoViccilin Meiji

Pycin 750 Berno

co amoxiclavclanexi sanbe

Pyricef Piridamgenerik

Pyricef Piridamgenerik

Capabiotik Yarindo

Cefabiotic Berno

Cefila lapiCefila lapi

generikTaxegram Sanbe

lapixim lapi

Yadim Yarindo

generikcephaflox guardian

Moraxine Yarindo

Meropex Bernogenerik

generikdoxacin otto

Suprabiotik Zenith

Lanacetin landsencoromycetin coronetcrown

Page 264: formularium mawaddah-dH2015

Nama Dagang Pabrik

Promixin PyridamDexicol Dexa

Phenobiotic BernoBiothicol Sanbe

Sanprima Sanbemiratrim sampharindo

Lapikot forte LapiPrimadex forte Dexamedika

Sanprima SanbePrimadex DexamedicaMiratrim Sampharindo

generik

generikerisanbe sanbe

erisanbe chewable sanbe

generik

generikvaroc pyridam

zibramax guardiangenerik

Sagestam Sanbe

Cravox Lapigenerik

generikCravox Lapi

generik

Page 265: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikBaquior forte sanbe

Lapiflox Lapi

generikLapiflox inf Lapi

Sulcolon Berno

Metrolet HarsenTrychodazole Sanbe

Metrolet Harsenpromuba mepro

Flagyl Sanovi

Vagistin Combiphar

Trychodazole Sanbegeneric

Colistine Actavis

Page 266: formularium mawaddah-dH2015

Nama Dagang Pabrik

Page 267: formularium mawaddah-dH2015

Nama Dagang Pabrik

generik

Nogren Pyridam

generiklatropril Lapigenerik

Neurotam kalbegenerik

Neociti Lapi

Nicholin TakedaNeociti Lapi

Encephabol Merck

Page 268: formularium mawaddah-dH2015

Nama Dagang Pabrik

Kalmeco KalbefarmaKalmeco Kalbefarma

Folacom combi

Natabion PyridamArtoferumMaltofer Combi

Neurobion 5000 MercNeurobat Interbat

Neurosanbe SanbeNeurodex dexamedika

Sakaneuron sakafarma

Neurosanbe 5000 SanbeNeurobion 5000 merck

Kalnex KalbeTransamin Otto/daichi

Transamin Otto/Daichi

generikNeo K Combi

Thrombopop Gel tunggal idaman

Page 269: formularium mawaddah-dH2015

Nama Dagang Pabrik

Antithromb Mecosin

generic Bernofafm

Kalmethasone HexapharmaIndexon InterbatCortidex Sanbe

Kalmethasone HexapharmaScandexon Tempo

Carbidu Sampharindo

Mexon sampharindo

generikDuradryl Dura

Generik

pehachlor

avil sanofiavil sanofi

generikclarihis lapi

Zenris Pyridamgenerik

Tiriz Lapi

generikLameson lapiLameson lapigenerik

Pronicy Kalbe

interhistin interbat

generikSanmag (+dzp 2mg) Sanbe

Page 270: formularium mawaddah-dH2015

Nama Dagang Pabrik

MagtralStomacain Combiphar

Mylacid EmbaBufantacyd Bufa(+cimeticon)

Carsida Sampharindo

generik

generik

generikOMZ Ferron

generikAcran sanbe

generikIndoran IndofarmaAcran sanbe

generikUlsikur Hexapharma

Ulsafate CombipharPropepsa Gracia

Srocain-P Eisai

lybrozim

lybrozim plus

Tripanzym Sanbe

Mertigo DexaMerislon Mersi

Page 271: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikMantino samparindo

lopamid HarsenLodia Sanbe

Nilatika sampharindoDamaben Capri

Tomit interbatDamaben Capri

generikODR Lapi

Insetron Indofarmavometraz Dexamedika

generikDom Lapi

Omedon MutifaDom Lapi

Omedon mutifagenerik

Braxidin Sanbe

Topazole Lapi

Anvomer B6 Dexamedika

Lanaven Lansond

generik

Haemocain Gelenium

Borraginol S Takeda

Page 272: formularium mawaddah-dH2015

Nama Dagang Pabrik

Atropin Ethica

Spasminal (+methampiron)Buscopan Boehringer

Gitas Interbat

generikgenerik

Oralit OGB

Corosorb CoronetcrownNovadiar CorsaOmegdiar

L-bio LapiLacto B pharosLacidofil DexaLacbon Pharmasolindo

OrezincZincare Kalbe

Dulcolax Paed Boehringer

Dulcolax Paed Boehringer

Dulcolax Paed Boehringer

Laxadine Geleniumfleet enema combiphar

Lactulax Ikapharmindo

Page 273: formularium mawaddah-dH2015

Nama Dagang Pabrik

Fleet Fosfosoda Combi

Sulcolon Bernofarm

Page 274: formularium mawaddah-dH2015

Nama Dagang Pabrik

Page 275: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 3

c Analgesik, Antipiretik, Antiinflamasi NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @10ml

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik

1 Asam asetilsalisilat Tab 100mg(asetosal)

2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

7 Meloxicam Tab 15mg

Tab 7,5 mg

Bentuk Sediaan,kekuatan dan kemasan

Page 276: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

8 Metampiron Tab 500mg

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

6.2 Antibakteri

6.2.1 Beta Laktam1 Amoksisilin trihidrat tab 500mg

dry syr 125mg/5ml

drops 100mg/ml

Page 277: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

serb inj 1000mg

2 Ampisilin cap 500mgserb inj 1000mg

3 Ampicillin + Sulbactam serb inj 500+250mg

4 kap 500+125mg

5 Cefadroksil caps 500mg

dry syr 125mg/5ml

6 Sefaklor caps 500mg

7 Sefaleksin caps 500mg

8 Sefiksim caps 100mgdry syr 100mg/5ml

9 Sefotaksim serb inj 1gr

10 Seftazidim serb inj 1gr

11 Seftriakson serb inj 1gr

12 Sephalotin serb inj 1gr

13 Meropenem serb inj 1 gr

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg

3 Tetrasiklin caps 500mg

6.2.2.2 Kloramfenikol

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 278: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

1 Kloramfenikol caps 250mgsusp 125mg/5ml

2 Tiamfenikol caps 500mg

dry syr 125mg/5ml

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet

sulfametoksazol 400mg +trimetoprim 80mg

2 sulfa 800mg+ Tablettrimetoprim 160mg

3 Kotrimoksazol suspensi suspkomb : sulfametoksazol200mg + trimetoprim 40mg/5ml

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg

2 Eritromisin caps 500mg

erisanbe chewable

syr 200mg/5ml

3 Spiramisin tab 500mg

4 Azytromicin caps 500mg

6.2.2.5 Amiglikosida1 Gentamisin inj 40mg/ml

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg

lar infus 500mg/100ml

Page 279: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Ofloksasin tab 200&400mg

3 Siprofloksasin tab 500mg

lar infus 500mg/100ml

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg

2 Metronidazol tab 500mg

syr 125mg/5ml

supp 500mg

ovul + nistatin 100000iu

lar infus 500mg/100ml

3 Colistin sulfat Tab 250000 iu

10 Darah, Obat yang Mempengaruhi

8.1 Antianemi1 Asam folat tab 1mg

2Besi III sulfat (sulfas ferosus)

tab salut 300mg

syr. 50mg/50ml, @150ml

3 Vit B1, B6, B12 tab

Page 280: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

inj. Amp 3ml

8.2 Koagulasi, obat yang mempengaruhi

1 Asam traneksamat inj 250mg/5ml

tab 500mg

2 Fitomenadion (vit K) tab salut 10mg, kalenginj 10mg/ml

3 Heparin Na gel

4 Lidocain inj 2%

13 Kulit, obat topikal untuk

13.1. Antibakteri1 Framisetin casa steril 1%

2 Natrium fusidat cream 20mg/gr

3 Perak sulfadiazin cream 1%

4 Gentamisin sulfat cream 1mg/gr

5 Gentian violet lar 1% larutan 1%

6 neomycin sulfat + creamfluocinolon acetonide

7 Chloramphenicol+ creamhidrocortison

13.2 Antifungi1 Ketokonazol cream

2 Miconazol cream 2%

3 Nystatin,zinc oxide cream

Page 281: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

4 Gentian Violet larutan 1%

13.4 Antiinflamasi dan Antipruritik1 Betametason cream

cream + neomycincream + miconazole

2 Clobetasol cream 0,05%

3 Desoksimetason cream 0,25%

4 Hidrokortison cream 2,5%

5 Triamsinolon cream oral base

13.5 Antiskabies dan antipedikulosis 1 Lindane 1%, cream

ursic acid 1%

13.6 Keratolitik dan keratoplastik1 Urea cream 20%

13.7 Extrac placentagel 10gr

13.8 Hyaluronic acid cream 15gr

13.9 Lain-lain1 Centella asiatica phytosom

& vit E cream

2 Asam sulfonat+ solution 10mlformaldehid

3 Herbal ointment cream

15.2 Parenteral1 Plasme expander lar infus 6%, botol 500ml

(HES)

Page 282: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Glukosa lar infus 5%, botol 500mllar infus 10%, botol 500mllar infus 40%, botol 25ml

3 Kalsium glukonat inj 10% @10ml

4 Kalium Klorida inj 25ml/vial

5 Human Albumin lar infus 20 % @50ml(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi: Glukose 5%. + NaCl 0,45% -lar infs btl 500ml Wida D5 1/2 NS

9 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225% -lar infs btl 500ml

10 Natrium bikarbonat lar inf 25Meq, 25mL

11 Natrium klorida 0,9%lar inf. 500ml

lar.inf 100ml

12 Ringer laktat

13 kombinasi:Dextrose 5% + NaCl 0,9% -lar infs btl 500ml

14 kombinasi :Nacl 0,18 % b/v Otsu D10 1/5 NSglukosa 10 % -lar infs btl 500ml

15 kombinasi :NaCl 2,34grKCl 0.75grNa Lactate 2,24grDextrose anhydrat 27gr -lar infs btl 500ml

16 kombinasi :NaCL 1,75gr

Page 283: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

KCl 1,5grNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

17 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml

18 Kombinasi :Glukosa 12,5 gNaCl 1 gKCl 0,65 gNa Lactat 1,55 g

19 kombinasi :Amino Acids 100mgNitrogen 15,7mgNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

20 kombinasi :Asam Amino 2,72%Sorbitol 15% -lar infs btl 500ml

21 Kombinasi :Dextrose Anhydrose 100grSodium Chlorid 1,75grPotasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi

23 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus1 Antasida DOEN I kombinasi : tab

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

Page 284: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Antasida DOEN II susp, kombinasi :Al (OH)3 200mg/5ml + Mg (OH)2 200mg/5ml

3 Famotidin tab 20mg

4 Lanzoprazol caps 30mg

5 Omeprazol caps 20mginj.

6 Ranitidin tab 150mg

inj 25mg/2ml

7 Simetidin tab 200mginj. 200mg,amp

8 Sulkrafat tab 500mgsyr 100ml

9 Polymigel tab

19.2 Enzim1 Pankreatin,diastease kap

2 kombinasi : pankreatin kapdiastase, cimetikon

3 Pankreatin,activated kapletdimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat tab 6mg

2 Dimenhidrinat tab 50mg

Page 285: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

3 Loperamid tab 2mg

4 Metoklopramid tab 5mg

inj 5mg/ml

5 Ondansetron inj 4mg/2ml

tab 4mg

6 Domperidon tab 1mg

syr 5mg/5ml

7 Chlordiazepoxid 5mg+ tabdclonidium 2,5mg

8 Pantoprazol inj inj 40mg

9 Pyratiazine chloroteo- tabletphylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : kapsul 100mg

Soybean purified extract

2 Antihemoroid kombinasi :bismutsubgalat150mg Suppheksaklorofen

3 Lidocain HCl +Al subacetathidrocortison acetat, ointmenZinc oxide

4 Lithospermi radix, prednisolon,lidocain,benzocain,cetrimide ointmen

19.4 Antispasmodik

Page 286: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

1 Atropin Sulfat inj. 0,25mg/ml @iml

2 Hyoscine-N-butil bromide tab. 10mgSpasminal (+methampiron)

inj 20mg/mL

3 Papaverin tab 40mginj im 40mg/ml

19.6 Kataritik1 Bis supp 5mg Dulcolax Paed

supp 10mg Dulcolax Paed

tab 5mg Dulcolax Paed

2 GliserinKomsusp botol 60ml LaxadineParacairan supp. fleet enemafenolftalen

3 Lacsyr Lactulax

4 Fossusp Fleet Fosfosoda

19.7 Antiinflamasi, obat untuk1 Sul tablet 500mg Sulcolon

20 Saluran Kencing dan Prostat, obat yang mempengaruhi20.1 Saluran kencing

tetes

Caps20.2 Renal insufisiensi

1 Kap 650mgL-tyrosin,L-lysin,dst

2 valeric acid, butiric acid, Tablycin monoacetat, tryptopan,tyrosin, histidin

20.3 Prostat (anti BPH)

α ketoisoleusin, L-hitidin

Page 287: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

1 Finasteride tab 5mg

24 Vitamin dan Mineral1 Asam Folat tab 1mg

2 Calcitriol Tab 0,25mcg

3 Calsium lactat Kap

4 Ca laktat,Ca phospat, Kap vit C, vit D Syr

5 Ca glukonas inj 100mg/ml

6 Vitamin A sugar coated 6000IUsugar coated 20000IUinj. Im. Amp

7 Vit B kompleks Tab

tab, kaleng

tab, + methampiron

inj. Amp

inj im, vial

8 Vitamin B1 Tab, kalenginj. Amp

9 Vitamin B6 Tab, kaleng

10 Vitamin C dan kombinasi- Vit C tab, kaleng

inj, amp 200mg

- B1,B2,B6,B12,vit C500mg kaps

Page 288: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

Ca pantotenat 20mg- vit C 750mg,vit E30iu, B1, kaps B2,B6,B12, as folat,Zn, niacin

11 Vitamin D +calsium Kap

12 Vitamin E dan Kombinasi Kapl 100 IU

13 Vitamin K tab salut gula 10mginj 10mg/ml

14 Vitamin Ibu Hamil dan MenyusuiKap.

15 Glukosamine dan KapletEfferfescen

16 Multivitamin Anak syr

Drop

17 Multivitamin inj inj, vial(vit A,B,C,D, lecitin)

25 Suplemen dan terapi Adjuvan lain1 Astaxantin caps

2 Echinacea, Zn,Se,vit c kapsyr

2 Extrac curcuma sugar coated tab

Page 289: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang Pabrik

4 5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

generikosteloc sanbegenerik

Page 290: formularium mawaddah-dH2015

Nama Dagang Pabrik

AntalginAnalsik Sanbe

(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

Xillomidon Dura

Amoxan SanbeZemoxil Zenith

Brodamox Sampharindo

Amoxan SanbeZemoxil ZenithAmoxan Sanbe

Page 291: formularium mawaddah-dH2015

Nama Dagang Pabrik

Amoxan Sanbe

Brodapen SampharindoViccilin Meiji

Pycin 750 Berno

co amoxiclavclanexi sanbe

Pyricef Piridamgenerik

Pyricef Piridamgenerik

Capabiotik Yarindo

Cefabiotic Berno

Cefila lapiCefila lapi

generikTaxegram Sanbe

lapixim lapi

Yadim Yarindo

generikcephaflox guardian

Moraxine Yarindo

Meropex Bernogenerik

generikdoxacin otto

Suprabiotik Zenith

Page 292: formularium mawaddah-dH2015

Nama Dagang Pabrik

Lanacetin landsencoromycetin coronetcrown

Promixin PyridamDexicol Dexa

Phenobiotic BernoBiothicol Sanbe

Sanprima Sanbemiratrim sampharindo

Lapikot forte LapiPrimadex forte Dexamedika

Sanprima SanbePrimadex DexamedicaMiratrim Sampharindo

generik

generikerisanbe sanbe

erisanbe chewable sanbe

generik

generikvaroc pyridam

zibramax guardiangenerik

Sagestam Sanbe

Cravox Lapigenerik

generik

Page 293: formularium mawaddah-dH2015

Nama Dagang Pabrik

Cravox Lapi

generik

generikBaquior forte sanbe

Lapiflox Lapi

generikLapiflox inf Lapi

Sulcolon Berno

Metrolet HarsenTrychodazole Sanbe

Metrolet Harsenpromuba mepro

Flagyl Sanovi

Vagistin Combiphar

Trychodazole Sanbegeneric

Colistine Actavis

Folacom combi

Natabion PyridamArtoferumMaltofer Combi

Neurobion 5000 MercNeurobat Interbat

Neurosanbe SanbeNeurodex dexamedika

Sakaneuron sakafarma

Page 294: formularium mawaddah-dH2015

Nama Dagang Pabrik

Neurosanbe 5000 SanbeNeurobion 5000 merck

Kalnex KalbeTransamin Otto/daichi

Transamin Otto/Daichi

generikNeo K Combi

Thrombopop Geltunggal idamanAntithromb Mecosin

generic Bernofafm

sofratulle Sanovi

Fuson Pyridam

Burnazin Darya

generiksagestam sanbeGenoint erela

Genoint erela

Ociderm-N Pyridam

Chloramphecort KF

Mycoderm Otto

generikdactarin powder

Myco-z taisho

Page 295: formularium mawaddah-dH2015

Nama Dagang Pabrik

Betason cream KFBenoson Berno

Benoson N BernoBenoson M Berno

Kloderma SDM

Pyderma Pyridam

generik

Kanalog Taiso

Scabicid KF

Moistderm interbat

Bioplacenton KalbeBismecon Mecosin

Bionect Combiphar

Lanakeloid Landson

Albothyl Pharos

Meibo Combi

Wida HES 130 WidatraWida HES 200 WidatraTetra HES 130 Claris

Page 296: formularium mawaddah-dH2015

Nama Dagang Pabrik

D 5% otsu, widatraD 10% otsu,widatraD 40% Otsu

Ca Gluconat Ethica

KCl 7,46% Otsu

Octalbin Kalbe

Wida D5 1/2 NS Widatra

Wida D5 1/4 NS Widatra

Meylon Otsu

Wida NS WidatraOtsu NS Otsu

Otsu NS pegy Otsu

RL Widatra

D5 NS OtsuInfusan RD5% Widatra

Otsu D10 1/5 NS Otsu

KA EN 3A Otsu

KA EN 3B Otsu

Page 297: formularium mawaddah-dH2015

Nama Dagang Pabrik

KA EN 1B Otsu

Wida 1/2 DaD Widatra

Kalbamin Kalbe

Pan Amin G Otsu

KA EN MG3 otsu

Water For Injc Otsu

generikSanmag (+dzp 2mg) Sanbe

Magtral

Page 298: formularium mawaddah-dH2015

Nama Dagang Pabrik

Stomacain Combiphar

Mylacid EmbaBufantacyd Bufa(+cimeticon)

Carsida Sampharindo

generik

generik

generikOMZ Ferron

generikAcran sanbe

generikIndoran IndofarmaAcran sanbe

generikUlsikur Hexapharma

Ulsafate CombipharPropepsa Gracia

Srocain-P Eisai

lybrozim

lybrozim plus

Tripanzym Sanbe

Mertigo DexaMerislon Mersi

generik

Page 299: formularium mawaddah-dH2015

Nama Dagang Pabrik

Mantino samparindo

lopamid HarsenLodia Sanbe

Nilatika sampharindoDamaben Capri

Tomit interbatDamaben Capri

generikODR Lapi

Insetron Indofarmavometraz Dexamedika

generikDom Lapi

Omedon MutifaDom Lapi

Omedon mutifagenerik

Braxidin Sanbe

Topazole Lapi

Anvomer B6 Dexamedika

Lanaven Lansond

generik

Haemocain Gelenium

Borraginol S Takeda

Page 300: formularium mawaddah-dH2015

Nama Dagang Pabrik

Atropin Ethica

Spasminal (+methampiron)Buscopan Boehringer

Gitas Interbat

generikgenerik

Boehringer

Boehringer

Boehringer

Geleniumcombiphar

Ikapharmindo

Combi

Bernofarm

Kalkurenal darya faiaBatugin elixir KF

Nefrolit

Tonar Sandoz

Prorenal Novell

Page 301: formularium mawaddah-dH2015

Nama Dagang Pabrik

Prostide Pharos

Folacom Combi

Osteofem Kalbe

Caltron PyridamKalk KF

Calsifar Ifars

Elkana SanbeElkana Sanbe

Ca glukonat Ethica

generik KFgenerik KFgenerik

Alinamin F TakedaNeurosanbe sanbe

neurobion 5000 mercneurodex

sakaneuron akafarmagenerik

neuromec Sampharindo

Alinamin F TakedaNeurosanbe sanbe

neurobion 5000 mercgenerik

Neurotropic

generikgenerik

Liconam

generikgenerik

Becom C Sanbe

Page 302: formularium mawaddah-dH2015

Nama Dagang Pabrik

Becom Zet Sanbe

Calsic-D Sampharindo

Santa E SanbeOriginal E Capri

generik KFNeo K Combi

Formom PyridamLycalvit InterbatEtabion ErritaElkana sanbe

Caviplex erelaProlacta mother novell

Moloco B-12 darya faria

Osteor plus pyridamCartos pryridam

Apyalis LapiVitacur lapiAsedas Pyridam

Hufavit kalk HufaElkana SanbeApyalis Lapi

Cernevit Kalbe

Axanthin Ethica

Imunos lapiStimuno Pyridam

Curcuma soho

Page 303: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

NO N A M A O B A T

1 2 31 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika1 Kodein Tab 10mg, kaleng

2 Fentanyl inj. 50 mcg/ml @10ml

2 Morphin HCl Tab, 10 mgInj. 10 mg/ml

3 Petidin injc i.m/s.k/i.v 50mg/ml

1.2 Analgesik Non-Narkotik1 Asam asetilsalisilat Tab 100mg

(asetosal)2 Asam mefenamat Tab 500 mg

3 Ibuprofen Tab 200mg

syr.100mg/5mlSupp. 125 mg

4 Kalium Diklofenac tab 50mg,25mgtab 50mg

5 Ketoprofen Supp 100mgTab 100mg

6 Ketorolac inj. 30mg/ml

7 Meloxicam Tab 15mg

Tab 7,5 mg

Bentuk Sediaan,kekuatan dan kemasan

Page 304: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

8 Metampiron Tab 500mg

9 Metamizole sodium Tablet 500mgInjc. 500mg/ml@2ml

10 Natrium diklofenak Tab 50mgTab 25 mggel

11 Paracetamol Tab 500mg

Syr 120mg/5ml

drop 60mg/0,6mlSupp 240mgSupp 160mg

12 Piroksikam tab 20 mggel

13 Tinoridine HCl tab 50 mg

14 Tramadol inj 50mg/mltab 37,5mg+paracetamol 32,5mg

15 Kombinasi :Antalgin 250mg inj 15ml/vialPyramidon 50mgLidocain HCl 15mg

1.3 Antipirai1 Allopurinol Tab 100mg

2 Anestetik

2.1 Anestetik Lokal1 Bupivacain HCl inj 5mg+ dextrose80mg

amp, 4ml

Page 305: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

2 Etil klorida spray, botol 100ml

3 Lidokain inj 2%inj 2% (HCl)+epinefrin 1:80000inj 2%+dextrosa 5%

2.2 Anastetik Umum dan Oksigen1 Halotan cairan inhalasi

250ml

2 isoflurane cairan inhalasi

3 Ketamin inj iv 100mg/ml@20ml

4 Nitrogen Oksigen gas tabung 15kg

5 Oksigen gas dlm tabung

6 Propofol inj 10mg/ml, amp20ml

2.3 Prosedur Peri Operatif, Obat untuk1 Atropin sulfat inj 0,25mg/ml@1ml

2 Diazepam tab 5mgtab 2mginj 5mg/ml

rectal 5mg/2,5ml

3 Midazolam inj 5mg/5mlinj 15mg/3ml

6.2 Antibakteri

6.1 Antelmintik6.1.1 Antelmintik Intestinal

1 Pirantel tab 125mgsusp 125mg/5ml

6.2 Antibakteri6.2.1 Beta Laktam

Page 306: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

1 Amoksisilin trihidrat tab 500mg

dry syr 125mg/5ml

drops 100mg/ml

serb inj 1000mg

2 Ampisilin cap 500mgserb inj 1000mg

3 Ampicillin + Sulbactam serb inj 500+250mg

4 kap 500+125mg

5 Cefadroksil caps 500mg

dry syr 125mg/5ml

6 Sefaklor caps 500mg

7 Sefaleksin caps 500mg

8 Sefiksim caps 100mgdry syr 100mg/5ml

9 Sefotaksim serb inj 1gr

10 Seftazidim serb inj 1gr

11 Seftriakson serb inj 1gr

12 Sephalotin serb inj 1gr

13 Meropenem serb inj 1 gr

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 307: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin

1 Doksisiklin caps 100mg

3 Tetrasiklin caps 500mg

6.2.2.2 Kloramfenikol1 Kloramfenikol caps 250mg

susp 125mg/5ml

2 Tiamfenikol caps 500mg

dry syr 125mg/5ml

6.2.2.3 Sulfa - Trimetoprim1 (dewasa)kombinasi : Tablet

sulfametoksazol 400mg +trimetoprim 80mg

2 sulfa 800mg+ Tablettrimetoprim 160mg

3 Kotrimoksazol suspensi suspkomb : sulfametoksazol200mg + trimetoprim 40mg/5ml

6.2.2.4 Makrolit1 Clindamisin caps 150mg & 300mg

2 Eritromisin caps 500mg

syr 200mg/5ml

3 Spiramisin tab 500mg

4 Azytromicin caps 500mg

6.2.2.5 Amiglikosida

Page 308: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

1 Gentamisin inj 40mg/ml

6.2.2.6 Kuinolon1 Levofloksasin tab 500mg

lar infus 500mg/100ml

2 Ofloksasin tab 200&400mg

3 Siprofloksasin tab 500mg

lar infus 500mg/100ml

6.2.2.7 Penggunaan khusus1 Sulfasalazin tab 500mg

2 Metronidazol tab 500mg

syr 125mg/5ml

supp 500mg

ovul + nistatin 100000iu

lar infus 500mg/100ml

3 Colistin sulfat Tab 250000 iu

6.3 Antiinfeksi Khusus6.3.1 Antituberkulosis

1 Etambutol tab 500mg

2 Isoniazid tab 300mg

3 Pirazinamid tab 500mg

4 Rifampicin caps 450mg

Page 309: formularium mawaddah-dH2015

NO N A M A O B A T Bentuk Sediaan,kekuatan dan kemasan

5 Kombinasi (OAT TB dots):untuk dewasa kap : INH 75,Rifam 150,

Pza 400, ethambutol 275

kap: INH 150, Rifam 150

untuk pediatri INH100, rifam75,Pza200

INH 100, Rifam 75

6 Kombinasi : Ethambutol, INH, B6 caps

7 INH50+Rifam75+PZA150 caps8 INH50+ Rifam75

6.3 Antifungi1 Itrakonazol caps 100mg

2 Ketokonazol tab 200mg

3 Mikonazol cream

4 Nistatin ovul + metronidazol

drops

6.5 Antimalaria1 Sulfadoxin 500mg, tab

primetamin 25 mg

6.6 Antivirus6.6.1 Antiherpes

1 Asiklovir tab 200mgtab 400mgcream 5%

Page 310: formularium mawaddah-dH2015

PERENCANAAN PENGADAAN OBAT FORMULARIUM

RSUD PROF DR SOEKANDAR KAB. MOJOKERTOTAHUN 2009

Nama Dagang Pabrik

4 5

generik KF

Fentanyl janssen-cilag

MST Mahakamgenerik KF

KF

Aspilet Medifarma

Mefinal SanbeCargesic SanprimaOpistan OttoPondex Dexa

generikProris PharosProris PharosProris Pharos

Exaflam GuardianX-flam Combiphar

Kaltrofen KalbePronalges pharosKaltrofen kalbe

generiktrolac inj Berno

generikosteloc sanbegenerik

Page 311: formularium mawaddah-dH2015

Nama Dagang Pabrik

AntalginAnalsik Sanbe

(+Dzp 2mg)

AntalginNorages MeproNovalgin Sanovi-aventis

Voltadex DexamedikaRenadinac FahrenheitScantaren Scanpasific

Mirasic SanprimaSanmol SanbeSanmol SanbePyridol PyridamMirasic Sanprima

Sanmol drops sanbePropyretic 240 CombiPropyretic 160 Combi

generikPirofel Sanbe

Nonflamin Takeda

generikPatral mahakam

Xillomidon Dura

generikRinolic GMPAlluric Kalbefarma

Regivell Novell

Page 312: formularium mawaddah-dH2015

Nama Dagang Pabrik

lidocainPehacain Phapros

Lidodex Berno

Halotan Dexa

isofluran Dexa

KetaminKTM Guardian

Safol Novell

sulfas atropin ethica

Valisanbe SanbeValisanbe SanbeValisanbe Sanbe

Stesolid Actavis

Dormicum RocheDormicum Roche

PyrantinCombantrin Pfizer

Page 313: formularium mawaddah-dH2015

Nama Dagang Pabrik

Amoxan SanbeZemoxil Zenith

Brodamox Sampharindo

Amoxan SanbeZemoxil ZenithAmoxan Sanbe

Amoxan Sanbe

Brodapen SampharindoViccilin Meiji

Pycin 750 Berno

co amoxiclavclanexi sanbe

Pyricef Piridamgenerik

Pyricef Piridamgenerik

Capabiotik Yarindo

Cefabiotic Berno

Cefila lapiCefila lapi

generikTaxegram Sanbe

lapixim lapi

Yadim Yarindo

generikcephaflox guardian

Moraxine Yarindo

Meropex Bernogenerik

Page 314: formularium mawaddah-dH2015

Nama Dagang Pabrik

generikdoxacin otto

Suprabiotik Zenith

Lanacetin landsencoromycetin coronetcrown

Promixin PyridamDexicol Dexa

Phenobiotic BernoBiothicol Sanbe

Sanprima Sanbemiratrim sampharindo

Lapikot forte LapiPrimadex forte Dexamedika

Sanprima SanbePrimadex DexamedicaMiratrim Sampharindo

generik

generikerisanbe sanbe

erisanbe chewable sanbe

generik

generikvaroc pyridam

zibramax guardiangenerik

Page 315: formularium mawaddah-dH2015

Nama Dagang Pabrik

Sagestam Sanbe

Cravox Lapigenerik

generikCravox Lapi

generik

generikBaquior forte sanbe

Lapiflox Lapi

generikLapiflox inf Lapi

Sulcolon Berno

Metrolet HarsenTrychodazole Sanbe

Metrolet Harsenpromuba mepro

Flagyl Sanovi

Vagistin Combiphar

Trychodazole Sanbegeneric

Colistine Actavis

generik

generik

generik

generik

Page 316: formularium mawaddah-dH2015

Nama Dagang Pabrik

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

OAT fase intensif Indofarma

OAT fase lanjutan Indofarma

BacbutinhNiazitol

Rimcure paed SandozRimtazid paed Sandoz

Itzol Lapi

generik

generik

vagistin Combi

Kandistatin lapi

Fansidar Roche

generikgenerikgenerik

Page 317: formularium mawaddah-dH2015

NAMA :____________________ PN / KIN NAMA

TGL OBAT JUMLAH TGL

NAMA :____________________ PN/ KIN NAMA

TGL OBAT JUMLAH TGL

Page 318: formularium mawaddah-dH2015
Page 319: formularium mawaddah-dH2015

:____________________ PN / KIN

OBAT JUMLAH

:____________________ PN/KIN

OBAT JUMLAH

Page 320: formularium mawaddah-dH2015
Page 321: formularium mawaddah-dH2015

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Page 322: formularium mawaddah-dH2015

# of occurrences

4

Page 323: formularium mawaddah-dH2015

FORMULARIUM OBAT

RUMAH SAKIT MAWADDAH MEDIKA

TAHUN 2010

KLS N A M A O B A T kode obat Nama Dagang

1 2 3 4

1 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai

1.1 Analgesik Narkotika

1 Kodein 1.1.1 Tab 10mg, kaleng generik

2 Fentanyl 1.1.2 inj. 50 mcg/ml @10ml Fentanyl

3 Morphin HCl 1.1.3A Tab, 10 mg MST

1.1.3B Inj. 10 mg/ml generik

4 Petidin 1.1.4A inj 2ml clopedin

1.2 Analgesik Non-Narkotik

1 Asam asetilsalisilat 1.2.1 Tab 100mg Aspilet

(asetosal)

2 Asam mefenamat 1.2.2A Tab 500 mg grafik

Cargesic

Opistan

Pondex

Licostan

1.2.2E syr Pondex

3 Ibuprofen 1.2.3A Tab 200mg generik

1.2.3B Proris

1.2.3C syr.100mg/5ml Proris

1.2.3D Supp. 125 mg Proris

4 Kalium Diklofenac 1.2.4A tab 50mg,25mg Exaflam

1.2.4B tab 50mg X-flam

5 Ketoprofen 1.2.5A Supp 100mg Kaltrofen

1.2.5B Tab 100mg Pronalges

1.2.5C Kaltrofen

1.2.5D Tab 100 mg generik1.2.5E Tab 50 mg generik

6 Ketorolac 1.2.6A inj. 30mg/ml generik

1.2.6B trolac inj

1.2.6C Matolac

1.2.6D Teranol

7 Meloxicam 1.2.7A Tab 15mg generik

1.2.7B osteloc

1.2.7C Tab 7,5 mg generik

1.2.7D loxil

8 Metampiron 1.2.8A Tab 500mg Antalgin

1.2.8B Tab 500mg Analsik

(+Dzp 2mg)

1.2.8C Zyparon

1.2.8D potensik

1.2.9E injeksi xilomidon

9 Metamizole sodium 1.2.9A Tablet 500mg Antalgin

1.2.9B Injc. 500mg/ml Norages

1.2.9C Injc. 500mg/ml antrain

1.2.9D PRAGESOL

1.2.9E santagesik

10 Natrium diklofenak 1.2.10A Tab 50mg Voltadex

generik

1.2.10B Tab 25 mg Renadinac

1.2.10C gel Scantaren

1.2.10D gel 10 mg voltaren

Bentuk sediaan, kekuatan obat

Page 324: formularium mawaddah-dH2015

1.2.10E emulgel 5 mg voltaren

11 Paracetamol 1.2.11A Tab 500mg Mirasic

1.2.11B Sanmol

1.2.11C Syr 120mg/5ml Sanmol

1.2.11D Pyridol

1.2.11E Mirasic

1.2.11F Novagesic syr

1.2.11G drop 60mg/0,6ml Sanmol drops

1.2.11H Supp 240mg Propyretic 240

1.2.11I Supp 160mg Propyretic 160

1.2.11J SANMOL INFUS SANMOL

1.2.11K MORESIC DROP MORETIC DROP

1.2.11L tab Novagesic

12 Piroksikam 1.2.12A tab 20 mg generik

1.2.12B gel Pirofel

1.2.12C tab 10 mg generik

13 Tinoridine HCl 1.2.13 tab 50 mg Nonflamin

14 Tramadol 1.2.14A inj 50mg/ml generik

1.2.14B tab 37,5mg+ Patral

1.2.14C paracetamol 32,5mg

15 Kombinasi :

Antalgin 250mg 1.2.15 inj 15ml/vial Xillomidon

Pyramidon 50mg

Lidocain HCl 15mg

16 eperisone hcl 1.2.16 tab 50mg myonep

1.3

Antipirai

1 Allopurinol 1.3.1A Tab 100mg generik

1.3.1B Tab 300mg generik

2 Anestetik 1.3.1C Tab 300mg purinic

2.1

Anestetik Lokal

1 Bupivacain HCl 2.1.1A inj 5mg+ dextrose80mg RECAIN

amp, 4ml

2 Etil klorida 2.1.2 spray, botol 100ml

3 Lidokain 2.1.3A inj 2% lidocain

2.1.3B inj 2% (HCl) Pehacain

+epinefrin 1:80000

2.1.3C inj 100mg/2ml Lidodex

2.2

Anastetik Umum dan Oksigen

1 Halotan 2.2.1 cairan inhalasi Halotan

250ml

2 isoflurane 2.2.2 cairan inhalasi isofluran

3 Ketamin 2.2.3 inj iv 100mg/ml Ketamin

@20ml KTM

4 Nitrogen Oksigen 2.2.4 gas tabung 15kg

5 Oksigen 2.2.5 gas dlm tabung

6 Propofol 2.2.6 inj 10mg/ml, amp20ml Safol

2.3

Prosedur Peri Operatif, Obat untuk

1 Atropin sulfat 2.3.1 inj 0,25mg/ml@1ml sulfas atropin

2 Diazepam 2.3.2A tab 5mg Valisanbe

2.3.2B tab 2mg Valisanbe

2.3.2C inj 5mg/ml Valisanbe

2.3.2D rectal 5mg/2,5ml Stesolid

Page 325: formularium mawaddah-dH2015

3 Midazolam 2.3.3A inj 5mg/5ml Dormicum

2.3.3B inj 15mg/3ml Dormicum

2.3.3C inj 5mg/5ml Miloz

3 Anti Alergi dan Obat untuk Anafilaksis

1 Dexametasone 3.1A inj 5mg/ml@1ml Kalmethasone

3.1B Indexon

3.1C Cortidex

generik

3.1D tab 0,5mg Kalmethasone

3.1E Scandexon

3.1F Carbidu

generik

Kombinasi dengan 3.1G Tab Mexon

difenhidramin

2 Difenhidramin 3.2A Inj 10mg/ml generik

3.2B Inj 15mg/vial Duradryl

decadryl

3 Epinefrin (adrenalin) 3.3 Inj 0,1% Generik

4 Klorfeniramin 3.4 Tab 4mg pehachlor

generik

5 Pheniramine maleat 3.5A Tab 25mg avil

3.5B inj.50mg/2ml avil

genrik

6 Loratadine 3.6A tab 10mg

3.6B clarihis

7 Cetirizin 3.7A tab 10mg Zenris

3.7B generik

3.7C drops Tiriz

8 Metil Prednisolon 3.8A tab 8mg generik

3.8B Lameson

3.8C inj 125mg/ml Lameson

3.8D generik

3.8E tab 4mg generik

3.8F tab 8mg stenirol

9 Ciproheptadin 3.9 kap 4mg Pronicy

10 Mebhidroline Naphadisilat 3.10 tab 50mg interhistin

11 Mometasone furoate 3.11 cream Elok

4 Antidot dan obat lain

Untuk Keracunan

4.1 Khusus

1 Atropin 4.1.1 inj 0,25mg/ml sulfas atropin

2 Kaksium glukonat 4.1.2 100mg/ml Ca Gluconas

3 Natrium bikarbonat 4.1.3A tab 500mg generic

4.1.3B inf fl. 25 Meq, 25 mi Meylon

4 Naloxone HCl 4.1.4 inj.0,4mg/ml Nokoba

5 Neostigmin metylsulfat 4.1.5 inj 0,5mg/ml Prostigmin

Hameln

4.2 Umum

1 Magnesium sulfat 4.2.1A inj 20%25ml MgSo4 20%

4.2.1B inj 40%25ml MgSo4 40%

5 Antiepilepsi - Antikonvulsi-anti parkinson

Page 326: formularium mawaddah-dH2015

1 Carbamazepin 5.1 tab 200mg generik

2 Diazepam 5.2 rectal 5mg/2,5ml Stesolid

3 Fenitoin 5.3A inj 50mg/ml phenytoin

5.3B cap 100mg phenytoin

4 Phenobarbital 5.4A tab 30mg generik

5.4B inj 50mg Phental iv

5 Gabapentin 5.5A cap 300mg Gabexal

5.5B cap 100mg Gabexal

5.5C Generic

6 levodopa 5.6 tab Levazide

7 trihexi penidin 5.7 tab generik

6 Antiinfeksi

6.1

Antelmintik

6.1.1 Antelmintik Intestinal

1 Pirantel 6.1.1.1A tab 125mg Pyrantin

6.1.1.1B susp 125mg/5ml Combantrin

6.2 Antibakteri

6.2.1 Beta Laktam

1 Amoksisilin trihidrat 6.2.1.1A tab 500mg novax caps

6.2.1.1B dry syr 125mg/5ml Zemoxil

6.2.1.1C Brodamox

6.2.1.1D dry syr 125mg/5ml fosicol

6.2.1.1E Zemoxil

6.2.1.1F drops 100mg/ml Amoxan

6.2.1.1G Tab fosicol

6.2.1.1H serb inj 1000mg Amoxan

6.2.1.1I serb inj 1000mg generik

6.2.1.1J tab novax

2 Ampisilin 6.2.1.2A cap 500mg Brodapen

6.2.1.2B serb inj 1000mg Viccilin

serb inj 1000mg generik

3 Ampicillin + Sulbactam 6.2.1.3 serb inj 500+250mg Pycin 750

4 6.2.1.4A kap 500+125mg co amoxiclav

6.2.1.4B clanexi

6.2.1.4C injeksi clanexi

5 Cefadroksil 6.2.1.5A caps 500mg Pyricef

6.2.1.5B caps 500mg generik

6.2.1.5C dry syr 125mg/5ml Pyricef

6.2.1.5D generik

6 Sefaklor 6.2.1.6 caps 500mg Capabiotik

7 Cefaleksin 6.2.1.7 caps 500mg Cefabiotic

8 Cefixim 6.2.1.8A tab 100mg generik

NUCEF

PROFIM

6.2.1.8B dry syr 100mg/5ml NUCEF

generik

6.2.1.8C drop cefila

9 Cefotaksim 6.2.1.9A serb inj 1gr generik

6.2.1.9B FOBET

6.2.1.9C lapixim

6.2.1.9D simexem

6.2.1.9E taxfor

10 Ceftazidim 6.2.1.10 serb inj 1gr CEFDIM

11 Ceftriaxone 6.2.1.11A serb inj 1gr generik

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

Page 327: formularium mawaddah-dH2015

6.2.1.11B GRACEF

6.2.1.11C cephaflox

12 Sephalotin 6.2.1.12 serb inj 1gr Moraxine

13 Meropenem 6.2.1.13A serb inj 1 gr Meropex

6.2.1.13B generik

6.2.1.13C simpenem

14 Ceftizoxime 6.2.1.14C serb inj 1 gr e-zox

15 Cloxacillin 6.2.1.15 injeksi meixam

16 Penicilin 6.2.1.16 injeksi generik

6.2.2 Antibakteri Lain

6.2.2.1 Tetrasiklin

1 Doksisiklin 6.2.2.1.1A caps 100mg generik

6.2.2.1.1B siclidon

2 Tetrasiklin 6.2.2.1.2 caps 500mg Suprabiotik

6.2.2.2 Kloramfenikol

1 Kloramfenikol 6.2.2.2.1A caps 250mg Lanacetin

6.2.2.2.1B susp 125mg/5ml coromycetin

2 Thiamphenicol 6.2.2.2.2A caps 500mg Promixin

6.2.2.2.2B Dexicol

6.2.2.2.2C dry syr 125mg/5ml Phenobiotic

6.2.2.2.2D fosicolos

6.2.2.2.2E dry syr 250g/5ml sendicol forte

6.2.2.3 Sulfa - Trimetoprim

1 (dewasa)kombinasi : 6.2.2.3.1A Tablet Sanprima

sulfametoksazol 400mg + 6.2.2.3.1B miratrim

trimetoprim 80mg supp miratrim

2 sulfa 800mg+ 6.2.2.3.2A Tablet Lapikot forte

trimetoprim 160mg 6.2.2.3.2B Primadex forte

3 Kotrimoksazol suspensi 6.2.2.3.3A susp Sanprima

komb : sulfametoksazol 6.2.2.3.3B Primadex

200mg + trimetoprim 40mg/5ml 6.2.2.3.3C Miratrim

6.2.2.4 Makrolit

1 Clindamisin 6.2.2.4.1A caps 150mg & 300mg generik

6.2.2.4.1B caps BIODASIN

2 Eritromisin 6.2.2.4.2A caps 500mg generik

6.2.2.4.2B caps 500mg Eryra

6.2.2.4.2C caps 200 mg erisanbe

6.2.2.4.2D erisanbe chewable

6.2.2.4.2E syr 200mg/5ml generik

3 Spiramisin 6.2.2.4.3A tab 500mg generik

6.2.2.4.3B varoc

4 Azytromicin 6.2.2.4.4A caps 500mg zibramax

6.2.2.4.4B generik

6.2.2.5 Amiglikosida

1 Gentamisin 6.2.2.5.1A inj 40mg/ml Sagestam

6.2.2.5.1B inj 80mg/ml ottogenta

6.2.2.6 Kuinolon

1 Levofloksasin 6.2.2.6.1A tab 500mg Cravox

6.2.2.6.1B generik

6.2.2.6.1C lar infus 500mg/100ml generik

2 Ofloxasin 6.2.2.6.2A tab 200mg generik

Page 328: formularium mawaddah-dH2015

6.2.2.6.2B tab 400mg generik

3 Ciprofloksasin 6.2.2.6.3A tab 500mg generik

6.2.2.6.3B Baquinor forte

6.2.2.6.3C Lapiflox

6.2.2.6.3D vioquin

6.2.2.6.3E lar infus 500mg/100ml generik

6.2.2.6.3F Lapiflox inf

4 asam pipemidat 6.2.2.6.4 kap urotractin

6.2.2.7 Penggunaan khusus

1 Sulfasalazin 6.2.2.7.1 tab 500mg Sulcolon

2 Metronidazol 6.2.2.7.2A tab 500mg Metrolet

6.2.2.7.2B Trychodazole

Generik

6.2.2.7.2C syr 125mg/5ml Metrolet

6.2.2.7.2D promuba

6.2.2.7.2E supp 500mg Flagyl

6.2.2.7.2F supp 1 g Flagyl

6.2.2.7.2G ovul + nistatin 100000iu Vagistin

6.2.2.7.2H lar infus 500mg/100ml Trychodazole

6.2.2.7.2I generic

6.2.2.7.2J Tab nulagyl

3 Colistin sulfat 6.2.2.7.2 Tab 250000 iu Colistine

6.3 Antiinfeksi Khusus

6.3.1 Antituberkulosis

1 Etambutol 6.3.1.1 tab 500mg generik

2 Isoniazid 6.3.1.2 tab 300mg generik

3 Pirazinamid 6.3.1.3 tab 500mg generik

4 Rifampicin 6.3.1.4 caps 450mg generik

5 Kombinasi (OAT TB dots): 6.3.1.5

untuk dewasa kap : INH 75,Rifam 150, OAT fase intensif

Pza 400, ethambutol 275

INH generik

rimstar4fdc

kap: INH 150, Rifam 150 OAT fase lanjutan

untuk pediatri INH100, rifam75,Pza200 OAT fase intensif

INH 100, Rifam 75 OAT fase lanjutan

6 Kombinasi : 6.3.1.6

Ethambutol, INH, B6 caps Bacbutinh

Niazitol

7 INH50+Rifam75+PZA150 6.3.1.7 caps Rimcure paed

8 INH50+ Rifam75 6.3.1.8 Rimtazid paed

6.3 Antifungi

1 Itrakonazol 6.3.1 caps 100mg Itzol

2 Ketokonazol 6.3.2 tab 200mg generik

3 Mikonazol 6.3.3 cream generik

4 Nistatin 6.3.4A ovul + metronidazol vagistin

6.3.4B drops Kandistatin

5 flukonazol 6.3.4B 150mg tab generik

6.5 Antimalaria

1 Sulfadoxin 500mg, 6.5.1A tab Fansidar

primetamin 25 mg 6.5.1B

Page 329: formularium mawaddah-dH2015

6.6 Antivirus

6.6.1 Antiherpes

1 Acyclovir 6.6.1A tab 200mg generik

6.6.1B tab 400mg generik

6.6.1C cream 5% generik

7 Antimigren dan neuroprotector

1 Ergotamin cafein 7.1 tab 1mg generik

2 7.2 kap Nogren

3 Piracetam 7.3A tab 800mg&1200mg generik

7.3B latropril

7.3C inj 1gr/5ml generik

7.3D Neurotam

7.3E inj 3gr/5ml generik

7.3F Neurotam

7.3G tab 400mg generik

4 citikolin 7.4A tab 500mg Neuciti

7.4B inj 250mg/2ml Nicholin

7.4C Neociti

7.4D tab 500mg

7.4E lancolin

7.4F inj 250mg/2ml generik

5 Pyritinol HCL 7.5 syr 100ml Encephabol

6 Mecobalamin 7.6A inj. Amp 500mcg Kalmeco

lapibal

7.6B tab 500mg Kalmeco

generik

lapibal

7 Nicergoline 7.7 tab 10 mg serolin

8 Darah, Obat yang Mempengaruhi

8.1 Antianemi

1 Asam folat 8.8.1.1A tab 1mg Folacom

8.8.1.1B anelat

8.8.1.1C siobion

2 Besi III sulfat (sulfas ferosus) 8.8.1.2A tab salut 300mg Natabion

8.8.1.2B Artoferum

8.8.1.2C Generik

8.8.1.2D syr. 50mg/50ml, @150ml Maltofer

3 Vit B1, B6, B12 8.8.1.3A tab Neurobion 5000

8.8.1.3B Neurobat

8.8.1.3C Neurosanbe

8.8.1.3D Neurodex

8.8.1.3E Sakaneuron

generik

8.8.1.3F inj. Amp 3ml Neurosanbe 5000

8.8.1.3G Neurobion 5000

8.2 Koagulasi, obat

yang mempengaruhi

1 Asam traneksamat 8.8.2.1A inj 250mg/5ml Kalnex

8.8.2.1B Transamin

8.8.2.1C tranex

8.8.2.1D inj 250mg/5ml generik

8.8.2.1E tab 500mg Transamin

8.8.2.1F tranex

2 Fitomenadion (vit K) 8.8.2.2A tab salut 10mg, kaleng generik

8.8.2.2B inj 10mg/ml Neo K

3 Heparin Na 8.8.2.3A gel Thrombopop Gel

8.8.2.3B Antithromb

4 Lidocain 8.8.2.4 inj 2% generic

Kombinasi paracetamol 300mg, acetosal, cafein

Page 330: formularium mawaddah-dH2015

9 Diuretik

1 Furosemida 9.1A tab 40mg generik

9.1B inj 10mg/ml Lasix

2 Hidroklortiazid (HCT) 9.2 tab 25mg generik

3 Manitol 9.3 lar infus 20%@500ml manitol

4 Spironolacton 9.4 tab 25mg carpiaton

10 Hepatoprotector dan Cholelitiolisis

1 Lesitin 10.1A caps 300mg Lesichol

10.1B Lesipar

2 L-ornitin, L-aspartat 10.2A inj 5mg/10ml Hepa-Merz

10.2B sachet 3g Hepa-Merz granul

3 Ursodeoxycholic 10.3 caps 250mg Urdafalk

4 hepatoprotector 10.4A tab Hepa-Q

fitofarmaka 10.4B HP pro

11 Hormon, Obat Endokrin Lain dan

Kontraseptik

11.1.1 Antiabetes, Oral

1 Glibenclamida 11.1.1 tab 5mg generik

2 Glimepiride 11.1.2A tab 2mg Amaril

Gluvas

tab 2 mg Generik

11.1.2B tab 5 mg Generik

glucobay

3 Glikuidon 11.1.3A tab 30mg Glurenorm

11.1.3B generik

4 Metformin 11.1.4A tab 500mg generik

11.1.4B Eraphage

5 Gliklasid 11.1.5 tab 80mg generik

11.1.2 Antidiabetes, Parenteral

1 Isulin reguler 11.2.1 inj 100iu/ml @10ml Actrapid

11.2 Hormon Kelamin dan obat yang

mepengaruhi Fertilitas

11.2.1 Progestrogen

1 Noretisteron 11.2.1A tab 5mg Regumen

11.2.1B Norelut N

2 Alil Esternol 11.2.2A tab 5mg Preabor

11.2.2B Premastone

3 Ethinilestradiol 11.2.3 tab 50mcg Lynoral

4 11.2.4A cap 200mg uterogestan

11.2.4B cap 100mg uterogestan

11.2.2 Clomiphen Sitrat

11.2.2.1A tab 50mg Blesifen

11.2.2.1B Profertil

11.3 Kontraseptik

11.3.1 Oral

1 Levonogestrel, 11.3.1A tab 28 Microgynon ling-

ethinilestradiol,placebo 11.3.1B karan biru

11.3.2 Injeksi

Page 331: formularium mawaddah-dH2015

1 medroksiprogesteron 11.3.2.1A vial, 50mg/ml, 3mL Depo progestin

acetat 11.3.2.1B vial, 150mg/ml, 1ml Depo Neo

2 Medroksiprogesteron 11.3.2.2A vial, 0,5 ml Cyclofem

acetat 50mg+10 estradiol- 11.3.2.2B

cypionate

11.3.3 Intra Uterin 11.3.3 T-shaped dg copper wire Nova-T CU

dan silver core

11.4 Hormon Tiroid dan Antitiroid

11.4 Kortikosteroid

1 Propiltiorasil 11.4.1 tab 100mg generik

1 Deksametason 11.4.1A inj 5mg/ml @1ml Kalmethasone

11.4.1B Indexon

11.4.1C Cortidex

11.4.1D tab 0,5mg Kalmethasone

11.4.1E scandexon

11.4.1F carbidu

2 Metil prednisolon 11.4.2A tab 4mg generik

11.4.2B lameson

11.4.2C inj 125mg/2ml lameson

3 Prednison 11.4.3 tab 5mg generik

4 Triamsinolon 11.4.4A inj 10mg/ml Falmicort

11.4.4B oral base, tube Kenalog

11.4.4C inj 10mg/ml trilac

12 Kardiovaskuler, Obat

12.1 Antiangina

1 Atenolol 12.1.1 tab 100mg generik

2 Diltiazem HCL 12.1.2A tab 30mg generik

12.1.2B inj 5mg/ml

3 Isosorbit dinitrat 12.1.3A tab 5mg generik

12.1.3B Cedocard

12.1.3C Farsorbid

12.1.3D inj 10mg/10ml Farsorbid

4 Nitrogliserin 12.1.4 inj 1mg/ml generik

5 Propanolol 12.1.5 tab 10mg generik

12.2 Antiaritmia

1 Amiodaron HCT 12.2.1A inj Tiaryt

12.2.1B drops Tiaryt

2 Kuinidin 12.2.2 tab 100mg generik

3 Lisinopril 12.2.3A tab 10mg Noperten

tab 10mg generik

12.2.3B tab 5 mg generik

4 Propanolol 12.2.4A tab 10mg generik

12.2.4B tab 40mg generik

5 Trimetazidine diHCl 12.2.5 tab 35mg Trizedon MR

6 Verapamil 12.2.6 tab 80mg generik

12.3 Lain-lain

1 Amlodipin Besilat 12.3.1A tab 5mg generik

12.3.1B tab 10mg generik

12.3.1C lapiten

2 Losartan 12.3.2 tab 50mg Angioten

3 Valsartan 12.3.3 tab 80mg Valsartan-Ni

Page 332: formularium mawaddah-dH2015

4 irbesartan 12.3.4 tab 150mg generik

irvask

12.4 Antihipertensi

1 Bisoprolol 12.4.1 tab 5mg generik

2 Captopril 12.4.2A tab 25mg generik

12.4.2B tab 12,5mg generik

3 Klonidin 12.4.3 tab 0,15mg generik

4 Metildopa 12.4.4 tab salut 250mg generik

5 Nifedipin 12.4.5A tab 10mg generik

12.4.5B Nifedin

12.4.5C tab 5mg generik

6 Nicardipin 12.4.6 injeksi blistra

7 Nimodipin 12.4.7A cairan infus 50 ml ceremax

12.4.7B tab nimotop

8 lisinopril 12.4.8 tab interpril

9 Glyceryl trinitrate 12.4.9 tab nitrokaf

10 Ramipril 12.4.10 tab generik

12.6 Anticoagulan, antiplatelet

1 Clopidogrel 12.6.1A tab 75mg Pidofix

12.6.1B generic

2 Cilostazol 12.6.2 tab 50mg Pletaal

3 Streptokinase 12.6.3 inj 1.5 juta iu/vial Streptase

generik

12.7 Trombolitik

1 Pentoksifilin 12.7.1 tab 400mg Reotal SR

12.8 Gagal jantung, obat

1 Digoksin 12.8.1A tab 0,25mg generik

12.8.1B tab 0,25mg fargoxin

12.8.1B inj fargoxin

2 Furosemid 12.8.2A tab 40mg generik

12.8.2B inj 10mg/ml @2ml Lasix

3 Diltiazem 12.8.3 injeksi farmabes

12.9 Syok, obat untuk

11.9.1 Syok kardiogenik

1 Dopamin 12.9.1.1 inj 40mg/ml generik

2 Dobutamin 12.9.1.2 inj 250mg Dobutamin

3 Epineprin (adrenalin) 12.9.1.3 inj 0,1% generik

4 Norepinefrin 12.9.1.4A inj 0,1% generik

(noradrenalin) 12.9.1.4B raivas

5 amrinone lactat 12.9.1.5 injeksi cardiotone

11.9.2 Syok karena Anestesi

1 Ephedrin 12.9.2.1 inj 50mg/ml generik

12.10 Antihiperlipidemia

1 Gemfibrozil 12.10.1A caps 300mg generik

12.10.1B Lapibroz

2 Simvastatin 12.10.2A tab 10mg generik

12.10.2B Cholestat

12.10.2C tab 20mg generik

Page 333: formularium mawaddah-dH2015

13 Kulit, obat topikal untuk

13.1. Antibakteri

1 Framisetin 13.1 casa steril 1% sofratulle

2 Natrium fusidat 13.2 cream 20mg/gr Fuson

3 Perak sulfadiazin 13.3 cream 1% Burnazin

4 Gentamisin sulfat 13.4A cream 1mg/gr generik

13.4B sagestam

13.4C Genoint

13.4D salep kulit Gent oint

5 Gentian violet lar 1% 13.5 larutan 1% Genoint

6 neomycin sulfat + 13.6 cream Ociderm-N

fluocinolon acetonide

7 Chloramphenicol+ 13.7 cream Chloramphecort

hidrocortison

8 Mupirosin 13.8 cream 10 mg bactoderm

9 sub lingual tab Fg troches

13.2 Antifungi

1 Ketokonazol 13.2.1A cream Mycoderm

13.2.1B cream 15 gr generik

2 Miconazol 13.2.2A cream 2% generik

13.2.2B dactarin powder

3 Nystatin,zinc oxide 13.2.3 cream Myco-z

4 Gentian Violet 13.2.4 larutan 1%

13.4 Antiinflamasi dan Antipruritik

1 Betametason 13.4.1A cream Betason cream

13.4.1B Benoson

13.4.1C cream + neomycin Benoson N

13.4.1D cream + miconazole Benoson M

13.4.1E cream generik

13.4.1F tab gratamin

2 Clobetasol 13.4.2 cream 0,05% Kloderma

3 Desoksimetason 13.4.3 cream 0,25% Pyderma

4 Hidrokortison 13.4.4 cream 2,5% generik

chloramphecort

5 Triamsinolon 13.4.5 cream oral base Kanalog

6 Dexametason 13.4.6 tab grathazon

13.5 Antiskabies dan antipedikulosis

1 Lindane 1%, 13.5 cream 10 gr Scabicid

ursic acid 1%

13.6 Keratolitik dan keratoplastik

1 Urea 13.6.1 cream 20% Moistderm

13.7 Extrac placenta

13.7A gel 10gr Bioplacenton

13.7B Bismecon

13.8 Hyaluronic acid

13.8 cream 15gr Bionect

13.9 Lain-lain

1 Centella asiatica phytosom 13.9.1

& vit E cream Lanakeloid

2 Asam sulfonat+ 13.9.2A solution 10ml Albothyl

formaldehid 13.9.2B supp Albothyl Ovula

Fradiomisin dan Gramisidin

Page 334: formularium mawaddah-dH2015

3 Herbal ointment 13.9.3 cream Meibo

4 cream momilen tummy

14 Larutan irigasi

water for irigation 14.1 larutan 1L

15 Larutan Elektrolit,Nutrisi dan lain-lain

15.1 Oral

1 Garam oralit 15.1.1A Pedyalite

15.1.1B syr Renalyte

15.1.1C Oralyte

2 Kalium klorida 15.1.2A tab siap larut 600mg KSR

15.1.2B syr. Larutan 3%, 100mL KCl 3%

3 Natrium bikarbonat 15.1.3A tab 500mg generik

15.1.3B inf. 25 Meq, 25mL Meylon

15.2 Parenteral

1 Plasme expander 15.2.1A lar infus 6%, botol 500ml Wida HES 130

(HES) 15.2.1B Wida HES 200

15.2.1C Tetra HES 130

15.2.1D sanbe HES 130

2 Glukosa 15.2.2A lar infus 5%, botol 500ml D 5%

15.2.2B lar infus 10%, botol 500ml D 10%

15.2.2C lar infus 40%, botol 25ml D 40%

3 Kalsium glukonat 15.2.3 inj 10% @10ml Ca Gluconas

4 Kalium Klorida 15.2.4 inj 25ml/vial KCl 7,46%

5 Human Albumin 15.2.5A lar infus 20 % @50ml Octalbin

(tidak stock)

15.2.5B 20%100cc Biotest

6 Lar. Nutrisi DOEN IV kombinasi:

Glukose 5%. + NaCl 0,45%

-lar infs btl 500ml 15.2.6 Wida D5 1/2 NS

7 Lar. Nutrisi DOEN VI kombinasi :

Glukose 5% + NaCl 0,225% 15.2.7 -lar infs btl 500ml Wida D5 1/4 NS

8 Natrium bikarbonat 15.2.8 lar inf 25Meq, 25mL Meylon

9 Natrium klorida 0,9%

lar inf. 500ml 15.2.9A Wida NS

15.2.9B Otsu NS

lar.inf 100ml 15.2.9C Otsu NS piggy

15.2.9D INFUSAN NS 100

15.2.9E sanbe infusan

10 Ringer laktat 15.2.10 RL

RL

RL

11 kombinasi:

Dextrose 5% + NaCl 0,9% 15.2.11A D5 NS

-lar infs btl 500ml 15.2.11B Infusan RD5%

15.2.11C RL

15.2.11D Wida D5 piggy

12 kombinasi :

Nacl 0,18 % b/v 15.2.12 Otsu D10 1/5 NS

glukosa 10 %

-lar infs btl 500ml

13 kombinasi :

NaCl 2,34gr 15.2.13A KA EN 3A

KCl 0.75gr 15.2.13B TRIDEX 27 A

Na Lactate 2,24gr

Page 335: formularium mawaddah-dH2015

Dextrose anhydrat 27gr

-lar infs btl 500ml

14 kombinasi :

NaCL 1,75gr 15.2.14A KA EN 3B

KCl 1,5gr 15.2.14B TRIDEX 27B

Na Lactate 2,24gr

Dextrose anhydrat 27gr

-lar infs btl 500ml

15 kombinasi :

dextrose anhydrat 37,5 g

NaCl 2,25 g

-lar infs btl 500ml 15.2.15A KA EN 1B

15.2.15B Tridex plain

16 Kombinasi :

Glukosa 12,5 g

NaCl 1 g 15.2.16 Wida 1/2 DaD

KCl 0,65 g

Na Lactat 1,55 g

17 kombinasi :

Amino Acids 100mg

Nitrogen 15,7mg 15.2.17 Kalbamin

Na 2m EQ.

Acetate 120m EQ

-lar infs btl 500ml

18 kombinasi :

Asam Amino 2,72% 15.2.18A Pan Amin G

Sorbitol 15% 15.2.18B VALAMIN

-lar infs btl 500ml

19 kombinasi Aminofluid

asam amino 30 gr 15.2.19 renosan

glukosa 75 gr

20 Kombinasi :

Dextrose Anhydrose 100gr 15.2.20A KA EN MG3

Sodium Chlorid 1,75gr 15.2.20B Tridex 100

Potasium Chloride 1,50gr

Sodium lactat 2,24gr

-lar infs btl 500ml

21 NaCl 3.624 g, KCl 1.342 g 15.2.21 futrolit inf

CaCl2 0.294 g, ring as infus

Mg(OH)2 0.61 g

Na acetate 5.172g

22 Sorbitol 50 g, 15.2.22 tutofuhsin

NaCl 3,623 g

KCl 1,342 g, CaCl2 0,294g

MgCl2 0,610 g,

Na Acetate 5,171 g

15.3 Lain-lain

1 Air untuk injeksi 15.3.1A WFI 1 liter Water For Injc

15.3.1B WFI 25 ml Water For Injc

16 Mata, obat untuk

16.1 Sistemik

1 Manitol 16.1.1A lar infus 20%, botol 500ml Manitol

16.1.1B M.20 Manitol

16.2 Topikal

16.2.1 Anestetik Lokal

1 Tetrakain 16.2.1.1A tetes mata 0,5% Pantocain

16.2.1.1B 2% 15 ml Pantocain

16.2.1.1C 2% 5 ml Pantocain

16.2.2 Antimikroba

1 Gentamisin 16.2.2.1A tetes mata 0,3% Gent oint

Page 336: formularium mawaddah-dH2015

16.2.2.1B salep mata 0,3% Gent oint

16.2.2.1C tetes mata 0,3% generik

2 Kloramfenikol 16.2.2.2 salep mata 1% erlamicetin

3 Ofloxacin 16.2.2.3 tetes mata tarivid

4 Levofloxacin 5 mg 16.2.2.4 tetes mata LFX

5 Tobramycin 3 mg, 16.2.2.5 tetes mata Tobrosan

Dexamethasone 1 mg

6 Dibekasin sulfate 16.2.2.6 tetes mata generik

16.2.3 Anti inflamasi

1 Kombinasi : 16.2.3.1 tetes mata

Polimiksina sulfat 6.000 IU

Neomisin Sulfat 3,5mg

Deksametason Na Fosfat 1,3mg

-tts mata btl 5ml

2 Kombinasi : tetes mata

Polimiksina sulfat 6.000 IU 16.2.3.2A Alletrol

Neomisin sulfat 3,5mg 16.2.3.2B Oregan

Deksametason Na fosfat 1mg 16.2.3.2C Xitrol

-tts mata btl 5ml

3 Natrium diklofenak 16.2.2.3 tetes mata flamar

16.2.4 lain-lain

1 Antazolin phospat, 16.2.4.1A tetes mata Vasacon-A

hypomeloza 16.2.4.1B tetes mata Vasacon

2 Vitamin A 1000 IU 16.2.4.2 tetes mata astenof

Oxymetazoline hydro cl

0,25mg, Hydroxypropyl

Methylcellulose 5 mg

3 CaCl2 anhidrat 0,075 gr 16.2.4.3 tetes mata caterlent

Kalium Iodida 0,075 gr

Na Tiosulfat 0,0075 gr

Fenilmerkuri nitrat 0,3 mg

4 Carboxymethyl Cellulose 16.2.4.4 tetes mata cenfresh

Sodium 5 mg

5 Ion Natrium & Kalium . 16.2.4.5 tetes mata lyterss

Benzalkonium Cl

6 sodium hyaluronat 16.2.4.6 tetes mata hyaloph

7 16.2.4.6 tetes mata xiloxan

16.2.5. Anti Miotik dan Glaukoma

1 16.2.5.1A tetes mata 0,5 % Myriatil

16.2.5.1B tetes mata 1 % Myriatil

2 Atropine sulfat 16.2.5.2 tetes mata Teopin

3 Timolol maleat 16.2.5.3 tetes mata 0,5% 5ml Timol

16.2.6. Vitamin Mata

1 Ekstra bilberry 80 mg, 16.2.6.1 tab eyevit

retinol 1600 iu,

beta-carotene 5 mg,.

vitamin E 40 mg, lutein,

zeaxanthin, selenium,zinc

Page 337: formularium mawaddah-dH2015

17 Oksitosin dan relaksan uterus

17.1 Oksitosin

1 Metilergometrin 17.1.1A table salut 0,125mg generik

tablet 0,125 17.1.1B Pospargin

17.1.1C inj 0,200mg/ml Methergin

17.1.1D generik

17.1.1E metvell inj

17.1.1F inj 10 IU/ml oxyla

2 Oxytosin 17.1.2A inj 10 IU/ml Syntocinon

17.1.2B generik

17.1.2C pitogin

3 Misoprostol 17.1.3 tab 200mg Citrosol

17.2 Relaksan Uterus gastrul

1 Magnesium sulfat 17.2.1A inj 20% @25ml Mg SO4 20%

17.2.1B inj 40% @25ml Mg SO4 40%

2 Isoksuprin HCL 17.2.2A tabl 20mg Duvadilan

17.2.2B inj. 5mg/ml @2ml Duvadilan

18 Psikofarmaka

18.1 Antiansietas dan Antiinsomnia

1 Alprazolam 18.1.1A tab 0,25 mg Alganax

18.1.1B tab 0,5mg Alganax

2 Clobazam 18.1.2 tab 10mg generik

3 Diazepam 18.1.3A tab 2mg Valisanbe

18.1.3B tab 5mg valisanbe

18.1.3C Supp 5mg/2,5ml Stesolid

4 phenobarbital 18.1.4A tab 30 mg generik

18.1.4B inj Phental iv

18.2. Antidepresi dan Antimania

1 Amitriptilin 18.2.1 Tab 25 mg generik

2 Klorpromazin HCL 18.2.2 tab 100mg Cepezet

3 Fluoxetin 18.2.3 tab kalxetin

18.3 Antipsikosis

1 Haloperidol 18.3.1A tab 0,25mg generik

18.3.1B injeksi generik

injeksi govotil inj

2 Klorpromazin 18.3.2 tab salut 100mg cepezet

19 Saluran Cerna, Obat untuk

19.1 Antasida dan Antiulkus

1 Antasida DOEN I kombinasi : 19.1.1 tab generik

Al(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

Magtral

+ Stomacain

simeticon carsida

2 Antasida DOEN II susp, kombinasi : 19.1.2

Al (OH)3 200mg/5ml + Mg (OH)2 syr Mylacid

200mg/5ml Bufantacyd

(+cimeticon)

Carsida

3 Famotidin 19.1.3 tab 20mg generik

4 Lanzoprazol 19.1.4 caps 30mg generik

5 Omeprazol 19.1.5A caps 20mg generik

19.1.5B inj. OMZ

Page 338: formularium mawaddah-dH2015

19.1.5C Norsec

19.1.5D inj. pumpitor

6 Ranitidin 19.1.6A tab 150mg generik

19.1.6B Acran

19.1.6C inj 25mg/2ml generik

19.1.6D Indoran

19.1.6E Acran

19.1.6F getidin

7 Simetidin 19.1.7A tab 200mg generik

19.1.7B inj. 200mg,amp Ulsikur

8 Sucralfate 19.1.8A tab 500mg Ulsafate

19.1.8B Nucral

19.1.8C syr 100ml Propepsa

19.1.8D syr 200ml Nucral

9 Polymigel 19.1.9 tab Srocain-P

19.2 Enzim

1 Pankreatin,diastease 19.2.1 kap lybrozim

2 kombinasi : pankreatin 19.2.2 kap lybrozim plus

diastase, cimetikon

3 Pankreatin,activated 19.2.3 kaplet Tripanzym

dimetilpolisiloxan

19.3 Antiemetik

1 Betahistin mesilat 19.3.1 tab 6mg Mertigo

Merislon

Histigo

2 Dimenhidrinat 19.3.2A tab 50mg generik

19.3.2B Mantino

3 Loperamid 19.3.3A tab 2mg lopamid

19.3.3B Lodia

4 Metoklopramid 19.3.4A tab 5mg Nilatika

19.3.4B Damaben

19.3.4C inj 5mg/ml Tomit

19.3.4D Damaben

19.3.4E Meclam

5 Ondansetron 19.3.5A inj 4mg/2ml generik

19.3.5B ODR

19.3.5C Insetron

19.3.5D tab 4mg vometraz

19.3.5E generik

19.3.5F odanostin

19.3.5D tab 8mg generik

6 Domperidon 19.3.6A tab 1mg generik

19.3.6B Dom

19.3.6C Omedon

19.3.6D syr 5mg/5ml Dom

19.3.6E Omedon

19.3.6F generik

19.3.6G syr vesperum

19.3.6H drop vomistop

7 Chlordiazepoxid 5mg+ 19.3.7 tab Braxidin

dclonidium 2,5mg

8 Pantoprazol inj 19.3.8 inj 40mg Topazole

Pepzol

pantopump

9 Pyratiazine chloroteo- 19.3.9 tablet Anvomer B6

phylinate 40mg+B6 30mg

10 Pantoprazole 20 mg 19.3.10 tab generik

11 flunarizin 19.3.10 tab 10 mg unalium

Page 339: formularium mawaddah-dH2015

19.3 Antihemoroid

1 Kombinasi : 19.3.1 kapsul 100mg Lanaven

Soybean purified extract

2 Antihemoroid kombinasi : 19.3.2

bismutsubgalat150mg Supp generik

heksaklorofen

3 Lidocain HCl +Al subacetat 19.3.3

hidrocortison acetat, ointmen Haemocain

Zinc oxide

4 Lithospermi radix, prednisolon, 19.3.4

lidocain,benzocain,cetrimide ointmen Borraginol S

5 Benzokain, ZnO, Alukol 19.3.5 supp superhoid supp

19.4 Antispasmodik

1 Atropin Sulfat 19.4.1 inj. 0,25mg/ml @iml Atropin

2 Hyoscine-N-butil bromide 19.4.2A tab. 10mg

Spasminal (+methampiron)

Buscopan

19.4.2B inj 20mg/mL Gitas

3 Papaverin 19.4.3.A tab 40mg generik

19.4.3B inj im 40mg/ml generik

19.5 Diare, obat untuk

1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr + 19.5.1 Oralit

trinatrium sitrat dihidrat 0,58gr +

glukosa anhidrat 4gr

2 Kombinasi : 19.5.2A tab Corosorb

Kaolin 550mg + 19.5.2B susp Novadiar

pectin 200mg 19.5.2C Omegdiar

3 Lactobacillus 19.5.3A serbuk L-bio

19.5.3B Lacto B

19.5.3C Cap Lacidofil

19.5.3D Lacbon

4 Zinc 19.5.4A serbuk/sachet Orezinc

19.5.4B tablet Zincare

19.5.4C serbuk/sachet L-zinc

19.5.4D syr zirkum kid

19.6 Kataritik

1 Bisakodil 19.6.1A supp 5mg Dulcolax Paed

19.6.1B supp 10mg Dulcolax Paed

19.6.1C tab 5mg Dulcolax Paed

19.6.1D tab 5mg generik

2 Gliserin 19.6.2 1 liter generik

Kombinasi : 19.6.2A susp botol 60ml Laxadine

Parafin + Glicerin + 19.6.2B cairan supp. fleet enema

fenolftalen

3 Lactulosa 19.6.3 syr Lactulax

4 Fosfosoda 19.6.4 susp Fleet Fosfosoda

19.7 Antiinflamasi, obat untuk

1 Sulfasalazin 19.7.1 tablet 500mg Sulcolon

Page 340: formularium mawaddah-dH2015

20 Saluran Kencing dan Prostat, obat yang mempengaruhi

20.1 Saluran kencing

20.1A tetes Kalkurenal

20.1B Batugin elixir

20.1C Caps Nephrolit

20.2 Renal insufisiensi

1 α ketoisoleusin, L-hitidin 20.2.1 Kap 650mg Tonar

L-tyrosin,L-lysin,dst

2 valeric acid, butiric acid, 20.2.2 Tab Prorenal

lycin monoacetat, tryptopan,

tyrosin, histidin

20.3 Prostat (anti BPH)

1 Finasteride 20.3.1 tab 5mg Prostide

21 Saluran napas, Obat untuk

21.1 Antiasma

1 Aminofilin 21.1.1A tablet 200mg generik

21.1.1B inj. 24mg/ml @10ml generik

2 Deksametason 21.1.2A tab 0,5mg scandexon

21.1.2B carbidu

21.1.2C inj. 5mg/ml Indexon

21.1.2D Kalmetason

21.1.2E Cortidex

21.1.2F tab 0,5mg Kalmetason

3 Efedrin 21.1.3 tab 0,5mg generik

4 Epinefrin (adrenalin) 21.1.4 inj 0,1% generik

5 Fluticason propionat 21.1.5 nebules 0,5mg/2,5ml Fluxotide

6 Salbutamol 21.1.6A tab 2mg generik

21.1.6B tab 4mg generik

21.1.6C grafalin

21.1.6D rotacps 200mcg/dosis Ventolin

21.1.6E syr 2mg/5ml Lasal

21.1.6F syrup per 5ml : Lasal expectoran

salbutamol 2mg+Gg 75mg

21.2.6G inh.(aerosol) 100mcg/dosis Ventolin

7 kombinasi salbutamol 21.2.7A nebules 2,5mg Ventolin

dan ipratropium Br 21.2.7B rothaler Ventolin

21.2.7C nebules 2,5ml combiven

8 Terbutalin sulfat 21.2.8 inj. 0,5mg/ml bricasma

9 Teofilin 21.2.9A tab 150 mg generik

21.2.9B tab 300 mg rethapyl

10 N-acetylcysteine 21.2.10 injeksi n-ace

21.2 Antitusif

1 Dekstrometorfan 21.2.1A tab 15mg generik

2 Dextrometorfan 10mg + 21.2.1B Romiler

pseudoefedrin 30mg +

bromfeniramin maleat2mg 21.2.2 syr per 5ml @ 60ml Alco plusDMP syr

Page 341: formularium mawaddah-dH2015

3 kombinasi :

prometazin, Gg

21.2.3 syr 60ml Guamin

4 Kodein

5 Doveri 21.2.4 Tab 20 mg

21.3 Ekspektoran

1 Ambroxol 21.3.1A Tab 30mg Mirapect

21.3.1B Tab 30mg generik

21.3.1C silopect

2 Bromheksin 21.3.2A Syr 4mg/5ml Bisolvon elixir

21.3.2B inj. 4mg/2ml Bisolvon

21.3.2C tab 8mg mucohexin

Bromheksin 4mg+ 21.3.2C Syr /5ml ,@60mL Bisolvon extra

Guafenesin 100mg

3 Gliseril guaiakolat 21.3.3A Tab 100mg generik

21.3.3B cairan mulut Borak

4 Obat batuk hitam (OBH) 21.3.4 syr botol 100 ml

5 Kombinasi :

Paracet,Gg,efedrin 21.3.5A Tab. coparcetin

chlorfeniramin 21.3.5B Tab. Hufagrip forte

21.3.5C Syr 60ml coparcetin

21.3.5D Syr 60ml Flu Hufagrip

21.3.5E Syr 60ml Pilek Hufagrip

6 Kombinasi

Paraset, pseudoefedrin, 21.3.6 Tab Demacolin

chlorfeniramin,cafein

7 kombinasi : 21.3.7 Kap Dextral

DMP,GG,PPA, Dextral forte

chlorpheniramin

8 Kombinasi :

DMP,GG,Diphenhidramin 21.3.8 Kap grantusif

9 kombinasi : 21.3.9 Syr 60 ml Miradryl

diphenhidramin,

amonium Cl, Na sitrat

10 kombinasi :

diphen, Gg, mentol 21.3.10 Syr. 60ml Coredryl

11 Kombinasi:

ipekak,guefenesin 21.3.11A Syr 60ml Miradryl

21.3.11B zenirex

12 oxomemezin +Gg 21.3.12 syr 60ml oxopect syr

13 Kombinasi : 21.3.13 drops per ml, @ 15ml Nipe drop

acetaminofen 120,

fenilefrin HCl 1mg,

isothipendil HCl 1mg

14 Paracetamol 650 mg, 21.3.14 tab topras

phenylpropanolamin15mg

21.4 Decongestan dan anti rinitis

1 Fluticason furoat 21.4.1 Nasal spray 27,5mcg/spray Avamys

2 pseudoefedrin 60mg + 21.4.2A Tab Valved

tripolidin 2,5mg 21.4.2B Tremenza

21.4.2C Alerfed

syr per 5ml:

21.4.2D pseudoefedrin 30mg Valved

tripolidin 1,25mg

21.4.3A syr per 5ml Rhinos Junior

21.4.3B drop 7,5mg/0,8ml Rhinos Neo

3 Pseudoefedrin 15mg+

Page 342: formularium mawaddah-dH2015

clorfeniramin maleat 1mg 21.4.4 Tab Rhinos SR

4 Pseudoefedrin 60mg+

loratadin 5mg

22 Sistem Imun, Obat yang

Mempengaruhi

22.1 Serum dan Imunoglobin

22.1.1 inj im/iv 5ml

1 Serum anti bisa ular 22.1.2 inj 1500 IU ATS

2 Serum antitetanus (A.T.S) 22.1.3

inj. 250 IU Tetagam P

3 Imunoglubin Anti Tetanus (Human

Tetanus Imunoglobin)

22.2 Vaksin

1 Vaksin B.C.G 22.2.1 serb inj +pelarut 2 ml

2 Vaksin campak 22.2.2 serbuk inj +pelarut 5ml

3 Vaksin polio 22.2.3 tetes

4 Vaksin jerap difteri tatanus 22.2.4 inj 5ml

pertusis (DPT)

5 Vaksin jerap tetanus (tetanus 22.2.5 inj 5ml

adsorbed toxoid)

6 vaksin hepatitis B 22.2.6

23 Telinga, Hidung dan Tenggorokan

23.1 Antibakteri

1 Kombinasi :

Polimiksin BSO4 10.000 IU

Neomisina SO4 3,75mg 23.1.1 tetes telinga Otopain

Lidokain HCl 40mg

Fludrokkortison Asetat 1mg

- btl 10ml

2 Kloramfenikol 23.1.2 tetes telinga erlamicetin

23.2 Lain -Lain

1 Ofloxacin 23.2.1A tetes telinga tarivid

23.2.1B tab 200 mg tarivid

2 Oksimetazolin 23.2.2 tetes hidung Illiadin kinder

24 Vitamin dan Mineral

1 Asam Folat 24.1 tab 1mg Folacom

2 Calcitriol 24.2 Tab 0,25mcg Osteofem

3 Calsium lactat 24.3A Kap Caltron

24.3.B Kalk

24.3C Calsifar

24.3D tab oscal

4 Ca laktat,Ca phospat, 24.4A Kap Elkana

vit C, vit D 24.4B Syr Elkana

5 Ca glukonas 24.5 inj 100mg/ml Ca glukonas

6 Vitamin A 24.6A sugar coated 6000IU generik

24.6B sugar coated 20000IU generik

24..6C inj. Im. Amp generik

7 Vit B kompleks 24.7A Tab Alinamin F

24.7B Neurosanbe

Page 343: formularium mawaddah-dH2015

24.7C neurobion 5000

24.7D neurodex

24.7E sakaneuron

24.7F tab, kaleng generik

24.7G tab, + methampiron neuromec

24.7H inj. Amp Alinamin F

24.7I Neurosanbe

24.7J neurobion 5000

24.7K inj im, vial generik

24.7L Neurotropic

24.7M sirup Bevita

24.8N tab nerva plus

8 Vitamin B1 24.8A Tab, kaleng generik

24.8B inj. Amp generik

9 Vitamin B6 24.9 Tab, kaleng Liconam

generik

10 Vitamin C dan kombinasi

- Vit C 24.10A tab, kaleng generik

24.10B inj, amp 200mg generik

24.10C injeksi 1000mg ulvice

- B1,B2,B6,B12,vit C500mg 24.10C kaps Becom C

Ca pantotenat 20mg

- vit C 750mg,vit E30iu, B1, 24.10D kaps Becom Zet

B2,B6,B12, as folat,Zn, niacin prohelic

11 Vitamin D +calsium 24.11A Kap Calsic-D

24.11B tab calnic

24.11B syr calnic

12 Vitamin E dan Kombinasi 24.12A Kapl 100 IU Santa E

24.12B Original E

13 Vitamin K 24.13A tab salut gula 10mg generik

24.13B inj 10mg/ml Neo K

14 Vitamin Ibu Hamil dan Menyusui 24.14A Formom

24.14B Kap. Lycalvit

24.14C Etabion

24.14D Elkana

24.14E Caviplex

24.14F Prolacta mother

24.14G Moloco B-12

24.14H caps Bionemi

24.14I tab Afolat

24.14J caps formom

24.14k caps Inlacta

24.15A Kaplet Osteor plus

24.15B Efferfescen Cartos

15 Glukosamine dan 24.15B Kaplet Osteor

16 Multivitamin Anak 24.16A syr Apialys

24.16B Vitacur

24.16C Asedas

24.16D Hufavit kalk

24.16E Elkana

24.16F dhavit

24.16G Drop Apialys

17 Multivitamin inj 24.17A inj, vial Cernevit

(vit A,B,C,D, lecitin) 24.17B cap neurochol

18 vitamin jantung

(Ubiquinone 60 mg, 24.18 cap nu q ten com

L-Carnitine 250 mg,

Alpha Lipoic Acid 200mg)

19 vitamin lain 24.19 cap oxan

Page 344: formularium mawaddah-dH2015

25 Suplemen dan terapi Adjuvan lain

1 Astaxantin 25.1 caps Axanthin

2 Echinacea, Zn,Se,vit c 25.2A kap Imunos

25.2B syr Stimuno

25.2C syr Imunos

25.2D kap Nufit

3 Extrac curcuma 25.3 sugar coated tab Curcuma

syr plus DHA curcuma plus

4 Suplemen unt DHF 25.4A sachet Trolit

25.4B caps Psidii

25.4C syr Psidii

5 syr unt campuran puyer 25.5 syrplus syr

6 25.6A tab ezygard

Vitamin C 250 mg 25.6B syr ezygard

Zinc Picolinate 10 mg

7 Silymarin 70 mg, 25.7 cap proliver

Curcuminoid 20 mg,

Choline bitartrate 150 mg

vit B6 2 mg

8 Glycyrrhizine (GL), 25.8 inj snmc

Cycteine,

Glycine dalam larutan

fisiologi

9 Natural fish oil 25.9 cap vibrion

Ekstrak jahe, Fe fumarat

Asam folat, Magnesium

Kalsium sitrat

Vit A, Vit B1, Vit B2

Vit B6, Vit B12, Vit C

Vit D3, Vit E

26 Relaksan Otot Perifer dan

Penghabat Kolinesterase

28.1 Penghambat Neuromuskuler

1 Athracurium besilat 26.28.1 inj amp 10mg/2,5ml Notrixum

2 Pancuronium Br 26.28.2 inj 2mg/ml, amp 2ml Pavulon

3 Suksametonium

(suksinil kolin HCl) 26.28.3 injc 200mg/10ml vial Scholin

Echinacea 250 mg

Page 345: formularium mawaddah-dH2015

FORMULARIUM OBAT

RUMAH SAKIT MAWADDAH MEDIKA

TAHUN 2010

Pabrik

5

KF

janssen-cilag

Mahakam

KF

KF

Medifarma

gracia

Sanprima

Otto

Dexa

Berlico mulia

Dexa

Pharos

Pharos

Pharos

Guardian

Combiphar

Kalbe

dexa

kalbe

Berno

Mahakam

sydna

sanbe

gracia

Sanbe

novell

pyridam

Mepro

NOVELL

sanbe

Dexamedika

Fahrenheit

Scanpasific

sandoz

Page 346: formularium mawaddah-dH2015

sandoz

Sanprima

Sanbe

Sanbe

Pyridam

Sanprima

Novapharin

sanbe

Combi

Combi

SANBE

GRACIA

Novapharin

Sanbe

Takeda

mahakam

Dura

lapi

MAHAKAM

Phapros

Berno

Dexa

Dexa

Guardian

Novell

ethica

Sanbe

Sanbe

Sanbe

Actavis

Page 347: formularium mawaddah-dH2015

Roche

Roche

novell

Hexapharma

Interbat

Sanbe

Hexapharma

Tempo

Sampharindo

sampharindo

Dura

harsen

sanofi

sanofi

lapi

Pyridam

Lapi

lapi

lapi

guardian

Kalbe

interbat

Guardian

ethica

Ethica

Otsuka

Fahrenheit

Transfarma

Combiphar

Otsu

Otsu

Page 348: formularium mawaddah-dH2015

Actavis

ikapharmino

ikapharmino

KF

Combi

Sandoz

Sandoz

Pyrydam

Pfizer

gracia

Zenith

Sampharindo

gracia

Zenith

Sanbe

gracia

Sanbe

gracia

Sampharindo

Meiji

Berno

sanbe

sanbe

Piridam

Piridam

Yarindo

Berno

GUARDIAN

PROMED

GUARDIAN

lapi

MAHAKAM

lapi

simex

Pyridam

PROMED

Page 349: formularium mawaddah-dH2015

GRACIA

guardian

Yarindo

Berno

simex

nulab

Pt Meiji

ogb dexa

sanbe

Zenith

landsen

coronetcrown

Pyridam

Dexa

Berno

gracia

coronet

Sanbe

sampharindo

sampharindo

Lapi

Dexamedika

Sanbe

Dexamedica

Sampharindo

Promed

Pt rama

sanbe

sanbe

pyridam

guardian

Sanbe

otto

Lapi

Page 350: formularium mawaddah-dH2015

sanbe

Lapi

gracia

Lapi

sanbe

Berno

Harsen

Sanbe

Harsen

mepro

Sanovi

Sanovi

Combiphar

Sanbe

guardian

Actavis

Indofarma

sandoz

Indofarma

Indofarma

Indofarma

Sandoz

Sandoz

Lapi

Combi

lapi

Roche

Page 351: formularium mawaddah-dH2015

Pyridam

Lapi

kalbe

kalbe

Lapi

Takeda

Lapi

landson

Merck

Kalbefarma

lapi

Kalbefarma

lapi

Kalbe farma

combi

IFARS

sampharindo

Pyridam

Combi

Merc

Interbat

Sanbe

dexamedika

sakafarma

Sanbe

merck

Kalbe

Otto/daichi

gracia

Otto/Daichi

gracia

Combi

tunggal idaman

Mecosin

Bernofafm

Page 352: formularium mawaddah-dH2015

Sanofiaventis

Otsu

Fahrenheit

Landson

Lapi

Combi

Combi

darya-varia

Pyridam

Sanofiaventis

Dexa

bayer

Boehringer

guardian

Novo

Caprifarmindo

dexa

Caprifarmindo

Kalbe

Schering

lapi

lapi

Caprifarmindo

Kalbe

Bayer-Schering

Page 353: formularium mawaddah-dH2015

Harsen

Triyasa nagamas

Tunggal

Idaman Abdi

Bayer-Schering

Kalbe

Interbat

Sanbe

Kalbe

scan pasific

sampharindo

Lapi

Lapi

Dexa

Taisho

novell

Darya-Varya

Fahrenheit

Fahrenheit

Fahrenheit

Fahrenheit

Dexa

servier

Guardian

Kalbe

Dexa Medica

Page 354: formularium mawaddah-dH2015

kalbe

Sanbe

pharos

dankos farma

bayer

interbat

kimia farma

Lapi

Otsuka

Dexa

Kalbe

fahrenheit

fahrenheit

Sanofiaventis

fahrenheit

Combi

Dexa

Lapi

kalbe

Page 355: formularium mawaddah-dH2015

Sanovi

Pyridam

Darya

sanbe

erela

erela

erela

Pyridam

KF

ikapharmindo

Meiji

Otto

taisho

KF

Berno

Berno

Berno

gracia

SDM

Pyridam

kimia farma

Taiso

PT Graha

KF

interbat

Kalbe

Mecosin

Combiphar

Landson

Pharos

Pharos

Page 356: formularium mawaddah-dH2015

Combi

otsuka

Abbot

fahrenheit

Merck

Otsuka

Widatra

Widatra

Claris

sanbe

otsu, widatra

otsu,widatra

Otsu

Ethica

Otsu

Kalbe

biotest pharma

Widatra

Widatra

Otsu

Widatra

Otsu

Otsu

Widatra

sanbe

Widatra

OGB

sanbe

Otsu

Widatra

OGB

Widatra

Otsu , ,

Otsu

Sanbe

Page 357: formularium mawaddah-dH2015

Otsu

Sanbe

Otsu

Sanbe

Widatra

Kalbe

Otsu

Sanbe

otsuka

sanbe

otsu

Sanbe

sanbe

sanbe

kalbe

Otsu

Otsu

otsu

SANBE

cendo

cendo

cendo

erela

Page 358: formularium mawaddah-dH2015

erela

erela

kalbe

Cendo

Cendo

Statrol

Erela

GMP

Cendo

sanbe

Cendo

Cendo

Cendo

Cendo

Cendo

Cendo

sanbe

cendo

Cendo

Cendo

Cendo

Cendo

Lapi

Page 359: formularium mawaddah-dH2015

Kalbe

Novartis

novell

novell

Novartis

ethica

Otto

fahrenheit

Otsu

Otsu

Solvay farma

Solvay farma

Guardian

Guardian

sanbe

sanbe

Actavis

Combi

Mersi

kalbe

guardian

Mersi

Sanbe

Combiphar

Sampharindo

Emba

Bufa

Sampharindo

Ferron

Page 360: formularium mawaddah-dH2015

Guardian

sanbe

sanbe

Indofarma

sanbe

guardian

Hexapharma

Combiphar

guardian

Gracia

guardian

Eisai

Sanbe

Dexa

Mersi

ifars

samparindo

Harsen

Sanbe

sampharindo

Capri

interbat

Capri

gracia

Lapi

Indofarma

Dexamedika

ifars

Lapi

Mutifa

Lapi

mutifa

ifars

gracia

Sanbe

Lapi

Mahakam

interbat

Dexamedika

guardian

Page 361: formularium mawaddah-dH2015

Lansond

Gelenium

Takeda

triman

Ethica

Spasminal (+methampiron)

Boehringer

Interbat

OGB

Coronetcrown

Corsa

Lapi

pharos

Dexa

Pharmasolindo

Kalbe

lapi

meprofarm

Boehringer

Boehringer

Boehringer

Gelenium

combiphar

Ikapharmindo

Combi

Bernofarm

Page 362: formularium mawaddah-dH2015

darya faia

KF

hexpharm

Sandoz

Novell

Pharos

KF

KF

Scanpasific

Sampharindo

Interbat

Kalbe

Sanbe

Kalbe

Glaxo

graha farma

Glaxo

Lapi

Lapi

Glaxo

Glaxo

Glaxo

Boehringer

astra zeneca

kimia farma

fahrenheit

Behringer

Interbat

Page 363: formularium mawaddah-dH2015

kF

Sampharindo

Pyridam

Boehringer

Boehringer

sanbe

Boehringer

Pt ciubros

sampharindo

hufa

sampharindo

Hufa

Hufa

coronetcrown

Molex

Molex

grahafarma

Sampharindo

GMP

sampharindo

zenith

mahakam

Transfarma

Medika indah

gracia

Glaxo

GMP

sanbe

guardian

GMP

Dexa

Dexa

Page 364: formularium mawaddah-dH2015

Dexa

Biofarma

Biofarma

Dexa

Interbat

erela

kalbe

kalbe

Merck

Combi

Kalbe

Pyridam

KF

Ifars

glaxo

Sanbe

Sanbe

Ethica

KF

KF

Takeda

sanbe

Page 365: formularium mawaddah-dH2015

merc

akafarma

Sampharindo

Takeda

sanbe

merc

gracia

gracia

landson

Sanbe

Sanbe

promed

Sampharindo

gracia

gracia

Sanbe

Capri

KF

Combi

Pyridam

Interbat

Errita

sanbe

erela

novell

darya faria

gracia

Rama

Pyridam

interbat

pyridam

pryridam

pyridam

Lapi

lapi

Pyridam

Hufa

Sanbe

guardian

Lapi

Kalbe

landson

novell

gracia

Page 366: formularium mawaddah-dH2015

Ethica

lapi

Pyridam

lapi

guardian

soho

soho

Dexa

Dexa

Berno

promedraharjo

promedraharjo

simex

pt merapi

mahakam

Novell

Schering

Transfarma

Page 367: formularium mawaddah-dH2015

FORMULARIUM OBATRUMAH SAKIT MAWADDAH MEDIKA

TAHUN 2011

KLS N A M A O B A T kode obat Nama Dagang

1 2 3 41 Analgesik, Antipiretik, Antiinflamasi

NonSteroid, Antipirai1.1 Analgesik Narkotika

1. Kodein 1.1.1 Tab 10mg, kaleng generik

2. Fentanyl 1.1.2 inj. 50 mcg/ml @10ml Fentanyl

3. Morphin HCl 1.1.3A Tab, 10 mg MST1.1.3B Inj. 10 mg/ml generik

4. Petidin 1.1.4A injc i.m/s.k/i.v generik1.1.4B 50mg/ml

1.2 Analgesik Non-Narkotik1. Asam asetilsalisilat 1.2.1 Tab 100mg Aspilet

(asetosal)2. Asam mefenamat 1.2.2A Tab 500 mg Grafix

1.2.2B Cargesic1.2.2C Opistan1.2.2D Pondex

Bentuk sediaan, kekuatan obat

Page 368: formularium mawaddah-dH2015

3. Ibuprofen 1.2.3A Tab 200mg generik1.2.3B Proris1.2.3C syr.100mg/5ml Proris1.2.3D Supp. 125 mg Proris

4. Kalium Diklofenac 1.2.4A tab 50mg,25mg Exaflam1.2.4B tab 50mg X-flam

5. Ketoprofen 1.2.5A Supp 100mg Kaltrofen1.2.5B Tab 100mg Pronalges1.2.5C Kaltrofen

6. Ketorolac 1.2.6A inj. 30mg/ml generik1.2.6B trolac inj1.2.6C Matolac

7. Meloxicam 1.2.7A Tab 15mg generik1.2.7B osteloc1.2.7C Tab 7,5 mg generik1.2.7D loxil

8. Metampiron 1.2.8A Tab 500mg Antalgin1.2.8B Analsik

(+Dzp 2mg)1.2.8C Zyparon

9. Metamizole sodium 1.2.9A Tablet 500mg Antalgin1.2.9B Injc. 500mg/ml Norages1.2.9C @2ml1.2.9D PRAGESOL

10. Natrium diklofenak 1.2.10A Tab 50mg Voltadex1.2.10B Tab 25 mg Renadinac

Page 369: formularium mawaddah-dH2015

1.2.10C gel Scantaren

11. Paracetamol 1.2.11A Tab 500mg Mirasic1.2.11B Sanmol1.2.11C Syr 120mg/5ml Sanmol1.2.11D Pyridol1.2.11E Mirasic1.2.11F drop 60mg/0,6ml Sanmol drops1.2.11G Supp 240mg Propyretic 2401.2.11H Supp 160mg Propyretic 1601.2.11I infus Sanmol infus1.2.11J drop 60mg/0,6ml Moretic drop

12. Piroksikam 1.2.12A tab 20 mg generik1.2.12B gel Pirofel

13. Tinoridine HCl 1.2.13 tab 50 mg Nonflamin

14. Tramadol 1.2.14A inj 50mg/ml generik1.2.14B tab 37,5mg+ Patral1.2.14C paracetamol 32,5mg

15. Kombinasi :Antalgin 250mg 1.2.15 inj 15ml/vial XillomidonPyramidon 50mgLidocain HCl 15mg

1.3 Antipirai1. Allopurinol 1.3.1A Tab 100mg generik

1.3.1B reucid

Page 370: formularium mawaddah-dH2015

2 Anestetik2.1 Anestetik Lokal

1. Bupivacain HCl 2.1.1A inj 5mg+ dextrose80mg RECAINamp, 4ml

2. Etil klorida 2.1.2 spray, botol 100ml

3. Lidokain 2.1.3A inj 2% lidocain2.1.3B inj 2% (HCl) Pehacain

+epinefrin 1:800002.1.3C inj 2%+dextrosa 5% Lidodex

2.2 Anastetik Umum dan Oksigen1. Halotan 2.2.1 cairan inhalasi Halotan

250ml

2. isoflurane 2.2.2 cairan inhalasi isofluran

3. Ketamin 2.2.3 inj iv 100mg/ml Ketamin@20ml KTM

4. Nitrogen Oksigen 2.2.4 gas tabung 15kg

5. Oksigen 2.2.5 gas dlm tabung

6. Propofol 2.2.6 inj 10mg/ml, amp20ml Safol

2.3 Prosedur Peri Operatif, Obat untuk1. Atropin sulfat 2.3.1 inj 0,25mg/ml@1ml sulfas atropin

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2. Diazepam 2.3.2A tab 5mg Valisanbe2.3.2B tab 2mg Valisanbe

2.3.2C inj 5mg/ml Valisanbe

2.3.2D rectal 5mg/2,5ml Stesolid

3. Midazolam 2.3.3A inj 5mg/5ml Dormicum2.3.3B inj 15mg/3ml Dormicum

3 Anti Alergi dan Obat untuk Anafilaksis1. Dexametasone 3.1A inj 5mg/ml@1ml Kalmethasone

3.1B Indexon3.1C Cortidex

3.1D tab 0,5mg Kalmethasone3.1E Scandexon3.1F Carbidu

Kombinasi dengan 3.1G Tab Mexondifenhidramin

2. Difenhidramin 3.2A Inj 10mg/ml generik3.2B Inj 15mg/vial Duradryl

3. Epinefrin (adrenalin) 3.3 Inj 0,1% Generik

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4. Klorfeniramin 3.4 Tab 4mg pehachlor

5. Pheniramine maleat 3.5A Tab 25mg avil3.5B inj.50mg/2ml avil

6. Loratadine 3.6A tab 10mg generik3.6B clarihis

7. Ceterizin 3.7A tab 10mg Zenris3.7B generik3.7C drops Tiriz

8. Metil Prednisolon 3.8A tab 8mg generik3.8B Lameson3.8C inj 125mg/ml Lameson3.8D generik

9. Ciproheptadin 3.9 kap 4mg Pronicy

10. Mebhidroline Naphadisilat 3.10 tab 50mg interhistin

4 Antidot dan obat lain Untuk Keracunan4.1 Khusus

1. Atropin 4.1.1 inj 0,25mg/ml sulfas atropin

2. Kaksium glukonat 4.1.2 100mg/ml Ca Gluconas

3. Natrium bikarbonat 4.1.3A tab 500mg generic4.1.3B inf fl. 25 Meq Meylon

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4. Naloxone HCl 4.1.4 inj.0,4mg/ml Nokoba

5. Neostigmin metylsulfat 4.1.5 inj 0,5mg/ml Prostigmin

4.2 Umum1. Magnesium sulfat 4.2.1A inj 20%25ml MgSo4 20%

4.2.1B inj 40%25ml MgSo4 40%

5 Antiepilepsi - Antikonvulsi1. Carbamazepin 5.1 tab 200mg generik

2. Diazepam 5.2 rectal 5mg/2,5ml Stesolid

3. Fenitoin 5.3A inj 50mg/ml phenytoin5.3B cap 100mg phenytoin

4. Fenobarbital 5.4A tab 30mg generik5.4B inj 50mg Phental iv

5. Gabapentin 5.5A cap 300mg Gabexal5.5B generic

6 Antiinfeksi6.1 Antelmintik

6.1.1 Antelmintik Intestinal1. Pirantel 6.1.1.1A tab 125mg Pyrantin

6.1.1.1B susp 125mg/5ml Combantrin

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6.2 Antibakteri6.2.1 Beta Laktam1. Amoksisilin trihidrat 6.2.1.1A tab 500mg novax caps

6.2.1.1B Zemoxil6.2.1.1C Brodamox

6.2.1.1D dry syr 125mg/5ml fosicolos6.2.1.1E Zemoxil6.2.1.1F drops 100mg/ml Amoxan

6.2.1.1G serb inj 1000mg Amoxan

2. Ampisilin 6.2.1.2A cap 500mg Brodapen6.2.1.2B serb inj 1000mg Viccilin

3. Ampicillin + Sulbactam 6.2.1.3 serb inj 500+250mg Pycin 750

4. 6.2.1.4A kap 500+125mg co amoxiclav

6.2.1.4B clanexi

5. Cefadroksil 6.2.1.5A caps 500mg Pyricef6.2.1.5B generik

6.2.1.5C dry syr 125mg/5ml Pyricef6.2.1.5D generik

Kombinasi Amoksisilin 500mg dan clavulanat 125mg

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6. Sefaklor 6.2.1.6 caps 500mg Capabiotik

7. Sefaleksin 6.2.1.7 caps 500mg Cefabiotic8. Sefiksim 6.2.1.8A caps 100mg generik

NUCEFPROFIM

6.2.1.8B dry syr 100mg/5ml NUCEFgenerik

9. Sefotaksim 6.2.1.9A serb inj 1gr generik6.2.1.9B FOBET6.2.1.9C lapixim

10. Seftazidim 6.2.1.10 serb inj 1gr CEFDIM

11. Seftriakson 6.2.1.11A serb inj 1gr generik6.2.1.11B GRACEF 6.2.1.11C cephaflox

12. Sephalotin 6.2.1.12 serb inj 1gr Moraxine

13. Meropenem 6.2.1.13A serb inj 1 gr Meropex6.2.1.13B generik

14. Seftisoxim 6.2.1.13C serb inj 1 gr e-zoxgenerik

6.2.2 Antibakteri Lain6.2.2.1 Tetrasiklin1. Doksisiklin 6.2.2.1.1A caps 100mg generik

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2. Tetrasiklin 6.2.2.1.2 caps 500mg Suprabiotik

6.2.2.2 Kloramfenikol1. Kloramfenikol 6.2.2.2.1A caps 250mg Lanacetin

6.2.2.2.1B susp 125mg/5ml coromycetin

2. Tiamfenikol 6.2.2.2.2A caps 500mg Promixin6.2.2.2.2B Dexicol6.2.2.2.2C dry syr 125mg/5ml Phenobiotic6.2.2.2.2D fosicolos

6.2.2.3 Sulfa - Trimetoprim1. (dewasa)kombinasi : 6.2.2.3.1A Tablet Sanprima

sulfametoksazol 400mg + 6.2.2.3.1B miratrimtrimetoprim 80mg

2. sulfa 800mg+ 6.2.2.3.2A Tablet Lapikot fortetrimetoprim 160mg 6.2.2.3.2B Primadex forte

3. Kotrimoksazol suspensi 6.2.2.3.3A susp Sanprimakomb : sulfametoksazol 6.2.2.3.3B Primadex200mg + trimetoprim 40mg/5ml 6.2.2.3.3C Miratrim

6.2.2.4 Makrolit1. Clindamisin 6.2.2.4.1 caps 150mg & 300mg generik

2. Eritromisin 6.2.2.4.2A caps 500mg generik6.2.2.4.2B erisanbe

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6.2.2.4.2C erisanbe chewable

6.2.2.4.2D syr 200mg/5ml generik

3. Spiramisin 6.2.2.4.3A tab 500mg generik6.2.2.4.3B varoc

4. Azytromicin 6.2.2.4.4A caps 500mg zibramax6.2.2.4.4B generik

6.2.2.5 Amiglikosida1. Gentamisin 6.2.2.5.1A inj 40mg/ml Sagestam

6.2.2.5.1B inj 80mg/ml ottogenta6.2.2.6 Kuinolon1. Levofloksasin 6.2.2.6.1A tab 500mg Cravox

6.2.2.6.1B generik

6.2.2.6.1C lar infus 500mg/100ml generik6.2.2.6.1D Cravox

2. Ofloksasin 6.2.2.6.2 tab 200&400mg generik

3. Siprofloksasin 6.2.2.6.3A tab 500mg generik6.2.2.6.3B Baquior forte6.2.2.6.3C Lapiflox

6.2.2.6.3D lar infus 500mg/100ml generik6.2.2.6.3E Lapiflox inf

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6.2.2.7 Penggunaan khusus1. Sulfasalazin 6.2.2.7.1 tab 500mg Sulcolon

2. Metronidazol 6.2.2.7.2A tab 500mg Metrolet6.2.2.7.2B Trychodazole

6.2.2.7.2C syr 125mg/5ml Metrolet6.2.2.7.2D promuba6.2.2.7.2E supp 500mg Flagyl

6.2.2.7.2F ovul + nistatin 100000iu Vagistin

6.2.2.7.2G lar infus 500mg/100ml Trychodazole6.2.2.7.2H generic

3. Colistin sulfat 6.2.2.7.2 Tab 250000 iu Colistine

6.3 Antiinfeksi Khusus6.3.1 Antituberkulosis1. Etambutol 6.3.1.1 tab 500mg generik

2. Isoniazid 6.3.1.2 tab 300mg generik

3. Pirazinamid 6.3.1.3 tab 500mg generik

4. Rifampicin 6.3.1.4 caps 450mg generik

5. Kombinasi (OAT TB dots): 6.3.1.5

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untuk dewasa kap : INH 75,Rifam 150, OAT fase intensifPza 400, ethambutol 275

kap: INH 150, Rifam 150 OAT fase lanjutan

untuk pediatri INH100, rifam75,Pza200 OAT fase intensif

INH 100, Rifam 75 OAT fase lanjutan

6. Kombinasi : 6.3.1.6Ethambutol, INH, B6 caps Bacbutinh

Niazitol

7. INH50+Rifam75+PZA150 6.3.1.7 caps Rimcure paed8. INH50+ Rifam75 6.3.1.8 Rimtazid paed

6.3 Antifungi1. Itrakonazol 6.3.1 caps 100mg Itzol

2. Ketokonazol 6.3.2 tab 200mg generik

3. Mikonazol 6.3.3 cream generik

4. Nistatin 6.3.4A ovul + metronidazol vagistin

6.3.4B drops Kandistatin

6.5 Antimalaria

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1. Sulfadoxin 500mg, 6.5.1A tab Fansidarprimetamin 25 mg 6.5.1B

6.6 Antivirus6.6.1 Antiherpes1. Asiklovir 6.6.1A tab 200mg generik

6.6.1B tab 400mg generik6.6.1C cream 5% generik

7 Antimigren dan neuroprotector1. Ergotamin cafein 7.1 tab 1mg generik

2. 7.2 kap Nogren

3. Piracetam 7.3A tab 800mg&1200mg generik7.3B latropril7.3C inj 1gr/5ml generik7.3D Neurotam7.3E inj 3gr/5ml generik

4. Sitikolin/citikolin 7.4A tab 500mg Neociti

7.4B inj 250mg/2ml Nicholin7.4C Neociti

5. Pyritinol HCL 7.5 syr 100ml Encephabol

6. Mecobalamin 7.6A inj. Amp 500mcg Kalmeco

Kombinasi paracetamol 300mg, acetosal, cafein

Page 381: formularium mawaddah-dH2015

7.6B tab 500mg Kalmeco

8 Darah, Obat yang Mempengaruhi8.1 Antianemi

1. Asam folat 8.8.1.1 tab 1mg Folacom

2.Besi III sulfat (sulfas ferosus)

8.8.1.2A tab salut 300mg Natabion8.8.1.2B Artoferum8.8.1.2C syr. 50mg/50ml, @150ml Maltofer

3. Vit B1, B6, B12 8.8.1.3A tab Neurobion 50008.8.1.3B Neurobat8.8.1.3C Neurosanbe 8.8.1.3D Neurodex8.8.1.3E Sakaneuron

8.8.1.3F inj. Amp 3ml Neurosanbe 50008.8.1.3G Neurobion 5000

8.2 Koagulasi, obat yang mempengaruhi1. Asam traneksamat 8.8.2.1A inj 250mg/5ml Kalnex

8.8.2.1B Transamin

8.8.2.1C tab 500mg Transamin

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2. Fitomenadion (vit K) 8.8.2.2A tab salut 10mg, kaleng generik8.8.2.2B inj 10mg/ml Neo K

3. Heparin Na 8.8.2.3A gel Thrombopop Gel8.8.2.3B Antithromb

4. Lidocain 8.8.2.4 inj 2% generic

9 Diuretik1. Furosemida 9.1A tab 40mg generik

9.1B inj 10mg/ml Lasix

2. Hidroklortiazid (HCT) 9.2 tab 25mg generik

3. Manitol 9.3 lar infus 20%@500ml manitol

4. Spironolacton 9.4 tab 25mg carpiaton

10 Hepatoprotector dan Cholelitiolisis1. Lesitin 10.1A caps 300mg Lesichol

10.1B Lesipar

2. L-ornitin, L-aspartat 10.2A inj 5mg/10ml Hepa-Merz10.2B sachet 3g Hepa-Merz granul

3. Ursodeoxycholic 10.3 caps 250mg Urdafalk

4. hepatoprotector 10.4A tab Hepa-Qfitofarmaka 10.4B HP pro

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11 Hormon, Obat Endokrin Lain dan Kontraseptik11.1 Antidiabetes

11.1.1 Antiabetes, Oral1. Glibenclamida 11.1.1 tab 5mg generik

2. Glimepiride 11.1.2 tab 2mg AmarilGluvas

3. Glikuidon 11.1.3A tab 30mg Glurenorm11.1.3B generik

4. Metformin 11.1.4A tab 500mg generik11.1.4B Eraphage

5. Gliklasid 11.1.5 tab 80mg generik

11.1.2 Antidiabetes, Parenteral1. Isulin reguler 11.2.1 inj 100iu/ml @10ml Actrapid

11.2 Hormon Kelamin dan obat yang mepengaruhi Fertilitas11.2.1 Progestrogen1. Noretisteron 11.2.1A tab 5mg Regumen

11.2.1B Norelut N

2. Alil Esternol 11.2.2A tab 5mg Preabor11.2.2B Premastone

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3. Ethinilestradiol 11.2.3 tab 50mcg Lynoral

11.2.2 Clomiphen Sitrat11.2.2.1A tab 50mg Blesifen11.2.2.1B Profertil

11.3 Kontraseptik11.3.1 Oral1. Levonogestrel, 11.3.1A tab 28 Microgynon ling-

ethinilestradiol,placebo 11.3.1B karan biru

11.3.2 Injeksi1. medroksiprogesteron 11.3.2.1A vial, 50mg/ml, 3mL Depo progestin

acetat 11.3.2.1B vial, 150mg/ml, 1ml Depo Neo

2. Medroksiprogesteron 11.3.2.2A vial, 0,5 ml Cyclofemacetat 50mg+10 estradiol- 11.3.2.2Bcypionate

11.3.3 Intra Uterin 11.3.3 T-shaped dg copper wire Nova-T CUdan silver core

11.4 Hormon Tiroid dan Antitiroid1. Propiltiorasil 11.4.1 tab 100mg generik

11.4 Kortikosteroid1. Deksametason 11.4.1A inj 5mg/ml @1ml Kalmethasone

Page 385: formularium mawaddah-dH2015

11.4.1B Indexon11.4.1C Cortidex

11.4.1D tab 0,5mg Kalmethasone11.4.1E scandexon11.4.1F carbidu

2. Metil prednisolon 11.4.2A tab 4mg generik11.4.2B lameson11.4.2C inj 125mg/2ml lameson

3. Prednison 11.4.3 tab 5mg generik

4. Triamsinolon 11.4.4A inj 10mg/ml Falmicort11.4.4B oral base, tube Kenalog

12 Kardiovaskuler, Obat12.1 Antiangina

1. Atenolol 12.1.1 tab 100mg generik

2. Diltiazem HCL 12.1.2A tab 30mg generik12.1.2B inj 5mg/ml

3. Isosorbit dinitrat 12.1.3A tab 5mg generik12.1.3B Cedocard12.1.3C inj 10mg/10ml Farsorbid

4. Nitrogliserin 12.1.4 inj 1mg/ml generik

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5. Propanolol 12.1.5 tab 10mg generik

12.2 Antiaritmia1. Amiodaron HCT 12.2.1 tab 200mg dan inj Tiaryt

2. Kuinidin 12.2.2 tab 100mg generik

3. Lisinopril 12.2.3 tab 10mg Noperten

4. Propanolol 12.2.4 tab 10mg generik

5. Trimetazidine diHCl 12.2.5 tab 35mg Trizedon MR

6. Verapamil 12.2.6 tab 80mg generik

12.3 Lain-lain1 Amlodipin Besilat 12.3.1A tab 5mg generik

12.3.1B tab 10mg generik12.3.1C lapiten

2 Losartan 12.3.2 tab 50mg Angioten

3 Valsartan 12.3.3 tab 80mg Valsartan-Ni

12.4 Antihipertensi1 Bisoprolol 12.4.1 tab 5mg generik

2 Captopril 12.4.2A tab 25mg generik12.4.2B tab 12,5mg generik

Page 387: formularium mawaddah-dH2015

3 Klonidin 12.4.3 tab 0,15mg generik

4 Metildopa 12.4.4 tab salut 250mg generik

5 Nifedipin 12.4.5A tab 10mg generik12.4.5B Nifedin

12.6 Anticoagulan, antiplatelet1 Clopidogrel 12.6.1A tab 75mg Pidofix

12.6.1B generic

2 Cilostazol 12.6.2 tab 50mg Pletaal

3 Streptokinase 12.6.3 inj 1.5 juta iu/vial Streptase

12.7 Trombolitik1 Pentoksifilin 12.7.1 tab 400mg Reotal SR

12.8 Gagal jantung, obat1 Digoksin 12.8.1A tab 0,25mg generik

12.8.1B fargoxin

2 Furosemid 12.8.2A tab 40mg generik12.8.2B inj 10mg/ml @2ml Lasix

12.9 Syok, obat untuk11.9.1 Syok kardiogenik

1 Dopamin 12.9.1.1 inj 40mg/ml generik

Page 388: formularium mawaddah-dH2015

2 Dobutamin 12.9.1.2 inj 250mg Dobutamin

3 Epineprin (adrenalin) 12.9.1.3 inj 0,1% generik

4 Norepinefrin 12.9.1.4 inj 0,1% generik(noradrenalin)

11.9.2 Syok karena Anestesi1 Ephedrin 12.9.2.1 inj 50mg/ml generik

12.10 Antihiperlipidemia1 Gemfibrozil 12.10.1A caps 300mg generik

12.10.1B Lapibroz

2 Simvastatin 12.10.2A tab 10mg generik12.10.2B Cholestat

13 Kulit, obat topikal untuk13.1. Antibakteri

1 Framisetin 13.1 casa steril 1% sofratulle

2 Natrium fusidat 13.2 cream 20mg/gr Fuson

3 Perak sulfadiazin 13.3 cream 1% Burnazin

4 Gentamisin sulfat 13.4A cream 1mg/gr generik13.4B sagestam13.4C Genoint

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5 Gentian violet lar 1% 13.5 larutan 1% Genoint

6 neomycin sulfat + 13.6 cream Ociderm-Nfluocinolon acetonide

7 Chloramphenicol+ 13.7 cream Chloramphecorthidrocortison

13.2 Antifungi1 Ketokonazol 13.2.1 cream Mycoderm

2 Miconazol 13.2.2A cream 2% generik13.2.2B dactarin powder

3 Nystatin,zinc oxide 13.2.3 cream Myco-z

4 Gentian Violet 13.2.4 larutan 1%

13.4 Antiinflamasi dan Antipruritik1 Betametason 13.4.1A cream Betason cream

13.4.1B Benoson 13.4.1C cream + neomycin Benoson N13.4.1D cream + miconazole Benoson M

2 Clobetasol 13.4.2 cream 0,05% Kloderma

3 Desoksimetason 13.4.3 cream 0,25% Pyderma

Page 390: formularium mawaddah-dH2015

4 Hidrokortison 13.4.4 cream 2,5% generik

5 Triamsinolon 13.4.5 cream oral base Kanalog

13.5 Antiskabies dan antipedikulosis 1 Lindane 1%, 13.5 cream Scabicid

ursic acid 1%

13.6 Keratolitik dan keratoplastik1 Urea 13.6.1 cream 20% Moistderm

13.7 Extrac placenta13.7A gel 10gr Bioplacenton13.7B Bismecon

13.8 Hyaluronic acid 13.8 cream 15gr Bionect

13.9 Lain-lain1 Centella asiatica phytosom 13.9.1

& vit E cream Lanakeloid

2 Asam sulfonat+ 13.9.2 solution 10ml Albothylformaldehid

3 Herbal ointment 13.9.3 cream Meibo

14 Larutan irigasiwater for irigation 14.1 larutan 1L

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15 Larutan Elektrolit,Nutrisi dan lain-lain 15.1 Oral

1 Garam oralit 15.1.1A Pedyalite 15.1.1B Renalyte15.1.1C Oralyte

2 Kalium klorida 15.1.2A tab siap larut 600mg KSR15.1.2B syr. Larutan 3%, 100mL KCl 3%

3 Natrium bikarbonat 15.1.3A tab 500mg generik15.1.3B inf. 25 Meq, 25mL Meylon

15.2 Parenteral1 Plasme expander 15.2.1A lar infus 6%, botol 500ml Wida HES 130

(HES) 15.2.1B Wida HES 20015.2.1C Tetra HES 130

2 Glukosa 15.2.2A lar infus 5%, botol 500ml D 5%15.2.2B lar infus 10%, botol 500ml D 10%15.2.2C lar infus 40%, botol 25ml D 40%

3 Kalsium glukonat 15.2.3 inj 10% @10ml Ca Gluconat

4 Kalium Klorida 15.2.4 inj 25ml/vial KCl 7,46%

5 Human Albumin 15.2.5 lar infus 20 % @50ml Octalbin(tidak stock)

6 Lar. Nutrisi DOEN IV kombinasi:

Page 392: formularium mawaddah-dH2015

Glukose 5%. + NaCl 0,45% -lar infs btl 500ml 15.2.6 Wida D5 1/2 NS

7 Lar. Nutrisi DOEN VI kombinasi :Glukose 5% + NaCl 0,225% 15.2.7 -lar infs btl 500ml Wida D5 1/4 NS

8 Natrium bikarbonat 15.2.8 lar inf 25Meq, 25mL Meylon

9 Natrium klorida 0,9%lar inf. 500ml 15.2.9A Wida NS

15.2.9B Otsu NSlar.inf 100ml 15.2.9C Otsu NS pegy

15.2.9D INFUSAN NS 10010 Ringer laktat 15.2.10 RL

11 kombinasi:Dextrose 5% + NaCl 0,9% 15.2.11A D5 NS -lar infs btl 500ml 15.2.11B Infusan RD5%

12 kombinasi :Nacl 0,18 % b/v 15.2.12 Otsu D10 1/5 NSglukosa 10 % -lar infs btl 500ml

13 kombinasi :NaCl 2,34gr 15.2.13A KA EN 3AKCl 0.75gr 15.2.13B TRIDEX 27 ANa Lactate 2,24grDextrose anhydrat 27gr

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-lar infs btl 500ml

14 kombinasi :NaCL 1,75gr 15.2.14A KA EN 3BKCl 1,5gr 15.2.14B TRIDEX 27BNa Lactate 2,24gr Dextrose anhydrat 27gr -lar infs btl 500ml

15 kombinasi :dextrose anhydrat 37,5 gNaCl 2,25 g -lar infs btl 500ml 15.2.15A KA EN 1B

15.2.15B Tridex plain16 Kombinasi :

Glukosa 12,5 gNaCl 1 g 15.2.16 Wida 1/2 DaDKCl 0,65 gNa Lactat 1,55 g

17 kombinasi :Amino Acids 100mgNitrogen 15,7mg 15.2.17 KalbaminNa 2m EQ.Acetate 120m EQ -lar infs btl 500ml

18 kombinasi :Asam Amino 2,72% 15.2.18A Pan Amin G

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Sorbitol 15% 15.2.18B VALAMIN -lar infs btl 500ml

19 Kombinasi :Dextrose Anhydrose 100gr 15.2.19A KA EN MG3Sodium Chlorid 1,75gr 15.2.19B Tridex 100Potasium Chloride 1,50grSodium lactat 2,24gr -lar infs btl 500ml

15.3 Lain-lain1 Air untuk injeksi 15.3.1 Water For Injc

16 Mata, obat untuk16.1 Sistemik

1 Manitol 16.1.1A lar infus 20%, botol 500ml Manitol16.1.1B M.20 Manitol

16.2 Topikal16.2.1 Anestetik Lokal

1 Tetrakain 16.2.1.1 tetes mata 0,5% Pantocain

16.2.2 Antimikroba1 Gentamisin 16.2.2.1A tetes mata 0,3% Gent oint

16.2.2.1B salep mata 0,3% Gent oint

2 Kloramfenikol 16.2.2.2 salep mata 1% erlamicetin

Page 395: formularium mawaddah-dH2015

16.2.3 Anti inflamasi1 Kombinasi : 16.2.3.1 tetes mata

Polimiksina sulfat 6.000 IUNeomisin Sulfat 3,5mgDeksametason Na Fosfat 1,3mg -tts mata btl 5ml

2 Kombinasi : tetes mataPolimiksina sulfat 6.000 IU 16.2.3.2A AlletrolNeomisin sulfat 3,5mg 16.2.3.2B OreganDeksametason Na fosfat 1mg 16.2.3.2C Xitrol -tts mata btl 5ml

16.2.4 lain-lain1 Antazolin phospat, 16.2.4.1 tetes mata Vasacon-A

hypomeloza

17 Oksitosik dan relaksan uterus17.1 Oksitosik

1 Metilergometrin 17.1.1A table salut 0,125mg generiktablet 0,125 17.1.1B Pospargin

17.1.1C inj 0,200mg/ml Methergin

2 Oksitosin 17.1.2 inj 10 IU/ml Syntocinon

3 Mesoprostol 17.1.3 tab 200mg Citrosol

17.2 Relaksan Uterus1 Magnesium sulfat 17.2.1A inj 20% @25ml Mg SO4 20%

Page 396: formularium mawaddah-dH2015

17.2.1B inj 40% @25ml Mg SO4 40%

2 Isoksuprin HCL 17.2.2A tabl 20mg Duvadilan17.2.2B inj. 5mg/ml @2ml Duvadilan

18 Psikofarmaka18.1 Antiansietas dan Antiinsomnia

1 Alprazolam 18.1.1A tab 0,25 mg Alganax18.1.1B tab 0,5mg Alganax

2 Clobazam 18.1.2 tab 10mg generik

3 Diazepam 18.1.3A tab 2mg Valisanbe18.1.3B tab 5mg valisanbe18.1.3C Supp 5mg/2,5ml Stesolid

4 phenobarbital 18.1.4A tab 30 mg generik18.1.4B inj Phental iv

18.2. Antidepresi dan Antimania1 Amitriptilin 18.2.1 Tab 25 mg generik

2 Klorpromazin HCL 18.2.2 tab 100mg Cepezet

18.3 Antipsikosis1 Halloperidol 18.3.1 tab 25mg generik

2 Klorpromazin 18.3.2 tab salut 100mg cepezet

Page 397: formularium mawaddah-dH2015

19 Saluran Cerna, Obat untuk19.1 Antasida dan Antiulkus

1 Antasida DOEN I kombinasi : 19.1.1 tab generikAl(OH)3 200mg + Mg (OH)2 200mg Sanmag (+dzp 2mg)

MagtralStomacain

2 Antasida DOEN II susp, kombinasi : 19.1.2Al (OH)3 200mg/5ml + Mg (OH)2 Mylacid200mg/5ml Bufantacyd

(+cimeticon)Carsida

3 Famotidin 19.1.3 tab 20mg generik

4 Lanzoprazol 19.1.4 caps 30mg generik

5 Omeprazol 19.1.5A caps 20mg generik19.1.5B inj. OMZ19.1.5C Norsec

6 Ranitidin 19.1.6A tab 150mg generik19.1.6B Acran19.1.6C inj 25mg/2ml generik19.1.6D Indoran19.1.6E Acran

7 Simetidin 19.1.7A tab 200mg generik19.1.7B inj. 200mg,amp Ulsikur

Page 398: formularium mawaddah-dH2015

8 Sulkrafat 19.1.8A tab 500mg Ulsafate19.1.8B syr 100ml Propepsa

9 Polymigel 19.1.9 tab Strocain-P

19.2 Enzim1 Pankreatin,diastease 19.2.1 kap lybrozim

2 kombinasi : pankreatin 19.2.2 kap lybrozim plusdiastase, cimetikon

3 Pankreatin,activated 19.2.3 kaplet Tripanzymdimetilpolisiloxan

19.3 Antiemetik1 Betahistin mesilat 19.3.1 tab 6mg Mertigo

Merislon

2 Dimenhidrinat 19.3.2A tab 50mg generik19.3.2B Mantino

3 Loperamid 19.3.3A tab 2mg lopamid19.3.3B Lodia

4 Metoklopramid 19.3.4A tab 5mg Nilatika19.3.4B Damaben19.3.4C inj 5mg/ml Tomit19.3.4D Damaben

Page 399: formularium mawaddah-dH2015

5 Ondansetron 19.3.5A inj 4mg/2ml generik19.3.5B ODR 19.3.5C Insetron19.3.5D tab 4mg vometraz

6 Domperidon 19.3.6A tab 1mg generik19.3.6B Dom19.3.6C Omedon19.3.6D syr 5mg/5ml Dom19.3.6E Omedon19.3.6F generik

7 Chlordiazepoxid 5mg+ 19.3.7 tab Braxidindclonidium 2,5mg

8 Pantoprazol inj 19.3.8 inj 40mg TopazolePepzol

9 Pyratiazine chloroteo- 19.3.9 tablet Anvomer B6phylinate 40mg+B6 30mg

19.3 Antihemoroid1 Kombinasi : 19.3.1 kapsul 100mg Lanaven

Soybean purified extract

2 Antihemoroid kombinasi : 19.3.2bismutsubgalat150mg Supp generikheksaklorofen

3 Lidocain HCl +Al subacetat 19.3.3

Page 400: formularium mawaddah-dH2015

hidrocortison acetat, ointmen HaemocainZinc oxide

4 Lithospermi radix, prednisolon, 19.3.4lidocain,benzocain,cetrimide ointmen Borraginol S

19.4 Antispasmodik1 Atropin Sulfat 19.4.1 inj. 0,25mg/ml @iml Atropin

2 Hyoscine-N-butil bromide 19.4.2A tab. 10mgSpasminal (+methampiron)

Buscopan19.4.2B inj 20mg/mL Gitas

3 Papaverin 19.4.3.A tab 40mg generik19.4.3B inj im 40mg/ml generik

19.5 Diare, obat untuk1 Garam oralit I komb :

NaCl 0,7gr + KCl 0,3gr + 19.5.1 Oralittrinatrium sitrat dihidrat 0,58gr +glukosa anhidrat 4gr

2 Kombinasi : 19.5.2A tab CorosorbKaolin 550mg + 19.5.2B susp Novadiarpectin 200mg 19.5.2C Omegdiar

3 Lactobacillus 19.5.3A serbuk L-bio

Page 401: formularium mawaddah-dH2015

19.5.3B Lacto B19.5.3C Cap Lacidofil19.5.3D Lacbon

4 Zinc 19.5.4A serbuk/sachet Orezinc19.5.4B tablet Zincare

19.6 Kataritik1 Bisakodil 19.6.1A supp 5mg Dulcolax Paed

19.6.1B supp 10mg Dulcolax Paed

19.6.1C tab 5mg Dulcolax Paed

2 GliserinKombinasi : 19.6.2A susp botol 60ml LaxadineParafin + Glicerin + 19.6.2B cairan supp. fleet enemafenolftalen

3 Lactulosa 19.6.3 syr Lactulax

4 Fosfosoda 19.6.4 susp Fleet Fosfosoda

19.7 Antiinflamasi, obat untuk1 Sulfasalazin 19.7.1 tablet 500mg Sulcolon

20 Saluran Kencing dan Prostat, obat yang mempengaruhi20.1 Saluran kencing

20.1A tetes Kalkurenal

Page 402: formularium mawaddah-dH2015

20.1B Batugin elixir20.1C Caps Nefrolit

20.2 Renal insufisiensi1 20.2.1 Kap 650mg Tonar

L-tyrosin,L-lysin,dst

2 valeric acid, butiric acid, 20.2.2 Tab Prorenallycin monoacetat, tryptopan,tyrosin, histidin

20.3 Prostat (anti BPH)1 Finasteride 20.3.1 tab 5mg Prostide

21 Saluran napas, Obat untuk21.1 Antiasma

1 Aminofilin 21.1.1A tablet 200mg generik21.1.1B inj. 24mg/ml @10ml generik

2 Deksametason 21.1.2A tab 0,5mg scandexon21.1.2B carbidu21.1.2C inj. 5mg/ml Indexon21.1.2D Kalmetason21.1.2E Cortidex

3 Efedrin 21.1.3 tab 0,5mg generik

4 Epinefrin (adrenalin) 21.1.4 inj 0,1% generik

5 Fluticason propionat 21.1.5 nebules 0,5mg/2,5ml Flixotide

α ketoisoleusin, L-hitidin

Page 403: formularium mawaddah-dH2015

6 Salbutamol 21.1.6A tab 2mg generik21.1.6B Ventolin

21.1.6C syr 2mg/5ml Lasal

21.1.6D syrup per 5ml : Lasal expectoransalbutamol 2mg+Gg 75mg

21.2.6E inh.(aerosol) 100mcg/dosis Ventolin

21.2.6F nebules 2,5mg Ventolin

7 kombinasi salbutamol 21.2.7 nebules 2,5ml combivendan ipratropium Br

8 Terbutalin sulfat 21.2.8 inj. 0,5mg/ml bricasma

9 Teofilin 21.2.9 tab 150 mg generik

21.2 Antitusif1 Dekstrometorfan 21.2.1A tab 15mg generik

21.2.1B Romiler

2 Dextrometorfan 10mg + 21.2.2 syr per 5ml @ 60ml Alco plusDMP syrpseudoefedrin 30mg +bromfeniramin maleat2mg

Page 404: formularium mawaddah-dH2015

3 kombinasi : 21.2.3 syr 60ml Guaminprometazin, Gg

4 Kodein 21.2.4 Tab 20 mg

5 Doveri 21.2.5 Tablet

21.3 Ekspektoran1 Ambroxol 21.3.1A Tab 30mg Mirapect

21.3.1B generik

2 Bromheksin 21.3.2A Syr 4mg/5ml Bisolvon elixir21.3.2B inj. 4mg/2ml Bisolvon

Bromheksin 4mg+ 21.3.2C Syr /5ml ,@60mL Bisolvon extraGuafenesin 100mg

3 Gliseril guaiakolat 21.3.3 Tab 100mg generik

4 Obat batuk hitam (OBH) 21.3.4 syr botol 100 ml

5 Kombinasi :Paracet,Gg,efedrin 21.3.5A Tab. coparcetinchlorfeniramin 21.3.5B Hufagrip forte

21.3.5C Syr 60ml coparcetin

6 KombinasiParaset, pseudoefedrin, 21.3.6 Tab Demacolinchlorfeniramin,cafein

Page 405: formularium mawaddah-dH2015

7 kombinasi : 21.3.7DMP,GG,PPA, Kap Dextralchlorpheniramin Dextral forte

8 Kombinasi :DMP,GG,Diphenhidramin 21.3.8 Kap grantusif

9 kombinasi : 21.3.9 Syr 60 ml Miradryldiphenhidramin, amonium Cl, Na sitrat

10 kombinasi :diphen, Gg, mentol 21.3.10 Syr. 60ml Coredryl

11 Kombinasi:ipekak,guefenesin 21.3.11 Syr 60ml Miradryl

12 oxomemezin +Gg 21.3.12 syr 60ml oxopect syr

13 Kombinasi : 21.3.13 drops per ml, @ 15ml Nipe dropacetaminofen 120, fenilefrin HCl 1mg,isothipendil HCl 1mg

21.4 Decongestan dan anti rinitis1 Fluticason furoat 21.4.1 Nasal spray 27,5mcg/spray Avamys

2 pseudoefedrin 60mg + 21.4.2A Tab Valved

Page 406: formularium mawaddah-dH2015

tripolidin 2,5mg 21.4.2B tremenza

syr per 5ml: 21.4.2C pseudoefedrin 30mg Valved

tripolidin 1,25mg

3 Pseudoefedrin 15mg+ 21.4.3A syr per 5ml Rhinos Juniorclorfeniramin maleat 1mg 21.4.3B drop 7,5mg/0,8ml Rhinos Neo

4 Pseudoefedrin 60mg+ 21.4.4 Tab Rhinos SRloratadin 5mg

22 Sistem Imun, Obat yang Mempengaruhi22.1 Serum dan Imunoglobin

1 Serum anti bisa ular 22.1.1 inj im/iv 5ml

2 Serum antitetanus (A.T.S) 22.1.2 inj 1500 IU ATS

3 Imunoglubin Anti Tetanus (Human 22.1.3Tetanus Imunoglobin) inj. 250 IU Tetagam P

22.2 Vaksin1 Vaksin B.C.G 22.2.1 serb inj +pelarut 2 ml

2 Vaksin campak 22.2.2 serbuk inj +pelarut 5ml

Page 407: formularium mawaddah-dH2015

3 Vaksin polio 22.2.3 tetes

4 Vaksin jerap difteri tatanus 22.2.4 inj 5mlpertusis (DPT)

5 Vaksin jerap tetanus (tetanus 22.2.5 inj 5ml adsorbed toxoid)

23 Telinga, Hidung dan Tenggorokan23.1 Antibakteri

1 Kombinasi : 23.1.1 tetes telinga OtopainPolimiksin BSO4 10.000 IUNeomisina SO4 3,75mgLidokain HCl 40mgFludrokkortison Asetat 1mg - btl 10ml

23.2 Lain -Lain1 23.2.1 tetes telinga tarivid

2 Oksimetazolin 23.2.2 tetes hidung Illiadin kinder

24 Vitamin dan Mineral1 Asam Folat 24.1 tab 1mg Folacom

2 Calcitriol 24.2 Tab 0,25mcg Osteofem

3 Calsium lactat 24.3A Kap Caltron24.3.B Kalk

Page 408: formularium mawaddah-dH2015

24.3C Calsifar

4 Ca laktat,Ca phospat, 24.4A Kap Elkana vit C, vit D 24.4B Syr Elkana

5 Ca glukonas 24.5 inj 100mg/ml Ca glukonat

6 Vitamin A 24.6A sugar coated 6000IU generik24.6B sugar coated 20000IU generik24..6C inj. Im. Amp generik

7 Vit B kompleks 24.7A Tab Alinamin F24.7B Neurosanbe24.7C neurobion 500024.7D neurodex24.7E sakaneuron24.7F tab, kaleng generik

24.7G tab, + methampiron neuromec

24.7H inj. Amp Alinamin F24.7I Neurosanbe24.7J neurobion 500024.7K inj im, vial generik24.7L Neurotropic

8 Vitamin B1 24.8A Tab, kaleng generik24.8B inj. Amp generik

Page 409: formularium mawaddah-dH2015

9 Vitamin B6 24.9 Tab, kaleng Liconam

10 Vitamin C dan kombinasi- Vit C 24.10A tab, kaleng generik

24.10B inj, amp 200mg generik

- B1,B2,B6,B12,vit C500mg 24.10C kaps Becom C Ca pantotenat 20mg- vit C 750mg,vit E30iu, B1, 24.10D kaps Becom Zet B2,B6,B12, as folat,Zn, niacin

11 Vitamin D +calsium 24.11 Kap Calsic-D

12 Vitamin E dan Kombinasi 24.12A Kapl 100 IU Santa E24.12B Original E

13 Vitamin K 24.13A tab salut gula 10mg generik24.13B inj 10mg/ml Neo K

14 Vitamin Ibu Hamil dan Menyusui 24.14A Formom24.14B Kap. vibrion24.14C procalma

siobion24.14D elkana

bionemi24.14E Caviplex24.14F24.14G Moloco B-12

Page 410: formularium mawaddah-dH2015

15 Glukosamine dan 24.15A Kaplet Osteor plus24.15B Efferfescen Cartos

16 Multivitamin Anak 24.16A syr Apyalis24.16B Vitacur24.16C Asedas24.16D Hufavit kalk24.16E Elkana24.16F Drop Apyalis

17 Multivitamin inj 24.17 inj, vial Cernevit(vit A,B,C,D, lecitin)

25 Suplemen dan terapi Adjuvan lain1 Astaxantin 25.1 caps Axanthin

2 Echinacea, Zn,Se,vit c 25.2A kap Imunos25.2B syr Stimuno

3 Extrac curcuma 25.3 sugar coated tab Curcuma

4 Suplemen unt DHF 25.4A sachet Trolit25.4B caps Psidii

5 syr unt campuran puyer 25.5 syrplus syr

26 Relaksan Otot Perifer dan Penghabat Kolinesterase28.1 Penghambat Neuromuskuler 26.28.1

Page 411: formularium mawaddah-dH2015

1 Athracurium besilat inj amp 10mg/2,5ml Notrixum2 Pancuronium Br 26.28.2 inj 2mg/ml, amp 2ml Pavulon3 Suksametonium

(suksinil kolin HCl) 26.28.3 injc 200mg/10ml vial Scholin

Page 412: formularium mawaddah-dH2015

FORMULARIUM OBATRUMAH SAKIT MAWADDAH MEDIKA

TAHUN 2011

Pabrik

5

KF

Janssen-cilag

MahakamKF

KF

Medifarma

GraciaSanprima

OttoDexa

Page 413: formularium mawaddah-dH2015

IndofarmaPharosPharosPharos

GuardianCombiphar

KalbeDexaKalbe

IndofarmaBerno

Mahakam

sanbe

gracia

Sanbe

novell

Mepro

NOVELLDexamedikaFahrenheit

Page 414: formularium mawaddah-dH2015

Scanpasific

SanprimaSanbeSanbe

PyridamSanprima

sanbeCombiCombiSANBEGRACIA

Sanbe

Takeda

Indofarmamahakam

Dura

Indofarmaotto

Page 415: formularium mawaddah-dH2015

MAHAKAM

IndofarmaPhapros

Berno

Dexa

Dexa

PfizerGuardian

Novell

ethica

Page 416: formularium mawaddah-dH2015

SanbeSanbe

Sanbe

Actavis

RocheRoche

HexapharmaInterbatSanbe

HexapharmaTempo

Sampharindo

sampharindo

Dura

Page 417: formularium mawaddah-dH2015

Phapros

sanofisanofi

Indofarmalapi

Pyridam

Lapi

Indofarmalapilapi

Kalbe

interbat

ethica

Ethica

Otsuka

Page 418: formularium mawaddah-dH2015

Fahrenheit

Transfarma

Otsu

Otsu

Indofarma

Actavis

ikapharminoikapharmino

KFCombi

Sandoz

Pfizer

Page 419: formularium mawaddah-dH2015

graciaZenith

Sampharindo

graciaZenithSanbe

Sanbe

SampharindoMeiji

Berno

sanbe

PiridamBernofarm

PiridamHexpharm

Page 420: formularium mawaddah-dH2015

Yarindo

Berno

GUARDIAN

PROMEDGUARDIAN

MAHAKAMlapi

PROMED

GRACIAguardian

Yarindo

Berno

nulabnovell

dexa

Page 421: formularium mawaddah-dH2015

Zenith

landsencoronetcrown

PyridamDexaBernogracia

Sanbesampharindo

LapiDexamedika

SanbeDexamedicaSampharindo

sanbe

Page 422: formularium mawaddah-dH2015

sanbe

pyridam

guardiandexa

Sanbeotto

Lapi

dexaLapi

dexa

IndofarmasanbeLapi

novellLapi

Page 423: formularium mawaddah-dH2015

Berno

HarsenSanbe

HarsenmeproSanovi

Combiphar

Sanbe

Actavis

Bernofarm

Indofarma

Indofarma

Indofarma

Page 424: formularium mawaddah-dH2015

Indofarma

Indofarma

Indofarma

Indofarma

SandozSandoz

Lapi

Hexpharm

KF

Combi

lapi

Page 425: formularium mawaddah-dH2015

Roche

IndofarmaIndofarmaIndofarma

KF

Pyridam

IndofarmaLapi

kalbe

Lapi

TakedaLapi

Merck

Kalbefarma

Page 426: formularium mawaddah-dH2015

Kalbefarma

combi

Pyridam

Combi

MercInterbatSanbe

dexamedikasakafarma

Sanbemerck

KalbeOtto/daichi

Otto/Daichi

Page 427: formularium mawaddah-dH2015

KFCombi

tunggal idamanMecosin

Bernofafm

Sanofiaventis

Indofarma

Otsu

Fahrenheit

LandsonLapi

CombiCombi

darya-varia

Pyridam

Page 428: formularium mawaddah-dH2015

Indofarma

SanofiaventisDexa

Boehringerdexa

dexaguardian

Novo

Caprifarmindodexa

CaprifarmindoKalbe

Page 429: formularium mawaddah-dH2015

Schering

CaprifarmindoKalbe

Bayer-Schering

HarsenTriyasa nagamas

TunggalIdaman Abdi

Bayer-Schering

Kalbe

Page 430: formularium mawaddah-dH2015

InterbatSanbe

Kalbescan pasific

sampharindo

IndofarmaLapiLapi

DexaTaisho

Darya-VaryaFahrenheit

Page 431: formularium mawaddah-dH2015

Fahrenheit

Dexa

Indofarma

servier

Guardian

Kalbe

Dexa Medica

Page 432: formularium mawaddah-dH2015

Sanbe

Lapi

Otsuka

Dexa

Kalbe

fahrenheit

Sanofiaventis

Page 433: formularium mawaddah-dH2015

Combi

Lapi

kalbe

Sanovi

Pyridam

Darya

sanbeerela

Page 434: formularium mawaddah-dH2015

erela

Pyridam

KF

Otto

taisho

KFBernoBernoBerno

SDM

Pyridam

Page 435: formularium mawaddah-dH2015

Taiso

KF

interbat

KalbeMecosin

Combiphar

Landson

Pharos

Combi

otsuka

Page 436: formularium mawaddah-dH2015

Abbotfahrenheit

Merck

Otsuka

WidatraWidatraClaris

otsu, widatraotsu,widatra

Otsu

Ethica

Otsu

Kalbe

Page 437: formularium mawaddah-dH2015

Widatra

Widatra

Otsu

WidatraOtsuOtsu

WidatraWidatra

OtsuWidatra

Otsu

OtsuSanbe

Page 438: formularium mawaddah-dH2015

OtsuSanbe

OtsuSanbe

Widatra

Kalbe

Otsu

Page 439: formularium mawaddah-dH2015

Sanbe

otsuSanbe

Otsu

otsuSANBE

cendo

erelaerela

erela

Page 440: formularium mawaddah-dH2015

Statrol

Erela GMP

Cendo

Cendo

Kalbe Novartis

Novartis

Otto

Otsu

Page 441: formularium mawaddah-dH2015

Otsu

Solvay farmaSolvay farma

GuardianGuardian

sanbe sanbe Actavis

Combi

Indofarma

Mersi

Mersi

Page 442: formularium mawaddah-dH2015

Sanbe

Combiphar

EmbaBufa

Sampharindo

FerronGuardian

sanbe

Indofarmasanbe

Hexapharma

Page 443: formularium mawaddah-dH2015

CombipharGracia

Eisai

Sanbe

DexaMersi

samparindo

HarsenSanbe

sampharindoCapri

interbatCapri

Page 444: formularium mawaddah-dH2015

LapiIndofarma

Dexamedika

LapiMutifaLapi

mutifa

Sanbe

LapiMahakam

Dexamedika

Lansond

Page 445: formularium mawaddah-dH2015

Gelenium

Takeda

Ethica

Spasminal (+methampiron)Boehringer

Interbat

OGB

CoronetcrownCorsa

Lapi

Page 446: formularium mawaddah-dH2015

pharosDexa

Pharmasolindo

Kalbe

Boehringer

Boehringer

Boehringer

Geleniumcombiphar

Ikapharmindo

Combi

Bernofarm

darya faia

Page 447: formularium mawaddah-dH2015

KF

Sandoz

Novell

Pharos

KFKF

ScanpasificSampharindo

InterbatKalbeSanbe

Glaxo

Page 448: formularium mawaddah-dH2015

Glaxo

Lapi

Lapi

Glaxo

Glaxo

Boehringer

astra zeneca

Behringer

Interbat

Page 449: formularium mawaddah-dH2015

kF

KF

Sampharindo

BoehringerBoehringer

Boehringer

sampharindohufa

sampharindo

coronetcrown

Page 450: formularium mawaddah-dH2015

MolexMolex

grahafarma

Sampharindo

GMP

sampharindo

mahakam

TransfarmaMedika indah

Glaxo

GMP

Page 451: formularium mawaddah-dH2015

sanbe

GMP

DexaDexa

Dexa

Biofarma

Biofarma

Dexa

Page 452: formularium mawaddah-dH2015

Interbat

kalbe

Merck

Combi

Kalbe

PyridamKF

Page 453: formularium mawaddah-dH2015

Ifars

SanbeSanbe

Ethica

KFKF

Takedasanbemerc

akafarma

Sampharindo

Takedasanbemerc

Page 454: formularium mawaddah-dH2015

Sanbe

Sanbe

Sampharindo

SanbeCapri

KFCombi

Pyridammahakammeprofarm

sampharindosanbegracia

darya faria

darya faria

Page 455: formularium mawaddah-dH2015

pyridampryridam

Lapilapi

PyridamHufa

SanbeLapi

Kalbe

Ethica

lapiPyridam

soho

Dexa

Berno

Page 456: formularium mawaddah-dH2015

NovellSchering

Transfarma

Page 457: formularium mawaddah-dH2015

eCompatibility Report for formularium mawaddah-dH2015.xlsRun on 6/13/2015 13:50

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Page 458: formularium mawaddah-dH2015

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