draft formularium

8/18/2019 Draft Formularium

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formularium rs dkt bandar lampung 2012/2013 1

FORMULARIU

RS. TK. IV 02

BANDAR LAM

2012/20

No. Kelas Tea!" Na#a Ge$e"%

1 2 3

1 A$al&es"%/A

1.1 Analgesik narkotikaCodein

Morphin HCl

Pethidin HCl

1.2 Analgesik non-narkotikaAntalgin/Methampiron

Antalgin + diazepam

Asam mefenamat

Asetosal

Ibprofen

!etorola"

Parasetamol

Parasetamol + asetilsistein




1 2 3

#ramadol HCl

#ramadol HCl + Parasetamol

1.$ Antirematik/antipirai Aloprinol

%lkosamin + !ondroitin

!alim/&atrim diklofenak 2' mg( ') mg

!etoprofen

Meloksikam *.' mg( 1' mg

Piroksikam

2 A$es'

2.1 Anestetik okalidokain HCl

idokain HCl + epinefrin

2.2 Anestetik ,mm piakain HCl

Halotan

!etamin HCl

Midazolam HCl

Propofol

3 A$'"ale&" (a$ O

Adrenalin/pinefrin



formularium rs dkt bandar lampung 2012/2013 $

1 2 3

0eksametason

!lorfeniramin maleat

oratadin HCl

oratadin + psedoefedrin

Mebhidrolin napadisilat

Cetirizin HCl

iproheptadin HCl

4 A$'"(o' (a$ O)a' La"

.1 !hss

&atrim bikarbonat

.2 ,mm!arboadsorben

- A$'"e!"l

%abapentin

!arbamazepin

&atrim fenitoin

3henitoin

34"akarbazepin

A$'"#"%

5.1 Antibakteri

5.1.1 Penisilin Amoksisilin

Atropin 3

Magnesim 3



formularium rs dkt bandar lampung 2012/2013 '

1 2 3

e7ksim

efoperazon + slbaktam

efotaksim

efpirom

eftazidim

eftriakson

5.1.* #etrasiklin 0oksisiklin HCl

#etrasiklin HCl

348tetra"8"line

5.1.9 ain-lain Metronidazol HCl ')) mg( 2') mg

lfametoksazol + trimetoprim

5.2 Antitberklosis tambtol HCl ')) mg( 2') mg

Isoniazid :I&H; $)) mg( 1)) mg

Pirazinamid

<ifampisin

treptomisin

5.$ Antifngi !etokonazol

!lotrimazol

Mikonazol

%riseoflin

5. Antimalaria !lorokin difosfat

:menggnakan obat paket03#;




1 2 3

5.' Antiirs Asikloir

7 A$'"#"&a"$/

etahistin mesilat

=lnarizin HCl

A$'"$eo!las'"% "#+$os+!esa$

9.1 Antihormon #amoksifen

9.2 Imnospresan Azatioprin

iklosporin

9.$ Antineoplastik '-6ororasil

Metoktreksat :M#>; A$'"!a%

#riheksilfenidil HCl

10 O)a' a$& #e#!

1).1 Antianemia Asam folat

?itamin 12

1).2Asetosal

1).$ Hemostatik Asam traneksamat

!arbazokrom + &a lfonat

Antikoaglan( antiplatelet( dantrombolitik



formularium rs dkt bandar lampung 2012/2013 *

1 2 3

?itamin !

11 Po(+% (aa5 (a$ !

Albmin

12 A$'"se

Poidon iodin

!lorheksidin glkonas

1$ O)a' +$'+% &"&

Heksetidin

14 D"+e

=rosemid

Hidroklortiazid/ HC#

Manitol

pironolakton

1- 6o#o$ e$(o%"$ la"

1'.1 Antidiabetik %libenklamid

A"arbose

%li@idone

Pioglitazone

%liklazid/ %l"ode4

%limepirid




1 2 3

Metformin HCl ')) mg

Metformin HCl 9') mg

Inslin

1'(1.1 Antiparkinson enzerasid + eodopa

Pramipeksl

1'.2 Hormon kelamin dan 3bat 8ang Mempengarhi fertilitas

1'.2.1 strogen &omergestrol asetat

1'.2.2 Progesteron Alilstrenol

&oretisteron &orelt

Primolt

1'.2.$ !ontraseptik tinilestradiol + leonorgestrel

1'.2. Indikator olasi !lomifen sitrat

1'.$ Hormon tiroid dan antitiroid Propiltiorasil

th8ro4

1'. !ortikosteroid etametason

0eksametason

Hidrokortison + !loramfenikol

Methilprednisolon

etametason + &eomisin 3



formularium rs dkt bandar lampung 2012/2013 1)

1 2 3

15.5 Penrn kolesterol %em7brosil

Atorastatin

=eno7brate

Praastatin

oastatin

imastatin

15.* ?asodilator Isoksprin HCl

Citikolin

15.9 Hipotensi Pirasetam

17 O)a' 'o

1*.1 Antibakteri %entamisin 3

%entamisin + =lisinolon

!loramfenikol

1*.1.1 Antihipertensi isoprolol

Imidapril

Irbesartan 1') mg

Candsartan

isinopril

Mertildopa

<amipril

#elmisartan

?alsatran

!arediol

Amlodipin ' mg

1*.2 Antifngi !lotrimazol

!etokonazol

Mikonazol

1*.$ Antiirs Asikloir

1*. Antiradang Clobetazole propionat

0esoksimetason




1 2 3

1 La+'a$ el

19.1 3ral &aCl( !Cl( glkosa

19.2 Parenteral 0ekstrosa

&atrim klorida

<inger laktat

&a( !( Cl(glkosa

H 1$)

!alsim glkonas

Magnesim 3

!alim klorida

&atrim bikarbonat

Asam amino

Comafsin Hepar

1 O)a' +$'+% #a'

1.1 istemik 8"opene

ilberr8( betakarotene( retinol

1.2 #opikal

1.2.1 Anti A"ne Asam retionat

Clindam8"in

&atrim =sidat




1 2 3

,rea

1.2.2 Anti =ngsi Asam benzoat

1.2.$ Anti kabies Permetrin

alep 2

H8ppoalergeni"

1.2. Antimikroba !loramfenikol

%entamisin

1.2.' ain-lain &a doksat

Pol8mi4in

&eom8"in

ido"ain

=ldo"ortison

!arbogliserin

&asa"ort nasal spra8

Cloramfeni"ol

20 U'eo'o$"% (a$

2).1 ,terotonik Metilergometrin maleat

3ksitosin

2).2 <elaksan ters Isoksprin HCl

21 Ps"%oa

21.1 Antiansietas dan antiinsomnia Alprazolam

Amitriphiline

Clonazepam : <i"lona ;

0iazepam

!lobazam

!lordiasepoksid HCl

!lordiazepoksid HCl+ !lidinim bromida

orazepam

Maprotilin HCl



formularium rs dkt bandar lampung 2012/2013 1$

1 2 3

21.2 Antipsikosis !lorpromazin HCl

Haloperidol

21.$ Anti A0H0 Me"obalamin

22 Rela%sa$ o'o' !e"e (a$ !

22.1 Penghambat neromsklar Atraktrim besilat

22.2 3bat ntk miastenia grais &eostigmin

23 O)a' +$'+% sa

2$.1 Antasida dan lks( antibsa =amotidin

ansoprazol

Mg( Al :3H;

Mg( Al :3H;( 0MPs

Mg( Al :3H;( simetikon

Misoprostrol

3meprazol

Pantoprazol

<anitidin

imetidin

kralfat

2$.2 Antiemetik 0imenhidrinat

0omperidon

!isapirida




1 2 3

Metoklopramida HCl

3ndansetron HCl

2$.$ Antihemoroid 0iosmin + hesperidin

2$. Antispasmodik =laoksat HCl

Hiosin n-btilbromid

Hiosin n-btilbromid + PC#

Metampiron + eladona + Papaerin

4trabeladona + Para"etamol + metampiron

Papaerin HCl

2$.' 3bat ntk diare Attaplgit

!aolin + pektin

operamid HCl

&ifrroksazide

in"

2$.5 aksatif isakodil

aktlosa

Para7n li@( PP( %liserin

2$.* ain-lain a"toba"ills

Metionin

Pankreatin



formularium rs dkt bandar lampung 2012/2013 1'

1 2 3

,rsodeoksilat

krkma

24 O)a' +$'+% sa

2.1 Antiasma Amino7lin

fedrin HCl

albtamol 2 mg( mg

albtamol + #eo7lin

#eo7lin

#erbtalin

erote" M0I

2.2 Antitsif 0MP Hr

0MP Hr+ C#M( PC#( PPA

Psedoefedrin HCl

oratadin + Psedoefedrin

Psedoefedrin + C#M

#erfendain + psedoefedrin

Pipazetat HCl

2.$ Mkolitik dan ekspektoran Ambroksol HCl

%liseril gaiakolat

2. 0ekongestan( antiin6ensa Psedoefedrin HCl + #ripolidin HCl

2- O)a' a$& #e#!e$&

erm dan imnogloblin Albmin

Anti bisa lar

0MP Hr + prometazin+ bromheksin + &asitrat+&HCl




1 2 3

Anti rabies

erm tetans

Hman Imnogloblin

2 V"'a#"$ (a

25.1 ?itamin ?itamin 1

?itamin 5

?itamin 1

?itamin + kombinasi

?itamin C

Anemolat

tarfolat

#rolit

25.2 Mineral !alsim laktat

!alim

27 La"$l

"hina"heae

-%ltamin

kstrak Pelargonim

=koidan

Antioksidan

asam amino



formularium rs dkt bandar lampung 2012/2013 1*

1 2 3

2 A$'el#

P8rantel pamoat

2 A$'" se!'"% sal

2.1 Asam Pipemidat

2.2 ,rsodeo48lat

30 O)a' +$'+

$).1 Cendo Cortihist

Cendo H8alb

Cendo 8teers

Cendo Pol8nel

Cendo #ropin

rlami"etin/ Chlorampheni"ol

%entami"in

=>

&on"ort

31 8e#o

$1.1 H8dro48 ,rea meda" :C8todro4;

32 M"s'e$"a

$2.1 Mestinon




OBAT

07.04

PUNG

3

Na#a Da&a$& Be$'+% Se("aa$ Pa)"%

4 -

'"!"e'"%

generik tablet !imia =arma

generik inBeksi !imia =arma

M# Continos tablet !imia =arma

generik inBeksi !imia =arma

generik tablet erno / Phapros

3pineron kaplet 3tto

Analsik tablet anbe =arma

<onalgin tablet

generik tablet erno / Phapros

Me7nal tablet anbe =arma

Ponsami" tablet %ardian

0enta"id tablet

Clopidrogel tablet

Artepid tablet

Plaos tablet

Aspilet miniaspi tablet

#hromboaspilet tablet Medifarma

generik tablet Phapros

Proris tablet( sirp Pharos

generik inBeksi He4aparm / Phapros

#oramine inBeksi 3tto

generik tablet Phapros / !imia =arma

Pamol tablet

0min pp A"tais

anmol tablet( sirp anbe =arma

istenol kaplet 0e4a Medi"a




4 -

generik kapsl( inBeksi &oell / erno

#ramifen tablet 3tto

generik tablet erno

Col"isine tablet

<e"olfar tablet

3ste( forte kapsl oho

generik tablet Phapros / He4aparm

Me6amin tablet Me"osin

0e6amat tablet

generik tablet( spp !imia =arma / erno

Ptotopen pp

Pronalges tablet( inBeksi( spp 0e4a Medi"a

0e4ketoprofen tablet( inBeksi

!eren tablet( inBeksi

generik tablet 0e4a Medi"a

Mo4i"( forte tablet 3tto

generik tablet &oell / !imia =arma

'"%

generik inBeksi Phapros / erno

Peha"ain inBeksi Phapros

0e"ain inBeksi 0e4a Medi"a

<egiell inBeksi &oell

Halothane infs 0e4a Medi"a

Iso6ran botol

eo6ran botol

&23 tabng

!#M inBeksi %ardian

Miloz inBeksi &oell

eda"m inBeksi 0e4a Medi"a

afol inBeksi &oell

ipro inBeksi ran

a' A$a*la%s"s

generik inBeksi Phapros

&orephneprin inBeksi



formularium rs dkt bandar lampung 2012/2013 2)

4 -

0iphenhidramin inBeksi

Hido"ortison inBeksi

generik tablet Phapros / erno

generik tablet Phapros / !imia =arma

generik tablet &oell / He4aparm

<hinos < kapsl 0e4a Medi"a

Interhistin tablet Interbat

generik tablet &oel/ He4aparm

stin tablet %ra"ia

Cetinal tablet

<8zen tablet

generik tablet

+$'+% Kea,+$a$

generik inBeksi thi"a


generik tablet

generik serbk

e!s"

ipentin tablet Mersifarma

Alpentin tablet

amgetol tablet Mersifarma

Phernobabital tablet

minal tablet

Asam ?alproat tablet

0epakene tablet

0epakote tablet

!toin kapsl( inBeksi Mersifarma

kapsl( inBeksi

Prolepsi tablet Mersifarma

o)a

generik tablet( sirp( inBeksi Phapros/ Igm

Amo4san( forte anbe =armakapsl( sirp( drop(inBeksi




4 -

!almo4illin tablet

Pro"ain penisillin inBeksi

3pimo4( forte kaplet( sirp( inBeksi 3tto

Claneksi kapsl anbe =arma

Co amo4i"latablet

generik tablet( sirp( inBeksi Pharos/ erno

generik tablet 0e4a Medi"a

!anam8"in ial

treptom8"in ial

generik inBeksi( salep I%M

agestam inBeksi( salep anbe =arma

%enolon salep %ardian

generik tablet( sirp Phapros/ erno

generik tablet( sirp Pharos

iothi"ol tablet( sirp anbe =arma

generik tablet &oel/ 0e4a

#ariid tetes telinga =ahrenheit

generik tablet( infs Pharos/ He4aparm

#e@inol kaplet( infs 3tto

Ci6os tablet

generik kaplet !imia farma

inoz8t tablet

generik tablet I%M/ !imia farma

risanbe tablet( sirp anbe =arma

generik tablet

Clindame" tablet Me"osin

generik kapsl

in"ome" !apsl Me"osin

generik

Mero4i inBeksi Mersifarma

Cefazolin :Cefazol ; inBeksi

generik kapsl( sirp( inBeksi 3tto

D"ef kaplet( sirp %ardian



formularium rs dkt bandar lampung 2012/2013 2$

4 -

Artesnat tablet

Arsamoon tablet

Coartem tablet

Prima@in tablet

!ina tablet

generik tablet( salep

$'"e'"&o

Mertigo tablet 0e4a Medi"a

etaser" tablet

generik tablet erno

ilm tablet Mersifarma

inral tablet

(a$ o)a' +$'+% 'ea!" !al"a'"

"$so$

generik tablet I%M

$&a+5" (aa5

generik tablet Pharos

Heparin sodim tablet

Milmor tablet

mineton tablet

Earfarin :imar"; tablet


generik tablet

As"ardia tablet Pharos

#hromboaspilet tablet Medifarma

generik tablet( inBeksi erno/ &oel

!alne4 tablet( inBeksi !albe

?el"hrome inBeksi &oell Pharma

Adona tablet( inBeksi




4 -

generik tablet( inBeksi

&eo ! inBeksi Combiphar

Prohem inBeksi

e$&&a$'" !las#a

Hman Albmin infs 0e4a Medi"a

<obmin infs &oell

Albman infs

Plasbmin infs

'"%

generik botol !imia =arma

Hibis"rb botol

oftaman botol ran

- Care botol

" (a$ #+l+'

He4adol gargle 3tto

etadine gargle gargle

=rinfe" gargle

H232 botol'"%

generik tablet( inBeksi I%M

asi4 inBeksi

=arsik inBeksi

generik tablet I%M

generik infs 3tska

Alda"ton tablet oho

pirola"ton tablet Phapros

(a$ %o$'ase!s"


tablet

tablet

tablet

tablet

generik tablet

%las tablet 0e4a Medi"a



formularium rs dkt bandar lampung 2012/2013 2'

4 -

generik tablet erno/ Pharos

A"trapid HM inBeksi &oo

eemir 6e4pen

&oorapid 6e4pen

&oomi4 6e4pen

ants 6e4pen

A"trapid inBeksi

Hmlin < inBeksi

generik tablet

eparsone tablet

eazide tablet

Pardoz tablet

ifrol < tablet

ten8l kaplet Mer"k

Pregnolin tablet 0e4a Medi"a

Premaston tablet

tablet

tablet

Mikrodiol tablet !imia =arma

Prola tablet 0e4a Medi"a

generik tablet 0e4a/ !imia =arma

eo7roksin tablet

!arbimazole tablet #iamazole tablet

enoson salep ernofarm

etason & salep !imia =arma


Corsona tablet( inBeksi Phapros

Cortide4 tablet anbe =arma

Chloramfe"ort salep !imia =arma

generik tablet( inBeksi Pharos




4 -

tablet

tablet

tablet( inBeksi

salep

!etri"in salep

generik tablet

3ste( forte kapsl oho

3steotin kapsl Phapros

!olkatriol kapsl Phapros

as%+le

generik tablet 0>A

=arnormin tablet

Atenolol tablet


generik tablet 0>A

Adalat tablet a8er

#8arit tablet =ahrenheit


generik inBeksi I%M/ !imia farma

Catapres inBeksi oehringer

generik tablet 0>A


Intersiak tablet 0e4a Medi"a

opiten tablet %ardian

0opamet tablet Alpharma

H8trin tablet Abbott

&operten tablet 0e4a Medi"a

generik tablet I%M

0obBe"t tablet 0e4a Medi"a

0obtamin tablet

generik inBeksi Pharos

&-epi inBeksi &oell Pharma



formularium rs dkt bandar lampung 2012/2013 2*

4 -

tablet Combiphar

tablet

tablet

tablet

tablet anbe =arma

generik He4aparm

tablet Mersifarma

H8stolan tablet 0e4a Medi"a

Cholinaar tablet( inBeksi &oell Pharma

generik tablet( inBeksi 0e4a/ He4aparm

Mersitropil Mersifarma

"%al

generik salep !imia =arma

agestam salep anbe =arma

%enolon salep %ardian


generik tablet

tablet

Irell tablet

tablet

&operten tablet

0opamet tablet

tablet

tablet

0ioan tablet

?- lo"k tablet

tablet

generik salep

=orm8"o salep anbe =arma


=ngares salep %ardian

generik salep Pharos

amode4 salep %ardian

#op"ort salep anbe =arma

tablet( sirp( inBeksi(infs




4 -

Mometason salep

e%'ol"'

3ralit sa"het !imia =arma

0'F infs ran( anbe

01)F infs ran( anbe

0)F infs ran( anbe

&aCl )(F infs ran

&aCl $F infs anbe =arma

Infsan < infs anbe =arma

< infs ran

!aen $A/$ infs Eidatra

#ride4 infs anbe =arma

=trolit infs anbe =arma

#etraspan infs ran

anbe Hess infs anbe =arma

Ca glkonas infs thi"a

Mg 3 sa"het 3tska

!alim klorida infs

Me8lon infs 3tska

Amino6id infs 3tska

Aminofsin paed infs

Aminspasminal infs ran

iamin infs

#riofsin infs

#tofsin infs

(a$ 'el"$&a

anbeision kapsl anbe =arma

Cendo ber8 tablet

Matoit kapsl anbe =arma

alep( gel

tretinoin

0a"lin alep( gel

="ile4 alep

=son alep




4 -

Moisderm alep

enzola" #be

"abi"id alep

"abimite alep

3pi"el #be

generik salep mata( #M( ## !imia =arma

generik salep mata

=ormen tetes telinga anbe =arma

3ttopain tetes telinga

tetes telinga

inBeksi

tetes telinga

tetes telinga

#riam"inolon semprot hidng

tetes telinga

la%sa$ +'e+s

M8omergin tablet( inBeksi

Pospargin/ Pitrogin inBeksi !albe

Ind4in inBeksi !albe

H8stolan tablet 0e4a Medi"a

#a%a

Algana4 tablet %ardian

8praz tablet

tablet

tablet

generik tablet( inBeksi I%M

tesolid inBeksi( spp Alpharma

generik tablet 0>A

tablet oho

ra4idin tablet anbe

ibra4 tablet

generik tablet



formularium rs dkt bandar lampung 2012/2013 $)

4 -


Cepezet tablet( inBeksi Mersifarma

generik tablet I%M

$&5a#)a' %ol"$es'ease

&otri4m inBeksi &oell

Prostigmin inBeksi

l+a$ ,e$a

generik tablet I%M

generik He4aparm

Antasid tablet( sirp

0e4anta sirp 0e4a

Magtral( forte tablet( sirp 3tto

%astrl tablet =ahrenheit

Proster tablet %ardian

generik tablet( inBeksi &oell

<o"er kapsl( inBeksi 3tto

&orse" kapsl %ardian

Panzo inBeksi oho

Pantozol inBeksi

%enerik tablet( inBeksi

%etidin tablet( inBeksi %ardian

generik tablet ernofarm

Propepsa sirp %ra"ia

,lsafate sirp Combiphar

,lside4 sirp

M"ogard sirp


0ramamine tablet oho

generik tablet He4aparm

?omitas =0# tablet( sirp( drop

?ometa =# tablet( sirp( drop

A"plsif tablet 0e4a



formularium rs dkt bandar lampung 2012/2013 $1

4 -

%arposid tablet %ardian

generik tablet( inBeksi

Primperan tablet( inBeksi oho

0amaben tablet( inBeksi anbe =arma

otati" tablet( inBeksi

3ndane inBeksi %ardian

Cedantron tablet( inBeksi oho

&arfoz tablet( inBeksi

Anadim kapsl %ardian

oraginol ( & spp #akeda

Ardim spp

H8trin

"opamin tablet( inBeksi 3tto

s"opan inBeksi

"opamin pls kaplet 3tto

tablet #ropi"a Mas

pasminal tablet

Para"etamol

Metampiro


tablet

&eokaolana tablet( sirp anbe =arma

generik tablet

odia tablet anbe =arma

=zide sirp 3tto

generik tablet I%M

0l"ola" tablet( spp oehringer

ola" sirp

Mi"rola4 spp Pharos

a"bon tablet !=

a"to b sa"het &oell

Methioson tablet oho

Pankreo6at tablet



formularium rs dkt bandar lampung 2012/2013 $2

4 -

,rdahe4 kapsl !albe =arma

,rsoli" kapsl %ardian

generik tablet

io"rli tablet oho

l+a$ $aas

generik tablet( inBeksi Phapros

Phamino inBeksi Phapros

generik tablet( inBeksi !imia =arma


?entolin nebla %la4o

#eosal tablet 0e4a

generik tablet

#ismalin tablet

eretide M0I nebla

?entolin M0I nebla

Combient nebla

=li4otide nebla

piria nebla

generik tablet( sirp

#zalos kaplet anbe =arma

Halmezin sirp "oronet

<hinos &eo drop 0e4a Medi"a

<hinos < kapsl 0e4a Medi"a

<hinos Gnior sirp 0e4a Medi"a

<hinofed tablet( sirp 0e4a Medi"a

Alerfed tablet( sirp

pe4ol tablet anbe =arma

M"os sirp Meprofarm


Alerfed irp( drop %ardian

a+5" s"s'e# "#+$

Albmin inBeksi Pharmasolindo

A, inBeksi !imia =arma



formularium rs dkt bandar lampung 2012/2013 $$

4 -

A# inBeksi Pharos

#etagam inBeksi 0e4a Medi"a

#"$eal


Alinamin = inBeksi #akeda

generik !imia =arma

Mersibion kapsl( inBeksi Mersi

&erode4 #ablet 0e4a

&erobion-'))) kapsl Mersi

esi"hol #ablet

Proital #ablet

e"omzet kapsl anbe =arma

e"om C kapsl anbe =arma

etropar kapsl #ropi"a Mas

generik #ablet

#ablet

#ablet

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Aminoral kaplet oho

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#etes Mata C&03

#etes Mata C&03

#etes Mata C&03

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#etes Mata C&03

#etes Mata C&03

#etes Mata C&03

#etes Mata C&03

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