form usulan formularium
TRANSCRIPT
7/24/2019 Form Usulan FORMULARIUM
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NO NAMA OBAT
IBUPROFEN TAB 400 MG
SIR 200 MG/5 BTL
METAMPIRON TAB 500 MG
INJ 500 MG/ML, AMP @2 ML
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NO NAMA OBAT Generik Paten 1
1 Ibuprofen
Tab. 200mg
Tab./tab. Sa!t S"a#!t 400 mg
S$%. S!&#. 100 mg/5m, bt@ '0m
S$%. 200mg/5m, bt @ 2m
2 Metampiron Tab. 500 mg
I(). 500mg/m, am# @2m
* Parasetamol
Tab./+a#. 500 mg
S$%!# 120mg/5m, bt @ '0 m
%-# 100 mg/m, bt @ 15 m
Pa%a&"tam- I(!& 100m
Pa%a&"tam- 500mg (a"t&t"$( 200mg
4 Asam Mefenamat
3a#&. 500 mgS!#&.50 mg/5m. bt @ '0m
5 Tramadol
3a#&. 50 mg
I(). 50 mg/m, am# @ 2m
T%ama- Pa%a&"tam-
' Ketorolac Tromethanime
Tab. 10 mg
I(). 10mg/m, am# @ 1m
I(). *0mg/m, Am# @ 1m
1 Diklofenak Natrium
Tab./tab. Sa!t "(t"%$+ 25 mg
Tab.50 mg
2 Ketoprefon
Tab./tab &a!t 50mg
Tab./tab. Sa!t "(t"%$+ 100mg
I(). 50 mg/m, am# @ 2m
S!##-&&$t-%$a 100 mg
* Meloksikam
Tab. ,5 mg
Tab. 15mgI().15mg/1,5 m, am# @ 1,5m
S!##-&$t-%$a 15 mg
1 A-#!%$(-
Tab. 100 mg
Tab. *00 mg
2 P%-b"("&$
Tab. 500 mg
* P$%-+&$+am
Tab. 10 mg3a#./tab. 20 mg
4 3-+$&$(
Tab.
1 M$a6-am
I(). 5mg/5m, am# @ 5m
1! ANTIPI"AI
! AN#$T#TIK
!1 %M%M
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I(). 15mg/*m, am# @ *m
1 "+&am"ta&-(
I(). 5mg/m 7&bg. Na F-&at8 am#@ 1m
2 $"(9$%am$(
I(). 10mg/m, am# @ 1 m
* E#$("%$( 7a%"(a$(8I(). 0,1: 7&bg. ;<$/b$ta%t%at8, am# @ 1m
4 3-%"($%am$(
Tab 4 mg 79$%-g%"( Ma"at8
5 L-%ata$("
Tab./+a#. 10 mg
' S"t$%$6$(" ;<I
Tab ./tab. Sa!t/+a#&. 10 mg
S$%. 5mg/5m, bt @ '0m
3-mb$(a&$ =
">am"t9a&-(" 0,5 mg"+&-%"($%am$(a ma"at 2 mg
Tab
1 3a%b- A&-%b"(
Tab. 0,5g
2 Mag("&$!m S!at
S"%b!+, +tg *0g
* 3a&$!m G!+-(at
I(). 100mg/m, am# @ 10 m4 Nat%$!m T$-&!at
I() 25: am# @ 10 m
1 ""%-+&am$( m"ta(&!-(at
S"%b. I(). 500mg/m, ?$a @ 10m
2 ""%a&$%-+&
Tab. 250 mg
* ""%$#%-("
Tab. 500mg
La%. O%a 100mg/m, bt @ 500m4 M"&(a
I(). 400mg, am# @ 4m
5 N--+&-( ;<I
I(). 0,4mg/m, am# @ 2m
' N"-&t$gm$("
I(). 0,5mg/m
1 $a6"#am
Tab. 5 mgI(). 10 mg/2m
La%. R"+ta 5mg/2,5m, t!b" @ 2,5m
La%. R"+ta 10mg/2,5m, t!b" @ 2,5 m
2 F"($t-$( Na.
3a#&. 100 mg
I(). 100mg/2m, am# @ 2m
I(). 250mg/5m
&
ANTIA'#"GI DAN ANA(I'AK$I$
) ANTIDOT DAN OBAT 'AIN %NT%K K#"A*%NAN
)1 %M%M
)! K+%$%$
, ANTI#PI'#P$I DAN ANTIKON-%'$I
,1
ANTI#PI'#P$I DAN ANTIKON-%'$I
7/24/2019 Form Usulan FORMULARIUM
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* F"(-ba%b$ta
Tab. *0 mg
I(). 200mg/2m, ?$a @ 2m
4 Nat%$!m a#%-at
Tab. Sa!t "(t%$+ 250mg
Tab. ER 250 mg
Tab. ER 500 mgS% 250 mg/5 m bt @ 120 m
5 A&am a#%-at
Tab. *00mg
S$%. 250 mg/5 m
1 3a%bama6"#$(a
Tab 200 mg
2 Gaba#"(t$(
3a#&. 100 mg
3a#&. *00mg
1 Ab"(a6-
Tab. 400mg
2 M"b"(a6-
Tab. 500 mg
* P$%a(t"
Tab 125 mg 7&"baga$ Pam-at8
S$%.
1 $"t$+a%bama6$(
Tab. 100 mg 7$9$%-g"( &$t%at8
1 Am-+&$&$$( A(9$%at
Tab. S-%"/+a#"t 500 mg
S$% 3"%$(g 125 mg/ 5 m, bt '0 m
S"%b I() 1000 mg, ?$a
Am->$$( 500 mg <a?!a($ A$ 125 mg
Am->$$( 125 mg <a?!a($ A$ *1,25 mg b-t-
2 Am#$&$$(
3a#&./+a#. 500 mg
S$% +"%$(g 125/5m, bt @ '0m
S"%b $() 1000 mg/?$a
* F"(-+&$m"t$ P"($&$$( 7P"($$$( 8
Tab 125mg 7&bg. Ga%am 38
Tab. 250mg 7&bg. Ga%am 38
Tab. 500mg 7&bg. Ga%am 38
4 P%-+a$( B"(6$ P"($&$$(
S"%b. I(). *.000.000 UI/m, ?$a@ 1m
5 B"(6at$( P"("&$$(
S"%b. I(). 1.200.000 IU, ?$a@ 20m
S"%b. I(). 2.400.000 IU, ?$a@ 20m
' M"%-#"("m
I(). 500mg, ?$a
I(). 1.000mg, ?$a
<"a6-$(
I(). 1 g%am, ?$a @ 50 m
,! ANTI N.#"I PADA $A"A(
/ ANTIIN(#K$I
/1
ANT#'MINTIK DAN ANTI(I'A"IA
/11 ANT#'MINTIK INT#$TITA'
/1! ANTI(I'A"IA
/!
ANTIBAKT#"I
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1 T"t%a+&$$( ;<I
3a# 250 mg
3a#&. 500mg
2 O+&$t"t%a&$+$( ;<I
I(). 500mg/m, $a @ 10m
* -+&$&$+$(3a#&. 100mg 7&bg.9$+at/;<I8
1 3-%am"($+-
3a#&. 250 mg
S!&# 125 mg /5 m 7&bg. Pam$tat8, bt @ '0 m
S"%b. I(). 1000 mg 7&bg. Nat%$!m S!+&$(at8, ?$a @ 10m
2 T9$am#9"($- 500mg
T9$am#9"($- S$%!# 125mg
1 3-t%$m-+&a6- OEN II 7#"$at%$83-mb$(a&$ =
Tab.
2 3-t%$m-+&a6- 7#"$at%$8
3-mb$(a&$ t$a# 5m &!#&"(&$ =
S$%., bt @ '0m
* 3-t%$m-+&a6- OEN I 7"a&a83-mb$(a&$ =
Tab.
4 3-t%$m-+&a6- F-%t"
3-mb$(a&$ =
Tab.
1 E%$t%-m$&$(
3a#&. 250 mg 7&"baga$ &t"a%at8
Tab. 500mg
S$% 3"%$(g 200 mg/5m 7&bg. Et$ S!+&$(at8, bt @'0m
2 S#$%a&$m$(
Tab. 500 mg
* 3$(am$&$(
3a#&. 150 mg
3a#&. *00mg
4 R->$t9%-ma$(
Tab. 150 mg
Tab. *00mg
5 A6$t9%-m$(
Tab. 250mg
Tab 500 mg
S$%. 3"%$(g 200mg/5m, bt @ 15m
S$%. 3"%$(g 200mg/5m, bt @ '0m
/!! T#T"A$IK'IN
/!& K'O"AM(#NIKO'
/!) KOT"IMOK$A0O'
a. S!am"t-+&a6- 200mg
b. T%$m"t-#%$m 20mg
a. S!am"t-+&a6- 200mg
b. T%$m"t-#%$( 40mg
a.
S!am"t-+&a6- 400mg
b. T%$m"t-#%$m C0mg
a. S!am"t-+&a6- C00mg
b.
T%$m"t-#%$m 1'0mg
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1 G"(tam$&$(
I() 40 mg/m 7&bg. S!at8,am#@ 2m
2 St%"#t-m$&$(
S"%b. I(). 1000 mg 7&bg. S!at8, ?$a @ 1m
S"%b. I(). 5000 mg 7&bg. S!at8, ?$a @ 1m
* Am$+a&$( S!atI() 250 mg, ?$a @ 2m
I() 500mg, ?$a @ 2 m
1 S$#%-D-+&a&$(
Tab. 500 mg
I(. 2mg/m, bt @ 100 m
2 L"?-D->a$(
Tab. 500mg
I(. 500mg/100m, bt @100m
* OD-+&aa&$(
Tab 200 mg
Tab. 400 mg
1 S"a%-+&$ M-(-9$%at
3a#./+a#&. 500 mg
S$%. 3"%$(g 125mg/5m, bt @ '0m
S$%. 3"%$(g 250mg/5m, bt @ '0m
2 S"-ta>$m
S"%b. $(). 1000 mg/?$a
* S"t%$a+&-(
S"%b. I() 1000 mg/?$a
4 <"ta6$$m"
S"%b. I(). 1000mg, ?$a
5 <"!%->$m" a>"t$
Tab. Sa!t 250 mg
<"!%->$m" 50mg $().
' <"-#"%a6-(" 1g%
<"-#"%a6-(" 0.5 g &!batam 0.5g
C <"#$%-m" 1g
<""#$m" 1g
10 <">$m" &$%!#
<">$m" 100
<">$m" 200
11 <"t%$a6-(" Na 1 g
1 a(+-m$&$( 9$%-+9-%$a
S"%b. I(). 500mg, ?$a2 T"$-#a($(
I() 400 mg
1 S!a&aa6$(
Tab. 500 mg
2 M"&aa6$("
Tab. 250 mg
/!, MAK"O'ID
/!/ AMINOG'IKO$ID
/!
K%INO'ON
/!2 $#(A'O$(O"IN
/!3
G'IKOP#PTIDA
/!14
ANTI BAKT#"I 'AIN
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* Im$(#"("m $(). 500mg, $a&tat$( 500mg
1 R$am#$&$(
Tab. *00 mg
1 Etamb!t- 9$%-+-%$ Tab. 250 mg
Tab. 500mg
2 I&-($a6$
Tab 100 mg
Tab *00 mg
* P$%a6$(am$
Tab 500 mg
4 R$am#$&$(
Tab. *00mg
Tab. 450mg
Tab. '00mg
R$am#$&$( S$%!# 100m #"% 5m 7b-t- 120m8
5 3-mb$(a&$ /F$>" -&" <-mb$(at$-(=
Tab.
' 3-mb$(a&$/F$>" -&" <-mb$(a&$-(=
3a#.
3-mb$(a&$=
Tab. 3!(a9 25mg
C 3-mb$(a&$ =
Tab. 3!(a9
1 G%$&"-!?$( = M$%-($6"
Tab 125 mg
Tab./+a#. 500mg
2 3"t-+-(a6-
Tab 200 mg
3%$m 2:, t!b" @5g
3%$m 2:, t!b" @10g
Sam#- 2:, @ m '0
* N$&tat$(
Tab 500.0000 IU
S!&#. 100.000 IU/m, bt @ 12m
S!&#. 100.000 IU/m, bt @ 15m
Tab ag$(a 100.000 IU
4 P-$+%"&!"( 7+-("(&a&$ M"ta+%"&- S!-(at M"ta(a8
S!##. ag$(a 0mg
/&
ANTI IN(#K$I K+%$%$
/&1 ANTI '#P"A
/&!
ANTIT%B#"KO'O$I$
a. R$am#$$( 150 mg
b.
I&-($a6$ 5 mg
. P%a6$(am$" 400 mg
. Et9amb!t- 25 mg
a.
R$am#$&$( 450mgb. I&-($a6$ *00mg
a. R$am#$&$( 5mg
b. I&-($a6$ 50mg
. P%a6$(am$" 150mg
a.
R$am#$&$( 5mg
b.
I&-($a6$ 50mg
/) ANTI(%NGI
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5 F!-(a6-
3a#&. 150 mg
I() 200mg/100m, ?$a @ 100m
' M$a!(g$( S-$!m
S"%b. I()"+&$ 50mg, ?$a
1 M"t%-($a6- Tab. 500 mg
La%. I(!& 5 mg/m, bt @ 100 m
S$%. S!&#. 125mg/5m, bt @ '0m
O?!a 500mg
3-mb$(a&$ =
O?!a
1 A(t$maa%$a OEN=3-mb$(a&$ =
3a#.
2 3!$($(
Tab 200 mg
* P%$ma+!$(
Tab. 15mg 7&bg. F-&at8
4 3-mb$(a&$
Tab.
5 A%t"m"t9"%
I(). C0mg
' A%t"&!(at"
I(). '0mg
1 P"gat" $(t"%"%-( 2a
I(). 1*5mg/0.5m, #& @ 0.5m
I(). 1C0mg/0.5m, #& @ 0.5m
2 R$ba?$%$(
Tab. 200mg
* T"b$?!$(
Tab. '00mg
4 Lam$?!$(
Tab. 100mg
5 A"-?$% $?$?->$
Tab. 10mg
1 E%g-tam$(
Tab. 1mg 7ta%t%at8
2 B"ta9$&t$(" $9$%-+-%$a
Tab. Cmg
* B"ta9$&t$(" M"&$at
Tab. 'mg
1 T%$9"+&$"($$ ;<I
/,
ANTIP"OTO0OA
a.
M"t%-($a6- 500 mg
b. N&tat$( 100.000 $!
/,1 ANTIAM%BA DAN ANTIGIA"DIA$I$
a.
P$%$m"tam$( 25 mg
b. S!a-+&$( 500 mg
a. A%t"m"t9"% 20mg
b. L!m"a(t%$(" 120mg
/,! ANTIMA'A"IA
//
ANTI -I"%$
ANTIMIG"#N DAN ANTI-#"TIGO
2 ANTIPA"KIN$ON
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Tab. 2mg
2 3-mb$(a&$ =
3a#&.
* P%am$#">-"
Tab. 0.*5mg Tab. 0,50mg
4 3-mb$(a&$ =
Tab.
5 R-#$($%-"
Tab. P%--(g" R""a&" 2mg
Tab. P%--(g" R""a&" 4mg
Tab. P%--(g" R""a&" Cmg
1 P%$-&t$gm$("
Tab. '0mg
1 A&am F-at
Tab 1 mg
Tab 400 mg
2
Tab &a!t mg *00mg
S$%. 15mg/5m, bt @ 100m
%-# 15mg/m, bt @ 15m
* S$a(-+-baam$( 7$t B128
Tab. 50mg
4 L- M-"!" I%-( 7III8 S!%-&"
I(). 100mg/5m, am# @ 5m
5 L- M-"!a% H"$g9t
I(). 100mg/2m, am# @ 2m
1 F$t-m"(a$-( 7?$tam$( 38
Tab &a!t 10 mg
I(). 10 mg/m
I(). 2 mg/m
2 ;"#a%$( Nat%$!m
I(). 5.000 IU/m, ?$a @5 m
* Ha%a%$(
Tab &-%" 2mg 7ga%am Na/38
4 A&am T%a("+&amat
3a#./tab. 500mg
I(). 250mg/5m, am# @ 5m
I(). 500mg/5m, am# @ 5m
5 Na%-#a%$(" a$!m
I(). 500 A>a/m, &%$(g" @0.*m
I(). 500 A>a/m, &%$(g" @0.4m
I(). 500 A>a/m, &%$(g" @0.'m
' E(->a#a%$(" S-$!m
I(). 20mg/0,2m, &%$(g" @0.2m
I(). 20mg/0,4m, &%$(g" @0.4m
a. L"?--#a 100 mg
b.
B"(6"%a6$ 25 mg
a. L"?--#a 100mg
b. <a%b$-#a 25mg
. E(t"a#-(" 200mg
3 ANTI MIA$T#NIA G"A-I$
14 OBAT %NT%K DA"A+ DAN 5A"INGAN P#MB#NT%K DA"A
141
ANTIAN#MI
B"&$ 7II8 S!at. ;2O
14! ANTIKOAG%'A$I
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I(). 20mg/0,'m, &%$(g" @0.'m
F-(a#a%$(!>
I(). 2.5mg, ?$a @0.5m
C R$?a%->aba(
Tab. 10mg
ab$gat%a( Et">$at"
3a#&. 5mg3a#&. 110mg
1 ;$%-g"( P"%-+&$a
<a$%a( *: bt @100 m
2 3a$!m P"%ma(ga(at
S"%b. 3tg @ 5 g
* P-?$-( L-$a
La%t 10:, bt @*0m
La%t 10:, bt @'0m
1 Eta+%$$( 7R$?a(-8
La%t, 0,1: bt @200 m
2 Eta(- 0:
Bt @100m
1 Am$-%$ ;<I
Tab. 2.5mg
2 F!%-&"m$
Tab. 40mg
I(). 10mg/m, am# @2m
I(). 20mg/m, am# @2m
* ;$%-+-%t$a6$ 7;<T8
Tab 25 mg
4 Ma($t-
La%. I(!& 20:, b% @500m
5 S#$%-(-a+t-(
Tab. 25mg
Tab. 100mg
' 3-mb$(a&$ =
Tab.
1 T"%a6-&$( ;<I
Tab. 1mg
Tab. 2mg
2 ->a&-6$( M"&at"
Tab. 1mg
Tab. 2mg
* !ta&t"%$"
3a#&. L!(a+ 0.5mg
4 Tam&!-&$("
Tab. 0.2mg
Tab. 0.4mg
1 A&am P$#"m$at
11 ANTI$#PTIK DAN D#$IN(#KTAN
111 ANTI$#PTIK
11! D#$IN(#KTAN
1! DI%"#TIK DAN OBAT %NT%K $A'%"AN K#MI+
1!1
DI%"#TIK
a. S#$%-(-a+t-( 25mg
b. T9$ab!ta6$" 2.5mg
1!!
OBAT %NT%K +IP#"T"OPI P"O$TAT
1!& OBAT %NT%K ANTI$#PTIK $A'%"AN K#MI+
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3a#&. 400mg
1 G$b"(+am$
Tab 5 mg
2 G$a6$" Tab C0 mg
Tab. *0mg
* G$#$6$"
Tab 5 mg
4 G$+!$-(
Tab *0 mg
5 G$m"#$%$"
Tab. 1mg
Tab. 2mg
Tab. *mg Tab. 4mg
1 M"t-%m$(
Tab 500 mg,
Tab. C50 mg
1 Aa%b-&"
Tab. 50mg
Tab. 100mg
1 P$-g$ta6-("
Tab. 15mg
Tab. *0mg
1 B$-at$?" F%at$-( LBS*2**
3a#&. 50mg
3a#&. 100 mg
1 ;!ma( $(&!$(
I(). 100 IU/m, ?$a @ 10m
I(). 100 IU/m, a%t%$g" @*m
I(). 100 IU/m, #"( @*m
2 A(a-g $(&!$(
Ba&a $(&!$( a(a-g
I(). 100 UI/m, &--&t"% #"( @*m
* Ra#$ I(&!$( A(a-g
4 M$> I(&!$( A(a-g
1 B%-m-%$#t$("
Tab. 2.5mg
2 Et$($"&t%a$-
Tab. 0,05 mg
* A$"&t%"(-
1&
+O"MON6 OBAT #NDOK"IN 'AIN6 ANTIDIAB#TIK PA"#NT
1&1 ANTI DIAB#TIK O"A'
1&11
$%'(ONI' %"#A
1&1!
BIG%ANID
1&1& A'(A G'%KO$IDA IN+IBITO"
1&1) T+IA0O'IDINDION
1&1,
OBAT DIAB#T#$ GO'ONGAN 'AIN
1&!
ANTIDIAB#TIK PA"#NT#"A'
a.
I(). 100 UI/m, &--&ta% #"(@*m
b. I(). 100 UI/m, a%t%$g" @*m
a. I(). 100 UI/m, D">#"( @*m
b.
I(). 100 UI/m, a%t%$g" @*m
1&& +O"MON K#'AMIN
1&&1 #$T"OG#N
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Tab
1 N-%"t$&t"%-(
Tab 5 mg
2 M"%->#%-g"&t"%-("
Tab 5 mg
1 L!g-
La%, bt @*0m
2 Nat%$!m T$%-+&$(
Tab. 0.1mg
* P%-#$t$-!%a&$
Tab. 100mg
4 +a%b$ma6-
Tab. 5mg
5 T9$ama6-
Tab. 5mg
1 "+&am"ta&-(
Tab. 0.5mg
I() 0,5 mg/m, am# @2m
2 M"t$ P%"($&--("
Tab. 4mg
Tab. Cmg
Tab. 1'mg
I(). 125 mg/2m, ?$a @2m
* P%"($&-("
Tab. 5mg
4 T%$am&$(--( a"t-($
Tab mg 4
I() 10mg/m, ?$a@5 m
1 $t$a6"m ;<I
Tab. *0 mg
$t$a6"m ;<I
3a#"t. 1C0mg
$t$a6"m ;<I
I(). 25mg /5m am# @5mg
2 I&-&-%b$t $($t%at
Tab S!b$(g!a 5 mg
tab S!b$(g!a 10 mg
I(). 10mg/10m, am# @ 10m
* I&-&-%b$t M-(-($t%at
Tab. 10mg
Tab. '0 mg &- %""a&"
4 G$&"%$ T%$($t%at
Tab. 2.5mg
Tab. 5mg
1 E#$("%$( 7A%"(a$(8
I().0.1:7&bg.;<I/b$ta%t%at8,am#@1m
2 P%-#a(-- ;<I
Tab 10 mg
* Am$-a%-( ;<I
1&&!
P"OG#$T#"ON
1&)
+O"MON TI"OID DAN ANTITI"OID
1&, KO"TIKO$T#"OID
1) OBAT KA"DIO-A$K%'#"
1)1
ANTIANGINA
1)! ANTIA"ITMIA
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Tab. 200mg
I(). 150mg/*m, am# @ *m
4 $g->$(
0.25mg tab"t
$g->$(
0.5mg/2m $()"+&$
1 3a#t-#%$
Tab. S-%" 12.5mg
Tab. S-%" 25mg
Tab. 50mg
2 L$&$(-#%$
Tab. 5mg
Tab. 10mg
* Ram$#%$
Tab. 1,25mg Tab. 2,5mg
Tab. 5mg
Tab. 10mg
4 Im$a#%$
Tab. 5mg
Tab. 10mg
5 P"%$(%-#%$ A%g$($("
Tab. 5mg
1 P%-#%a(-- ;<I.
Tab. 10mg
Tab. 40 mg
2 At"(--
Tab. 50mg
Tab. 100mg
* B$&-#%--
Tab. 5mg
1 N$"$#$(
Tab. 10mg
Tab. O%-& 20mg
Tab. O%-& *0mg
2 Am-$#$( B"&at
Tab. 5mg
Tab. 10mg
* Am-$#$( Ma"at
Tab. 5mg
Tab. 10mg
4 "%a#am$
Tab. C0mg
5 $t$a6"m
Tab. 100mg
Tab. 1C0mg
I(). 25mg/5m, ?$a, @ 5m
I(). 50mg, ?$a, @ 5m
' N$+a%$#$( ;$%-+-%$a
I(). 10mg/10m,am# @10m
N$m-$#$("
1)&
ANTI+IP#"T#N$I1)&1 A*# IN+IBITO"
1)&! B#TA B'O*K#"
1)&&
KA'$I%M ANTAGONI$
7/24/2019 Form Usulan FORMULARIUM
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Tab. *0mg
I(. 10mg/50m, bt @ 50m
1 a&a%ta(
Tab. C0mg
Tab. 1'0mg
2 I%b"&"%ta( Tab. 150mg
Tab. *00mg
* T"m$&a%ta(
Tab. C0mg
4 <a("&a%ta( <$">"t$
Tab. Cmg
Tab. 1'mg
5 L-&a%ta(
Tab. 50mg
1 3-($$( ;<I
Tab. 0,15MG
I(). 0,15 mg/m, am#@ 1m
2 M"t$-#a
Tab. 250 mg
* B"%a#%-&t S-$!m
tab. 20mg
4 T"%a6-&$( ;<I
Tab. 1mg
Tab. 2mg
5 ->a&-6$( M"&at"
Tab. 1mg
Tab. 2mg
1 $g-+&$(
Tab 0,25 mg
2 B$&-#%--
Tab. 2,5mg
* <a%?"$-
3a#. ',25mg
4 Ram$#%$
Tab. 1,25mg
Tab. 2,5mg
Tab. 5mg
Tab. 10 mg
1 A&am A&"t$ Sa$&$at 7A&"t-&a8
Tab./tab. 3!(a9 C0mg
Tab./tab. Sa!t "(t"%$+ 100mg
2 <-#$-g%" Tab. 5mg
* <$-&ta6-
Tab. 50mg
1 St%"#t-+$(a&"
S"%b.$(). 1.500.000 IU, ?$a @1m
2 At"#a&"
1)&) ANGIOT#N$IN II ANTAGONI$
1)&,
ANTI+IP#"T#N$I 'AIN
1))
GAGA' 5ANT%NG
1), ANTIT"OMBOTIK
1)/ T"OMBO'ITIK
7/24/2019 Form Usulan FORMULARIUM
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I(). 50mg, ?$a @50m
* B$-at$?" #%-t"$( F%at$-( LBS10** 7LUMBRO3INASE8
Tab. 40mg
4 Natt-+$(a&" II <-"(6m" 10
1 A&am A&"ta$t Sa$&$at 7A&"t-&a8
Tab. 500mg
1 -#am$( ;$%-+-%$
I() 40 mg/m, am# @ 5 m
2 -b!tam$( ;<I
I(). 250mg, ?$a @5m
* N-%"#$("#9%$("
I(). 4mg/4m, am# @4m
I(). Cmg/Cm, am# @Cm
1 S$m?a&tat$(
Tab. S-%"/+a#. 10mg
Tab. 20mg
2 Pa%a?a&tat$( S-$!m
Tab 10 mg
Tab 20 mg
* G$mb%-&$
Tab. *00mg
4 F"(-b%at"
3a#&. 100 mg
1 P%am$&"t$( S!at
3a&a &t"%$ 1:, "mba% @ 10>10m
3a&a &t"%$ 1:, "mba% @ 5>5m
2 Nat%$!m F!&$at
Sa"# 20mg/g, t!b" @5g
3%$m 20mg/g, t!b" @5g
* P"%a+ S!a$a6$(
3%$m 1:, t!b" @*5mg
3%$m 1:, t!b" @500mg
4 E%t%-m$&$( G"
5 3$(am$&$( g"
1 A(t$!(g$ OEN
3-mb$(a&$ =
Sa"#, #-t @*0g
2 M$+-(a6-
3%$m/&a"# 2: 7N$t%at8, t!b" @10g
1 B"tam"ta&-(
3%$m 0,1: 7&bg. a"%at8, t!b" @5g
3%$m 0,05: 7&bg. a"%at8,t!b" @10g
2 ;$%-+-%t$&-( A&"tat
3%$m 1:, t!b" @5mg
3%$m 2,5:, t!b" @5mg
1) ANTI P#N.AKIT 5ANT%NG "#MATIK
1, OBAT %NT%K $.OK
1,1 $.OK KA"DIOG#NIK
1/
ANTI+IP#"'IPID#MIA
1 OBAT TOPIKA' %NT%K K%'IT
11
ANTIBAKT#"I
1! ANTI(%NGI
a. A&am B"(6-at ':
b. A&am Sa$&$at *:
1&
ANTI IN('AMA$I DAN ANTIP"%"ITIK
7/24/2019 Form Usulan FORMULARIUM
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* "&-+&$m"ta&-(
3%$m 0,25:, t!b" @ 10g
3%$m 0,25:, t!b" @ 15g
4 $D!+-%t--( a"%at
Sa"# b"%"ma+ 0,1:, t!b" @10g
1 Sa"# 2 43-mb$(a&$ =
Sa"#, #-t @ *0g
2 P"%m"t9%$(
3%$m 5:, t!b" @ 10g%
* Gam">a(
3%$m t!b" @ 10g%
1 U%"a3%$m 10:, t!b" @20g
3%$m 10:, t!b" @40g
1 P-$+%"&!"( 73-("(&a&$ M"ta+%"&- S!-(at M"ta(a8
La%!ta(, bt @10m
1 N$-t$(am$ g", @15 g%
2 L-&$- 3!m"%"$ m 100
* R"t$(-$ a$
<% 0,05:, 0,1: @10 g%
4 B"(6-$ #"%-+&$" 2,5 : a( 5:, @5 g%
1 B"a+ Sa$&$
S"%b. 2:, +t+ @50g%
L"?"%t%a(
Sa"# 10:, #-t *0g%
2 L$-a$(
<% 2: @ 5g%
* M$(->$$ @m '0
4 P&"!-"%ma $#$
3%$m C0 mL
5 3-mb$(a&$ =
3%$m '0 mL
1 Ga%am O%a$t II
3-mb$(a&$ =
S"%b. 100g !(t!+ 200m a$%, &a9"t @ 100g
2 3a$!m 3-%$a
Tab. S$a# a%!t '00mg
* 3.L. A&#a%tat"
1)
ANTI$KABI#$ DAN ANTIP#DIK%'O$I$
a. A&am Sa$&$at 2:
b. B""%a(g E(a# 4:
1, K#"ATO'ITIK DAN K#"ATOP'A$TIK
1/ KA%$TIK
1
ANTI 5#"A7AT 8 A*N#
12 'AIN 9 'AIN
a. (O
b.
P&"!-"%ma $#$
12
'A"%TAN #'#KT"O'IT DAN N%T"I$I
121 O"A'
a.
Nat%$!m 3-%$a 0,0gb. 3a$!m +-%$a 0,*0g
. T%$(at%$!m S$t%at $9$%at 0,5Cg
.
G!+-&a A(9$%at 4g
7/24/2019 Form Usulan FORMULARIUM
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Tab. *00mg
4 <a$!m P-&t%"(" S!-(at
S"%b, &a9"t @5g
5 $(+
Tab. 20mg
S$%. 10mg/m, bt @100m
1 G!+-&a
I(!& 5:, bt- @500m
I(!& 10:, bt- @500m
I(!& 40:, bt- @25m
2 3a$!m 3-%$a
I(). ,4':, ?$a @ 25m
* Nat%$!m 3-%$a
La%. I(!& 0,:, bt @500m
La%. I(!& 0,:, bt @1000m
4 R$(g"% La+tatLa%. I(!&, bt @ 500m
La%. I(!&, bt @ 1000m
5 3-mb$(a&$ =
La%. I(!&, bt @500m
' 3-mb$(a&$ = I(!& #"% L
La%. I(!&, bt/&-tbag @500m
3-mb$(a&$ = I(!& #"% L
La%. I(!&, bt/&-tbag @500m
C Nat%$!m B$+a%b-(at
I(). C,4:, $(!& @25m
La%!ta( N!t%$&$ 3-mb$(a&$
La%. I(!&, bt/&-tbag @500m
10 La%!ta( N!t%$&$ 3-mb$(a&$
La%. I(!&, bt @500m
11 La%!ta( N!t%$&$ OEN
3-mb$(a&$ =
La%. I(!&, bt/&-tbag @500m
12 La%!ta( N!t%$&$ 3-mb$(a&$ =
12!
PA"#NT#"A'
a. ">t%-&a 5:
b.
Nat%$!m 3-%$a 0,:
a. Na<I 2,*4g
b. 3<I 0,5g
. Na La+tat 2,24g
. "+&t%-&a A(9$%at 2g
a.
Na<I 1,5g
b. 3<I 1,5g
.
Na La+tat 2,24g
. "+&t%-&a A(9$%at 2g
a. G!+-&a 5:
b. Nat%$!m 3-%$a 0,45:
a. G!+-&a 2,5:
b.
Nat%$!m 3-%$a 0,45:
a.
G!+-&a 5:
b. Nat%$!m 3-%$a 0,225:
a. A&am Am$(- 50g/L
b.
. &-%b$t- 100g/L
. A&am A&+-%bat 7$tam$( <8 0,4g/L
.
I(-&$t- 0,5g/L
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La%. I(!&, bt @500m
1* 3-mb$(a&$ =
La%. I(!&, bt @500m
14 3-mb$(a&$ = $(!& #"% L
La%. I(!&, bt @250 m
15 3-mb$(a&$ = $(!& #"% L
La%. I(!&, bt @500 m
1' 3-mb$(a&$ = $(!& #"% L
La%. I(!&, bt/&-tbag @500 m
1 3-mb$(a&$ =
La%. I(!&, bt @500m
1C 3-mb$(a&$ =
La%. I(!&, bt @500m
1 3-mb$(a&$ =
La%. I(!&, bt @500m
20 N!t%$&$ L$#$ M<T/L<T
La%. I(!& 20:, bt @100m
21 La%!ta( N!t%$&$ 3-mb$(a&$
La%. I(!&, !a <9amb"% bag @1000m
22 La%!ta( N!t%$&$ 3-mb$(a&$
La%. I(!&, !a <9amb"% Bag @ 500m
La%. I(!&, !a <9amb"% Bag @ 1000m
2* 3-mb$(a&$ = I(!& P"% L
". N$+-t$(am$a 7N$a&$(am$a8 0,0'g/L
.
P$%$-+&$( ;<I. 7$tam$( B'8 0,04g/L
g. R$b-Da?$( Nat%$!m F-&at 2,5mg/m
9.
R!t-&$ 7R!t$(8 0,4g/L
$. M$("%a
a. A&am Am$(-
b. K$t-
. $tam$(
. M$("%a
a. A&am Am$(- E&&"(&$a 1Cg
b.
;$&t$$( 'g
a. F%!+t-&a '0g
b.
G!+-&a **g
. K$t- *0g
a. Na. 100mE, 3 1CmE
b.
<a. 4mE, Mg 'mE
. <I 0mE, A&"tat *CmE
. S-%b$t- 50g
a. A&am Am$(- Ra(ta$ <aba(g 3aa% T$(gg$
b. A&am Am$(- A%-mat$+ 3aa% R"(a9
.
Na. <I 7t$a+ aa t$%-&$(8
a. A&am Am$(- 100mg
b.
N$t%-g"( 15,mg
. Na. 2 mE
.
A&"tat 120mE
a. A&am Am$(- 2,2:
b. S-%b$t- 15:
a. A&am Am$(- 40g
b. G!+-&a E"+t%-$t C0g
a. A&am Am$(- *:
b.
G!+-&a ,5:
. E"+t%-$t (
7/24/2019 Form Usulan FORMULARIUM
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La%. I(!&, bt @ 500m
24 A&am Am$(- E&"(&$a N-( E&"(&$aI(!& :, bt @ 250m
1 A&"ta6-am$
Tab. 250mg
1 T"t%a+a$( ;<I
Tt&. Mata 0,5:, bt@ 5m
1 Am-t"%$&$(
Sa"# mata 1:, t!b" @*,5g
2 G"(tam$&$(
Sa"# mata 0,*:, t!b" @*,5g
Tt&. Mata 0,*:, bt @5m
* O+&$t"t%a&$+$(
Sa"# mata 1:, t!b" @*,5g
4 Natam$$(
Tt&. Mata 50 mg/0,' m, t!b" @ 5 > 0,' m
5 M-+&$D-+&a&$(
Tt&. Mata 0,5:, bt @*m
1 3-mb$(a&$ =
Tt&. Mata, bt @5m
Sa"# mata, t!b" @ *,5g
2 3-mb$(a&$ =
Tt&. Mata, bt @5m
* 3%-m$$( Nat%$!m
Tt&, mata 2:, bt @15m
4 3-mb$(a&$ =
Tt& mata, bt @5m
5 P%"($&--( A&"tat
Tt&. Mata 10mg/0,'m, t!b" @ 5 > 0,'m
' 3-mb$(a&$ =
Tt&. Mata 15mg/m, bt @ 5m
3-mb$(a&$ =
a. Na 140mE
b.
3 4 mE
. <I 10mE
.
<a *mE
". A&"tat 2C mE
13 OBAT MATA
131 $I$T#MIK
13!
TOPIKA'
13!1 AN#$T#TIK 'OKA'
13!!
ANTIMIK"OBA
13!& ANTI MIK"OBA DAN ANTI IN('AMA$I
a.
P-$m$+&$(a S!at '.000 IU
b. N"-m$&$( S!at 5mg
.
"+&am"ta&-( Na F-&at 1,*mg
a.
P--m$+&$(a S!at '.000 IU
b.
N"-m$&$( S!at *,5mg
. "+&am"ta&-( Na -&at 1mg
a.
F%am$&"t$( S!at 5mg
b. G%am$$$(" 0.05mg
. "+&am"ta&-( 0.5mg
a.
;$%-+-%t$&-( 5mg/m
b. 3-%am"($+- 10mg/m
a.
;$%-+-%t$&-( 0.5:
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Tt&. Mata *.:, t!b" @ *,5g
C B"tam"ta&-(
Tt&. Mata 1mg/m, t!b" @ 5 > 0,'m
1 At%-#$( S!at
Tt&. Mata 0,5:, bt @5m2 ;-mat%-#$( ;$%-b%-m$
Tt&. Mata 2:, bt @5m
* T%-#$+am$
Tt&. Mata 1:, bt @5m
1 P$-+a%#$(
Tt&. Mata 2: 7;<I/N$t%at8, bt @5m
2 T$m--
Tt&. Mata 0,25: 7Ma"at8, bt @5m
Tt&. Mata 0,5: 7Ma"at8, bt @5m* Lata(-#%-&t
Tt&. Mata 0,01:/0.' m, t!b" @5 > 0.'m
Tt&. Mata 0,005:, bt @2,5m
4 B%$(6-am$"
Tt&. Mata 1:, bt @5m
5 T%a?-#%-&t
Tt&. Mata 0,004:, bt @2,5m
1 $(at%$!m E"at
Tt&. Mata 0,*5:, bt @15m
2 M"t$&"!-&a
La%. 2:, bt @5m
* T"t%a9$%-6-$( ;<I
Tt&. Mata 0,05:, bt @5m
4 3-mb$(a&$ =
Tt&. Mata, bt @15m
5 A&$+-?$%
Sa"# mata *:, t!b" @*,5g
1 3-%am"($+-
Tt&. T"$(ga *:, bt @5m
1 T%$am$(--("
Na&a &#%a 55mg/#!, bt @120 -&$&
2 F!t$a&-(" A"t-($"
I(t%a(a&a &#%a, bt @120 -&$&
1 3a%b-g$&"%$(
Tt&. T"$(ga 10:, bt @5m
2 O+&$m"ta6-$( ;$%-+-%$
Tt&. ;$!(g 0,025:, bt @10m
Tt&. ;$!(g 0,050:, bt @15m
1 M"t$""%g-m"t%$(
b. 3-%am"($+- 0.2:
13!) MID"IATIK
13!, MIOTIK DAN ANTIG'A%KOMA
13!/ 'AIN 9'AIN
a.
Nat%$!m 3-%$a C,''4mg
b. 3a$!m 3-%$a 1,*2mg
!4
OBAT T#'INGA6 +ID%NG DAN T#NGGO"OKAN
!41 ANTIBAKT#"I TOPIKA'
!4!
KO"TIKO$T#"OID
!4& 'AIN 9'AIN
!1
OK$ITO$IK DAN "#'AK$AN %T#"%$
!11 OK$ITO$IK
7/24/2019 Form Usulan FORMULARIUM
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Tab. Sa!t 0,125mg 7Ma"at8
I(). 0,200mg/m, am# @1m
2 O+&$t-&$(
I(). 10 IU/m, am# @1m
1 Mag("&$!m S!at
I(). 20:, am# @20mI(). 40:, am# @20m
2 I&-+&!#%$( ;<I
Tab. 20mg
1 3-ba6am
Tab. 10mg
2 A#%a6-am
Tab. 0,5mg
Tab. 1 mg* L-%a6"#am
Tab. 2mg
1 Am$t%$#t$$(
Tab. Sa, 25 mg 7;<I8
2 Im$#%am$(a ;<I
Tab. 25mg
* M"#%-t$$( ;<I
Tab. 25 mg
Tab. 50 mg
4 F!->"t$(" ;<I
3a#&. 10 mg
3a#&. 20mg
1 3-m$#%am$(
Tab. 25 mg 7;<I8
1 ;a-#%"($-
Tab. 0.5mg
Tab. 1,5 mg
Tab. 5mg
I(). 5mg/m, am# @ 1m
I(). 50mg/m, am# @ 1m
2 3-%#%-ma6$(
Tab. Sa 25 mg
Tab. Sa!t 100 mg 7;<I8
I(). 25mg/5m 7;<I8, am# @ 5m
* T%$D!-#"%a6$(
Tab . 5 mg
4 R$&#"%$-("
Tab. 1mg
Tab. 2mg
5 <-6a#$("
Tab. 100mg
' Oa(6a#$("
3a#. Sa!t 5mg
3a#. Sa!t 10mg
I(). 10mg/?$a
!1! "#'AK$AN %T#"%$
!!
P$IKO(A"MAKA
!!1 ANTIAN$I#TA$ DAN ANTIIN$OMNIA
!!! ANTID#P"#$I DAN ANTIMANIA
!!&
ANTIOB$#$I( KOMP%'$I(
!!) ANTIP$IKO$I$
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F!"(a6$(
I(). 25mg/m, ?$a @ 1m
C !"t$a#$("
Tab. 200mg
1 M"t9#9"($at" ;<I
Tab. 10mg
1 A(ta&$a OEN I
3-mb$(a&$ =
Tab. +!(a9
3-mb$(a&$ =
Tab. +!(a9
2 A(ta&$a OEN I
3-mb$(a&$ #"% 5m =
S!&#., bt @ '0m
S!&#., bt @ 100m
* Ra($t$$("
Tab. 150 mg
I(). 50mg/2m, am# @ 2m
4 S!+%aat
Tab. 500mg
S!&#. 500mg/5m, bt @100m
5 La(&-#%a6-
3a#&. *0mg
Pa(t-#%a6-" 40 mg
' Om"#%a6-"
3a#&. 20 mg
S"%b. I(). 40mg, ?$a #"a%!t @ 10m
M$&-#%-&t- 200 mg
Tab"t
1 $m"(9$%$(at
Tab. 50 mg
2 3-%#%-ma6$(
Tab. Sa. 25 mg 7;<I8
I(). 5mg/m, am# @ 2m
I(). 25mg/m, am# @ 2m
* M"t-+-#%am$
Tab. 10mg 7&"baga$ ;<I8 Tab. 4 mg
Tab. C mg
S$%, bt @'0m
%-#, bt @10m
I(). 5mg/m 7&"baga$ ;<I8, am# @2m
I(). 4 mg/2 mL
I(). C mg/4 mL
GANGG%AN P#M%$ATAN P#"+ATIAN8+IP#"AKTI-ITA$ :GPP8
!& OBAT $A'%"AN *#"NA
!&1 ANTA$IDA DAN ANTI%'K%$
a. A!m$($!m ;$%-+&$a 200mg
b.
Mag("&$!m ;$%-+&$a 200mg
a. A!m$($!m ;$%-+&$a 200mg
b.
Mag("&$!m ;$%-+&$a 200mg
a. A!m$($!m ;$%-+&$a
b.
Mag("&$!m ;$%-+&$a
!&! ANTI#M#TIK
7/24/2019 Form Usulan FORMULARIUM
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4 O(a(&"(t%-(
Tab. 4 mg
Tab. Cmg
I(). 4mg/2m, am# @2m
I(). Cmg/4m, am# @4m
5 G%a($&"(t%-(
I(). 1mg a( *mg' -m#"%$-(
S$%. 5mg/m, bt @'0m
Tab. 5mg
1 A(t$9"m-%-$ OEN
3-mb$(a&$=
S!##. @2g
1 A(t%-#$( S!at
I(). 0,25mg/m, am# @1m
2 ;-$&$( N B!t$ B%-m$
Tab./+a#. 10mg
Tab. 10mg
I(). 20mg/m, am# @1m
* T$m"#$$!m
3a#&. *0mg
1 3-mb$(a&$=
Tab
1 B$&a+-$
Tab. 5mg
S!##-&$t-%$a 5mg
S!##-&$t-%$a 10mg
2 3-mb$(a&$=
1 Am$(-$(
Tab. S-%" 200mg
I(). 24mg/m, am# @10m
2 E"%$(
Tab. 25mg 7;<I8
* Sab!tam-
Tab. 25mg 7&bg. &!at8
Tab. 4mg 7&bg. &!at8
S$%. 2mg/m, bt @100m
$.9. 100mg/#!, tbg @200 -&$&
N"b!"&, ?$a @2,5mg
!&& ANTI+#MO"OID
a. B$&m!t9 S!bgaat 150mg
b.
;"+&a+-%-"( 2,5mg
. L$-+a$(
.
S"(g O+&$a 120mg
!&)
ANTI$PA$MODIK
!&, OBAT DIA"#
a. 3a-$( 550mg
b.
P"t$( 20mg
!&/
KATA"TIK
a. F"(-ta"$(
b. L$. Pa%a(
. G$&"%$(
.
S!&#/"m!&, bt @'0m
!) OBAT $A'%"AN NAPA$
!)1
ANTI A$MA
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4 T"%b!ta$( S!at
Tab. 2,5mg
S$%. 1,5mg/5m, bt @'0m
I(). 0,5mg/m, am# @1m
T!%b!. 0.50mg, tbg @ 200 -&$&
R"&#!"& 2,5mg/m
5 T"-$( Tab. 150mg
Tab. SR *00mg
' B!"&-($"
I(9. 200mg/#!, tbg @ 100 -&$&
I(9. 200mg/#!, tbg @ 200 -&$&
R"&#!"& 0,25mg/m, %"&# @2m
F"(-t"%- ;B%
I(9. 100mg/#!, tbg @200 -&$&
C 3-mb$(a&$=
N"b!"&, ?$a/am# @2,5m
3-mb$(a&$=
Sam"t"%- K$(a-at" 25mg,
I(9. 50mg/#!, tbg @120 -&$&
Sam"t"%- K$(a-at" 50mg,
F!t$a&-(" P%-#%$-(at 100mg
$&+!&. 100mg/#!, tbg @'0 -&$&
Sam"t"%- K$(a-at" 50mg,
F!t$a&-(" P%-#%$-(at 250mg
$&+!&. 250mg/#!, tbg @'0 -&$&
Sam"t"%- K$(a-at" 50mg,
$&+!&. 500mg/#!, tbg @'0 -&$&
10 F!t$a&-(" P%-#$-(at"
N"b!"& 0,5mg, am# @2m
11 B!"&-($" F-%m-t"%- 7F$>" <-mb$(at$-(8
I(9. C0/4.5 mg, tbg @'0 -&$&
I(9. C0/4.5 mg, tbg @'0 -&$&
12 I#%at%-#$!m
I(9. 20mg/#!, tgb @200 -&$&
1 T$-t%-#$!m
3a#&. 1C mg/-&$& 9a($a"%
3a#&. 1C mg/-&$&, %"
1 "+&t%-m"t-%a(
Tab. Sa!t 15 mg
S$%. 10mg/5m, bt @'0m
2 3-"$( 7;<I/F-&at8
Tab. 10mg
Tab. 15mg
Tab. 20mg
1 G$&"%$ G!a$a+-at
Tab. 100mg
2 Obat Bat!+ ;$tam 7O.B.;.8
S$%., bt @100m
S$%., bt @200m
a.
I#%at%-#$!m B%-m$a 0,5mgb. Sab!tam- 2,5mg
!)!
PPOK
!)&
ANTIT%$I(
!)) #K$P#KTO"AN
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* 3-mb$(a&$=
S$%., bt@'0mS$%., bt@'0m
1 B"%ata(t
I(). 25mg/m, ?$a @Cm
1 Na"t&t"$("
I(). N"b!$6"% *00mg/*m, am#
1 A&am A&+-%bat 7$tam$( <8
Tab. 50mg Tab. 250mg
2 3a&$!m La+tat
Tab. 500mg
*
Tab. 10mg
I(). 100 mg/m, am# @1m
4
Tab. 50mg 7;<I N$t%at8
I(). 100mg/m, am# @1m
5 $tam$( B <-m#">
Tab
' 3-mb$(a&$=
I(). 25mg/10m, am# @10m
3-mb$(a&$=
Tab./+a#. &a!t &"a#!t
C 3-mb$(a&$=
Tab
I()., am# @*m
3-mb$(a&$ =
Tab
<a$t%$-
3a#&. L!(a+ 0,25mg
10 3-mb$(a&$ =
a.
$"(9$%am$( ;<I 1*,5mg
b. Am-($!m 3-%$a 1*1,5mg
.
Na&$t%at 55mg
. M"(t- 1mg
".
A+-9- 5:
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!)/ M%KO'ITIK
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-ITAMIN DAN MIN#"A'
P$%$-+&$( ;<I 7$tam$( B'8
T$am$( ;<I 7$tam$( B18
a. F!%&!t$am$( ;<I 25mg/m
b.
G!+-&a 2000mg/m
a. $t B1 M-(-($t%at" 100mg
b. $t B' 200mg
. $t B12
250mg
a. $t B1 M-(-($t%at" 100mg
b.
$t B'100mg
. $t B12
5000mg
a. ATP 20 mg
b. $t. B1 100 mg
. $t. B' 200 mg
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$t. B12 200 mg
". $t. E *0 mg
a. L!t"$( * mg
b.
L-#"(" C mg
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3a#&!
Nat!%a A&ta>a(t9$( ' mg
1 3a&$!m 3a%b-(at
Tab./tab. 3!(a9 500mg
2 A$% !(t!+ $()"+&$
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* A$% !(t!+ $%$ga&$
La%. I(!&, bt @1000m
4 3-mb$(a&$ =
Bt.
5 Nat%$!m P9-&#at
Bt @ 1**m
' 3a&$!m A&"tat
Tab. ''mg
<a$%a( T%$9-%-a"tat 7T<A8 '0,C0, 100:
C <a$%a( P--$(
1 S$+-&#-%$(
3a#&. L!(a+ 25mg
3a#&. L!(a+ 100mg
2 M-#9"(-at"
3a#. 500mg
* E?"%-$m!&
Tab. 0,25mg
Tab. 0,50mg
4 Ta%-$m!&
3a#. 0.5mg
3a#. 1mg
5 M"t-t%"+&at
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1 Tam-+&$"(
Tab. 20mg 7&bg. &$t%at8
2 M"%-+&$ P%-g"&t"%-( A&"tat
Tab. 500mg
* A(a&t%-6-"
Tab. 1mg
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Tab. 2,5mg
5 E>"m&"ta(
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I(). *,5mg, ?$a
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$t. < 250 mg
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B"ta 3a%-t"( 10.000 $!
g. S""($!m "a&t *0 mg
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b.
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! ANTIN#OP'A$TIK6 IM%NO$%P"#$AN DAN T#"API PA'IATI(
!1 IMM%NO$%P"#$AN
!! ANTI+O"MON
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I(). 11,25mg, ?$a
G-&"%"$( A&"tat
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I(). 10.C mg/?$a
1 A&#a%ag$(a&"
S"%b. I(). 10.000 IU/?$a2 B"-m$&$(
S"%. I(). 15 mg/am# 7&bg. S!at8
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S"%b. I(). 200mg/20m
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S"%. I(). 10 mg/?$a 7;<I8, ?$a @5m
S"%. I(). 50 mg/?$a 7;<I8, ?$a @25m
5 Et-#-&$
I(). 20 mg/m, am# @5m
' F!-%-!%a&$I(). 250 mg/?$a, ?$a @1m
I(). 500 mg/?$a, ?$a @10m
3a&$!m F-$(at
I(). 50 mg/m, ?$a @5m
C M"t-t%"+&at
S"%b $(). 5mg/2m 7&bg. Ga%am Na8, ?$a @2m
S"%b. I(). 50mg/2m, ?$a @2m
S$+--&am$
Tab. Sa!t 50
S"%b. I(). 200mg/?$a
S"%b. I(). 500mg/?$a
S"%b. I(). 1000mg/?$a
10 <$&#at$(
S"%b. I(). 10mg/?$a
S"%b. I(). 50mg/?$a
11 <$ta%ab$(
S"%b. I(). 1000mg, ?$a @10m
12 $(ba&t$(
S"%b. I(). 10mg/?$a, 7&!at8, ?$a @10m
1* $(+%$&t$(
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&"%. I(). 2mg/?$a, ?$a @2mg
14 <a%b-#at$(
I(). 150mg/?$a, ?$a @15m
I(). 450mg/?$a, ?$a @45m
15 E#$%!b$$(
S"%b. I(). 10mg/?$a, ?$a @5m
S"%b. I(). 50mg/?$a, ?$a
1' M$t-m$$( <
S"%b. I(). 10mg/?$a, ?$a
1 Pa$ta+"
I(). *0mg/?$a, ?$a @5m
I(). 100mg/?$a, ?$a @1','m
I(). 150mg/?$a, ?$a @25m
1C <a#"$tab$("
Tab. 500 mg
1 ;$%-+&$ U%"a
Tab. 500mg
!& $ITOTOK$IK
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20 I-&am$"
I(). 1000mg/?$a
21 -"ta>"
I(). 20 mg/?$a, ?$a @0,5m
I(). C0 mg/?$a, ?$a @2m
22 G"m$tab$("
I(). 200 mg/?$a, ?$a @5mI(). 1000 mg/?$a, ?$a @25m
2* $(-%"b$("
I(). 10mg, ?$a
24 O>a$#at$("
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I(). 100mg, ?$a
25 I%$(-t"a(
I(). 40mg/2m, am# @2m
I(). 100mg/5m, am# @5m
2' T%a&t!6!mabI(). 440mg/20m, ?$a @20m
2 R$t!>$mab
I(). 100mg/10m, ?$a @10m
I(). 500mg/50m, ?$a @50m
2C $&-$!m <-%-(at" T"t%a9%at"
I(). *00mg/5m, am# @5m
2 A&am -"%-(at
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*0 A&am Iba(%-(at
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*1 La#at$($b $t-&at"
Tab. Sa!t 250mg
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** E%$t%-#-"t$(Aa
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I(). *000 IU/m, #& @1m
*4 E%$t%-#-"t$( B"ta
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*5 B$a!tam$"
Tab. 50mg
*' Imat$($b M"&at
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2 L"(-g%a&t$m
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G"O7 *O'ON. $TIM%'ATING (AKTO" :G*$(;
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1 M-%(
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Tab. *0mg
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2 P"t$$(I(). 50mg/m 7;<I8, am# @2m
* F"(ta($
I(). 0,05mg/m 7&bg. S$t%at8, am# @10m
I(). 0,05mg/m 7&bg. S$t%at8, am# @10m
Pat9 12.5mg/)am
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Pat9 50mg/)am
4 S!"(ta($
I(). 5mg/m 7&bg S$t%at8, ?$a @10m
5 3-mb$(a&$=
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1 Fa+t-% III 73-(&"(t%a8
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S"%b. I(). 4C0 '00 IU, ?$a
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I(). $.?. 500 IU, ?$a
1 Ab!m$( S"%!m N-%ma
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I(). 25:, bt @20m
I(). 5:, bt @50m
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2 Pa&ma P%-t"( F%at$-( 7;!ma(8
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* ;$%-+&$ Et$ Sta%9 BM 200.000
La%. I(!& ':, bt @500m
4 3--$ ;ES BM1*0.000
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5 3--$ ;ES BM 40.000
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' 3--$ Baa(" E"+t%-$t ;ES 1*0/0.42
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1 Pa(+!%-($!m
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* At%a!%$!m B"&at"
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!2 ANA'G#$IK NA"KOTIK
a. 3-"$( *0mg
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!3 P"OD%K DA"A+ DAN P#NGGANTI P'A$MA
!31
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&4 "#'AK$AN OTOT P#"I(#" DAN P#NG+AMBAT KO'IN#$T
&1
IM%NOG'OB%'IN DAN $#"%M
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1 Im!(-g-b!$( A(t$ T"ta(!& 7;!ma( T"ta(!& Im!(-g-b!$(8
I(). 250 IU/am#, am# @1m
2 ;"#at$t$& B Im!(-g-b!$( 7;!ma(8
I(). 0.5 m/&%$(g", &%$(g" @ 0,5m
1 A(t$ B$&a Ua% 7ABU.I8
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2 A(t$ T"ta(!& 7A.T.S8
I(). 1.500. IU/am#, @1m
I(). 20.000. IU/am#, @4m
* a+&$( Rab$"&
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&11 IM%NOG'OB%'IN
&1! $#"%M
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Paten ! Paten !
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