NON FORMULARIUM OBAT

TAHUN 2018

NO NAMA GENERIK GOLONGAN / TERAPI PABRIKAN

Amoxicillin 500 mg kapsul ANTIBIOTIK
1
Amoxicillin 1 gram injeksi
Amoxicillin 125mg/5ml syrup
2 Ampicillin 1 gram
Ampicillin 500mg tablet
3 Azythromycin 500mg tablet
4 Ciprofloksasin 200mg/100ml infus
Thiamfenicol 500 mg kapsul
5
Thiamfenicol 125mg/5ml syrup
Cefadroxyl 500 mg kapsul
6
Cefadroxyl 150mg/1ml
Cefadroxyl 125mg/5ml syrup
7
Cefadroxyl 250 mg/5ml syrup
Cefrixime 100mg kapsul

8
Cefixime 100mg/5ml syrup

Cefotaxim 1 gram injeksi

9

Ceftriaxon 1 gram injeksi

10

Chloramphenicol TM
11

1
 Chloramphenicol TT
12 Co amoxiclav 500mg kapsul

Co amoxiclav 500mg sirup

13 Clindamycin 150 mg kapsul
15 Metronidazol 500 mg tablet
Metronidazol 500mg/100ml infus

16 Metronidazol Supp

Metronidazol 500 mg/ml syrup

Gentamicin 40mg/ml injeksi

17
Gentamicin cream

Levofloxacin 500 mg/ 100 ml infus

Cotrimoxazole 240 mg tablet

Cotrimoxazole 480 mg tablet

18

Cotrimoxazole 120 mg/5 ml syrup

1 Miconazole nitrate 2% ANTI FUNGI

Ketoconazole 200 mg tablet

2
Ketoconazole 2% cream

3 Flukonazole 50 mg kapsul
4 Nystatin 100.000IU/ml

1 Loratadine 10 mg tablet ANTI ALERGI

Cetirizine 10 mg tablet
2

2
 Cetirizine 5 mg/ 5 ml syrup

Cetirizine 10 mg/ml drops

3 CTM 4mg tablet

Salbutamol 2 mg tablet ANTI ASMA

Salbutamol 4 mg tablet
1 Salbutamol 2,5 mg Nebul

2 Theophylin 300mg + salbutamol

3 Ketotifen 1 mg tablet
epedrin inj
4 Aminophyllin 24mg/ml injeksi

NASAL DEKONGESTAN,
ANTITUSIF DAN
1 Tripolidine 2,5 mg tablet + INFLUENZA
Pseudoefedrine 60 mg tablet

Loratadine 5 mg tablet +
2
Pseudoefedrine 120 mg tablet
3 DMP 10mg, diphenhidramin,amm klorida
4 Tripolidine + pseudoephedrin syrup
5 Pseudoefedrin hcl 7.5 mg drop

1 Natrium Diclofenac 50 mg tablet GOLONGAN NSAID

Kalium Diclofenac 50 mg tablet

2

3
 Meloxicam 7,5 mg tablet
3
Meloxicam 15 mg tablet

Methampyron 500 mg, Vit B1 50 mg,

4
Vit B6 100 mg, Vit B12 100 mcg tablet
Natrium Diclofenac 50 mg, Vit B1 50 mg,
5
Vit B6 50 mg, Vit B12 1 mg tablet
6 Ketorolac Tromethamine 30 mg/ml
Ketoprofen 100 mg supp

7 Piroxicam 20 mg kapsul
Tramadol 37,5 mg + Paracetamol 325 mg

GOLONGAN
1
Mometasone Furoate 0,1% cream 5 gr KORTIKOSTEROID

Methylprednisolone 8 mg tablet
Methylprednisolone 16 mg tablet
Dexamethasone 0,5 mg

Dexamethasone 5 mg/ml
4 Betamethasone cream
5 Desoximethasone cream

GOLONGAN ANTIBIOTIK
1 + KORTIKOSTEROID
Betamethasone + Neomycin cream TOPIKAL
2 Betamethasone + Gentemycin cream
3 Desonid + Neomycin

1
Acyclovir 200 mg tablet GOLONGAN ANTI VIRUS
Acyclovir cream
2 Methisoprinol tablet
Metisoprinol sirup

1 Paracetamol 500 mg tablet GOLONGAN

4
 ANTIPIRETIK/ANALGESIK

Paracetamol 120 mg/5 ml

Paracetamol 60 mg/0,6 ml drops

Paracetamol 100 mg/100 ml infus

Asam Mefenamat 500 mg
2

Ibuprofen 200 mg tablet

3 Ibuprofen 400 mg tablet
Ibuprofen 100 mg/5 ml suspensi

Metamizole 500 mg tablet

Metamizole 500 mg/ml injeksi
4

Metamizole 500 mg/5 ml syrup

GOLONGAN ANTI MUAL

1 Metoclopramide 10 mg tablet DAN MUNTAH
Metoclopramide 5 mg/ml injeksi
metoclorpramid 10mg/5ml
Ondansetron 4 mg tablet
Ondansetron 8 mg tablet
Ondansetron 4 mg/ 2 ml injeksi
2
Ondansetron 8 mg/ 4 ml injeksi
Ondansetron 4 mg/5 ml syrup

Domperidone 10 mg tablet
Domperidone 5 mg/5ml syrup
3

Domperidone 5 mg/ml drops

4 Pyrathiazine Theoclate + Pyridoxine

5
 GOLONGAN ANTI ULKUS
1 Omeprazole 20 mg kapsul PEPTIKUM
Omeprazole 40 mg injeksi
Pantoprazole 40 mg injeksi
2

Ranitidin 25 mg/ml injeksi

Ranitidin 150 mg tablet
3
Sucralfate 500 mg/5ml syrup

Magnesium Hydroxide, Magnesium,

4
Simethicone tablet
Magnesium Hydroxide, Magnesium,
5
Simethicone syrup

6 Dimetilpolisiloksan
Misoprostol
7

8 Famotidin 20 mg tablet
9 Simetidin 200 mg tablet
Clidinium bromide 2,5mg, klordiazepoksid
10
5mg
11 lansoprazol

GOLONGAN ANTI ULKUS

1
Flunarizine 5 mg tablet PEPTIKUM
2 Piracetam 3 gr injeksi
3 Piracetam 800 mg tablet
4 Donepezil
Citicoline 500 mg tablet
5

GOLONGAN
1 Vit B1 100 mg, B6 200 mg, B12 200 mcg NEUROTROPIK VITAMIN

Vit B1 100 mg, B6 200 mg, B12 5000 mcg

2

3 Mecobalamin 500 mcg

4 Mecobalamin 500 mcg injeksi

6
 GOLONGAN SUPLEMEN
DAN VITAMIN DAN
1 Echinacea Purpurea 500 mg, Pink Rock Rose OBAT LAIN
50 mg, Zink Picolinate 10 mg,
Selenium 15 mcg kaplet
Echinacea Purpurea 250 mg, Pink Rock Rose
2
50 mg, Zink Picolinate 5 mg syrup
Co-enzym Q10 30 mg
3

Co-enzym Q10 100 mg

4

Natural Asthaxantine 4 mg tablet

5

6 Kalsium Karbonat 1250mg

7 Calcuim Lactate, Vit B6, Vit C, Vit D3
8 Calcium, Isoflavone, Vit D, K, Magnesium
9 Curcumae tablet
10 Curcumae + Vit lain syrup

11 Diosmin 450 mg + Hesperidine 50 mg

Lysine 25 mg + Vit A, D, B1, B2, B6, B12
12

Dekspantenol, Vit A, Vit D, Vit B1, Vit B6 dll

13

14 Omega 3 64,5 mg, EPA/DHA 48,5/12,5 MG

Asam Folat 400 mcg dan vit lain
15

16 Vitamin E 200 mcg

17 Vitamin E 400 mcg
18 Zinc Sulphate 20 mg/5 ml syrup
19 Zinc Sulphate 20 mg tablet
Essential Keto acid
20

Lecithin 150mg dll

21

22 Sericocalyx folium dll

7
 GOLONGAN ANTI
23 Fe Fumarate 250 mg, dll ANEMIA

24 Fe Fumarate 360 mg, dll

GOLONGAN
ANTIKOAGULAN, ANTI
1
PLATELET DAN
Silostazol 100mg tablet TROMBOLITIK
Asam asetilsalisilat 80mg
2

3 Klopidogrel 75 mg
Karbazokrom 10mg /tablet
4
Karbazokrom 5mg/5ml inj
Asam traneksamat 500mg tablet
5
Asam traneksamat 50mg/ml inj
6 Vitamin K 5mg/ml
7 Vitamin K 2mg/ml
8 Fondaparinuks 2,5 mg/0,5ml

GOLONGAN PRODUK
1 DARAH DAN PENGGANTI
Human Albumin 20% 50 ml PLASMA
2 Human Albumin 20% 100 ml
HES 130
3

1 Ambroxol 30 mg tablet GOLONGAN MUKOLITIK

2 Ambroxol 15 mg/5 ml syrup
3 Ambroxol 15 mg/ml drops
4 Erdostein 300 mg

5 Bromhexine 8 mg
6 Bromhexine 4 mg/5 ml
7 N. Acetylsistein 200 mg kapsul

8
 GOLONGAN ANTI DIARE
1
Attapulgite dan PROBIOTIK

2 Loperamide
3 Dioctahedral Smectite 30mg
4 Lactobacillus Reuteri

5 Lactobacillus Acidophillus, L.lactis

kaolin + pectin sirup

nifuroxazide sirup
furazolidone

Diazepam 5 mg/ml injeksi

Diazepam 5 mg supp
5 Midazolam 5 mg/5 ml injeksi
2 Eperison 50mg tablet

3 Neostigmin 0,5mg/ampul

GOLONGAN ANTI
1 EPILEPSI +
Carbamazepin 200mg tablet ANTIPARKINSON
2 Trihexyphenidyl 2mg
3 Asam valproat 500mg tablet
Asam valproat 50mg/ml syrup
4 Penitoin 100mg tablet
Penitoin 50mg /ml injeksi
5 Gabapentin 100 mg
Gabapentin 300 mg
6 Pregabalin 75 mg
7 Phenobarbital 30 mg tablet
Phenobarbital 200mg/2mlinj
8 Levodopa 100mg, benserazide HCl 25mg
9 Pramipeksol 0,375 mg
Pramipeksol 0,250 mg

9
 GOLONGAN
1
Metformin 500 mg tablet ANTIDIABETIK ORAL

2 Glimepiride 1 mg tablet
Glimepiride 2 mg tablet
Glimepiride 3 mg tablet
Glimepiride 4 mg tablet
3 Acarbose 50mg tablet
Acarbose 100mg tablet

1 Insulin aspart 100 iu/ml GOLONGAN INSULIN

2 insulin lispromix 100 ui/ml

3 Insulin detemir 100 iu/ml

4 Insulin glargine 100 iu/ml

GOLONGAN ANASTESI
1
Ketamin HCl 100 mg/ ml UMUM
2 Bupivacain 5mg/ml
3 Lidocain2%, ephineprin
4 Lidocain2% injeksi
5 Propofol 10mg/ml injeksi

6 Halothan
7 Isofluran

GOLONGAN
1
Nifedipin 10mg tablet KARDIOVASKULER
Nifedipin 20mg tablet SR
Nifedipin 30mg tablet SR
2 Nitrogliserin inj
3 ISDN 5mg tablet
ISDN 1mg/ml
4 Diltiazem 30mg tablet
Diltiazem 50mg/ml injeksi

10
5 Amiodaron 200 mg/tablet
Amiodaron 50 mg/ml injeksi
6 Kaptopril 12,5 mg tablet
Kaptopril 25 mgtablet
7 Ramipril 10 mg tablet
8 Lisinopril 5mg tablet
9 Valsartan 80 mg tablet
Valsartan 160 mg tablet
10 Bisoprolol 5mg tablet
Bisoprolol 2,5mg tablet
11 Propanolol 10mg tablet
Propanolol 40mg tablet
12 Amlodipin 5mg tablet
Amlodipin 10mg tablet
13 Nimodipin 30mg tablet
Nimodipin 0,2mg /ml injeksi
14 Nicardipin 1mg/ml

15 Terazosin 1 mg tablet
16 Irbersartan 150mg tablet
Irbersartan 3000mg tablet
17 Candesartan 80mg tablet
Candesartan 160mg tablet
18 Telmisartan 40 mg tablet
Telmisartan 80 mg tablet
19 Metyldopa 250mg tablet
20 Digoxin 0,25mg tablet
Digoxin injeksi
21 Dopamin 10mg/ml
22 Dobutamin 50mg/ml

23 ephinephrin1mg/ml inj
Norephineprin 1mg/ml
24 Atorvastatin 20mg tablet
Atorvastatin 40mg tablet
25 Simvastatin 10mg tablet

Simvastatin 20mg tablet

26 Pravastatin 10 mg
27 Gemfibrosil 300 mg kapsul
28 Fenofibrate 100mg kapsul
Fenofibrate 300mg kapsul
29 Trimetazidine diHCl

11
1 Furosemid 40mg tablet GOLONGAN DIURETIK
Furosemid 10mg/2ml inj
2 Spironolacton 25mg tablet
Spironolacton 100mg tablet

1 Allopurinol 100mg tablet GOLONGAN ANTIPIRAI

Allopurinol 300mg tablet
2 Kolsisin 0,5mg tablet

GOLONGAN
UTEROTONIK, RELAKSAN
1
UTERUS DAN OBAT
Metylergometrin 125mcg GYNEKOLOG LAIN

2 Metylergometrin 200mcg/ml
3 Oksitosin 0,2mg/ml
4 Isoksuprin hcl 20mg/tablet

Isoksuprin hcl injeksi

5 Progesteron 100mg
Progesteron 200mg
6 Lactobacillus rhamnosus
7 Clomiphen Sitrat 50mg

8 Siproteron 2mg
9 Allylestrenol 5 mg
10 Noretisteron 5mg

11 Etynilestradiol 0,03mg
12 Medroksiprogesteron asetat 50mg,
estradiol sipionat 10mg/ml inj
13 Medroksiprogesteron asetat 150mg/ml

14 Levonorgestrel
15 IUD
16 Drospirenon 3 mg, etinilestradiol 0,03mg

1 Codein 10mg tablet GOLONGAN NARKOTIK Kimia Farma

12
2 Morphine 10 mg tablet Mundipharma
3 Pethidin 50mg/ml injeksi
4 Fentanyl 2.1 mg per transdermal patches Janssen
5 Fentanyl 0,05mg /ml inj

USULAN/TAMBAHAN
1
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