Lampiran

AAM

DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016

No Nama Produk Kandungan
1 Anxibloc Tab Clobazam 10mg
2 Apazol 0,5 Tab Alprazolam 0,5mg
3 Biscor-5 Tab Bisoprolol 5mg
4 Cameloc Supp Meloxicam Supp 15mg
5 Cameloc-15 Tab Meloxicam 15mg
6 Cameloc-7,5 Meloxicam 7,5mg
7 Cholestor 10mg Atorvastatin 10mg
8 Dexacap 12,5 Tab Captopril 12,5mg
9 Dexacap 25 Tab Captopril 25mg
10 Dexadrox 500 Kap Cefadroxil 500mg
11 Dexazol-200 Tab Ketoconazole 200mg
12 Diabemin FC Tab Metformin 500mg
13 Diabemin XR Tab Metformin 500mg
14 Diaversa 1MG Tab Glimepiride 1mg
15 Diaversa 2MG Tab Glimepiride 2mg
16 Diaversa 3MG Tab Glimepiride 3mg
17 Diaversa 4MG Tab Glimepiride 4mg
18 Dilavask 5MG Tab Amlodipin 5mg
19 Dilavask 10MG Tab Amlodipin 10mg
20 Esvat 10MG Tab Simvastatin 10mg
21 Esvat 20MG Tab Simvastatin 20mg
22 Pondex Susp As.Mefenamat Suspensi
23 Suprasma 4MG Tab Salbutamol 4mg
24 Vastigo Tab Betahistine 6mg
25 Vometraz 4MG Tab Ondansetron 4mg
26 Vometraz 8MG Tab Ondansetron 8mg
27 Zorel 200MG Tab Acyclovir 200mg
28 Zorel 400MG Tab Acyclovir 400mg
29 SISTENOL PARACETAMOL 500MG + N ASETILSISTEIN 200MG
30 VECTRIN 300MG ERDOSTEINE 300MG
31 VECTRIN DS ERDOSTEINE 175MG/5ML
32 RHINOS SR LORATADINE 5MG +PSEUDOEPHEDRIN 60MG
33 RHINOS JUNIOR SYR PSEUDOEPHEDRIN 15+CTM

DISTRIBUTOR AAM
Lampiran

NOVEL
DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016
No Nama Produk Kandungan
1 BREATHY ND NACL 6.5 MG SETARA NACL 0.9%
2 ISPRINOL TABLET METHISOPRINOL TABLET 500MG
3 ISPRINOL SYRUP METHISOPRINOL SYRUP 250MG/5ML
4 VELUTINE NEB SALBUTAMOL NEBUL 2.5MG/4ML
5 LACTO B PROBIOTIC DUAL PDR COATED (POLY BAG)
6 OREZINC SYR ZINC SULFAT HEPTAHYDRATE 43.96MG RASA JERUK
7 ETERFIX PARACETAMOL INFUS

DISTRIBUTOR KALLISTA DAN PENTAVALENT

Lampiran

OTTO

DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016

No Nama Produk
1 Acilaz 30mg Kap
2 Dextrosin Tab
3 Dextrosin Syrup Anak
4 Folac Tab
5 Gerdilium Tab
6 Gerdilium Suspensi
7 Gerdilium drop
8 Opicef Dry Syrup
9 Magtral Forte Tab
10 Magtral Suspensi Mint
11 Moxic Forte Tab
12 MUCERA TABLET
13 Opimox Tab
14 Opimox Dry Syrup
15 OPINACEA CAPLET
16 opinacea syr
17 OSTARIN 400MG CAPLET
18 OSTARIN FORTE SYR
19 Ottopan Syrup
20 Ottopan Drop
21 Prednicort 4MG Tab
22 Opigran 1MG Inj
23 Opigran 3MG Inj
24 Opilax 60ML Syrup
25 Opiphen Dry Syrup
26 Opithrocin Dry Syrup
27 Scopamin TABLET
28 Trogyl Suspensi
29 Trogyl Infus
30 Trogyl Tab
31 Visebad Drop
32 Visebad Plus Suspensi
33 Betasin Cream
34 Etason Inj
35 Fluzep Tab
36 Hexadol Solution 60ML
37 Renvol Tab
38 Serfac 250 Inj
FTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016
Kandungan
Lansoprazole 30mg
GG 100mg, DMP 15mg, CTM 2mg, PPA 12,5mg
GG 50mg, Noscapin 10mg, Paracetamol 125mg, DMP 6,5mg, Phenylephrine 5mg
Asam Folat 400mg
Domperidon 10mg
Domperidon 5mg/5ml
Domoeridon 5mg/ml
Cefadroxil 125mg/5ml
Al(OH)2 400mg, Mg(OH)2 400mg, Simethicone 100mg
Al(OH)2 250mg, Mg(OH)2 250mg, Simethicone 50mg
Meloxicam 7,5mg
AMBROXOL 30MG
Amoxicillin 500mg
Amoxicillin 125mg/5ml
Echinacea purpurea ext; vit c, popolis bee, zinc picolinate
Echinacea purpurea ext; vit c, popolis bee, zinc picolinate
IBUPROFEN 400MG
IBUPROFEN 200MG/5ML
Paracetamol 120mg/5ml
Paracetamol 100mg/5ml
6 -L-METHYLPREDNISOLON
Granicetron 1mg
Granicetron 3mg
Lactulose 3,335g/5ml
Thiamfenikol 125mg/5ml
Erythromycin 200mg/5ml
Hyoscine-N-butylbromide 10mg, PARACETAMOL
Metronidazol 125mg/5ml
Metronidazol 500mg/100ml
Metronidazol 500mg
Vit.A, Vit.B Komplex, Vit.C, Vit.D
Vit.A, Vit.B Komplex, Vit.C, Vit.D, Lysine, Prebiotik, DHA, Nicotinamide, D-Pantenol
Betamethasone 0,05%, Gentamycin
Dexametason 5mg/ml
Paracetamol 500mg, PPA 12,5mg, GG 50mg, DexCTM 2mg, DMP 15mg
Hexetidine 0,1%
Na Diclofenac 25mg
Cithicolin 250mg
Lampiran

MEPRO

DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016

No Nama Produk
1 Arsinal FC Tab
2 Pyrexin Tab
3 Pyrexin 80 Supppsitoria
4 Pyrexin 160 Suppositoria
5 Norages Inj
6 Suprafenid Suppositoria
7 VOSTEON FC TABLET
8 Nostren Cream
9 Arcapec Tab
10 Tricker Inj
11 MUCIFAT SUSPENSION
12 MUCOS TABLET
13 MUCOS SYR
14 MUCOS DROP
15 RINOCET SYR
16 Eflin Tab
17 Eflin Syrup
18 Intunal Forte Tab
19 Intunal Syrup
20 Solvinex Tab
21 Prodexon Tab
22 Lusanoc Cream
23 Supralysin 60ml Syrup
24 Supralysin Drop
25 Tuderm-N Cream
26 Sirplus All Variant
27 Phenytoin Inj
28 Meprotrin Tab
29 Meprotrin Forte Tab
30 Meprotrin Suspensi
DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016
Kandungan
Metamizole, Vit.B Complex, Vit.E
Paracetamol 500mg
Paracetamol 80mg
Paracetamol 160mg
Metamizole 500mg/ml
Ketoprofen 100mg
GLUCOSAMIN HCL 250MG, CHONDROITIN SULPHATE 200MG, IPRIFLAVONE 65 MG CA CITRATE 165 MG
Methyl salisilat, Menthol, Eugenol, Capsaicin
Attapulgite 600mg, Pectin 50mg
Ranitidin 50mg/2ml
SUCRALFATE 500MG
AMBROXOL 30MG
AMBROXOL 15MG
AMBROXOL 15MG
CITERIZINE 2HCL 5MG
Tripolidine 2,5mg, Pseudoefedrin 60mg
Pseuodoefedrin 30mg, Tripolidin 1,25mg/5ml
Paracetamol 500mg, PPA 15mg, DexCTM 1mg, GG 50mg, DMP 15mg
Paracetamol 125mg, PPA 3,5mg, DexCTM 0,5mg, GG 50mg, DMP 7,5mg
Bromhexin 8mg
Dexametason 0,5mg
Ketoconazole 2%
Vit B1, Vit B2, Vit B6, Vit B12, Nicotinamide, D-panthenol, Vit A, Vit D, Vit C, Lysine HCl
Vit B1, Vit B2, Vit B6, Vit B12, Nicotinamide, D-panthenol, Vit A, Vit D, Vit C, Lysine HCl
Betamethasone Valerate 0,1%, Neomycin 0,5%
Natural Sugar Aneka Rasa
Phenytoin Sodium 50mg
Trimetoprim 80mg, Sulfametoxazole 400mg
Trimetoprim 160mg, Sulfametoxazole 800mg
Trimetoprim 40mg, Sulfametoxazole 200mg/5ml
Lampiran

SANBE

DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016

No Nama Produk
1 Acran inj
2 Alloris
3 Biothicol 500mg
4 Biothicol ds
5 Cinam inj
6 Cinolon n cr
7 Flamar 50mg
8 Flamar gel
9 Lodia
10 MEFINAL 500mg
11 Neo kaolana syr
12 Mucohexin syr
13 Neurosanbe 5000mg
14 Neurosanbe inj
15 Neurosanbe plus
16 sagestam cr
17 Sanadryl DMP 60ml
18 Sanmol talet
19 Eprinoc Tab
20 Topcort Cream
21 Trovensis 2ml Inj
22 Histapan
23 Megabal
24 Pirofel 10mg
25 Pirofel 20mg
NAMA PRODUK YANG MASUK FORMULARIUM 2016
Kandungan
Ranitidin hcl
Loratadine
Thiamphenicol 500mg
Thiamphenicol 125mg
Ampicilin 1000mg, sulbactam 500mg
Fluocinolone 0.25mg
diclofenac sodium
diclofenac diethylammonium
Loperamide hcl 2mg
asam mefenamat 500mg
kaolin 700mg, pectin 66mg
Bromhexine hcl
Vit.B1 100mg, Vit.B6 200mg, Vit. B12 5000mcg
Vit.B1 100mg, Vit.B6 200mg, Vit. B12 5000mcg
Vit.B1 100mg, Vit.B6 200mg, Vit. B12 5000mcg
gentamycin
dextromethorphan hbr
paracetamol 500mg
Esperisone HCl 50mg
Desoxymethasone
Ondancetron 4mg/2ml
mebhydrolin napadisylate
Mecobalamin
Piroxicam 10mg
Piroxicam 20mg
Lampiran

BERNOFARM

DAFTAR NAMA PRODUK YANG MASUK FORMULARIUM 2016

No Nama Produk Kandungan
1 ANGISIS DROP NYSTATIN 100IU/ML
2 BENOSON M BETAMETHASON VALERAT 0.1%+ MICONAZOLE NITRATE 2%
3 BENOXURIC 100MG ALLOPURINOL 100MG
4 BENOXURIC 300MG ALLOPURINOL 300MG
5 KLIRAN 4MG ONDANCENTRON 4MG
6 KLIRAN 4MG INJ ONDANCENTRON 4MG
7 NOMESIS SYR DOMPERIDON5MG/5ML
8 TRANXA INJ TRANEXAMIC ACID 250MG/5ML