FORMULARIUM 2020

RSIA BINA MEDIKA

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PEDOMAN PELAYANAN PENGORGANISASIAN FARMASI
 2020 | Formularium Obat RSIA Bina Medika
No. Kelas Terapi Bentuk Sediaan Kode Famasi
I. SISTEM GASTROINTESTINAL DAN HEPATOBILIER
A. Antasida, Obat Antirefluks & Antiulserasi
1 Ranitidine
Acran Tablet 150 mg Sanbe
Tablet 300 mg Sanbe
Ampul 25mg/mL-2mL Sanbe
Ranivel Sirup 75mg/5mL-60mL Novell

2 Lansoprazole
Lancid Kapsul 30 mg Kalbe
Lapraz Kapsul 30 mg Sanbe
3 Misoprostol
Invitec Tablet 200mcg Dankos
Noprostol Tablet 200mcg Novell
4 Pantoprazole
Topazol Vial 40mg Lapi
Pranza Vial 40mg Kalbe
5 Omeprazole
Pumpitor Kapsul 20 mg Sanbe
Omz Kapsul 20 mg Ferron
Vial 40mg Ferron
6 Sucralfat
Suspensi
Episan Sanbe
500mg/5mL-100mL
Suspensi
Nucral Guardian
500mg/5mL-100mL
Sachet 1000mg/10mL Guardian
7 Esomeprazole
Esola Vial 40mg Lapi
Nexium Tablet 20mg Astra Zeneca
Tablet 40mg Astra Zeneca
8 Mg(OH)2, Al(OH)3, dimethicone
Polysilane Tablet Pharos
Sirup 100mL Pharos
9 Activated methylpolysiloxane, Mg(OH), Al(OH)3-Mg
carbonate
Polycrol Gel 100mL Nicholas
B. Regulator GIT, Antiflatulen & Antiinflamasi
1 Cisapride
Acpulsif Tablet 5 mg Dexa
2 Dimetipolisiloksan
Disflatyl Tablet 40mg Pharos
3 Domperidone
Vometa Tablet FT 10mg Dexa
Sirup 5mg/5mL-60mL Dexa
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Drops 5mg/mL-10mL Dexa
C. Antispasmodik
1 Chlordiazepoxide 5mg, Clidinium Bromide 2,5mg
Braxidin Tablet Sanbe
2 Hyoscine butylbromide 10mg, Paracetamol 500mg
Buscopan Plus Tablet Boehringer
3 Hyoscine butylbromide
Buscopan Tablet 10mg Boehringer
Ampul 20mg/mL-1mL Boehringer
4 Metamizole Na 500mg, Belladona extrak 10mg,
Papaverine HCl 25mg
Spasminal Tablet Kalbe
5 Atropine Sulfate
Atropine Sulfat Vial 0,25mg/mL-1mL Ethica
D. Antidiare
1 Zinc sulfate monohydrate
DaryaZinc Drops 10mg/mL-15mL Darya-Varia
Interzink Tablet 20mg Interbat
Sirup 20mg/5mL-60mL Interbat
Zinkid Tablet 20mg Indofarma
Sirup 10mg/5mL-60mL Indofarma
2 Lactobacillus acidophilus
L-bio Sachet Lapi
Lacto-b Sachet Novell
3 Probiotics 3 x 109 CFU, Lactobacillus helveticus R0052
(60%), Bifidobacterium infantis R0033 (20%),
Bifidobacterium bifidum R0071 (20%), 80 mg
Probiostim Kapsul Sanbe
4 Dioktahedral Smectite
Smecta Sachet 3g Combiphar
5 Activated Attapulgite
New Diatabs Tablet 600mg Darya Varia
E. Laksatif, Pencahar
1 Lactulosa
Constuloz Sirup 10g/15mL-120mL Novell
Lactulax Sirup 10g/15mL-120mL Ikapharmindo
2 Phenolphtalein 55 mg, paraffin liquidum 1200 mg,
glycerin 378 mg
Laxadine Sirup 60mL Galenium
3 Bisacodyl
Dulcolax Tablet 5mg Boehringer
Suppositoria Paed 5mg Boehringer
Suppositoria Adult 10mg Boehringer
4 Sodium biphosphate 19 g, Disodium phosphate 7 g
Fleet enema Enema 133mL Combiphar
5 Na Lauryl Sulfoacetate 45 mg, Na Citrate 450 mg, Sorbic
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Acid 5 mg, Sorbitol 4.465 mg, PEg-400 625 mg
Microlax Enema 5mL Pharos
F. Digestan
1 Koenzim B12 1000 mcg
Cobazym Tablet 1000mcg Interbat
Tablet 3000mcg Interbat
2 Pancreatin 170 mg, activated dimethylpolysiloxane 80
mg
Tripanzym Kapsul Sanbe
G. Kolagogum, Kolelitolitik & Hepatoprotektor
1 Ekstr Silymarin phytosome 8.75 mg, ekstr Schizandrae
fructus 33.75 mg, ekstr Curcuma xanthorrhizae 37.5 mg,
ekstr Liquiritiae radix 33.75 mg, vit B6 0.5 mg
Curliv Sirup/5mL-120mL Soho
2 Pure lecithin (PPC 95%), vit B1 6 mg, vit B2 6 mg, B6 6
mg, vit B12 6 mcg, vit E 10 mg, Nicotinamide 30 mg
Lesichol Kapsul 300mg Landson
Kapsul 600mg Landson
3 Curcuma longa rhizome extr (Curcuminoid 95%) 150
mg, silybin phospholipids 140 mg, Schizandrae fructus
extr 135 mg, choline L-bitartrate 150 mg, vit B1 1 mg,
B2 1,2 mg, B6 2 mg, B12 2,4 mcg, vit E 15 mg
Sanfulic Tablet Sanbe
4 Monoammonium glycyrrhizinate (as glycyrrhizin) 40mg,
amino acetic acid 400mg, L-cycteine HCl 20mg
Stronger Neo-Minophagen C Vial-20mL Dexa
H. Preparat Anorektal
1 Ekstrak citrus sinensis pericarpum setara dengan
diosmin 90% dan hesperidin. Mikronisasi flavonoid
Ardium Tablet 500mg Servier
2 Lithospermi radix extractum 0.18 mg, Prednisolonum 1
mg, Lidocainum 15 mg, Aethylis Aminobenzoas 20 mg,
Cetrimide 2.5 mg
Borraginol-S Suppositoria Takeda
3 Lithospermi radix extractum 0.18 mg, Dibucain HCl 0.5
mg, Diphenhydramine HCl0.5 mg, Cetrimide 2.5 mg,
Aethylis Aminobenzoas 20 mg
Borraginol-N Suppositoria Takeda
4 Policresulen 50 mg, Cinchocaine HCl 10 mg
Faktu Suppositoria Pharos
Ointment 20g/Tube Pharos
5 Fluocortolone pivalate 1 mg, Lidocaine HCl 40 mg
Ultraproct-N Suppositoria Schering-Plough
Krim 10g/Tube Schering-Plough
I. Antiemetik
1 Pyrathiazine chlorotheophyllinate 40 mg, vit B6 30 mg
Anvomer B6 Tablet Dexa
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2 Granisetron
Granon Ampul 1mg/mL Dexa
Ampul 3mg/3mL
3 Pyrathiazine Theoclate 40 mg, Pyridoxine HCl 37.5 mg
Mediamer B6 Tablet Darya-Varia

4 Ondansentron
Narfoz Sirup 4mg/5mL-30mL Pharos
Tablet 4mg Pharos
Tablet 8mg Pharos
Ampul 8mg/4mL Pharos
Trovensis Tablet 8mg Sanbe
Ampul 4mg/2mL Sanbe
Vomceran Sirup 4mg/5mL-60mL Kalbe
5 Metoclopramide HCl 10 mg
Primperan Tablet 10mg Soho
Ampul 5mg/mL 2mL Soho

II. SISTEM KARDIOVASKULAR & HEMATOPOIETIK

A. Obat Jantung
1 Amiodarone
Amiodarone Ampul 150mg/3mL OGB Ethica
Cordarone Tablet 200mg Sanofi
Ampul 150mg/3mL Sanofi
Tiaryt Tablet 200mg Fahrenheit
Ampul 150mg/3mL Fahrenheit

2 Digoxin
Digoxin Tablet 0,25mg OGB Fahrenheit
Fargoxin Tablet 0,25mg Fahrenheit
Ampul 0,25mg/mL Fahrenheit
3 Dobutamine HCl
Dobuject Ampul 250mg/5mL Dexa
4 Epinephrine
Epinephrine Ampul 1mg/mL Ethica
5 Dopamine HCl
Indop Ampul 40mg/mL-2mL Fahrenheit
B. Obat Antiangina
1 Isosorbide Dinitrate
Cedocard Tablet 5mg Darya-Varia
Ampul 10mg/10mL Darya-Varia
Farsorbid Tablet 5mg Fahrenheit
Tablet 10mg Fahrenheit
Ampul 10mg/10mL Fahrenheit
2 Diltiazem HCl
Herbesser CD Tablet 100mg Tanabe
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Tablet 200mg Tanabe
Vial 50mg Tanabe
3 Glyceryl trinitrate (nitroglycerin)
Nitrokaf Retard Kapsul 2,5mg Kimia Farma
NTG Ampul 10mg/10mL Ferron
C. ACE Inhibitor
1 Captopril
Captensin Tablet 12,5mg Kalbe
Tablet 25mg Kalbe
Tensicap Tablet 12,5mg Sanbe
Tablet 25mg Sanbe
2 Lisinopril
Interpril Tablet 5mg Interbat
Tablet 10mg Interbat
Tensinop Tablet 5mg Sanbe
Tablet 10mg Sanbe
D. Penyekat Beta
1 Bisoprolol Hemifumarate
Concor Tablet 2,5mg Merck
Tablet 5mg Merck
Beta-One Tablet 2,5mg Kalbe
Tablet 5mg Kalbe
2 Nebivolol
Transfarma
Nebilet Tablet 5mg
Medica
3 Carvedilol
V-Bloc Tablet 6,25mg Kalbe
Tablet 25mg Kalbe
E. Antagonis Kalsium
1 Nifedipine
Farmalat Tablet 10mg Fahrenheit
Adalat Oros Tablet 30mg Bayer
2 AmLodipine Besylate
Cardisan Tablet 5mg Sanbe
Tablet 10mg Sanbe
Divask Tablet 5mg Kalbe
Tablet 10mg Kalbe
Norvask Tablet 5mg Pfizer
Tablet 10mg Pfizer
3 AmLodipine besylate, Valsartan
Exforge Tablet 10mg/160mg Novartis
Tablet 5mg/160mg Novartis
Tablet 5mg/80mg Novartis
4 Nicardipine
Nicardipine Ampul 10mg/10mL Dexa

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F. Antagonis Angiotensin II
1 Candesartan Cilexetil
Canderin Tablet 8mg Dexa
Tablet 16mg Dexa
2 Losartan K
Angioten Tablet 50mg Kalbe
3 Telmisartan
Micardis Tablet 40mg Boehringer
Tablet 80mg Boehringer
G. Anti Hipertensi Golongan Lain
1 Clonidine HCl
Catapres Tablet 0,075mg Boehringer
Tablet 0,15mg Boehringer
Ampul 0,15mg/mL Boehringer
2 Methyldopa
Dopamet Tablet 250mg Actavis
H. Diuretik
1 Spironolactone
Carpiaton Tablet 25mg Fahrenheit
Tablet 100mg Fahrenheit
Letonal Tablet 25mg Otto
Tablet 100mg Otto
2 Furosemide
Farsix Tablet 40mg Fahrenheit
Vial 10mg/mL Fahrenheit
Lasix Tablet 40mg Sanofi
Vial 10mg/mL Sanofi
I. Obat Dislipidemia
1 Gemfibrozil
Hypofil Kapsul 300mg Sanbe
2 Atorvastatin Ca
Lipitor Tablet 10mg Pfizer
Tablet 20mg Pfizer
Tablet 40mg Pfizer
3 Pravastatin Na
Pravinat Tablet 20mg Interbat
Tablet 40mg Interbat
4 Cholestyramine
Sequest Sachet 4g Novell
5 Fenofibrate
Trolip Kapsul 100mg Dexa
Kapsul 300mg Dexa
6 Simvastatin
Valemia Tablet 5mg Sanbe
Tablet 10mg Sanbe

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J. Hemostatik
1 Carbazochrome Na sulfonate
Adona Tablet AC 10mg Tanabe
Tablet Forte 30mg Tanabe
Crome Vial 5mg/mL Ferron
2 Tranexamic acid
Kalnex Tablet 500mg Kalbe
Plasminex Tablet FC 500mg Sanbe
Vial 100mg/5mL Sanbe
3 Phytomenadione
Neo-K Vial 2mg/mL Combiphar
Vitadion Vial 2mg/mL Kalbe
4 Octreotide
Sandostatin Ampul 0,1mg/mL Novartis

K. Trombolitik
1 Fondaparinux Na
Arixtra Ampul 0,5mg/0,5mL GSK
2 Clopidogrel
CPG Tablet 75mg Kalbe
Plavix Tablet 75mg Pfizer
3 Acetylsalicylic Acid
Farmasal Tablet 100mg Fahrenheit
Thrombo Aspilet Tablet 80mg Darya-Varia
4 Purified streptokinase 1,500,000 IU
Fibrion Vial 10mL Dexa
5 Heparin Na 5000 IU
Inviclot Vial 5mL Fahrenheit
L. Preparat Flebitis & Varises
1 Micronized purified flavonoid fraction
Ardium Tablet 500mg Servier
2 Heparin Na 20,000 IU
Tunggal Idaman
Thrombopop Gel 20g
Abdi
3 Hidrosmin
Venosmil Kapsul 200mg Kalbe
III. SISTEM PERNAFASAN
A. Preparat Antiasma
1 Aminophylline
Aminophylline Ampul 24mg/mL-10mL Ethica
2 Salbutamol Sulfate
Astharol Sirup 2mg/5mL-60mL Sanbe
3 Fluticasone Furoate
Nasal Spray
Avamys GSK
27,5mcg/spray
4 Terbutaline Sulfate
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Bricasma Tablet 2,5mg Astra Zeneca
Ampul 0,5mg/mL Astra Zeneca
5 Ipratropium Br 0.52 mg, salbutamol sulphate 3.01 mg
Combivent UDV 2,5mL Boehringer
6 Epinephrine
Epinephrine Ampul 0,1%-1mL Ethica
Vasodrin Ampul 50mg/mL-1mL Mahakam

7 Fluticasone Propionate
Flixotide Nebules Ampul 0,5mg/2mL GSK
8 Salbutamol Sulfate
Lasal Tablet 2mg Lapi
Tablet 4mg Lapi
Sirup 2mg/5mL-100mL Lapi
Nebules 0,5mg/mL-2mL Lapi
Velutine Inhalation sol 2,5mg-4mL Novell
Ventolin Tablet 2mg GSK
Sirup 2mg/5mL-100mL GSK
Nebules 2.5mg/2.5mL GSK
Inhaler 100mcg/puff GSK
9 Glyceryl guaiacolate, salbutamol sulfate
Sirup
Lasal Expectorant Lapi
(75mg/2mg)/5mL-100mL
Sirup
Ventolin Expectorant GSK
(50mg/1mg)/5mL-100mL
10 Procaterol HCl hemihydrate
Meptin Sirup 25mcg/5mL Otsuka
Tablet 50mcg Otsuka
Mini Tablet 25mcg Otsuka
11 Budesonide
Pulmicort Respules 0,25mg/mL-2mL Astra Zeneca
12 Theophylline
Retaphyl SR Tablet 300mg Kimia Farma
Theobron Sirup 130mg/15mL Kalbe
Capsul 130mg Kalbe
13 Salmeterol, fluticasone propionate
Inhaler 25 mcg/125mcg-
Seretide 125 inhaler GSK
60'

14 Montelukast Na
Singulair Tablet FC 10mg Merck
Chewable Tablet 4mg Merck
B. Obat Batuk & Pilek
1 Acetylcysteine
Tablet Effervescent
Acetyn Sanbe
600mg
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N-Ace Kapsul 200mg Fahrenheit
Ampul 100mg/mL-3mL Fahrenheit
Nalitik Kapsul 200mg Mahakam
Resfar Infus 200mg/mL-25mL Fahrenheit
2 Paracetamol 500 mg, N-acetylcysteine 200 mg
Sistenol Tablet FC Dexa
3 Paracetamol, dextromethorphan HBr, chlorpheniramine
maleate, phenylpropanolamine HCl
Tablet (500mg; 15mg;
Anadex Interbat
1mg; 15mg)
Sirup (120mg; 3,5mg;
Interbat
0,5mg; 3,5mg)/5mL-60mL
4 Bromhexine HCl
Bisolvon Solution 2mg/mL-60mL Boehringer
5 Codein HCl
Codikaf Tablet 10mg Kimia Farma
Tablet 15mg Kimia Farma
Tablet 20mg Kimia Farma
6 Codeine, Phenyltoloxamine
Codipront Kapsul (30mg;10mg) Kimia Farma
Sirup
(11,11mg;3,67mg)/5mL-6 Kimia Farma
0mL
7 Codeine, Phenyltoloxamine, Guaifenesin
Kapsul
Codipront Cum Expectorant Kimia Farma
(30mg;10mg;100mg)
Sirup
(11,11mg;3,67mg;55,55m Kimia Farma
g)/5mL-60mL
8 Ambroxol HCl
Epexol Tablet 30mg Sanbe
Sirup 15mg/5mL-120mL Sanbe
Forte Sirup
Sanbe
30mg/5mL-60mL
Drops 15mg/mL-20mL Sanbe
Mucopect Tablet 30mg Boehringer
Paed Sirup
Boehringer
15mg/5mL-60mL
Adult Sirup
Boehringer
30mg/5mL-60mL
Drops 7,5mg/mL-20mL Boehringer
9 Erdosteine
Dry Sirup
Erdobat Interbat
175mg/5mL-60mL
Vectrine Kapsul 300mg Dexa
Dry Sirup
Dexa
175mg/5mL-60mL
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Vestein Kapsul 300mg Kalbe
10 Succus liquiritiae 500mg, ammon Cl 300mg, SASA
300mg
OBH Ikapharmindo Sirup -100mL Ikapharmindo
11 Noscapine
Mercotin Drops 10mg/mL-20mL Eisai
12 Pseudoephedrine, Terfenadine
Rhinofed Tablet (30mg;40mg) Dexa
Sirup
Dexa
(15mg;20mg)/5mL-60mL
13 Pseudoephedrine HCl, Chlorpheniramine Maleate
Sirup
Rhinos Junior Dexa
(15mg;1mg)/5mL-60mL
14 Pseudoephedrine HCl
Rhinos Neo Drops 7,5mg/0,8mL-10mL Dexa
15 Loratadine 5 mg, pseudoephedrine HCl 60mg
Rhinos SR SR Kapsul Dexa
16 Guaifenesin 37.5mg, thyme extr 250mg, primulae extr
50mg, althaea extr 175mg, droserae extr 25mg, serpylli
extr 175mg, eucalyptus oil 0.5mg, anise oil 1.25mg
Silex Sirup 100mL Darya-Varia
17 Eucalyptus oil 100mg, Menthol 50mg, Camphor 25mg,
Sage oil 25mg, Extractive subs from chamomile flowers
2mg
Transfarma
Transpulmin Balsam
Medica
18 Conc camomile 7.44 mg, Eucalyptol 100 mg
Transfarma
Transpulmin BB Balsam
Medica
19 Pseudoephedrine HCl, Triprolidine HCl
Tremenza Tablet (60mg;2,5mg) Sanbe
Sirup
(30mg;1,25mg)/5mL-60m Sanbe
L
C. Dekongestan Nasal & Preparat Nasal Lain
1 Oxymetazoline HCl 0.05%
Nasal Spray
Afrin Schering-Plough
0,5mg/mL-15mL
Nasal Spray
Illiadin P&G Health
0,5mg/mL-10mL
Nasal Drops
P&G Health
0,25mg/mL-10mL
2 NaCl
Nasal Drops
Breathy Novell
6,5mg/mL-30mL
Respimer Baby Decongestant Nasal Spray 22g/L-60mL Interbat
Respimer Normal Jet Nasal Hygiene Nasal Spray 9g/L-135mL Interbat
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3 Mometasone Furoate
Nasonex Nasal Spray 50mcg/dose Merck
IV. SISTEM SARAF PUSAT
A. Antipsikotik/Antidepresan
1 Alprazolam
Alganax Tablet 0,25mg Guardian
Tablet 0,5mg Guardian
Tablet 1mg Guardian
2 Haloperidol
Lodomer Tablet 2mg Mersi Farma
Tablet 5mg Mersi Farma
Drops 2mg/mL-15mL Mersi Farma
Vial 5mg/mL Mersi Farma
3 Risperidone
Persidal Tablet 1mg Mersi Farma
Tablet 2mg Mersi Farma
Tablet 3mg Mersi Farma
4 Diazepam
Stesolid Rectal Tube 5mg/2,5mL Actavis
Rectal Tube 10mg/2,5mL Actavis
Ampul 5mg/mL-2mL Actavis
Sirup 2mg/5mL-60mL Actavis
Valisanbe Tablet 2mg Sanbe
Tablet 5mg Sanbe
Ampul 10mg/2mL Sanbe
5 Amitriptyline
Tryptanol Tablet 25mg OBS
B. Hipnotik & Sedatif
1 Midazolam
Miloz Ampul 5mg/5mL Novell
Ampul 15mg/3mL Novell
Fortanest Ampul 5mg/5mL Kalbe
Ampul 15mg/3mL Kalbe
C. Obat Antikonvulsan
1 Carbamazepine
Bamgetol Kaplet 200mg Mersi Farma
2 Valproic acid
Depakene Tablet 250mg Abbott
Tablet ER 500mg Abbott
Sirup 250mg/5mL-120mL Abbott
Valpi Sirup 250mg/5mL-60mL Kalbe
Vellepsy Sirup 250mg/5mL-120mL Novell
3 Divalproex Na
Depakote Tablet 250mg Abbott
Tablet ER 500mg Abbott
Sirup 250mg/5mL-120mL Abbott
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4 Phenytoin Na
Dilantin Kapsul 100mg Pfizer
Ampul 250mg/5mL pfizer
Kutoin Kapsul 100mg Mersi Farma
Ampul 100mg/2mL Mersi Farma
5 Nitrazepam
Dumolid Tablet 5mg Actavis
6 Levetiracetam
Keppra Tablet FC 250mg GSK
Tablet FC 500mg GSK
Eterlox Tablet 500mg Novell
7 Clobazam
Frisium Tablet 10mg Sanofi
8 Lamotrigine
Lamictal Tablet FC 50mg GSK
Tablet FC 100mg GSK
9 Haloperidol
Lodomer Tablet 2mg Mersi Farma
Tablet 5mg Mersi Farma
Drops 2mg/mL-15mL Mersi Farma
Vial 5mg/mL Mersi Farma
10 Gabapentin
Nepatic Kapsul 300mg Kalbe

11 Oxcarbazepine
Prolepsi FC Tabelt 300mg Mersi Farma
12 Pregabalin
Provelyn Kapsul 75mg Kalbe
Kapsul 150mg Kalbe
13 Clonazepam
Rivotril Tablet 2mg Roche
14 Phenobarbital Na
Sibital Tablet 50mg Mersi Farma
Ampul 200mg/2mL Mersi Farma
15 Topiramate
Johnson &
Topamax Sprinkle Kapsul 15 mg
Johnson
Johnson &
Tablet 25mg
Johnson
D. Obat Antivertigo
1 Betahistine Mesilate
Merislon Tablet 6mg Eisai
Vesitab Tablet 6mg Kalbe
2 Betahistine diHCl
Betaserc Tablet 8mg Abbott
Tablet 24mg Abbott
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2 Cinnarizine
Johnson &
Stugeron Tablet 25mg
Johnson
E. Antiparkinson
1 Trihexyphenidyl HCl
Hexymer Tablet 2mg Mersi Farma
2 Levodopa 100 mg, Benserazide HCl 25 mg
Levopar Tablet Mepro
F. Obat Antimigraine Preparations
1 Ergotamine 1 mg, caffeine 100 mg
Ericaf Tablet Tempo
2 Propranolol HCl
Propranolol HCl Tablet 10mg OGB Dexa
Farmadral Tablet 10mg Fahrenheit
3 Pizotifen
Lysagor Tablet 0,5mg Kalbe
G. Obat Nootropics & Neurotonics
1 Piracetam
Neurotam Kapsul 800mg Kalbe
Kapsul 1200mg Kalbe
Sirup 500mg/5mL Kalbe
Ampul 1g/5mL Kalbe
Ampul 3g/15mL Kalbe
2 Mecobalamin
Methycobal Kapsul 500mcg Eisai

3 Citicoline
Brainact Tablet 500mg Kalbe
Ampul 250mg/2mL Kalbe
H. Obat Vasokontriktor
1 Norepinephrine bitartrate monohydrate
Raivas Ampul 1mg/mL-4mL Dexa
I. Obat Sistem Saraf Pusat Golongan Lain
1 Methylphenidate HCl
Prohiper 10 Tablet 10mg Mersi Farma
Ritalin Tablet 20mg Novartis
V. SISTEM MUSKULOSKELETAL
A. Obat Hiperurisemia & Gout
1 Allopurinol
Zyloric Tablet 100mg GSK
B. Obat Relaksan Otot
1 Eperisone HCl
Forres Tablet FC 50mg Kalbe
Myobat Tablet FC 50mg Interbat

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2 Baclofen
Lioresal Tablet 10mg Novartis
3 Tizanidine HCl
Phardex Tablet 2mg Pharos
C. Obat Neuromuscular Blocking Agents
1 Vecuronium Br
Ecron Vial 4mg/mL Pharos
2 Atracurium Besylate
Notrixum Ampul 50mg/5mL Novell
3 Rocuronium Br
Roculax Ampul 10mg/mL Kalbe
D. Obat Gangguan Neuromuscular
1 Pyridostigmine Br
Transfarma
Mestinon SC Tablet 60mg
Medica
2 Neostigmine Methylsulfate
Neostigmine Ampul 0,5mg/mL Combiphar
Transfarma
Prostigmin Ampul 0,5mg/mL
Medica
VI. ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NONSTEROID
A. Analgesik (Opiat)
1 Tramadol HCl
Tradosik Kapsul 50mg Sanbe
Ampul 100mg/2mL Sanbe
Tramal Suppositoria 100mg Pharos
Ampul 50mg/mL Pharos
2 Tramadol HCl 37.5 mg, paracetamol 325 mg
Analtram Kaplet Salut Lapi
Sincronik FC Kaplet Kalbe
3 Fentanyl
Fentanyl Ampul 0,05mg/mL-2mL Kimia Farma
Transdermal Patch Johnson &
Durogesic
12,5mcg/hr Johnson
Transdermal Patch Johnson &
25mcg/hr Johnson
4 Morphine Sulfate
Morphin Ampul 10mg/mL Kimia Farma
MST Continus Tablet 10mg Kimia Farma
Tablet 15mg Kimia Farma
5 Pethidine
Pethidine Ampul 50mg/mL-2mL Kimia Farma
B. Analgesik (Non Opiat) & Antipiretik
1 Ibuprofen
Bufect Sirup 100mg/5mL-60mL Sanbe
Forte Sirup
Sanbe
200mg/mL-50mL
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Brufen Sirup 100mg/5mL-60mL Abbott
Proris Tablet 200mg Pharos
Suppositoria 125mg Pharos
Spedifen Tablet FC 400mg Zambon
2 Paracetamol
Suspensi
Naprex Darya-Varia
250mg/5mL-60mL
Pamol Suppositoria 125mg Interbat
Suppositoria 250mg Interbat
Sanmol Tablet 500mg Sanbe
Forte Tablet 650mg Sanbe
Sirup 120mg/5mL-60mL Sanbe
Drops 60mg/0,6mL-15mL Sanbe
Infus 1000mg/100mL Sanbe
Tamoliv Infus 500mg/50mL Kalbe
Infus 1000mg/100mL Kalbe
C. Obat Antiinflamasi Non Steroid
1 Methampyrone 500 mg, Diazepam 2 mg
Analsik Tablet Sanbe
2 Kalium Diklofenak
Cataflam Tablet 25mg Novartis
Tablet 50mg Novartis
3 Celecoxib
Celebrex Kapsul 100mg Pfizer
Kapsul 200mg Pfizer
4 Natrium Diklofenak
Flamar Emulgel 10mg/g Sanbe
EC Tablet 25mg Sanbe
EC Tablet 50mg Sanbe
5 Dexketoprofen trometamol
Ketesse Tablet Salut Selaput 25mg Ferron
6 Asam Mefenamat
Mefinal Tablet FC 500mg Sanbe
7 Meloxicam
Ostelox Tablet 7.5mg Sanbe
Tablet 15mg Sanbe
8 Ketoprofen
Profenid Suppositoria 100mg Sanofi
Pronalges Tablet 50mg Dexa
Tablet 100mg Dexa
Suppositoria 100mg Dexa
9 Ketorolac Tromethamine
Remopain Injeksi 10mg/mL Dexa
Injeksi 30mg/mL Dexa
Torasic Injeksi 30mg/mL Dankos
Xevolac Tablet 30mg Novell
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 2020 | Formularium Obat RSIA Bina Medika
D. Imunosupresan
1 Azathioprine
Imuran Tablet FC 50mg GSK
VII. HORMON
A. Estrogen & Progesteron
1 Progesterone
Crinone Vag Gel 8% Merck
Cygest Ovula 200mg Actavis
Ovula 400mg Actavis
Darstin Gel 10mg/g-80g Seid Lab
2 11 tab each containing estradiol valerate 2mg, 10 tab
each containing estradiol valerate 2mg, norgestrel
0.5mg
Cyclo-Progynova Tablet Bayer
3 Dydrogesterone
Duphaston Tablet FC 10mg Abbott
4 Nomegestrol Acetate
Lutenyl Tablet 5mg Merck
5 Ethinylestradiol
Lynoral Tablet 0,05mg Silverline
6 17 β-estradiol
Transdermal Gel
Oestrogel Lapi
0,006%-80g
7 Allylestrenol
Premaston Tablet 5mg Kalbe
8 Norethisterone
Primolut-N Tablet 5mg Bayer
9 Estradiol valerate
Progynova 28 Tablet 2mg Bayer
10 Medroxyprogesterone acetate
Provera Tablet 10mg Pfizer
11 Micronised progesterone
Utrogestan Kapsul 100mg Lapi
Kapsul 200mg Lapi
12 Dienogest
Visanne Tablet 2mg Bayer
B. Hormon Androgen & Preparat Sintetiknya
1 Danazol
Azol Kapsul 200mg Merck
2 Testosterone Undecanoate
Nebido Ampul 1000mg/4mL Bayer
C. Hormon Kortikosteroid
1 Dexamethasone
Cortidex Tablet 0,5mg Sanbe
Ampul 5mg/mL-1mL
Kalmethasone Ampul 4mg/mL-1mL Kalbe
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2 Triamcinolone Acetonide
Ampul IA/IB/ID
Flamicort Dexa
10mg/mL-5mL
Ampul IM 40mg/mL-1mL Dexa
Ketricin Tablet 4mg Ferron
Trilac Tablet 4mg
Vial powder
Novell
10mg/mL-5mL
Vial powder 40mg/1mL Novell
3 Methylprednisolone
Hexilon Tablet 4mg Kalbe
Tablet 8mg Kalbe
Tablet 16mg Kalbe
Medixon Vial 125mg/2mL Ferron
Solu-Medrol Vial 125mg/2mL Pfizer
Vial 500mg/8mL Pfizer
4 Prednisone
Prednisone Tablet 5mg OGB Phapros
D. Hormon Tropik & Preparat Sintetiknya
1 Bromocriptine Mesylate
Cripsa Tablet 2,5mg Capri Farmindo
2 Leuprolide Acetate
Endrolin Vial 3,75mg Kalbe
Tapros depot Vial 3,75mg Takeda
3 Follitropin α
Gonal-F Vial 75 IU Merck

4 Choriogonadotropin α
Ovidrel Pref Pen 250mcg/0.5mL Merck
5 Clomiphene Citrate
Profertil Tablet 50mg Kalbe
E. Hormon Kanker
1 Letrozole
Femara Tablet 2,5mg Novartis
Letraz Tablet 2,5mg Kalbe
F. Obat Lain yang Mempengaruhi Hormon
1 Cabergoline
Dostinex Tablet 0,5mg Pfizer
VIII. KONTRASEPSI
A. Kontrasepsi Suntik
1 Medroxyprogesterone acetate 50 mg, estradiol
cypionate 10 mg
Tunggal Idaman
Cyclofem Vial 0,5mL
Abdi
2 Medroxyprogesterone acetate
Depo Progestin Vial 150mg/3mL Dio Farma
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 2020 | Formularium Obat RSIA Bina Medika
B. Kontrasepsi Lain
1 Kawat tembaga tipis yang distabilkan dengan inti
polyethylene dengan Safe Load
Coper T IUD Kimia Farma
2 Kawat tembaga tipis distabilkan dengan Silver core
Nova T IUD Schering-Plough
C. Kontrasepsi Oral
1 Cyproterone acetate 2 mg, Ethinyl estradiol 0.035 mg
Diane 35 Tablet Bayer
2 Levonorgestrel 0.03 mg
Microlut Tablet Bayer
3 Levonorgestrel
Tunggal Idaman
Postinor-2 Tablet
Abdi
IX. ANTI INFEKSI
A. Aminoglikosida
1 Amikacin Sulfate
Mikasin Ampul 250mg/2mL Kalbe
2 Gentamicin Sulfate
Sagestam Cream 0,1%-10g Sanbe
Ampul 40mg/mL-2mL Sanbe
3 Streptomycin Sulfate
Streptomycin Sulphate Meiji Vial powder 1g Meiji
B. Sefalosporin
1 Cefoperazone Natrium
Bifotik Vial powder 1g Sanbe
2 Cefoperazone 500 mg, sulbactam 500 mg
Cefobactam Vial powder 1g Sanbe
3 Ceftriaxone Ntrium
Broadced Vial powder 1g Kalbe
Terfacef Vial powder 1g Sanbe
4 Cefadroxil monohydrate
Cefat Kapsul 500mg Sanbe
Dry Sirup
Sanbe
125mg/5mL-60mL
Forte Dry Sirup
Sanbe
250mg/mL-60mL
Renasistin Drops 150mg/mL-15mL Fahrenheit
5 Cefazolin Natrium
Cefazol Vial powder 1g Kalbe
6 Cefepime HCl monohydrate
Ceforim Vial powder 1g Sanbe
7 Cefixime Trihydrate
Ceptik Kapsul 100mg Interbat
Kapsul 200mg Interbat
Dry Sirup Interbat
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 2020 | Formularium Obat RSIA Bina Medika
100mg/5mL-30mL
Sporetik Kapsul 50mg Sanbe
Kapsul 100mg Sanbe
Kapsul 200mg Sanbe
Dry Sirup
Sanbe
100mg/5mL-30mL
8 Cefotaxime Natrium
Kalfoxim Vial powder 1g Kalbe
Taxegram Vial powder 0,5g Sanbe
Vial powder 1g Sanbe
9 Cefditoren Pivoxil
Meiact Tablet 200mg Meiji
10 Ceftazidime Pentahydrate
Zidifec Vial powder 1g Sanbe
C. Penisilin
1 Amoxicillin
Amoxan Kapsul 250mg Capri Farmindo
Kapsul 500mg Capri Farmindo
Drops 100mg/mL-15mL Capri Farmindo
Dry Sirup
Capri Farmindo
125mg/5mL-60mL
Forte Dry Sirup
Capri Farmindo
250mg/mL-60mL
Vial powder 1g Capri Farmindo
Intermoxil Kapsul 500mg Interbat
Dry Sirup
Interbat
125mg/5mL-60mL
2 Sultamicillin 375mg: Ampicillin 250mg, sulbactam
125mg
Bactesyn Tablet 375mg Kalbe
Vial powder 750mg Kalbe
vial powder 1,5g Kalbe
3 Co-amoxiclav: Amoxycillin trihydrate, Clavulanate K
Tablet 500
Clabat Interbat
(500mg;125mg)
Dry Sirup
(125mg;31,25mg)/5mL-60 Interbat
mL
Forte Dry Sirup
(250mg;62,5mg)/5mL-60 Interbat
mL
Tablet 500
Claneksi Sanbe
(500mg;125mg)
Dry Sirup
(125mg;31,25mg)/5mL-60 Sanbe
mL
Forte Dry Sirup Sanbe
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 2020 | Formularium Obat RSIA Bina Medika
(250mg;62,5mg)/5mL-60
mL
Vial powder 1g
Sanbe
(1000mg;200mg)
4 Ampicillin Natrium
Sanpicillin Kapsul 250mg Sanbe
Kapsul 500mg Sanbe
Dry Sirup
Sanbe
125mg/5mL-60mL
Forte Dry Sirup
Sanbe
250mg/mL-60mL
Vial powder 1g Sanbe
Viccillin Vial powder 250mg Meiji
Vial powder 500mg Meiji
Vial powder 1g Meiji
5 Sultamicillin: Ampicillin 1,000 mg, sulbactam 500 mg
Viccillin-SX Vial powder 1,5g Meiji
6 Piperacillin 4 g, Tazobactam 500 mg
Tazocin Vial powder 4,5g Pfizer
D. Beta Laktam Golongan Lain
1 Meropenem Trihydrate
Merofen Vial powder 0,5g Kalbe
Vial powder 1g Kalbe
Merosan Vial powder 0,5g Sanbe
Vial powder 1g Sanbe
2 Imipenem 500 mg, Cilastatin 500 mg
Pelastin Vial powder Sanbe
3 Doripenem
Ribacter Vial powder 500mg Kalbe
E. Kloramfenikol
1 Thiamphenicol
Biothicol Kapsul 500mg Sanbe
Dry Sirup
Sanbe
125mg/5mL-60mL
Forte Dry Sirup
Sanbe
250mg/mL-60mL
Dry Sirup
Thiamycin Interbat
125mg/5mL-60mL

2 Chloramphenicol
Colsancetine Kapsul 250mg Sanbe
Sirup 125mg/5mL-60mL Sanbe
Vial powder 1g Sanbe
F. Makrolida
1 Clarithromycin
Abbotic XL Tablet 500mg Abbott
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 2020 | Formularium Obat RSIA Bina Medika
Granule Dry Sirup
Abbott
125mg/5mL-30mL
Granule Dry Sirup
Abbott
250mg/5mL-50mL
Bicrolid Tablet FC 500mg Sanbe
2 Azithromycin Dihydrate
Azomax Tablet FC 500mg Dexa
Dry Sirup
Dexa
200mg/mL-15mL
Mezatrin Kapsul 250mg Sanbe
Zithromax Tablet 500mg Pfizer
Dry Suspensi
Pfizer
200mg/5mL-15mL
3 Erythromycin
Erysanbe Chewable Tablet 200mg Sanbe
Tablet FC 500mg Sanbe
Dry Sirup
Sanbe
200mg/mL-60mL
4 Spiramycin
Spirasin Tablet FC 500mg Sanbe
G. Kuinolon
1 Ciprofloxacin HCl
Baquinor Tablet FC 250mg Sanbe
Tablet FC 500mg Sanbe
Infus 200mg/mL-100mL Sanbe
2 Levofloxacin
Cravit Tablet 500mg Kalbe
Infus 500mg/100mL Kalbe
Cravox Infus 750mg/150mL Lapi
Levocin Tablet 500mg Sanbe
Infus 500mg/100mL Sanbe
3 Moxifloxacin HCl
Avelox Tablet FC 400mg Bayer
Infus 400mg/250mL Bayer
Moxibat Tablet 400mg Interbat
4 Ofloxacin
Tarivid Tablet 200mg Kalbe
H. Tetrasiklin
1 Doxycycline Hyclate
Siclidon Kapsul 100mg Sanbe
Interdoxin Kapsul 50mg Interbat
Kapsul 100mg Interbat
2 Tetracycline HCl
Tetrasanbe Kapsul 500mg Sanbe
3 Tigecycline
Tygacil Vial powder 50mg Pfizer
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 2020 | Formularium Obat RSIA Bina Medika
I. Kombinasi Anti Bakterial
1 Co-trimoxazole: Trimethoprim, Sulfamethoxazole
Sanprima Tablet (80mg;400mg) Sanbe
Forte Tablet
Sanbe
(160mg;800mg)
Sirup
Sanbe
(40mg;200mg)/5mL-60mL
J. Antibiotik Golongan Lain-Lain
1 Clindamycin Phosphate
Clinium Gel 1% - 15 g/tube Interbat
Prolic Kapsul 150mg Sanbe
Kapsul 300mg Sanbe
2 Colistin sulfate (polymixin E. Sulphate)
Colistine Tablet 1,500,00 IU Actavis
3 Metronidazole
Farnat Infus 500 mg/100 mL Fahrenheit
Fladex Tablet 500 mg Dexa
Suppositoria 0,5mg Dexa
Suppositoria 1 g Dexa
Infus 500 mg/100 mL Dexa
Flagyl Tablet Forte 500 mg Sanofi
Sirup 125 mg/5 mL - 60
Sanofi
mL
Ovula 0,5 g Sanofi
Ovula 1 g Sanofi
Infus 500 mg/100 mL Sanofi
Promuba Sirup 125mg/5mL-60mL Mepro
Sirup 250mg/5mL-60mL Mepro
Trichodazol Tablet FC 500mg Sanbe
Suppositoria 1 g Sanbe
Infus 500mg/100mL Sanbe
4 Fosfomycin Na
Fosmidex Infus 1g Dexa
Infus 2g Dexa
5 Fosfomycin Trometamol
Monuril Granule 3g Zambon
6 Lincomycin HCl
Lincocin Kapsul 500mg Pfizer
Nolipo Kapsul 500mg Sanbe
sirup 250mg/5mL-60mL Sanbe
7 Vancomycin HCl
Vancep Vial powder 0,5g Fahrenheit
K. Obat Anti Tuberkulosis
1 Ethambutol diHCl
Etibi Tablet 500 mg
Santibi Tablet 500 mg Sanbe
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 2020 | Formularium Obat RSIA Bina Medika
2 Ethambutol HCl 250 mg, INH 100 mg, vit B6 6 mg
Santibi Plus Tablet Sanbe

3 Rifampicin
Rifamtibi Tablet FC 450mg Sanbe
Tablet FC 600mg Sanbe
4 Rifampicin 150 mg, INH 150 mg
Pro TB 2 Tablet Phapros
5 Rifampicin 75 mg, INH 50 mg, pyrazinamide 150 mg
Pro TB 3 Tablet Phapros
6 Rifampicin 150 mg, INH 75 mg, pyrazinamide 400 mg,
ethambutol HCl 275 mg
Pro TB 4 Tablet Phapros
Rifastar Tablet Indofarma
7 Pyrazinamide
Sanazet Tablet 500mg Sanbe
8 Isoniazide, vit B6
TB Vit 6 Tablet (400mg;24mg) Mepro
Sirup
(100mg;10mg)/5mL-120m Mepro
L
L. Antijamur
1 Nystatin
Drops 100,000
Constantia Novell
IU/mL-12mL
Drops 100,000
Candistin Pharos
IU/mL-12mL
Drops 100,000
Mycostatin Taisho
IU/mL-12mL
Drops 100,000
Taisho
IU/mL-30mL
2 Fluconazole
Fluconazole Kapsul 150mg Kimia Farma
Cryptal Tablet 50mg Fahrenheit
Tablet 200mg Fahrenheit
Diflucan Kapsul 150mg Pfizer
Vial 2mg/mL-100mL Pfizer
Zemyc Kapsul 50mg Phapros
Kapsul 150mg Pharos
3 Ketoconazole
Formyco Tablet 200mg Sanbe
Cream 2%-10g Sanbe
Fungasol-SS Shampo 2%/mL-80mL Guardian
Ketomed Cream 2%-15g SDM
Shampo 2%/mL-60mL SDM

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 2020 | Formularium Obat RSIA Bina Medika
4 Terbinafine HCl
Interbi Cream 1%-5g Interbat
5 Itraconazole
Itzol Kapsul 100mg Lapi
Sporacid Kapsul 100mg Ferron
6 Micafungin Na
Mycamine Vial powder 50mg Astellas
M. Antivirus
1 Valganciclovir HCl
Valcyte Kapsul 250mg Roche
Vial 500mg Roche
2 Acyclovir
Clinocir Tablet 200mg Pharos
Tablet 400mg Pharos
Cream 5%-5g Pharos
Zovirax Tablet 200mg GSK
Cream 5%-2g GSK
Vial powder 250mg GSK
3 Valacyclovir HCl
Herclov Tablet FC 500mg Sanbe
3 Methisoprinol
Isoprinosine Tablet 500mg Darya-Varia
Sirup 250mg/5mL-60mL Darya-Varia
Laprosin Tablet 500mg Lapi
Sirup 250mg/5mL-60mL Lapi
X. SISTEM KEMIH KELAMIN
A. Preparat untuk Vagina
1 Metronidazole 500 mg, Nystatin 22.7 mg (setara
dengan 100,000 IU)
Fladystin Ovula 0,5 g Dexa
Flagystatin Ovula 0,5 g Aventis
Neo Gynoxa Ovula 0,5 g Kalbe
Trichodazol plus Ovula 0,5 g Sanbe
2 Lactobacillus rhamnosus 2.5 x 109 CFU, Lactobacillus
reuteri 2.5 x 109 CFU
Floragyn Kapsul Lapi
B. Antiseptik Saluran Kemih
1 Pipemidic Acid
Urotractin Kapsul 400mg Sanbe
2 Flavoxate HCl
Promosinda
Urispas Tablet 200mcg
Medika
3 Phenazopyridine HCl
Transfarma
Urogetix Kapsul 100mg
Medica

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 2020 | Formularium Obat RSIA Bina Medika
C. Obat yang Bekerja pada Uterus
1 Oxytocin Sintetik
Induxin Ampul 10 IU/1mL Kalbe
Pitogin Ampul 10 IU/1mL Ethica
Oxyla Ampul 10 IU/1mL Novell
Syntocinon Ampul 10 IU/1mL Novartis
2 Methylergometrine Maleate
Metvell Tablet FC 0,125mg Novell
Ampul 0,25mg/1mL Novell
3 Isoxsuprine HCl
Proterine Tablet 20mg Novell
Ampul 10mg/2mL Novell
4 Sildenafil Citrate
Sanbenafil Tablet FC 50mg Sanbe
Tablet FC 100mg Sanbe
D. Obat Saluran Kemih Golongan Lain
1 Alpha-keto isoleucine 67 mg, alpha-keto leucine 101
mg, alpha-keto phenylalanine 68 mg, alpha-hydroxy
methionine 59 mg, alpha-keto valine 86 mg,
L-tryptophan 23 mg, L-threonine 53 mg, L-histidine 38
mg, l- tyrosine 30 mg, L-lysine acetate 105 mg, Ca 50 mg
Aminefron Tablet FC Dexa
2 DL-3-methyl-2-oxovaleric acid 67 mg,
4-methyl-2-oxovaleric acid 101 mg,
2-oxo-3-phenylpropionic acid 68 mg,
3-methyl-2-oxobutyric acid 86 mg,
2-hydroxy-4-methylthiobutyric acid 59 mg, L-lysine
monoacetate 105 mg, L-threonine 53 mg, L-tryptophan
23 mg, L-histidine 38 mg, l-tyrosine 30 mg
Prorenal Tablet Novell
XI. SISTEM ENDOKRIN & METABOLIK
A. Obat Anti Diabetes
1 Glimepirid
Amadiab Tablet 1mg Lapi
Tablet 2mg Lapi
Tablet 3mg Lapi
Tablet 4mg Lapi
2 Pioglitazone HCl
Deculin Tablet 15mg Dexa
Tablet 30mg Dexa
3 Metformin HCl
Forbetes Tablet FC 500mg Sanbe
Tablet FC 850mg Sanbe
Glucophage Tablet FC 500mg Merck
XR Tablet 500mg Merck
Tablet FC 850mg Merck

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 2020 | Formularium Obat RSIA Bina Medika
4 Insulin Glargine
Lantus Solostar Pen 100 U/mL-3mL Sanofi
5 Insulin Detemir
Levemir FlexPen Pen 100 U/mL-3mL Novo Nordisk
6 Insulin Sspart
NovoRapid FlexPen Pen 100 U/mL-3mL Novo Nordisk
B. Hormon Thyroid
1 Levothyroxine Na
Euthyrox Tablet 50mcg Merck
Tablet 100mcg Merck
2 Thiamazole
Thyrozol Tablet FC 10mg Merck
XII. ALERGI DAN SISTEM IMUN
A. Antihistamin dan Antialergi
1 Loratadine, Pseudoephedrine
Aldisa SR Kapsul 5mg/120 mg Sanbe
Rhinos SR Kapsul 5 mg/ 60 mg Dexa
2 Hydroxyzine
Bestalin Tablet 25 mg Lapi
Sirup 10 mg/5 mL - 100
Lapi
mL
5 Desloratadine
Desdin Sirup 2,5 mg/5 mL - 60 mL Lapi
Deslotin Tablet FC 5 mg Dexa
Eslor Sirup 0,5 mg/mL Fahrenheit
6 Cyproheptadine HCl
Heptasan Tablet FC 4 mg Caprifarmindo
7 Mebhydrolin Napadisylate
Histapan Tablet FC 50 mg Sanbe
8 Cetirizine
Intrizin Tablet FC 10 mg Interbat
Drops 10mg/mL -15mL Interbat
Sirup 5 mg/5 mL - 60 mL Interbat
Ritez Tablet FT 10mg Dexa
Drops 10 mg/mL Dexa
Sirup 5 mg/ 5 mL Dexa
9 Diphenhydramine HCl
Ipha
Iphadryl Ampul 10 mg/mL
Laboratories
10 Pseudoephedrine, Terfenadine
Rhinofed Tablet 30 mg/40 mg Dexa
Sirup 15 mg/ 20 mg - 60
Dexa
mL
B. Vaksin, Antiserum, dan Imunologikal
1 Vaksin Hepatitis A
Avaxim 80 Pre-filled syringe 80 Sanofi
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 2020 | Formularium Obat RSIA Bina Medika
IU/0,5 mL
Pre-filled syringe 720 Elisa
Havrix 720 GSK
U/0,5 mL
Havrix 1440 Vial 144 Elisa U/mL GSK
2 Vaksin Dasar BCG (TBC)
Vaksin BCG Ampul 4 mL Bio Farma
3 Vaksin DPT (Difteri, Pertusis (batuk rejan), Tetanus)
Boostrix Pre-filled syringe 0,5 mL GSK
4 Vaksin Dasar Campak
Vaksin campak Vial 5 mL Bio Farma
5 Vaksin HPV (Human Papiloma Virus)
Cervarix Pre-filled syringe 0,5 mL GSK
6 Vaksin Dengue Tetravalent (Vaksin demam berdarah)
Dengvaxia Pre-filled syringe 0,5 mL Sanofi
7 Vaksin Hepatitis B
Pre-filled syringe 10
Engerix-B GSK
mcg/0,5 mL
Vial powder 20 mcg/mL GSK
Vial powder 10 mcg/0,5
Euvax-B Sanofi
mL
Vial powder 20 mcg/mL Sanofi
Hyperhep-B S/D (Human hepatitis B Ig) Pre-filled syringe 0,5 mL Dipa
8 Vaksin Influenza
Flubio Vial powder Bio Farma
9 Human Immunoglobulin
Gammaraas Vial 50 mL Combiphar
10 Vaksin DPT, Hepatitis B, Poliomyelitis, Haemophilus
Influenza tipe B (Hib)
Infanrix Hexa Pre-filled syringe 0,5 mL GSK
11 Vaksin DPT, Poliomyelitis
Infanrix IPV Pre-filled syringe 0,5 mL GSK
12 Vaksin Meningitis
Menivax ACYW Vial powder Bio Farma
13 Vaksin Mumps (gondongan) Measles (campak) Rubella
(campak jerman)
MMR Vial powder Bio Farma
14 Vaksin Mumps Rubella
MR Vial powder Bio Farma
15 Vaksin DPT - Hepatitis B - Haemophilus Influenza tipe B
(Hib)
Pentabio Vial Bio Farma
16 Purified Protein Derivat (PPD) of Mycobacterium
tuberculosis
PPD 1,5 mL Vial Bio Farma
PPD 2TU Vial Bio Farma
17 Vaksin Rotavirus
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 2020 | Formularium Obat RSIA Bina Medika
Rotarix Oral Suspensi GSK
Rotateq Tube, Single-Dose oral use MSD
18 Vaksin Pneumococcal polysaccharide, NTHi Protein D
terkonjugasi
Synflorix Pre-filled syringe 0,5 mL GSK
19 Vaksin Tetanus
Tetagam P Ampul 250 IU CSL behring
20 Vaksin Typhoid
Typhim Vi Pre-filled syringe 0,5 mL Sanofi
21 Vaksin Polio
Oral polio vaksin Vial 1 mL Bio Farma
22 Vaksin Varicella (cacar air)
Varicella Vial Bio Farma
Varivax Vial powder MSD
Varilrix Vial powder GSK
24 Vaksin Rabies
Verorab Vial powder Sanofi
C. Antiseptik dan Desinfektan Kulit
1 Policrsulen
Albothyl Sol Solutio 36% - 10 mL Pharos
2 Povidone iodine
Betadine Sol Solutio 10% Mahakam
3 Feracrylum
Hemolok Solutio 1% Dexa
Gel 3% Dexa
Hemiseal Solutio 1% Kalbe
4 Tetra chlorodexa-oxygen anion complex
Oxoferin Solutio 0,001037% Pharos
5 Polyhexamethylene biguanide (PHMB) 0,1%, Betaine
0,1%
Prontosan Solutio 350 mL B Braun
D. Sediaan Kulit Lainnya
1 Basis cream hypoalergenic ambiphilic
Biocream Cream 20 g Merck
2 Cyclic & polymeric siloxanes, Vit C ester
Transfarma
Dermatix Ultra Gel
Medica Indah
3 Ekstrak llium cepa bulb, allantoin, daun Aloe
barbadensis
Mederma Gel 20 g Combiphar
4 Ekstrak Allium cepa, ekstrak palmitoyl pine bark,
dimethicone, cyclopentasiloxane, allantoin,
Butyrospermum parkii, ekstrak Macrocystis pyrifera,
palmitoyl tetrapeptide-7, palmitoyl tripeptide-1, asam
hyaluronat, squalane, vit A, vit E .
Novell Smoothing Cream Cream 30 g Novell
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 2020 | Formularium Obat RSIA Bina Medika
5 Radix scutellarae, Phellodendri cortex, Rhizoma coptidis
Sibro Oint 20g/Tube Combiphar
XIII. NUTRISI
A. Produk Nutrisi Bayi
1 Minyak ikan alami DHA 75 mg, EPA 7 mg, asam
arakidonat 100 mg
Prolacta DHA for Baby Kapsul lunak Novell
2 Per 100 g karbohidrat 54 g, lemak 25 g, as. linoleat
4,500 mg, as. linolenic 540 mg, DHA 83 mg, as.
arakidonat 167 mg, protein 14.7 g, air 2.9 g, mineral
(ash) 3.4 g, vit A 2,500 IU, vit D 490 IU, vit E 31 IU, vit K1
39 mcg, thiamine 980 mcg, riboflavin 1,470 mcg, vit B6
740 mcg, vit B12 1.23 mcg, niacin 19,600 mcg, folic acid
200 mcg, pantothenic acid 5,900 mcg, biotin 19.6 mcg,
vit C 98 mg, choline 88 mg, inositol 220 mg, taurine 29
mg, L-carnitine 9.8 mg, Ca 590 mg, P 320 mg, Mg 44 mg,
Fe 8.3 mg, Zn 4.9 mg, manganese 31 mcg, copper 515
mcg, iodine 123 mcg, selenium 5.4 mcg, Na 280 mg, K
490 mg, Cl 420 mg. Energy: 490 kCal
Enfamil A+ Premature Susu bubuk MeadJohnson
3 Per 4 sachet Protein 1.1 g, fat 1 g, carbohydrate <0.4 g,
LA 140 mg, ALA 17 mg, vit A 950 IU, vit D 150 IU, vit E
4.6 IU, vit K1 4.4 mcg, vit B1 150 mcg, vit B2 220 mcg, vit
B6 115 mcg, vit B12 0.18 mcg, vit B3 3,000 mcg, folic acid
25 mcg, vit B5 730 mcg, biotin 2.7 mcg, vit C 12 mg, Ca
90 mg, P 90 mg, Mg 1 mg, Fe 1.4 mg, Zn 0.72 mg,
manganese 10 mcg, copper 44 mcg, Na 16 mg, K 29 mg,
Cl 13 mg. Energy 14 kCal
Enfamil HMF (Human Milk Fortifier) Susu bubuk MeadJohnson
4 Per 100 g Carbohydrate 55 mg, fat 28 g, protein 10.9 g,
mineral (ash) 3.1 g, water 3 g, linoleic acid 4,900 mg,
α-linolenic acid 420 mg, DHA 88 mg, arachidonic acid
177 mg, vit A 1,610 IU, vit D 310 IU, vit E 6.6 mg, vit K1
78 mcg, thiamine 420 mcg, riboflavin 470 mcg, vit B6
310 mcg, vit B12 1.6 mcg, niacin 5,200 mcg, folic acid 83
mcg, pantothenic acid 2,600 mcg, biotin 15.6 mcg, vit C
100 mg, choline 125 mg, taurine 31 mg, inositol 88 mg,
carnitine 13 mg, Ca 600 mg, P 400 mg, Mg 60 mg, Fe 8.5
mg, Zn 5.2 mg, manganese 310 mcg, selenium 10.9
mcg, chromium 10.9 mcg, molybdenum 29 mcg, copper
390 mcg, iodine 130 mcg, Na 240 mg, K 600 mg, Cl 410
mg. Energy: 520 kCal
Enfamil A+ Free Lactose Susu bubuk MeadJohnson
5 Protein bebas laktosa, OPTIPRO HA Protein
Hypoallergenic, probiotik bifidus BL
NAN LActose Free Susu bubuk Nestle
6 Bubuk whey terhidrolisa, minyak nabati, maltodekstrin,
laktosa, 3 mineral dan premiks mineral, campuran
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 2020 | Formularium Obat RSIA Bina Medika
minyak LC-PUFA, kalium hidroksida, natrium hidroksida,
asam sitrat, pengemulsi lesitin kedelai, premiks vitamin,
Bifidobacterium lactis NCC818, premiks nukleotida
NAN pHPro 1 Susu bubuk Nestle
NAN pHPro 2 Susu bubuk Nestle
NAN pHPro 3 Susu bubuk Nestle
7 Per 100 g Protein 14 g, fat 28 g, carbohydrate 51 g,
linoleic acid 5,600 mg, α-linolenic acid 700 mg,
arachidonic acid 170 mg, docosahexanoic acid (DHA) 85
mg, medium-chain triglycerides (MCT) 15.2 g, water 3 g,
mineral (ash) 3.2 mg, vit A 570 mcg RE, vit D3 9.25 mcg,
vit E 13.5 mcg α-TE, vit K1 60 mcg, vit B1 400 mcg, vit B2
450 mcg, vit B6 300 mcg, vit B12 1.5 mcg, vit B3 (niacin)
5,000 mcg, folic acid 80 mcg, vit B5 (pantothenic acid)
2,500 mcg, biotin 15 mcg, vit C 95 mg, choline 120 mg,
myo-inositol 85 mg, taurine 30 mg, L-carnitine 12.5 mg,
Ca 580 mg, P 380 mg, iodine 105 mcg, Mg 55 mg, Fe 9
mg, Zn 5 mg, manganese 300 mcg, copper 380 mcg, Na
220 mg, K 550 mg, Cl 430 mg, selenium 11 mcg,
chromium 11 mcg, molybdenum 28 mcg. Energy: 500
kCal
Pregestimil Susu bubuk MeadJohnson
8 Per 100 g Fat 25.9 g, protein 14.4 g, carbohydrate 53.2
g, lactose 25 g, maltodextrin 25 g, linoleic acid 3.28 g,
linolenic acid 392 mg, ARA 78 mg, DHA 78 mg, vit A
1,080 mcg-RE, vit D 15.2 mcg, vit E 16 mg, vit K 32 mcg,
vit B1 0.68 mg, vit B2 1 mg, vit B3 11.92 mg, vit B5 4.8 mg,
vit B6 0.6 mg, vit B9 240 mcg, vit B12 1.92 mcg, vit C 99.6
mg, biotin 20 mcg, choline 60 mg, carnitine 8 mg,
inositol 44 mg, taurine 32 mg, Ca 646 mg, P 378.3 mg,
Mg 42.5 mg, Fe 8.32 mg, Zn 5 mg, manganese 56 mcg,
copper 0.62 mg, iodine 136 mcg, Na 269 mg, K 514.3
mg, Cl 365.5 mg, selenium 9 mcg, nucleotides 10.9 mg.
LA/ALA= 8.4, Ca/P=1.7, whey:casein=70:30. Energy: 498
kCal
Pre NAN Susu bubuk Nestle
9 Per 100 g Protein 27.8 g, fat 10 g, carbohydrate 50 g, vit
A, vit D, vit E, vit K, thiamine, riboflavin, niacin,
pantothenic acid, vit B6, folic acid, vit B12, vit C, biotin,
Ca, P, Mg, Fe, Zn, manganese, copper, Na, K, Cl,
selenium
Similac Neosure HMF (Human Milk Fortifier) Susu bubuk Abbott
B. Produk Nutrisi/Enteral
1 Minyak ikan alami DHA 214 mg, EPA 20 mg, Vit E 10 mg
Prolacta DHA for Mother Kapsul Lunak Novell
2 Minyak ikan 18/12 EPA/DHA 373 mg, minyak pepermin
3 mg, vit E 4 mg
Nulacta Kapsul lunak Guardian
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 2020 | Formularium Obat RSIA Bina Medika
3 Per penyajian (58 g) Total fat 8 g, saturated fat 5 g,
protein 10 g, carbohydrate 38 g, fiber 3 g, sugar 7 g, Na
130 mg, K 110 mg, inulin 2.5 g, biotin 14 mcg, Cl 168
mg, omega-3 fatty acids 150 mg, omega-6 fatty acids
710 mg. Energy: 260 kCal
Entramix Coklat Susu bubuk Kalbe
Entramix Vanila Susu bubuk Kalbe
4 Per serving (±60 g) Carbohydrate 44 g, protein 9 g
(BCAA 3.7 g), fat (MCT) 2.5 g, vit, minerals, lactulose.
Energy: 250 kCal
Hepatosol Coklat Susu bubuk Kalbe
Hepatosol Vanila Susu bubuk Kalbe
5 Per serving (±63 g) Carbohydrate 42 g, protein 14 g, fat
3 g, vit, minerals. Energy: 250 kCal
Peptisol Coklat Susu bubuk Kalbe
Peptisol Vanila Susu bubuk Kalbe
C. Produk Nutrisi Parenteral
1 Per L Asam amino 50 g, vit, elektrolit
Aminofusin Paed Infus 250 mL Kalbe
2 Per L Asam amino 50 g, sorbitol 50 g, xylitol 50 g, vit,
elektrolit
Aminofusin L 600 Infus 500 mL Kalbe
3 Asam Amino
Aminosteril Infant 6% Infus 100 mL Fresenius Kabi
Renxamin 9% Infus 200 mL Kalbe
4 Per 1,000 mL Amino acid 5% (BCAA 14.8%), vit B6, Na
30 mEq, K 25 mEq, Cl 10 mEq, Ca 10 mEq, Mg 5 mEq,
acetate 5 mEq, L-isoleucine 2,512 g, L-leucine 2,792 g,
L-lysine 2,092 g, L-methionine 0.976 g, L-phenylalanine
1.816 g, L-threonine 1.744 g, L-tryptophan 0.56 g,
L-valine 2,092 g, L-arginine 3,488 g, L-histidine 0.6 g,
L-alanine 9,256 g, L-aspartate acid 4,048 g,
n-acetylcysteine 0.16 g, L-glutamic acid 9.5 g, glycine
3,848 g, L-proline 4,188 g, N-acetyl-L-tyrosine 0.344 g,
nicotinamide 0.06 g, pyridoxine HCl 0.04 g,
riboflavin-5-phosphate Na 2.5 mg. Osmolarity: 600
mOsm. Energy: 200 kCal
Benutrion VE Infus 250 mL Sanbe
5 Asam amino, glukosa, elektrolit, vit B1
Bfluid Infus 500 mL Otsuka
6 Asam amino 28 g, glukosa 75 g, elektrolit
Clinimix N9G15E Infus 1000 mL Kalbe
7 Per L Lemak 20% (olive oil 80%, minyak kedelai 20%),
energi 2000 kCal/L
Clinoleic Infus 100 mL Kalbe
Infus 250 mL Kalbe
Infus 500 mL Kalbe
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 2020 | Formularium Obat RSIA Bina Medika
8 Maltosa
Martos Infus 500 mL Otsuka
9 Fruktosa, Glukosa, Xylitol
Triofusin 500 Infus 500 mL Kalbe
Triofusin 1000 Infus 501 mL Kalbe
Triofusin 1600 Infus 502 mL Kalbe
10 Per 1,000 mL Asam amino 2.72% (BCAA 27.5%),
d-sorbitol 50 g, L-arginine HCl 2.7 g, L-histidine HCl
monohydrate 1.3 g, L-isoleucine 1.8 g, L-leucine 4.1 g,
L-lysine HCl 6.2 g, L-methionine 2.4 g, L-phenylalanine
2.9 g, L-threonine 1.8 g, L-tryptophan 0.6 g, L-valine 2 g,
glycine 3.4 g. Osmolarity: 540 mOsm. Energy: 308 kCal
Valamin Infus 500 mL Sanbe
D. Elektrolit
1 Per 1,000 mL Gelatin polysuccinate 40 g, Na acetate
trihydrate 3.675 g, NaCl 4.59 g, KCl, 0.403 g, Ca chloride
dihydrate 0.133 g, Mg chloride hexahydrate 0.203 g, Na
hydroxide 0.98 g
Gelafusal Infus 500 mL Dexa
2 Per 1,000 mL Gelatin suksinat 40 g, Na. Klorida 7,01 g,
Na. Hidroksida 1,36 g
Gelofusin Infus 500 mL B Braun
3 Per L Dekstros anhidrat 37.5 g, NaCl 2.25 g
KA-EN 1B Infus 500 mL Otsuka
4 Per 500 mL Dekstros anhidrat 13.5 g, NaCl 1.17 g, KCl
0.375 g, Na lactate 1.12 g
KA-EN 3A Infus 500 mL Otsuka
5 Per 500 mL Dekstros anhidrat 13.5 g, NaCl 0.875 g, KCl
0.75 g, Na lactate 1.12 g
KA-EN 3B Infus 500 mL Otsuka
6 Per L Dekstrose anhidrat 100 g, NaCl 1.75 g, KCl 1.5 g,
Na lactate 2.24 g
KA-EN MG3 Infus 500 mL Otsuka
7 Mannitol
Manitol 20 Infus 500 mL Otsuka
8 Per L Na 45 mEq, K 20 mEq, Cl 35 mEq, citrate 30 mEq,
dextrose 25 g
Pedialyte Solutio 500 mL Abbott
9 Per 1,000 mL Na 60 meq, Cl 50 meq, K 10 meq, lactate
20 meq, anhydrous glucose 27 g, (NaCl 2.34 g, KCl 0.75
g, Na lactate 2.24 g, water for inj 1,000 mL). Osmolarity:
290 mOsm. Energy: 108 kCal
Tridex 27A Infus 500 mL Sanbe
10 Per 1,000 mL Na 50 meq, Cl 50 meq, K 20 meq, lactate
20 meq, anhydrous glucose 27 g, (NaCl 1.75 g, KCl 1.55
g, Na lactate 2.24 g)
Tridex 27B Infus 500 mL Sanbe
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 2020 | Formularium Obat RSIA Bina Medika
11 Per 1,000 mL Na 38.5 mEq, Cl 38.5 mEq, anhydrous
glucose 37.5 g (NaCl 2.25 g, KCl 0.75 g)
Tridex Plain Infus 500 mL Sanbe
12 Glukosa, natrium, nalium, chlorid, sitrat, karbohidrat
Vivity Oral elektrolit 200 mL
XIV. PREPARAT MATA
A. Antiseptik dan Antiinfeksi
1 Levofloxacin 0,5%
Cravit Tetes Mata 0,5% - 5 mL Santen
2 Kloramfenikol
Fenicol Tetes Mata 0,25% - 5 mL Cendo
Fenicol Salep Mata 1% - 10 g Cendo
Fenicol Minidose Minidose 0,5% Cendo
3 Ofloxacin
Floxa Minidose Cendo
Tarivid Tetes Mata 0,3% - 5 mL Santen
4 Gentamycin
Gentamycin Salep Mata 0,3% - 3 g Cendo
5 Asetazolamid
Galuseta Tablet 250 mg Sanbe
B. Antiseptik dengan Kortikosteroid
1 Tiap mL : Framycetin sulfas 5 mg, gramisidin 0,05 mg,
dexamethason 0,5 mg
Blecidex Tetes Mata - 5 mL Sanbe
Sofradex Tetes Mata - 5 mL Aventis
2 Tiap mL : Tobramycin 3 mg, dexamethason 1 mg
Bralifex Plus Tetes Mata - 5 mL Sanbe
Isotic Tobrizon Tetes Mata - 5 mL Fahrenheit
Tobroson Tetes Mata - 5 mL Cendo
3 Tiap mL : Hydrokortison 5 mg, kloramfenikol 2 mg
Mycos Minidose Cendo
4 Polymiksin B Sulfas, neomisin sulfas, dexamethason
Polydex Minidose Cendo
Xitrol Tetes Mata - 5 mL Cendo
Salep Mata - 3,5 g Cendo
Minidose Cendo
C. Kortikosteroid
1 Flumetholon
Ocuflam Tetes Mata 0,1% - 5 mL Sanbe
Posop Minidose Cendo
D. Sediaan Lubrikan
1 Sodium Carboxymethylcellulosa
Cenfresh Minidose Cendo
2 NaCl, KCl
Lyteers Tetes Mata - 15 mL Cendo
MInidose Cendo
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 2020 | Formularium Obat RSIA Bina Medika
3 Dextran, Hydroksipropil metilselulosa
Sanbe Tears Tetes Mata - 8 mL Sanbe
XV. PREPARAT TELINGA dan MULUT/TENGGOROKAN
A. Antiseptik dan Antiinfeksi
1 Ofloxacin
Tarivid Tetes Telinga 0,3% - 5mL Kalbe
B. Antiseptik dengan Kortikosteroid
1 Ciprofloxacin, Fluocinolon acetonide
Duoxal Tetes Telinga - 10 mL Hypens
2 Kloramfenikol, Polimiksin B sulfas, benzocain, nipagin
Otolin Tetes Telinga - 10 mL Kalbe
3 Polimiksin B sulfas, neomicin sulfas, fludrokortison
asetat, lidocain HCl
Otopain Tetes Telinga - 8 mL Interbat
C. Preparat Telinga Lainnya
1 Na Decusate
Tetes Telinga 5 mg/mL -
Forumen Sanbe
10 mL
D. Preparat Ulserasi Oral dan Antiinflamasi
1 Polivinilpirolidon (PVP), ekstrak Aloe vera, Na.
Hyaluronat, As. Glyryrrhetic
Aloclair Plus Gel 8 mL Kalbe
Oral Rinse 60 mL Kalbe
2 Fradiomycin sulfas 2,5 mg, gramisidin-S HCl 1 mg
FG Troches Tablet Hisap Meiji
3 Triamcinolone acetonide
Kenalog In Orabase Oint - 5 g Taisho
4 Benzydamine HCl
Solution 7,5 mg/5 mL -
Tantum Verde Soho
120 mL
XVI. TERAPI DERMATOLOGIS
A. Antibiotik Topikal
1 Asam fusidat
Afucid Cream 2% - 5 g Ferron
Fucidin Cream 2% - 5 g Leo Pharma
Fuladic Cream 2% - 5 g Guardian
2 Mupirocin
Bactoderm Oint 2% - 10 g Ikapharmindo
Bactroban Oint - 5 g GSK
3 Placenta extract 10%, neomisin sulfat 0,5%
Bioplacentron Gel 15 g Kalbe
4 Silver Sulfadiazine
Burnazin Cream 10 mg/g - 35 g Darya-Varia
5 Kloramfenikol
Kalmicetin Oint 20 mg/g - 15 g Kalbe
6 Gentamycin sulfas
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 2020 | Formularium Obat RSIA Bina Medika
Garamycin Cream 0,1% - 5 g Schering-Plough
Oint 0,1% - 5 g Schering-Plough
Sagestam Oint 0,1% - 10 g Sanbe
7 Mupirosin
Pibaksin Oint 2% - 10 g Sanbe
B. Antifungi dan Antiparasit Topikal
1 Ketoconazol
Formyco Cream 2% - 10 g Sanbe
Ketomed SS Shampo 2% - 60 mL SDM
2 Miconazol nitrat
Funtas Cream 2% - 20 g Sanbe
3 Terbinafin HCl
Interbi Cream 1% - 5 g Interbat
Termisil Cream 1% - 10 g Ferron
4 Bifonazole
Mycospor Cream 1% - 5 g Bayer
5 Nistatin 100000 IU/g, Zn Oxyde 200 mg/g
Myco-Z Oint 10 g Taisho
6 Tioconazole
Trosyd Cream 1% - 10 g Pfizer
C. Antivirus Topikal
1 Acyclovir
Zoter Cream 5% - 5 g Interbat
Zovirax Cream 5% - 2 g GSK
Cream 5% - 5 g GSK
D. Antiinfeksi dengan Kortikosteroid Topikal
1 Desonide 0,5 mg, Neomycin sulfat 5 mg
Apolar N Cream - 10 g Actavis
2 Dexamethason 0,4 mg/g, klotrimazole 10 mg/g
Baycuten N Cream - 5 g Bayer
3 Betametason (valerate) 0,1%, neomycin sulfast 0,5%
Benoson N Cream - 15 g Bernofarm
Betason N Cream - 5 g Kimia Farma
4 Betametasone valerate 0,1%, myconazol nitrat 2%
Benoson M Cream - 5 g Bernofarm
5 Betametasaon valerate 0,1%, gentamycin sulfat 0,1%
Benoson G Cream - 10 g Bernofarm
6 Fluocinolon acetonide 0,025%, neomycin sulfat 0,5%
Cinolom N Cream - 10 g Sanbe
7 Fluocinolon acetonide 0,025%, gentamycin sulfat 0,1%
Gentasolon N Cream - 5 g Ikapharmindo
E. Kortikosteroid Topikal
1 Desonide
Apolar Cream 0,5 mg/g - 10 g Actavis
2 Prednicarbate

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 2020 | Formularium Obat RSIA Bina Medika
Dermatop Cream 0,25 mg/g - 5 g Sanofi
3 Fluocinolon acetonide
Cinolon Cream 0,25 mg/g - 10 g Sanbe
4 Mometason furoate
Elocon Cream 0,1% - 5 g Merck
Lotion - 30 mL Merck
Intercon Cream 0,1% - 10 g Interbat
Mefurosan Cream 0,1% - 10 g Sanbe
5 Desoximethason
Esperson Cream 0,25% - 15 g Sanofi
Inerson Oint 0,25% - 15 g Interbat
Topcort Cream 0,25% - 10 g Sanbe
6 Clobetasol propionate
Kloderma Cream 0,05% - 10 g SDM
Oint 0,05% - 10 g SDM
Lotasbat Oint 0,05% - 10 g Interbat
7 Hydrocortisone butirate
Locoid Cream 0,1% - 30 g Combiphar
8 Diflucortolone valerate
Nerilon Cream 0,1% - 10 g Interbat
XVII. ANESTESI DAN PREPARAT BEDAH
A. Anestesi Lokal dan Umum
1 Isoflurane
Aerrane Larutan inhalasi - 250 mL Kalbe
Terrell Larutan inhalasi - 250 mL Fahrenheit
2 Bupivacain HCl
Bucain Ampul 5 mg/mL Bernofarm
Marcain Ampul 0,5% - 20 mL Astra Zeneca
Marcain Spinal Heavy Ampul 5 mg/mL - 4 mL Astra Zeneca
3 Lidocain HCl, Klorheksidin hidroklorid
Montavit
Cathejell Gel - 12,5 g
Pharma
4 Ketamin HCl
KTM Vial 100 mg/mL - 10 mL Guardian
5 Lidocain HCl Ampul 2% - 2 mL Bernofarm
Xylocain Syringe gel 2% - 10 g Astra Zeneca
Spray 10% - 50 mL Astra Zeneca
6 Propofol
Proanest Ampul 10 mg/mL - 20 mL Sanbe
Recofol Infus 10 mg/mL - 50 mL Dexa
Infus 10 mg/mL - 20 mL Dexa
Infus 20 mg/mL - 50 mL Dexa
7 Lidocaine, epinephrine
Pehacain Ampul - 2 mL Phapros
8 Sevoflurane
Sevodex Larutan inhalasi - 250 mL Dexa
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 2020 | Formularium Obat RSIA Bina Medika
Sevorane Larutan - 250 mL Abbott
XVIII. ANTIDOTUM, AGEN DETOKSIFIKASI DAN KETERGANTUNGAN OBAT
A. Pengobatan Ketergantungan Obat
1 Naloxone HCl
Nokoba Ampul 0,4 mg/mL - 2 mL Fahrenheit
XIX. LARUTAN INTRAVENA DAN SEDIAAN STERIL LAINNYA
1 Human Albumin
Albuminar Infus 25% - 50 mL CSL Behring
Infus 25% - 100 mL CSL Behring
Infus 20% - 50 mL CSL Behring
Octalbin Infus 20% - 50 mL Kalbe
Infus 20% - 100 mL Kalbe
Infus 25% - 50 mL Kalbe
Infus 25% - 100 mL Kalbe
2 Kalsium Klorid, Potasium Klorid, Sodium Klorid, Sodium
Asetat
Asering Infus - 500 mL Otsuka
3 Per 1,000 mL Na 77 mEq, Cl 77 mEq, dextrose 50 g,
Infus - 500 mL Sanbe
(NaCl 4.5 g)
Infusan D5 + 1/2 NS
4 Per 1,000 mL Na 38.5 meq, Cl 38.5 meq, dextrose 50 g,
(NaCl 2.25 g)
Infusan D5 + 1/4 NS Infus - 500 mL Sanbe
5 Natrium Chlorid (NaCl / NS) 0,9%
Infusan NS Infus - 100 mL Sanbe
Infus - 250 mL Sanbe
Infus - 500 mL Sanbe
Infus - 1000 mL Sanbe
Otsu NaCl Ampul - 25 mL Otsuka
Infus - 100 mL Otsuka
Infus - 500 mL Otsuka
6 Per 1,000 mL Na 131 meq, Cl 109 meq, K 4 meq, Ca 2.7
meq, acetate 28 meq, (NaCl 6 g, KCl 0.3 g, Ca chloride
0.2 g, Na acetate 3.8 g)
Infusan Ring-As Infus - 500 mL Sanbe
7 Per 1,000 mL Na 130 meq, Cl 109 meq, K 4 meq, Ca 2.7
meq, lactate 28 meq, (NaCl 6 g, KCl 0.3 g, Ca chloride
0.2 g, Na lactate 3.1 g)
Infusan RL Infus - 500 mL Sanbe
8 Glukosa
Otsu D10 Infus 10% - 500 mL Otsuka
Otsu D40 Ampul 40% - 25 mL Otsuka
Otsu D5 Infus 5% - 500 mL Otsuka
Infus 5% - 100 mL Otsuka
9 Kalium Klorid (KCl)
Otsu KCl Ampul 7,46% - 25 mL Otsuka
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 2020 | Formularium Obat RSIA Bina Medika
10 Natrium Bikarbonat
Otsu Meylon - 84 Ampul 8,4% - 25 mL Otsuka
11 Magnesium Sulfas
Otsu MgSO4 Ampul 40% - 25 mL Otsuka
Ampul 20% - 25 mL Otsuka
12 Natrium Klorid, Kalium Klorid, Kalsium Klorid, Dextrose
Otsu RD5 Infus - 500 mL Otsuka
13 Natrium Klorid, Kalium Klorid, Kalsium Klorid 2H2O,
Natrium Lactate
Otsu RL Infus - 500 mL Otsuka
14 Natrium Chloride
Otsu Saline Infus 3% - 500 mL Otsuka
15 Aquabidest
Otsu WI Ampul - 25 mL Otsuka
Wida WI Unicap (water for irrigation) Larutan irigasi - 1 L Wida
XX. VITAMIN DAN MINERAL
A. Vitamin A, D dan E
1 D-alfa-tocopherol (vitamin E)
Dalfarol 200 IU Kapsul lunak 200 IU Darya-Varia
Santa E Tablet 100 mg Sanbe
Chewable Tablet 200 mg Sanbe
Chewable Tablet 400 mg Sanbe
Eturol Kapsul Lunak 400 IU Dipa
2 Vitamin A
Vitamin A Tablet 100,000 IU Kimia Farma
Tablet 200,000 IU Kimia Farma
B. Vitamin B-Complex/dengan C
1 Fursultiamin HCl
Alinamin-F Ampul - 10 mL Takeda
Ampul 25 mg/10 mL - 10
Furamin Meprofarm
mL
2 Vit B1 5 mg, vit B2 2 mg, vit B3 20 mg, vit B5 3 mg, vit B6
2.5 mg, vit B12 3 mcg, L-lysine HCl 375 mg
Becombion Lysine Sirup 100mL P&G Health
3 Vit B1 50 mg, vit B2 25 mg, vit B6 10 mg, vit B12 5 mcg, vit
C 500 mg, nicotinamide 100 mg, pantothenic acid 18.4
mg
Becom-C Kaplet FC Sanbe
4 Co-enzym B12
Cobazim Kapsul 1000 mcg Interbat
Kapsul 3000 mcg Interbat
5 Asam Folat
Folavit Tablet 400 mcg Sanbe
Tablet 1000 mcg Sanbe
6 Vit B1 100 mg, vit B6 50 mg, vit B12 100 mcg, natural vit E
200 IU, folic acid 400 mcg
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 2020 | Formularium Obat RSIA Bina Medika
Forneuro Kapsul Lunak Kalbe
7 Vit B1, vit B6, vit B12
Neurosanbe Tablet FC Sanbe
Neurosanbe 5000 Tablet Salut Gula Sanbe
Neurosan be Ampul - 3 mL Sanbe
8 Metampyrone, vit B1, vit B6, vit B12
Neurosanbe Plus Kaplet FC Sanbe
C. Vitamin C
1 Vitamin C, Cutrus Bioflavonoid
Cester Tablet Ethica
2 Vitamin C
Tablet effervescent 1000
Biferce Sanbe
mg/tab
Larce Ampul 1000 mg/5 mL MBF
Sankorbin Ampul 200mg/mL - 5 mL Sanbe
D. Kalsium dengan Vitamin
1 Calcium Gluconase
Calcium Gluconate Ampul 10% - 10 mL Ethica
2 Coral Ca 500 mg, natural soy isoflavone 20 mg, vit D3
200 IU, vit K1 25 mcg, Mg 100 mg, Zn 5 mg, boron 1 mg
Cal-95 Kaplet FC Lapi
3 Vit B6 15 mg, vit C 1,000 mg, vit D 300 IU, Ca carbonate
625 mg (equiv to elemental Ca 250 mg)
Caldece Tablet Effervescent Sanbe
4 Kalsium Karbonat
Calos Kaplet Fahrenheit
5 Kalsium, Vit D3
Calnic Plus Sirup - 100 mL Gracia
6 Ca hydrogen phosphate 500 mg, cholecalciferol 133 IU
Cavit D3 Tablet P&G Health
7 Coral Ca 500 mg, genistein 20 mg, vit D3 200 IU, vit K1 25
mcg, Mg 100 mg, boron 1 mg, Zn 5 mg
Eazycal Kaplet FC Novell

8 Ossein hydroxyapatite, kalsium, fosfor

Ossoral Kaplet FC 800 mg Dexa
Tablet Salut Gula 200 mg Dexa
9 Genistein 15 mg, Ca carbonate 1,000 mg, vit D3 400 IU,
omega-3 50 mg
Ostogard Kaplet Novell
10 Vitamin D3
Vitamin D3 Softgels 1000 IU Nature Plus
E. Vitamin dan/atau Mineral
1 Fe gluconate 250mg, manganese sulfate 200mcg,
copper sulfate 200mcg, vit C 50mg, folic acid 1mg,
cyanocobalamin w/ intrinsic factor 7.5mcg, sorbitol
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 2020 | Formularium Obat RSIA Bina Medika
25mg
Biosanbe Kapsul Sanbe
2 β-carotene 10% 30 mg (5,000 IU), vit C 200 mg, vit E 50
mg, Zn 15 mg, selenium 25 mcg
Bevizil Kaplet FC Sanbe
3 Vit A 3,500 IU, vit D3 220 IU, vit E 11.2 IU, vit C 125 mg,
vit B1 3.51 mg, vit B2 4.14 mg, vit B5 17.25 mg, vit B6
4.53 mg, vit B12 6 mcg, folic acid 414 mcg, biotin 69 mcg,
nicotinamide 46 mcg, glycine 250 mg, glycocholic acid
140 mg, soybean lecithin 112.5 mg
Cernevit Vial Kalbe
4 Folic acid 1 mg, β-carotene 10,000 IU, vit B1 3 mg, vit B2
3.4 mg, nicotinamide 20 mg, vit B6 2 mg, Ca
pantothenate 7.5 mg, Ca carbonate 100 mg, vit B12 4
mcg, vit D3 400 IU, vit K1 50 mcg, biotin 30 mcg, copper
gluconate 0.1 mg, Fe polymaltose complex (IPC) 30 mg,
DHA from algae 40 mg, arachidonic acid 8 mg
Folamil Genio Kapsul Lunak Dexa
5 Echinacea, Zn picolinate, selenium, asam ascorbat
Imunos Kaplet Lapi
Sirup - 60 mL Lapi
6 Zinc, Vitamin C
Imunped Drops - 15 mL Darya-Varia
Sirup - 60 mL Darya-Varia
7 Kalsium, Vitamin D3, Minyak ikan tuna
Osfit DHA Kapsul Lunak Kalbe
8 β-carotene 5,000 IU, selenium 50 mcg, Zn picolinate 50
mg, Ca ascorbate 500 mg, α-lipoic acid 100 mg
Oxyvell Kaplet FC Novell
F. Vitamin dan Mineral (Pediatrik)
1 Vit. A, Vit. B1, Vit. B2, Vit. B6, Vit. B12, Vit. C, Vit. D,
nicotinamide, lysine, pantoterol
Apialys Drops - 10 mL Lapi
Sirup - 100 mL Lapi
2 Ca phosphate 200 mg, Ca lactate 100 mg, vit B6 20 mg,
vit C 25 mg, vit D3 100 IU
Elkana Tablet FC Sanbe
3 Per 5 mL susp Vit A 2,400 IU, vit B1 4 mg, vit B2 1.2 mg,
vit B6 1.2 mg, vit B12 4 mcg, vit C 60 mg, vit D 400 IU,
nicotinamide 16 mg, choline 12 mg, inositol 12 mg, Ca
33.1 mg, Na 5.2 mg, L-lysine HCl 200 mg
Elkana Sirup - 60 mL Sanbe
4 Per 5 mL Vit A 2,400 IU, vit D 400 IU, cod liver oil 8 mg,
DHA 10 mg, arachidonic acid (AA) 15 mg, curcuma extr
12 mg, vit B1 4 mg, vit B2 1.2 mg, vit B6 1.2 mg, vit B12
4 mcg, nicotinamide 16 mg, choline 12 mg, inositol 12
mg, L-lysine HCl 100 mg, Ca 33.1 mg, Na 5.2 mg, GOS
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 2020 | Formularium Obat RSIA Bina Medika
500 mg
Elkana Emulsi - 120 mL Sanbe
5 Zat besi, vitamin B1, vitamin B6, vitamin B12, asam folat
Ferlin Drops - 15 mL Darya-Varia
Sirup - 100 mL Darya-Varia
6 Bilberry dry extr 40 mg, retinol 800 IU, β-carotene 0.25
mg, vit E 25 mg, selenium 7.5 mcg, Zn picolinate 2.5 mg
Optalvit Sirup - 60 mL Lapi
7 Per 5 mL Ferrazone 113 mg (equiv elemental Fe 15 mg),
vit B1 1 mg, vit B2 1 mg, vit B3 15 mg, vit B6 1.5 mg, vit
B7 (biotin) 0.3 mg
Sangobion Kids Sirup - 100 mL P&G Health
8 Per 5 mL syr Vit A 2,000 IU, thiamine 5 mg, riboflavin 2
mg, pyridoxine 5 mg, cyanocobalamin 2 mcg,
nicotinamide 10 mg, folic acid 15 mcg, choline 5 mg,
inositol 12 mg, biotin 100 mcg, vit E 5 IU, Fe 5 mg, Zn
2.5 mg, Mg 35 mg, copper 300 mcg, selenium 20 mcg,
chromium 15 mcg, lysine 100 mg, L-glutamine 50 mg
Zamel Sirup - 60 mL Novell
9 Per mL Drops Vit D3 800 IU, Zn 5mg, vit A 2,000 IU, vit
B1 0.5mg, vit B2 0.6mg, vit B6 0.4mg, vit B12 2mcg, vit E
5 IU, nicotinamide 8mg, pantothenic acid 5mg, biotin
5mcg
Zamel Drops - 16 mL Novell
G. Vitamin dan Mineral (Pre-post Natal/Antianemia)
1 Fe fumarate 90 mg, Cupric sulfate 0.35 mg, Cobalt
sulfate 0.15 mg, Manganese sulfate 0.05 mg, vit.B6 3
mg, vit.B12 5 mcg, vit.C 60 mg, vit.E 5 mg, Folic Acid 400
mcg, Ca phosphate dibasic 60 mg
Emineton Tablet Dankos
2 Fe carbonyl 83 mg, Ascorbic Acid 150 mg, Folic Acid 1
mg, vit.B1 3 mg, vit.B2 3 mg, vit.B6 5 mg, vit.B12 10
mcg, Niacinamide 30 mg, Ca pantothenate 15 mg, Zn 15
mg, Lysine HCl 50 mg
Ferofort Kaplet FC Kalbe
3 Per 5 mL : Sodium Fe EDTA 115.4 mg setara dengan Fe
elemen 15 mg
Ferriz Sirup - 100 mL Nicholas
4 Folic acid 800 mcg, DHA 30 mg, vit B12 12 mcg
Folda Kaplet FC Simex
5 Fe fumarate 360 mg, folic acid 1.5 mg, vit B12 15 mcg, vit
C 75 mg, Ca carbonate 200 mg, cholecalciferol 400 IU
Hemobion Kapsul P&G Health
6 Besi (II) Hidroksida 100 mg
Maltofer Chewable Tablet Combiphar
7 Tuna oil 179 mg, omega-3 64.5 mg, DHA 48.5 mg, EPA
12.5 mg, folic acid 400 mcg, vit A 345 IU, vit D3 34.5 IU,
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 2020 | Formularium Obat RSIA Bina Medika
vit B12 0.5 mcg, vit B6 150 mcg, Ca carbonate 100 mg,
Mg oxide 62.5 mg, Fe fumarate 23.5 mg
Promavit Kapsul Lunak Lapi
8 Folic acid 800 mcg, vit A 5,000 IU, vit B6 15 mg, vit B12 4
mcg, vit D 400 IU, Mg 100 mg, Zn 15 mg,
fructooligosaccharide 50 mg, ginger extr 200 mg
Vitamam 1 Kapsul Novell
9 Per-kapsul: Folic acid 800 mcg, vit.A 5000 IU, vit.B1 10
mg, vit.B2 2.5 mg, vit.B6 15 mg, vit.B12 4 mcg, vit.D 400
IU, vit.C 100 mg, Niacinamide 20 mg, Ca pantothenate
7.5 mg, Mg 100 mg, Zn 15 mg, Copper sulfate 0.1 mg, K
iodide 0.1 mg, Na fluoride 1 mg, Fructo-oligosaccharide
50 mg.Per-kapsul Fe: Fe fumarate 75 mg
Vitamam 2 Kapsul Novell
10 Per cap Folic acid 800 mcg, vit A 5,000 IU, vit B1 10 mg,
vit B2 2.5 mg, vit B6 15 mg, vit B12 4 mcg, vit D 400 IU, vit
C 100 mg, vit E 100 mg, niacinamide 20 mg, Ca
pantothenate 7.5 mg, Mg 100 mg, Zn 15 mg,
manganese 1 mg, copper sulfate 0.1 mg, K iodide 0.1
mg, Na fluoride 1 mg, fructooligosaccharide 50 mg. Per
Fe cap Fe fumarate 90 mg
Vitamam 3 Kapsul Novell
11 Zat besi
Venofer Ampul - 5 mL Combiphar
H. Suplemen Kesehatan
1 Minyak hati Ikan Kod 7.5 mg, Ekstrak Curcuma 10 mg,
Asam Arachidonat (AA) 15 mg, DHA, 10 mg, FOS 500 m,
CA hipofosfit 500 mg, Vitamin D 100 ui, Dexpanthenol 3
mg, Vitamin A 850 ui, Vitamin B1 3 mg, Vitamin B2 2
mg, Vitamin B6 5 mg, Vitamin B12 5 mcg.
Curvit Cl Emulsi - 175 mL Soho
2 Minyak hati Ikan Kod 7.5 mg, Ekstrak Curcuma 10 mg,
Asam Arachidonat (AA) 15 mg, DHA, 10 mg, FOS 500 m,
CA hipofosfit 500 mg, Vitamin D 100 ui, Dexpanthenol 3
mg, Vitamin A 850 ui, Vitamin B1 3 mg, Vitamin B2 2
mg, Vitamin B6 5 mg, Vitamin B12 5 mcg.
Curvit Cl Tablet Soho
3 Per 5 mL Curcuminoid 2 mg, β-carotene 10% 4 mg, vit
B1 3 mg, vit B2 2 mg, vit B6 5 mg, vit B12 5 mcg, vit D
100 IU, dexpanthenol 3 mg, Ca pidolate 300 mg,
fructo-oligosaccharide 300 mg
Vitacur Sirup - 100 mL Lapi
I. Suplemen dan Terapi Pendukung
1 Tribulus terrestris L 275 mg
Teguhsindo
Biosan Kaplet FC
lestaritama
2 Vaccinium myrtillus fructus extract 80mg, calendula
officinalis flos extract 36,10mg, helenium autumnale
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 2020 | Formularium Obat RSIA Bina Medika
flos extract 12,09mg
Vitanorm Tablet Cendo
3 Akar curcuma
Curcuma dragee Tablet Soho
4 Superoxide dismute dari ekstrak melon dengan gliadin
Glisodin Kapsul 250 IU Kalbe
5 Echinacea pupurea, black elderberry ekstr, Zn picolinate
Imboost Force Kaplet FC Soho
Sirup 60mL Soho
6 Beta-caroten, ekstrak bilbery kering, retinol, vitamin E
Matovit Tablet Soho
7 Clomiphen sitrat
Plusfortil Tablet Kalbe
XXI. DERMATOLOGIS DAN PERAWATAN PRIBADI
A. Pelembab, Pembersih dan Pelindung Kulit
1 Na hyaluronate, Vitis vinifera, Butyrospermum parkii
butter, telmesteine, glycyrrhetinic acid
Transfarma
Atopiclair Cream - 40 mL
Medica Indah
2 Anhydrous lanolin 60 mg, isopropyl myristate 170 mg,
cetyl alcohol 20 mg, sorbitan monostearate 80 mg,
polysorbate 20 mg, glycerol 100 mg, dimethicone 50
mg, sorbic acid 1.5 mg
Decubal Cream - 20 g Actavis
3 Spent grain wax, butyrospermum parkii extr, argania
spinosa kernel oil, saccharide isomete
Ezerra Cream - 25 g Taisho
4 Pseudo-ceramide, phytosterols, stearic acid & other
nabati oil, Zn oxide (Noroid Derma Rash Cream)
Noroid Lotion - 200 mL Soho
Cream - 80 mL Soho
Derma Rash Cream - 60
Soho
mL
5 Ekstrak Allium cepa, ekstrak palmitoyl pine bark,
dimethicone, cyclopentasiloxane, allantoin,
Butyrospermum parkii, ekstrak Macrocystis pyrifera,
palmitoyl tetrapeptide-7, palmitoyl tripeptide-1, asam
hyaluronat, squalane, vit A, vit E .
Novell Smoothing Cream Cream 30 g Novell

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