Professional Documents
Culture Documents
Buku Dso 2021
Buku Dso 2021
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
2.6
Dige 2.6.1 Pancreatin + Activated Xepazym Kaplet 170 + 80 mg PT. Metiska Farma
stan Dimethylpolysiloxane
2.6.2 Amilase + Protease + Lipase + Enzyplex New Tablet 100 + 900 + IU + mg PT. Darya Varia Laboratoria Tbk
Deoxicolic acid + Dimeticon + 240 + 30 + 25
Simeticon +Vit B1 + Vit B2 + Vit + 624 + 10 +5
B6 + Vit B12 + Nicotinamid + + 5 + 5 + 10 +
Calcium Pantotenate 5
2.7
Kola 2.7.1 Ursodeoxycholic acid Ursodeoxycholic Acid kapsul 250 mg PT. Novell Pharmaceutical Laboratories
gog
um,
Estazor Tablet 250 mg PT. Pratapa Nirmala Fahrenheit
Urdex Tablet 250 mg PT. Dexa Medica
Ursolic kapsul 250 mg PT. Guardian Pharmatama
2.7.2 Mesalazine Salofalk Tablet 250 mg PT. Darya Varia Laboratoria Tbk
500 mg PT. Darya Varia Laboratoria Tbk
2.8
Pre 2.8.1 Fluocortolone pivalate, Ultraproct N Oint 1 mg /20 mg Apotek
par fluocortolone caproate ,
at Supp 1 mg /40 mg Apotek
cinchocaine HCL, clemizole
2.8.2 Policresulen, cinchocaine HCL Faktu Oint 100 mg/ 2.5 mg Apotek
Supp 50 mg Apotek
2.8.3 Lithospermi rdx, Benzocaine, Borraginol N Oint 0.09 mg PT. Takeda Indonesia
dll Supp 0.1 mg PT. Takeda Indonesia
Borraginol S Oint 0.1 mg PT. Takeda Indonesia
Supp 0.18 mg PT. Takeda Indonesia
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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3.4.1 Amoxycillin Trihydrate
YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
3.7.3 Pyrazinamide
NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI
Siramid Kaplet 500 mg PT. Mersifarma Tirmaku Mercusana
3.7.4 Rifampicin Merimac Kaplet 450 mg PT. Mersifarma Tirmaku Mercusana
Rifabiotic Kaplet 450 mg PT. Bernofarm Pharmaceutical
600 mg PT. Bernofarm Pharmaceutical
Rifampicin Kaplet 450 mg PT. Kimia Farma
kapsul 300 mg Apotek
Tablet 600 mg Apotek
3.7.5 Rifampicin + INH Pro TB 2 Tablet salut 150 + 150 mg PT. Phapros Tbk
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
5.5.4 Povidone Iodine Iodine Povidon Lar Cairan 10 % PT. Kimia Farma
5.5.5 Asam Salisilat 2 % Talk 98% Salisil Talk Bedak 50 mg PT. Ikapharmindo Putramas
Tabur
5.6 Kasa Steril Dengan Obat
5.6.1 Framycetin Sulfate Daryant Tulle 10 x 10 cm 2m mg BP 1% PT. Darya Varia Laboratoria Tbk
5.7 Topikal Anti Jamur dan Parasit
5.7.1 Cloritamazole Cotristen Cream 10 mg Apotek
5.7.2 Ketoconazole Ketoconazole Cream 2 % PT. Hexpharm Jaya
PT. Kimia Farma
Ketomed SS Solution 2 % PT. Surya Dermato Medica Laboratories
Muzoral Cream 2 % PT. Transfarma Medica Indah
Mycoral Cream 2 % PT. Kalbe Farma
5.7.3 Nystatin + Zinc Oxide Myco-Z Oint 100.000 IU + IU + mg PT. Taisho Pharmaceutical
200mg
5.7.4 Terbinafine Interbi Cream 5 gr PT. Interbat
5.7.5 Permethrin Permethrine Oint 15 gr PT. Novell Pharmaceutical Laboratories
30 gr PT. Novell Pharmaceutical Laboratories
Medscab Cream 5 % PT. Surya Dermato Medica Laboratories
5.8 Preparat Psoriasis, Seboroik & Iktiosis
5.8.1 Calcipotriol Daivonex Oint 50 mcg / g Apotek
5.8.2 Calcipotriol & Betamethasone Daivobet Oint 50 + 0,5 mcg + mg Apotek
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
6.2.2 Prednisolone Acetate P. Pred eye drop 10 mg/ml PT. Cendo Pharmaceutical Industries
Miconized Minidose 10 mg PT. Cendo Pharmaceutical Industries
6.2.3 Fluometholon Flumetholon eye drop 5 ml PT. Ferron Par Pharmaceuticals
6.3 Antiseptik & Kortikosteroid Mata
6.3.1 Dexamethasone + Neomycin + Polydex eye drop 1 + 3,5 + mg/ml + PT. Cendo Pharmaceutical Industries
Polymixin B Minidose 10000
2 + 3,5 + IU/ml
mg/ml + PT. Cendo Pharmaceutical Industries
6.3.2 Dexamethasone + Tobramycin Tobroson Minidose 10000
1+3 IU/ml
mg/ml PT. Cendo Pharmaceutical Industries
6.3.3 Framycetin Sulfate + Fradex Minidose 5 + 0,05 + 1 mg/ml PT. Cendo Pharmaceutical Industries
Gramicidin + Dexamethasone
6.3.4 Hydrocortison + Mycos Eye Oint 5+2 mg/ml PT. Cendo Pharmaceutical Industries
Chloramphenicol Minidose 5+2 mg/ml PT. Cendo Pharmaceutical Industries
6.4 Obat Midriatik
6.4.1 Atropine sulfate Tropine eye drop 10 mg/ml PT. Cendo Pharmaceutical Industries
6.4.2 Atropine sulfate Tropine Minidose 10 mg/ml PT. Cendo Pharmaceutical Industries
6.5 Obat Glaukoma
6.5.1 Brinzolamide Azopt eye drop 5 ml Apotek
Simbriza eye drop 5 ml PT. Novartis Indonesia
6.5.2 Latanoprost + timolol Glaoplus Minidose 0,05 + 5 mg/ml PT. Cendo Pharmaceutical Industries
Xalacom Eye Drops 50 + 5 mcg + mg PT. Pfizer Indonesia
6.5.3 Timolol maleate Timol eye drop 5 mg/ml PT. Cendo Pharmaceutical Industries
Minidose 0.25 mg/ml PT. Cendo Pharmaceutical Industries
5 mg/ml PT. Cendo Pharmaceutical Industries
6.5.4 Pilocarpine Carpine Minidose 20 mg/ml PT. Cendo Pharmaceutical Industries
6.5.5 Travoprost Travatan eye drop 0.004 % Apotek
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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9.1.5 Glimepiride
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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10.1.3 Paracetamol
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YAYASAN
10.2.4KESEJAHTERAAN
Diclofenac NaKARYAWAN BANK INDONESIA OBAT UMUM
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10.2.8 Etoricoxib
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YAYASAN
10.4.2KESEJAHTERAAN
Haloperidol KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN
10.6.4KESEJAHTERAAN
Gabapentin KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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10.10.1 Domperidone
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
13.2.10 Paracetamol + Fluzep Tablet 500 + 12,5 + 2 mg PT. Otto Pharmaceutical Industries
Phenylpropanolamine + CTM + + 15 + 50
DMP
Paratusin Tablet 500 + 50 + 15 mg PT. Darya Varia Laboratoria Tbk
+ 15 + 2
Pro-Inz Tablet 500 + 50 + 15 mg PT. Hexpharm Jaya
+ 15 + 2
13.2.11 Pseudoephedrine HCL Rhinos Neo Drops 7.5 mg/0,8 ml PT. Dexa Medica
13.2.12 Tripolidine HCL + Alerfed Syrup 1.25 + 30 mg PT. Guardian Pharmatama
pseudoephedrine HCL Tablet 2.5 + 60 mg PT. Guardian Pharmatama
Trifed Tablet 2.5 mg PT. Interbat
Librofed Syrup 2.5 + 30 mg PT. Hexpharm Jaya
13.2.13 Oksomemazin + Comtusi Syrup 100 ml PT. Combiphar
Gliserilguaiakolat Syrup 60 ml PT. Combiphar
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
13.2.13 Oksomemazin +
NO Gliserilguaiakolat
ZAT AKTIF MERK SEDIAAN DOSIS FARMASI
Comtusi Stroberry Syrup 60 ml PT. Combiphar
Comtusi Forte kapsul 1,65 + 33.3 mg PT. Combiphar
13.2.14 Paracetamol + Nodrof Flu Tablet 500 + 12.5 mg PT. Tempo Rx Farma
Phenylpropanolamine Antitussive
Nodrof Flu Tablet 500 + 12.5 mg PT. Tempo Rx Farma
Expectorant
13.2.15 Erdosteine Erdosteine kapsul 300 mg PT. Promedrahardjo Farmasi Industri
13.3 Dekongestan Nasal & Preparat Nasal Lain
13.3.1 Mometasone furoate Nasonex Nasal Nasal Spray 60 mcg PT. Transfarma Medica Indah
140 mcg PT. Transfarma Medica Indah
13.3.2 Oxymethazoline iliadin Nasal Drop 0.025 % Apotek
13.3.3 Triamcinole Acetonide Nasacort AQ Nasal Spray 55 mcg / dose PT. Aventis Farma- chc
14. Lain-lain
14.1 Antianemia
14.1.1 Folic Acid Anemolat Tablet 1 mg PT. Phapros Tbk
Folac Tablet 0.4 mg PT. Otto Pharmaceutical Industries
Folic Acid Tablet 400 mcg PT. Promedrahardjo Farmasi Industri
Starfolat Tablet 0.4 mg PT. Dexa Medica
Vitafol Kaplet 5 mg PT. Dipa Pharmalab Intersains
14.2 Elektrolit & Mineral
14.2.1 Glucose Anhydrous, NaCl, Na Oralit sachet 200 ml PT. Kimia Farma
Bicarbonate, CaCl2 Pedialyte Bubble Cairan Oral 500 ml PT Abbott Indonesia
Gum
Pedialyte Solution Cairan Oral 500 ml PT Abbott Indonesia
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
15.2 Multivitamin
15.2.1 Vit A 3, Vitamin B1, Vitamin B2 Lycalvit Tablet 100 mg PT. Interbat
, Vitamin B6, Vitamin B12,
Vitamin C , Vitamin D,
15.2.2 Vit B1 + Vit B6 Ca
nicotinamide, + Vit B12 + Vit E Neurovit E
pantothenate Tablet 100 + 200 + mg PT. Kimia Farma
100 + 50
15. BAHAN BAKU
15.1 Bahan Baku
15.1.1 Zink Oxyd Zink Oxyd Serbuk Apotek
15.1.2 Acidum Benzoic salbron Serbuk Apotek
15.1.3 Acidum salicilicum Acidum salicilicum Serbuk Apotek
15.1.4 Alkohol 96% Alkohol 96% Larutan Apotek
15.1.5 Benzocain Benzocain Serbuk Apotek
15.1.6 Calcium carbonat Calcium carbonat Serbuk Apotek
15.1.7 Camphora Camphora Serbuk Apotek
15.1.8 Coffein Coffein Serbuk Apotek
15.1.9 Glucosa oral Glucosa oral Serbuk Apotek
15.1.10 Glycerin Glycerin Larutan Apotek
15.1.11 H2O2 50% H2O2 50% Larutan Apotek
15.1.12 Lanolin Lanolin Larutan Apotek
15.1.13 LCD LCD Larutan Apotek
15.1.14 Menthol Menthol Serbuk Apotek
15.1.15 OBH OBH Sirup Apotek
15.1.16 OBH OBH Ika TDR Sirup Apotek
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT UMUM
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT KHUSUS
NO ZAT AKTIF MERK SEDIAAN DOSIS FARMASI
I. Anti Virus
I.1 Adefovir dipivoxil Hepsera Tablet 10 mg PT. Glaxo Welcome Indonesia
I.2 Daklastafir Dasvir Tablet 30 mg PT. Amarox Global
60 mg PT. Amarox Global
Mydekal Tablet 60 mg PT. Kimia Farma
I.3 Entecavir ATEVIR Tablet 0.5 mg PT. Dexa Medica
TKV Tablet 0.5 mg PT. Kalbe Farma
I.4 Interferon alfa-2b Rebif Syringe 22 mcg PT. Merck Tbk
I.5 Lamivudin 3TC Tablet 150 mg PT. Glaxo Welcome Indonesia
Heplav Tablet 100 mg PT. Kimia Farma
I.6 Peginterferon alfa-2a Pegasys PFS 135 mcg/ PT. Roche Indonesia
0,5 ml
180 mcg / PT. Roche Indonesia
0,5 ml
I.7 Peginterferon alfa-2b Peg-Intron Injeksi 50 mcg Apotek
80 mcg Apotek
100 mcg Apotek
I.8 Ribavirin Copegus Tablet 200 mg Apotek
Ribavirin Tablet 200 mg Apotek
I.9 Sofosbufir Ecplusa Tablet 400/100 mg PT. Soho indus Farmasi
salut
selaput
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II.2 Ciclosporin Neoral Tablet 25 mg PT. Novartis Indonesia
50 mg PT. Novartis Indonesia
100 mg PT. Novartis Indonesia
II.3 Eferolimus Afinitor Tablet 5 mg PT. Novartis Indonesia
10 mg PT. Novartis Indonesia
II.4 Mycophenolate mofetil Cellcept Tablet 500 mg PT. Roche Indonesia
II.5 Tacrolimus Prograf kapsul 0.5 mg PT. Astellas Pharma Indonesia
1 mg PT. Astellas Pharma Indonesia
III. Preparat Anti dotum
III.1 Deferiprone Ferriprox Tablet Apotek
III.2 Desferrioxamine Mesylate Desferal Injeksi 500 mg PT. Novartis Indonesia
IV. Preparat Haematopoietik
IV.1 Epoetin alfa Epotrex Injeksi 2000 IU PT. Novell Pharmaceutical Laboratories
4000 IU PT. Novell Pharmaceutical Laboratories
10000 IU PT. Novell Pharmaceutical Laboratories
Eprex Syringe 2000 IU PT. Johnson & Johnson Indonesia
4000 IU PT. Johnson & Johnson Indonesia
10000 IU PT. Johnson & Johnson Indonesia
40000 IU PT. Johnson & Johnson Indonesia
Hemapo Injeksi 3000 IU PT. Kalbe Farma
IV.2 Epoetin beta Recormon PFS 2000 IU PT. Roche Indonesia
5000 IU PT. Roche Indonesia
10000 IU PT. Roche Indonesia
IV.4 Filgrastim Leucogen Injeksi 300 mcg PT. Kalbe Farma
IX. Antikoagulan, Antiplatelet & Fibrinolitik
IX.1 Enoxaparin Na Lovenox 0.2 Syringe 10000 IU / ml PT. Aventis Pharma
IX.2 Fondaparinux sodium Arixtra Syringe 2.5 mg/0,5 PT. Mitsubishi Tanabe Pharma Indonesia
ml
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IX.3 Human antithrombin III Kybernin P Injeksi 50 IU/ml Apotek
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IX.4 Streptokinase Fibrion Vial 1500000 IU PT. Dexa Medica
IX.5 Berapros Na Dorner Tablet 20 mcg PT. Astellas Pharma Indonesia
IX.6 Ticagrelol Briclot Tablet 90 30 PT. Dexa Medica
Brilinta Tablet 60 mg PT. Astra Zeneca Indonesia
90 mg PT. Astra Zeneca Indonesia
V. Cairan Intravena
V.1 Human Albumin Human Albumin Infus 20 / 100 % PT. Kimia Farma
Biotest 20 / 50 % PT. Kimia Farma
Octalbin Infus 20 % PT. Kalbe Farma
25 % PT. Kalbe Farma
Plasbumin Infus 5 % PT. Dipa Pharmalab Intersains
20/100 % PT. Dipa Pharmalab Intersains
25/20 % PT. Dipa Pharmalab Intersains
25/100 % PT. Dipa Pharmalab Intersains
V.2 Nacl 538 mg, Na Lactate 448 mg, Dianeal Pd-2 Infus Apotek
Cacl2 25.7 mg, mgcl2 5.08 mg,
Dextrose
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VII.1 Granisetron HCL
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Granisetron Injeksi 1 mg / ml PT. Yarindo Farmatama
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VIII.16 Cyclofosfamid Cyclovid Injeksi
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VIII.16 Cyclofosfamid
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VIII.33 Imatinib Mesylate Glivec Tablet 100 mg PT. Novartis Indonesia
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VIII.33 Imatinib Mesylate
Imatero Tablet 100 mg PT. Amarox Global
400 mg PT. Amarox Global
VIII.34 Lapatinib ditosylate Tykerb Tablet 250 mg PT. Novartis Indonesia
VIII.35 Letrozole Femaplex Tablet 2.5 mg PT. Dipa Pharmalab Intersains
Lebrest Tablet 2.5 mg PT. Ferron Par Pharmaceuticals
Letraz Tablet 2.5 mg PT. Kalbe Farma
VIII.36 Leuprorelin Divalin Injeksi 3.75 mg PT. Darya Varia Laboratoria Tbk
Endrolin Injeksi 3.75 mg PT. Kalbe Farma
Tapros Injeksi 1.88 mg PT. Takeda Indonesia
3.75 mg PT. Takeda Indonesia
11.25 mg PT. Takeda Indonesia
VIII.37 Medroxyprogesterone acetate Provera Tablet 100 mg PT. Pfizer Indonesia
VIII.38 Megestrol Acetate Tracetate Syrup 40 mg / ml PT. Pratapa Nirmala Fahrenheit
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VIII.46 Paclitaxel
Paxus Injeksi
Page 157
VIII.47 Procarbazin Matulane kapsul 50 mg Apotek
VIII.48 Sorafenib Tosylate Nexavar Tablet 200 mg PT. Bayer Indonesia
VIII.49 Tamoxifen Tamofen Tablet 10 mg PT. Kalbe Farma
VIII.50 Temozolomide Temodal capsule 20 mg PT. Merck Sharp & Dohme Indonesia
100 mg PT. Merck Sharp & Dohme Indonesia
Temotero Tablet 20 mg PT. Amarox Global
100 mg PT. Amarox Global
VIII.51 Trastuzumab Herceptin Injeksi 440 mg/20 PT. Roche Indonesia
ml
VIII.52 Ustekinumab Stelara Syringe 90 mg PT. Johnson & Johnson Indonesia
VIII.53 Vinblastin DBL Vinblastin Injeksi 10 mg Apotek
VIII.54 Vinkristin Vincristine- Kalbe Injeksi 1 mg PT. Kalbe Farma
2 mg PT. Kalbe Farma
VIII.55 Vinoralbine Navelbine Injeksi 10 mg PT. Transfarma Medica Indah
50 mg PT. Transfarma Medica Indah
VIII.56 Afatinib Giotrif Tablet 20 mg PT. Boehringer Ingelheim
30 mg PT. Boehringer Ingelheim
40 mg PT. Boehringer Ingelheim
VIII.57 Lenvatinib mesylate Lenvima Tablet 4 mg PT. Eisai Indonesia
10 mg PT. Eisai Indonesia
VIII.58 Regorafenib Stirvaga Tablet 40 mg PT. Bayer Indonesia
VIII.59 Thalidomide Thalidomide Tablet 50 mg Apotek
100 mg Apotek
X. Preparat Affecting Metabolisme Tulang
X.1 Raloxifene Evista Tablet 60 (blank) PT. APL Zuellig Farma
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XII. Anti Psikosis
XII.1 Aripiprazole Ariski Tablet 10 mg PT. Actavis Indonesia
15 mg PT. Actavis Indonesia
Zipren Tablet 10 mg PT. Novell Pharmaceutical Laboratories
15 mg PT. Novell Pharmaceutical Laboratories
Zipren ODT Tablet 10 mg PT. Novell Pharmaceutical Laboratories
15 mg PT. Novell Pharmaceutical Laboratories
XIII. Injeksi Mata
XIII.1 Afliberceft Eylea Injeksi 100 mcl PT. Bayer Indonesia
XIII.2 Ranibizumab Patizra Injeksi 10 mg / ml PT. Novartis Indonesia
XI
V. XIV.1 Ca polystylene sulfonate Kalitake sachet 5 gr PT. Dipa Pharmalab Intersains
Su
XI
pl
X. XIX.1 Trimetazidine Angintriz MR Tablet 35 mg PT. Novell Pharmaceutical Laboratories
A
nt Miozidine Tablet 35 mg PT. Pratapa Nirmala Fahrenheit
Trimetazidine Tablet 35 mg PT. Novell Pharmaceutical Laboratories
XIX.2 Ivabradine Coralan Tablet 5 mg PT. Servier Indonesia
7,5 mg PT. Servier Indonesia
XV. Topical Kortikosteroid
XV.1 Hydrocortison butyrat Dermacoid Cream PT. Combiphar
Scalp 0.1 % PT. Combiphar
Lotion
XV.2 Momethasone Elocon Lotion 0.1 % PT. Transfarma Medica Indah
XVI. Anti Anemia
XVI.1 Epoetin beta + Methoxy Mircera PFS 50 mcg / PT. Roche Indonesia
polyethylene glycol 0,3 ml
75 mcg / PT. Roche Indonesia
0,3 ml
100 mcg / PT. Roche Indonesia
0,3 ml
XVII. Anti Trombositopenia
XVII.1 Anagrelid Agrylin Tablet 0.5 mg PT. Pratapa Nirmala Fahrenheit
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XVII.2 Eltrombopag Olamine Rebozet Tablet 25 mg PT. Novartis Indonesia
50 mg PT. Novartis Indonesia
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XVIII. Anti Koagulan
XVIII.1 Dabigatran etexilate Pradaxa kapsul 75 mg PT. Boehringer Ingelheim
110 mg PT. Boehringer Ingelheim
150 mg PT. Boehringer Ingelheim
XVIII.2 Heparin Inviclot Injeksi 5000 IU PT. Pratapa Nirmala Fahrenheit
XVIII.3 Rivaroxaban Nostrok Tablet 10 mg PT. Pratapa Nirmala Fahrenheit
15 mg PT. Pratapa Nirmala Fahrenheit
20 mg PT. Pratapa Nirmala Fahrenheit
Xarelto Tablet 10 mg PT. Bayer Indonesia
15 mg PT. Bayer Indonesia
20 mg PT. Bayer Indonesia
XX. Preparat Sistim Urogenital Lain
XX.1 Hyaluronate Cytistat Injeksi 40 mg Apotek
XX.2 Mirabegron Betmiga Tablet 50 mg PT. Astellas Pharma Indonesia
XXI. Oral Antidiabetic Agents
XXI.1 Dapaglifozin Forxiga Tablet 5 mg PT. Astra Zeneca Indonesia
10 mg PT. Astra Zeneca Indonesia
XXI.2 Linagliptin Trajenta Tablet 5 mg PT. Boehringer Ingelheim
XXI.3 Linagliptin + Metformin HCL Trajenta Duo FCT Tablet 2.5 + 1000 mg PT. Boehringer Ingelheim
2.5 + 500 mg PT. Boehringer Ingelheim
2.5 + 850 mg PT. Boehringer Ingelheim
XXI.4 Liraglutide Victoza Flexpen 6 mg / ml PT. Novo Nordisk Indonesia
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XXIII. Analgesik Sistem Syaraf Pusat
XXIII.1 Fentanyl Durogesic Patch 12 mcg PT. Johnson & Johnson Indonesia
25 mcg PT. Johnson & Johnson Indonesia
50 mcg PT. Johnson & Johnson Indonesia
XXIII.2 Hydromorphone HCL Jurnista Tablet 8 mg Apotek
16 mg Apotek
XXIII.3 Morphin Sulfate MST Continus Tablet 10 mg Apotek
30 mg Apotek
60 mg Apotek
100 mg Apotek
XXIV. Detoxifying Agent
XXIV.1 Sevelamer Renvela Tablet 800 mg PT. Aventis Pharma
XXIV.2 Lanthanum carbonate Fosrenol Tablet 500 mg PT. Pratapa Nirmala Fahrenheit
XXV. Therapi of Chorn's Disease
XXV.1 Budesonide Budenofalk kapsul 3 mg PT. Darya Varia Laboratoria Tbk
XXVI. Insulin
XXVI. 1 Insulin Decludec Tresiba PEN 100 IU/ml PT. Novo Nordisk Indonesia
XXVI. 2 Insulin Decludeg + Insulin Aspart Ryzodeg PEN 100 IU/ml PT. Novo Nordisk Indonesia
XXVI. 3 Insulin glargine + Lixisenatide Soliqua Solostar 100 + 33 IU/ml + PT. Aventis Pharma
Pen mcg/ml
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XXVIII.1 Methoxsalen Soralen Solution 0.001 PT. Surya Dermato Medica Laboratories
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XXIX. Anti Demensia
XXIX.1 Memantine HCL Abixa Tablet 10 mg Apotek
Pertam Tablet 10 mg PT. Novell Pharmaceutical Laboratories
XXX. Obat Hiperurisemia dan Gout
XXX.1 Febuxostat Feburic Tablet 80 mg PT. Astellas Pharma Indonesia
Festaric Tablet 40 mg PT. Dexa Medica
80 mg PT. Dexa Medica
XXXI. Diuretik
XXXI.1 Samsca Samsca Tablet 15 mg PT. Otsuka Indonesia
XXXII. Analgesik Anti Inflamasi Non Steroid
XXXII.1 Leflunomid Arava Tablet 20 mg PT. Aventis Pharma
XXXIII. Antihistamin dan Antialergi
XXXIII.1 Mycophenolic acid Myfortic Tablet 180 mg PT. Novartis Indonesia
360 mg PT. Novartis Indonesia
XXXIV. Beta Blocker
XXXIV.1 Nebivolol Nebilet Tablet 50 mg PT. Transfarma Medica Indah
Nevodio Tablet 50 mg PT. Dexa Medica
XXXV. Antihipertensi Pulmonal
XXXV. 1 Sildenafil Sildenafil Tablet 50 mg PT. Novell Pharmaceutical Laboratories
100 mg PT. Novell Pharmaceutical Laboratories
Viastar blu Tablet 50 mg PT. Soho indus Farmasi
100 mg PT. Soho indus Farmasi
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YAYASAN KESEJAHTERAAN KARYAWAN BANK INDONESIA OBAT KHUSUS DENGAN PERSETUJUAN
NO ZAT AKTIF MERK SEDIAA DOSIS FARMASI Keterangan
N
I. Anti Demensia
I.1 Donepezil Alzim Tablet 5 mg PT. Pratapa Nirmala Fahrenheit Diresepkan oleh dokter spesialis saraf (neurologi).
Lampirkan surat keterangan medis yang berisikan
Donacept Tablet 5 mg PT. Novell Pharmaceutical Laboratories diagnosis / keterangan penyakit yang diderita pasien
Donepezil Tablet 5 mg PT. Novell Pharmaceutical Laboratories dan lampirkan hasil pemeriksaan fungsi luhur terbaru
(dalam 1 tahun terakhir)
I.2 Rivastigmin Exelon Patch Patch 18 mg/10 cm2 PT. Novartis Indonesia
5.9 mg/5 cm2 PT. Novartis Indonesia
II. Anti Ulserasi
II.1 Esomeprazole Nexium Injeksi 40 mg PT. Astra Zeneca Indonesia Untuk kasus GERD dan/atau ulkus peptikum.
Diresepkan oleh dokter spesialis penyakit dalam.
Lampirkan hasil pemeriksaan endoskopi maksimal 3
Tablet 40 mg PT. Astra Zeneca Indonesia bulan (90 hari) terakhir. Maksimal pemberian untuk
selama 6-8 minggu dan diberikan secara bertahap.
20 mg PT. Astra Zeneca Indonesia
III. Antibiotik
III.1 Linezolid Zyvox Tablet 600 mg PT. Pfizer Indonesia
III.2 Pefloxacin Dexaflox Kaplet 400 mg PT. Dexa Medica
III.3 Moxifloxacin Avelox Tablet 400 mg PT. Bayer Indonesia
Moxifloxacin Tablet 400 mg PT. Bernofarm Pharmaceutical
MXN Tablet 400 mg PT. Dexa Medica Diresepkan oleh dokter spesialis. Lampirkan surat
keterangan medis yang berisikan diagnosis /
Respira Tablet 400 mg PT. Novell Pharmaceutical Laboratories keterangan penyakit yang diderita pasien.
III.4 Roxithromycin Rulid Kaplet 300 mg Apotek
Tablet 150 mg Apotek
Roxithromycin Tablet 300 mg Apotek
Tablet 150 mg Apotek
IV. Cerebral Activator
IV. 1 Citicoline Citicholine Injeksi 250 mg/2 ml PT. Hexpharm Jaya Untuk kasus CVD Akut. Diresepkan oleh dokter
Citicoline Kaplet 1000 mg PT. Novell Pharmaceutical Laboratories spesialis saraf (neurologi). Lampirkan hasil
pemeriksaan CT Scan Kepala atau MRI Kepala terbaru
500 mg PT. Novell Pharmaceutical Laboratories (6 bulan terakhir) atau resume medis pasca lepas
Tablet 500 mg PT. Hexpharm Jaya rawat inap terakhir. Maksimal pemberian untuk
PT. Indofarma Tbk selama 3-6 bulan dan diberikan secara bertahap.
Lancolin Tablet 500 mg PT. Pertiwi Agung (Landson)
Takelin Kaplet 1000 mg PT. Mersifarma Tirmaku Mercusana
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rawat inap terakhir. Maksimal pemberian untuk
selama 3-6 bulan dan diberikan secara bertahap.
Takelin
Tablet 500 mg PT. Mersifarma Tirmaku Mercusana
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V. Nootropik dan Neurotonik
V.1 Piracetam Piracetam Injeksi 1 gr PT. Bernofarm Pharmaceutical
3 gr PT. Bernofarm Pharmaceutical
Kaplet 1200 mg PT. Hexpharm Jaya
800 mg PT. Novell Pharmaceutical Laboratories
PT. Hexpharm Jaya Untuk kasus CVD Akut. Diresepkan oleh dokter
Tablet 1200 mg PT. Novell Pharmaceutical Laboratories spesialis saraf (neurologi). Lampirkan hasil
PT. Bernofarm Pharmaceutical pemeriksaan CT Scan Kepala atau MRI Kepala terbaru
(6 bulan terakhir) atau resume medis pasca lepas
400 mg PT. Bernofarm Pharmaceutical rawat inap terakhir. Maksimal pemberian untuk
800 mg PT. Bernofarm Pharmaceutical selama 3-6 bulan dan diberikan secara bertahap.
Mersitropil Kaplet 1200 mg PT. Mersifarma Tirmaku Mercusana
400 mg PT. Mersifarma Tirmaku Mercusana
800 mg PT. Mersifarma Tirmaku Mercusana
Syrup 30-50 mg/kg PT. Mersifarma Tirmaku Mercusana
VI. Preparat Osteoporosis
VI.1 Alendronate Alovell Tablet 10 mg PT. Novell Pharmaceutical Laboratories
Untuk kasus osteoporosis di daerah
70 mg PT. Novell Pharmaceutical Laboratories
Vertebrae/Femur/Radius/Ulna. Lampirkan hasil
pemeriksaan BMD dengan hasil osteporosis < -2.5
VI.2 Ibandronate Bonevell PFS Injeksi 3 mg/ml PT. Novell Pharmaceutical Laboratories dan/atau hasil pemeriksaan radiologi dengan hasil
ekspertise dokter spesialis radiologi terdapat fraktur
Bonevell Injeksi 6mg/ml PT. Novell Pharmaceutical Laboratories
VII. Suplemen
VII.1 Essential Aminefron Tablet 630 mg PT. Dexa Medica Untuk kasus CKD. Diresepkan oleh dokter umum atau
Ketoacids Aminoral Kaplet 630 mg PT. Ethica Industri Farmasi dokter spesialis. Lampirkan hasil laboratorium
maksimal 3 bulan (90 hari) dengan hasil nilai
kreatinin > 2 atau proteinuri (++) atau GFR < 29
mL/min/1.73m²
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VIII. Obat Relaksan Otot
VIII.1 Baclofen Lioresal Tablet 10 mg PT. Novartis Indonesia Terapi untuk Multiple Sclerosis. Diresepkan oleh
dokter spesialis dan dilampirkan surat keterangan
medis yang berisi diagnosis / keterangan penyakit
yang diderita pasien.
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