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Lampiran Surat Keputusan SALINAN


Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
1. Alergi dan Sistem Imun
1.1 Anti Histamin dan Anti Alergi
Bethamethason + dexchlophenramine Colergis
1.1.1 tablet/syrup 0,25 mg,2 mg Dexa Medica
maleate celestamine tablet/syrup 0,25 mg,2 mg Schering Plough
1.1.2 Dexamethason MICRONIZED DEXATAMINE tablet/syrup 300 mg,65 ml Pharos
1.1.3 Cetirizine Cetirizine OGB tablet 10 MG Indo Farma
Falergi tablet/drop 10 mg/ 20 ml Indo Farma
incidal OD Caplet,Syrup 10 mg,5 mg/5ml Bayer
1.1.4 Loratadine (micronized) Loratadine OG B tablet 10 MG Hexpharm
claritine tablet/syrup 10 mg,5 mg/5ml Schering Plough
Rhinos SR
lesidas cap/syrup 10mg,5mg/5ml Kalbe Farma
1.1.5 chlorpheniramine maleate CTM OGB tablet 4 MG Indo Farma
COHISTAN tablet 4 MG MEDI FARMA
1.1.6 Pheniramine Hydrogen Maleate Avil tablet/syrup/Amp 25 mg,15 mg/5ml.50 mg/2 ml Sanovi
1.1.9 Fexofenadine Hcl Telfast 30 tablet 30 mg sanovi
Telfast OD Tablet 120 MG sanovi
Pseudoefedhrine Hcl 15 mg , Telfast Plus tablet/susp 60 mg sanovi
1.1.10 Pseudoefedhrine 60 MG,TRIPROLIDINE Triaminic syrup 60 ml Novatis
1.1.11 Chlorfeniramine Maeleat 1 mg Triped tablet/syrup 125 mg/5 ml Interbat
HCL 2,5 MG rhinofed tablet dexa medica
1.1.13 prednisone predniso nufarindo tablet 5 mg nufarindo
2. Sistem Gastrointestinal
Antasid & Anti Ulcer
Ranitidin Gastridin Tab , Amp 150 mg, 50 mg / Interbat
Rantin Tab , Amp 150 mg, 50 mg / Kalbe Farma
Zantac Tablet , Amp 150,300 mg, 50 mg/2ml Glaxo Smith ind
Lansoprazole Digest Tablet 30 mg Kalbe Farma
Lansooprazole ogb Tablet 30 mg medikon
prosogan Tablet, amp 30 mg, Takeda

OMZ Kapsul . Amp 20 mg, 40 mg ferron


ozid Kapsul . 20 mg. darya varia
Sulpiride Dogmatil Kapsul, Tablet 50mg, 100mg, 200mg Soho
Sucralfate Episan Suspensi 500mg/ 5 ml sanbe
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Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Inpepsa Larutan 500mg/ 5 ml farenheit
Esomeprazole Nexium Tablet, vial 20 mg, 40 mg Astrazeneca
Na rabeprazole Pariet tablet 10, 20 mg Eisai

Simethicone Plantacid Tablet, suspensi 100 mg Kalbe farma


Dimeticone Polisilane Tablet, suspensi pharos
Anti Inflamasi gastrointestinal

Metoclorpropamide primperan Tablet. Tetes, Vial 5 mg,1 mg, 10 mg Soho

Domperidone Vometa Syrup, tetes 1 mg,5 mg Dexa


Vomitas Tablet, syr 10 mg, 5mg Kalbe
Anti spasmodik
Hyoscine- N-butybromide Gitas ampul 20 mg Interbat
Gitas Plus Kaplet Selaput gula Interbat
Antidiare
ActivatedColloidal Entrostop Tablet Kalbe farma
New Diatab tablet 600 mg Medifarma
Loperamide Hcl Immodium Tablet 2 mg Johnson&johnson
Lodia Tablet 2 mg Sanbe
Laksatif
Bisacodyl Bicolax Tablet 5 mg Armoxindo
Lactulose Lantulos Syr 3.43 mg/ 5ml Landson
susp Laxadine Emulsion 30 ml Gaenium

susp Microlax Enema 5 ml 5 ml Pharos


Digestan
Amylase Enzyplex Tablet Medifarma
Meloclopramide Primperan Tablet, draag soho
Pancreatin Tripanzym Kapsul Salut Sanbe
Vitazym Tablet Salut Kalbe
Kolagogum
Preparat Anorektal
Lithosphermi Borraginol N Salep 15 g Takeda
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Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Borraginol S Kaplet 30 mg Takeda
3. Antibiotik
3.1 Cefalosporin
cefadroxil biodrokcil srp 125 mg - 5 mg Sandos
cefadroxil Mohydrate Cefadroxil OGB Capsule/syrup 500 mg - 125 mg Hexparm
Dexacef Capsule/syrup 500 mg - 125 mg Ferron
3.1.2 Cefalexin Monohidrete Cefalexin OGB Capsule 500 mg Indofarma
Cefabiotic Capsule 250 mg - 500 mg Bernofram
Hexparm/kimia
3.1.3 Cefixime Cefixime OGB Capsule/syrup 100 mg
Trixim Capsule/syrup 100 mg farma
Ferron
3.1.4 Cefuroxime Axetil Anbacim Tablet 500 mg Sanbe farma
Soxime tablet 500 mg soho
3.1.5 Cefadroxil Opicef Capsule/syrup 500 mg - 125 mg Otto
Osadrox Capsule/syrup 500 mg - 100 mg Sandoz
3.1.6 Amoxicillin Amobiotic Capsulu/syrup 500 mg - 6 ml Bernofram
Sloxo Smith
Anoxyl Capsule/ syrup / Tab 500 mg 250/5ml 60 ml
Amoxillin Capsule/syrup 500 mg - 60 ml Klene
Kalbe Farma
Corsamex Capsule/ syrup 250 - 125 mg Corsn
Amoxan/ Amoxsef Capsule/syrup 500 mg - 250 mg - 6 ml Cefri Farmindo
Farmoxyl tablet/syrup 500mg,125mg/5ml/60ml Fahrenheit
Kalmoxillin tablet/syrup 500mg,125mg/5ml,60ml Kalbe Farma
3.1.7 Ampicillin Ampi Capsule/syrup 500 mg - 125 mg/5 ml,60 ml
Clavamox250tb - co Amoxiclav - Corsacillin capsule/syrup 250- 125 mg / 5 ml - 60 ml Corsa
3.1.8 Clavamox500tb Clavamox kaps/ vial 250 mg - 500 mg Kalbe Farma
3.1.9 Amoxiciilin 250 -kcoclavulanate
Amoxiclav1250mg
-
Clavamox kaps/ vial 250 mg - 500 mg Kalbe Farma
Amoxiciilin
3.2 Chloramphenicol 250 k clavulanate 1250mg
3.2.1 thiamphenicol biothicol cap/ syr 250 mg sanbe
3.2.2 chlorampenicol chloramex cap/ syr 250 mg Actavis
3.3 Makrolid
3.3.1 clarithomycin abbotica/ abbotic xl tab 500 mg abbot
3.3.2 erythromycin erysanbe kaps 250 mg sanbe
3.3.3 erythromycin Narlecin kaps 500 mg Mersi farma
3.3.4 Clarithromycin Orixal kaps 250 mg Ifars
3.3.5 spiramycin Osmycin tab 500 mg pharos
3.4 Penisilin
3.4.1 Amoxicilin amoxillin kaps 500 mg pharos
Lembar ke -4
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
3.5 Kuinolon
3.4.1 ciprofloxacin hcl baquinor tab 500 mg sanbe
3.4.2 ciprofloxacin ciprofloxacin cap 125 mg indo farma
3.4.3 Ofloxacin Akilen tab 200 mg Sanbe
3.6 Tetrasiklin
3.6.1 doxycycline doxycycline cap indo farma
3.7 Anti Jamur
3.7.2 acyclovir acyclovir tab 200 mg indo farma
3.7.3 acyclovir azovir tab 200 mg medikon
3.8 Kombinasi Anti Bakterial
3.9 Antibiotik Lain
3.9.1 metronidazol trichodazol tab 500 mg sanbe
4. Sistem Kardiovaskular dan Hematopoietik
4.1 OBAT JANTUNG
4.1.3 Amiodarone HCL Cordarone Tablet 200 mg Sanofi Aventis
4.1.5 Propafenone HCL Rytmonorm Tablet 150 mg Abbott
4.2. Obat Anti Angina
Cedocard / Cedocard Darya - Varia /
4.2.2 Isosorbide dinitrate Tablet 5,5 mg ; 10 mg ; 20 mg
Retard Tablet Retard 20 mg Nycomed
Farsorbid Tablet 5 mg ; 10 mg Fahrenheit
Isoket Spray Botol Spray 375 mg Phapros / UCB
Glaxo Smith
Isoket Tablet Tablet 5 mg ; 10 mg
Tab Retard 20 mg Kline Indonesia
Isorbid Tablet 10 mg Pharos
Tab sublingual 5 mg
4.2.3 Amiodarone HCL Cordarone Tablet 200 mg Sanofi Aventis
Injeksi 150 mg
4.2.4 Amlodipine besylate Intervask Tablet 5 mg Interbat
Tensivask Tablet 5 mg ; 10 mg Dexa Medica

4.3 ACE Inhibitor


Captopril Captensin Tablet 12,5 mg ; 25 mg Kalbe Farma
Farmoten Tablet 12,5 mg ; 25 mg Fahrenheit
4.4 Beta Blocker
4.4.1 Bisoprolol fumarate B-Beta Tablet 5 mg Ferron
Lembar ke -5
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
4.4.2 Bisoprolol hemifumarate Concor Tablet 1,25 mg ; 2,5 mg ; 5 mg Merck
4.4.3 Atenolol Betablok Tablet 50 mg ; 100 mg Hexpharm Jaya
4.5 Antagonis Kalsium
4.5.1 Nifedipine Adalat Tablet 5 mg ; 10 mg Bayer Healthcare
4.5.2 Nifedipine GITS Adalat Oros OGB
Amlodipine Tablet 20 mg ; 30 mg ; 60 mg Bayer Healthcare
4.5.4 Amlodipine besylate Tablet 5 mg ; 10 mg Medikon
Medikon
Norvask Tablet 5 mg ; 10 mg Pfizer
Tensivask Tablet 5 mg ; 10 mg Dexa Medica
4.5.6 Diltiazem HCL Farmabes Tablet 30 mg Fahrenheit
Injeksi 5 mg
4.5.7 Verapamil HCL Isoptin SR Kapsul 240 mg Abbott

4.6 Antagonis Angiotensin II


4.6.1 Losartan K Angioten Tablet 50 mg Kalbe Farma
4.6.2 Irbesartan Aprovel Tablet 150 mg ; 300 mg Sanofi Aventis
Co-Irvell Tablet Novell Pharma
Irvask Tablet 150 mg ; 300 mg Kalbe Farma
4.6.3 Candesartan cilexetil Blopress Tablet 8 mg ; 16 mg Takeda
Novartis
4.6.5 Valsartan Co-Diovan Tablet 80/12,5 mg
Tablet 160/12,5 mg Indonesia
Tablet 160/25 mg Novartis
Diovan Tablet 40 mg ; 80 mg ; 160 mg Boehringer
4.6.6 Telmisartan Micardis Tablet 40 mg ; 80 mg Indonesia
Boehringer
Ingelheim
Micardis Plus Tablet 40/12,5 mg
Tablet 80/12,5 mg Ingelheim
4.7 Anti Hipertensi Golongan Lain
4.7.1 Doxazosin mesylate Cardura Tablet 1 mg ; 2 mg Pfizer
4.8 Diuretik
4.8.2 Perindopril Bioprexum Plus Tablet 5 mg Servier
4.8.4 Irbesartan Coaprovel Tablet 150/12,5 mg Sanofi Aventis
Tablet 300/12,5 mg
4.8.5 Furosemide Lasix Tablet 40 mg Sanofi Aventis
Injeksi 20 mg/ 2 mL
4.8.6 Indapamide Natrilix SR Tablet 1,5 mg Servier
4.9 Vasodilator Perifer & Aktivator Cerebral
Lembar ke -6
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Global Multi
4.9.1 Flunarizine HCL Cedavil Tablet 5 mg ; 10 mg
Silum Tablet 5 mg ; 10 mg Pharmalab
Mersifarma(GMP)
TM
4.9.2 Citicoline Na Lancolin Injeksi 250 mg/2 mL ; 500 mg/4 mL Landson
Johnson &
4.9.3 Flunarizine Sibelium Tablet 5 mg ; 10 mg
4.9.4 Cinnarizine Stugeron Tablet 25 mg Johnson &
4.10 Obat Migrain & Obat Anti vertigo Johnson
Global Multi
4.10.1 Flunarizine HCL Cevadil Tablet 5 mg ; 10 mg
Silum Tablet 5 mg ; 10 mg Pharmalab
Mersifarma TM
4.10.5 Betahistine Mesylate Lexigo Tablet 6 mg Molex Ayus
Mertigo Tablet 6 mg Dexa Medica
Rotaver Tablet 6 mg Meprofarm
Johnson &
4.10.6 Cinnarizine Stugeron Tablet 25 mg
4.11 Hemostatik Johnson
Novartis
4.11.3 Octreotide Sandostatin Injeksi 0,1 mg/mL
4.11.4 Somatostatin Somanovell Injeksi 3 mg Indonesia
Novell Pharma
4.11.5 Tranexamic acid Tranec Kapsul 500 mg Gracia Pharmindo
Injeksi 50 mg/mL
4.12 Anti Koagulan, Anti Platelet & Fibrinolitik
4.12.1 Acetylsalicylic acid Ascardia Tablet 80 mg ; 160 mg Pharos
Aspilets Tablet 80 mg Medifarma
Cardio Aspirin Tablet 100 mg Bayer Healthcare
Thrombo Aspilates Tablet 80 mg Medifarma
4.12.2 Clopidogrel Plavix Tablet 75 mg Sanofi Aventis
4.12.3 Cilostazol Pletaal Tablet 50 mg ; 100 mg Otsuka
Pletaal Powder Bubuk 20% x 0,25 g Otsuka
4.12.4 Warfarin Na Simarc-2 Tablet 2 mg Fahrenheit
4.12.5 Clopidogrel bisulfate Simclovix Tablet 75 mg Simex
4.13 . Haemostatics
Novartis
4.13.3 Octreotide Sandostatin Injeksi 0,1 mg/mL
4.13.4 Somatostatin Somanovell Injeksi 3 mg Indonesia
Novell Pharma
4.13.5 Tranexamic acid Tranec Kapsul 500 mg Gracia Pharmindo
Injeksi 50 mg/mL
4.14. Anticoagulants, Antiplatelets & Fibrinolytics
4.14.1 Acetylsalicylic acid Ascardia Tablet 80 mg Pharos
Tablet 160 m
Lembar ke -7
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Cardio Aspirin Tablet 100 mg Bayer Healthcare
Farmasal Tablet 100 mg Fahrenheit
Thrombo Aspilates Tablet 80 mg Medifarma
4.14.2 Clopidogrel Plavix Tablet 75 mg Sanofi Aventis
4.14.3 Cilostazol Pletaal Tablet 50 mg ; 100 mg Otsuka
Pletaal Powder Bubuk (Sachet) 20 % x 0,25 g Otsuka
Stazol Tablet 100 mg Bernofarm
4.14.4 Warfarin Na Simarc-2 Tablet 2 mg Fahrenheit
4.14.5 Clopidogrel bisulfate Simclovix Tablet 75 mg Simex
4.15 Preparat Flebitis & Varises
Hidrosmin Venosmil Gel 2 % x 60 g Kalbe Farma
4.16. Obat Hemorheologi

4.17 Obat Hematopoietik


4.17.1 Epoetin
Recombinant human granulocyte colony Hemapo Inj 3.000 IU/mL ; 10.000 IU/mL Kalbe Farma
4.17.2 Novel - Leukokine Inj 300 mcg x 1,2 mL Novell Pharma
stimulating factor
4.18 Obat Kardiovaskular Golongan Lain
4.18.6 Pyridoxine HCL Myoviton Tablet 100 Pharos
5.Preparat Kulit Topikal
5.1 Antibiotik Topikal
5.1.1 Mupirocin Bactoderm Krim ; Salep 2% x 5 gr ; 2% x 10 gr Ikapharmindo
5.1.2 Neomycin Sulfate + Placenta Extr Bioplacenton Gel 0,5% + 10% Parazelsus
Kalbe Farma
5.1.3 Krim - Fusidic Acid ; Salep - Na Fusidate Fucidin Krim ; Salep 2% x 5 gr Indonesia / LEO
5.1.4 Chloramphenicol Kalmicetine Salep 2% x 15 gr Kalbe Farma
Pharma
5.1.5 Gentamycin Sulfate Sagestam Krim ; Salep 0,1% x 10 gr Sanbe
Gentamycin OGB Krim 0.10% Kimia Farma
Ottogenta Krim 0.10% Otto
5.1.6 Silver Sulfadiazine Burnazin Krim 10 mg Darya Varia
5.2 Anti Jamur & Anti Parasit Topikal Bayer Consumer
5.2.1 Clotrimazole Canesten Krim ; Bubuk 1.00% Johnson &
5.2.2 Miconazole Nitrate Daktarin Krim ; Bubuk 2.00% Care
Moladerm Krim 20 mg Johnson
Molex
JohnsonAyus
&
5.2.3 Miconazole Nitrate + Zn Oxide Daktarin Diaper Salep 25 mg + 150 mg
5.2.4 Ketoconazole Formyco Krim 2.00% Johnson
Sanbe
Johnson &
Nizoral Krim 2.00% Novartis
5.2.5 Terbinafine HCL Lamisil / Lamisil AT Krim 1.00% Johnson
Indonesia
Lembar ke -8
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Taisho
5.2.7 Nystatin + Zn Oxide Myco-Z Salep 100.000 u + 200 mg
5.2.8 Tioconazole Trosyd Krim 1.00% Pharmaceutical
Pfizer
5.3 Antivirus Topikal
5.3.1 Acyclovir Clinovir Krim 5.00% Pharos
Acyclovir OGB Krim 5.00% Kimia Farma
5.4 Anti Infeksi Topikal dengan Kortikosteroid
5.4.1 Desonide + Neomycin Sulfate Apolar -N Krim 0,5 mg + 5 mg Actavis
Bayer Health
5.4.2 Dexamethasone + Clotrimazole
Betamethasone valerate + Gentamycin Baycuten-N Krim 0,4 mg + 10 mg
5.4.3 Benoson G Krim 0,1% + 0,1% Care
Bernofarm
Betamethasone valerate + Miconazole
Sulfate
5.4.4 Gentamicin sulfate + Fluocinolone Benoson N Krim 0,1% + 2% Bernofarm
5.4.7 Nitrate Cinogenta Krim 1,67 mg + 0,25 mg Ferron
Betamethasone Dipropionate + Salicylic
Acetonide
5.4.9 Diprosalic Lotion 0,05% + 2% Schering - Plough
Acid Salep 0,05% + 3%
5.4.13 Flumethasone Pivalate + Salicylic Acid Locasalen Salep 0,02% + 3% Novartis
5.5 Kartikosteroid Topikal
5.5.5 Betamethasone Dipropionate Diprosone Krim
Lotion/ Salep
/ Krim / 0.05% Schering-Plough
5.5.6 Mometasone Furoate Elocon 0.10% Schering-Plough
5.5.7 Desoximetasone Esperson Salep
Gel 0.05% Sanofi Aventis
Salep 0.25% Taisho
5.5.8 Triamcinolone Acetonide Kenacort - A Krim 0.10%
5.5.9 Betamethasone Valerate Betamethasone OGB Krim 0.10% Pharmaceutical
Kimia Firma

5.6 Preparat Acne


5.6.1 Sulfur yang diendapkan Acne Feldin Lotion 6.60% Galenium
5.6.2 Clindamycin Phosphate Cindala Gel 1.00% Medikon
Clindamycin Phosphate Complex + Zn Clinika Solution ; Gel 1.00% Ikapharmindo
5.6.3 Climadan Gel 1,2% + 0,5% Kalbe Farma
5.6.4 Acetate
Fluocinolone Dermasolon Gel 0.03% Ikapharmindo
Johnson &
5.6.7 Tretinoin Retin - A Krim 0,025% ; 0,05% ; 0,1%
Trentin Krim 0,05% ; 1% Johnson
Ikapharmindo
Solution ; Gel ;
5.6.8 Retinoic Acid Vitacid 0,25% ; 0,05% ; 0,1% SDM Lab
5.6.9 Azelaic Acid Zelface Krim
Krim 20.00% Ferron
Zeliris Krim 20.00% Caprifarmindo
5.7 Anti Histamin / Anti Pruritus
5.8 Preparat Psoriasis, Seboroik & Iktiosis Parazelsus
5.8.1 Calcipotriol Daivonex Salep 0.05%
Indonesia / LEO
Lembar ke -9
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
5.8.2 Ketoconazole Interzol Scalp Solution 1% ; 2% Interbat
Johnson &
Nizoral - SS Solution 1% ; 2%
5.8.3 Calcipotriol + Betamethasone Dipropionate Daivobet Oint 0,05% + 0,5 mg/gr Johnson
Darya Varia
5.8.4 Urea Moisderm Krim 10.00% Interbat
5.9. Emolien & Pelindung Kulit
5.9.1 L-Ascorbic
Padimate O Acid 2-Glucoside
+ Oxybenzone + Aloe Vera
+ Titanium Bion - C Serum 2.00% Nicholas
5.9.2 Ethylhexyl-methoxycinnamate + Titanium Pabanox Krim 20 gr SDM Lab
5.9.3 Dioxide Parasol Krim 20 gr SDM Lab
Dioxide
5.10 Antiseptik + Oxybenzone
& Desinfektan Kulit Cons ; Gel Vag ;
5.10.1 Policresulen Albothyl 0.36% Pharos / Nycomed
5.10.2 Etakridin Rivanol 0,1% Ovula
Solution 0.10% Ikapharmindo
5.10.3 Hydrogen Perokside Hydrogen Peroside Solution 3.00% Apotek
5.10.4 Kalium Permanganat Kalium Permanganat Serbuk 5 gr Apotek
5.10.5 Povidone - Iodine Septika Solution 10.00% Ikapharmindo
5.11 Kasa Steril Mengandung Obat Daryant - Tulle
5.11.2 Framycetin Sulfate Kasa 1.00% Darya Varia
5.12 Topikal Anti Jamur dan Parasit Sterile Gz
5.12.1 Clotrimazole Fungiderm Krim 1.00% Konimex
5.12.2 Ketoconazole (Powder/Shampo) Zoloral - SS Shampo Solution 20 mg/mL Ikapharmindo
5.12.3 Nystatin Myco - Z Krim 100.000 IU Taisho
5.12.4 Terbinafine HCL Interbi Krim 1.00% Interbat
5.13 Topikal Analgestik & Anti Inflamasi
5.14 Topikal Anastesi
6. Preparat Mata, Telinga, Mulut/Tenggorokan
6.I Anti Infeksi & Antiseptik Mata
6.1.1 Ciprofloxacin Baquinor Tetes Mata 3 mg/mL Sanbe Vision
Interflox Tetes Mata 3 mg/mL Interbat
6.1.2 Levofloxacin Cravit Larutan Mata 0,5% x 5 mL Ferron / Santen
Levocin Tetes Mata 5 mg/mL x 5 mL Sanbe Vision
6.1.4 Chloramphenicol Ikamicetin
Chlorampenicol Salep Mata 1% x 3,5 mg Ikapharmindo
Salep Mata 1% Kimia Farma
OGB
Colme Eye Tetes Mata 0.05% Interbat
6.1.5 Neomycin sulfate 5 Nebacetin Salep Mata 2,5 mg Pharos
6.1.7 Ofloxacin Tarivid Tetes Mata 0,3% x 5 mL Ferron / Santen
Glaxo Smith
6.1.8 Acyclovir Zovirax Salep Mata 3% x 4,5 g
Hervis Tetes Mata 3% Kline
CendoIndonesia
Lembar ke -10
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
6.2 Antiseptik Mata dengan Kortikosteroid Sanbe Vision / Dr
6.2.1 Betamethasone dihydrogen phosphate Betagentam Tetes Mata 5 mL
Cendo Vosama Tetes Mata 0.10% Winzer
Cendo
6.2.2 Tobramycin + Dexamethasone Bralifex Plus Susp Mata 5 mL Sanbe Vision
Cendo Troboson Tetes Mata 0,1% + 0,3% Cendo
6.2.3 Dexamethasone + Neomycin + Polymixin B Inmatrol Tetes Mata 5 mL Interbat
Isotic Neolyson Tetes Mata 5 mL Fahrenheit
Isotic Tobrison Susp Mata 5 mL Fahrenheit
6.3 Kortikosteroid Mata
Betamethasone dihydrogen phosphate Sanbe Vision / Dr
6.3.1 Betam - Ophtal Tetes Mata 0,1 % x 5 mL
6.3.2 disodium
Fluorometholone Flumetholon Susp Mata 0,1 % x 5 mL Winzer
Ferron / Santen
6.3.3 Betamethasone Na Phosphate Cendo Vosama Tetes Mata 0.10% Cendo

6.4 Obat Midriatikum


6.4.1 Atropine Sulfate Cendo Tropine Tetes Mata 0,5% ; 1% Cendo
6.5 Obat Glaukoma
6.5.1 Acetazolamide Glauseta Tablet 250 mg Sanbe Vision
6.5.2 Latanoprost + Benzalkonium Latipress Tetes Mata 2,5 mL Global Multi
Kalbe Vision
6.5.3 Timolol maleate Opthil Tetes Mata 0,25% x 5 mL Pharmalab ( GMP
0,5% x 5 mL )
Cendo Tymol Tetes Mata 0.25% ; 05% Cendo
6.5.4 Betaxolol HCL Optibet Tetes Mata 0,5% x 5 mL Sanbe Vision
6.5.5 Brinzolamide Azopt Tetes Mata 1% Alcon
6.5.6 Latanoprost + Timolol Xalacom Tetes Mata 50 mcg + 5 mg Pfizer
6.5.7 Pilocarpine Cendo Carpine Tetes Mata 1% ; 2% Cendo
6.5.8 Travaprost Travatan Tetes Mata 0.00% Alcon

6.6 Obat Dekongesten, Anestesi, Antiinflamasi Mata


6.6.1 Diclofenac Na Flamar Tetes Mata 1 mg/mL x 5 mL Sanbe Vision
6.6.2 Na hyaluronate Hialid Lar Mata 0,1% x 5 mL Ferron / Santen
6.6.3 Tetrahydrozoline HCL Insto Tetes Mata 7,5 mL Global
SterlingMulti
Visto Tetes Mata 0,05% x 10 mL Pharmalab ( GMP
6.7 Preparat Mata Golongan Lain )
6.7.1 Dextran + Hydroxy Methylcellulose Tears Naturale II Tetes Mata 0,1% + 0,3% Alcon
6.7.2 Diclofenac Na Voltaren Ophtha Tetes Mata 1 mg/mL Novartis
6.7.3 Carboxy methylcellulose Cendo Cenfresh Tetes Mata Cendo
Lembar ke -11
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
6.7.4 Hypromellose /+ carbomer Genteal Tetes Mata / Salep 0,3% ; 0,3% + 0,22% Novartis
6.7.5 Na Hyaluronate Hialid Tetes Mata 0.10% Ferron
6.7.6 Naphazoline HCL + Pheniramine Maleat Naphcon-A Tetes Mata 0,025% + 0,3% Alcon
6.7.7 Pemirolast K Alegysal Tetes Mata 0.10% Ferron
6.8 Anti Infeksi dan Antiseptik Telinga
6.8.1 Chlorampenicol + Lidocain HCL Colme Tetes Telinga 10% + 4% Interbat
Kalbe Farma /
6.8.3 Ofloxacin Tarivid Otic Tetes Telinga 3 mg/mL
6.9 AntiseptikFludrocortison
& Kortikosteroid Telinga + Polymixin B Daiichi
+ Neomycin
6.9.1 Neomycin + Polimixin B + Furalthallidone Otopain Tetes Telinga 5 mg + 25 mg + 50.000 IU Interbat
6.9.2 dll Otozambon Tetes Telinga 500 mg + 1 jt IU + 450 mg Zambon
dll
6.10 Preparat Telinga Golongan Lain
6.10.1 Docusate Na Forumen Tetes Telinga 5 mg/mL Sanbe
6.10.2 Asam Asetat 2% Asam Asetat 2% Tetes Telinga 2% Apotek
6.11 Preparat Mulut / Tenggorokan Johnson &
6.11.1 Miconazole Daktarin Oral Gel Oral Gel 20 mg/gr
6.11.3 Chlorhexidine digluconate Fordenta Oral Gel 1,2% x 100 mg Johnson
Kalbe
TaishoFarma
6.11.4 Triamcinolone acetonide Kenalog In Orabase Oral Gel 0,1% 5 gr x 2
6.11.6 Hyaluronic acid Sanorine Obat Kumur 0,025% x 80 mL Pharmaceutical
Sanbe
6.11.7 Benzydamide HCL Tantum Verde Obat Kumur 7,5 mg/5 mL Soho
6.11.8 Povidone Iodine Betadine Obat Kumur 1% Mahakam
6.11.9 Chlorhexidine gluconate Minosep Obat Kumur 0.10% Minorock
7. Sistem Urogenital
7.1 Preparat Vagina
7.1.1 Metronidazole + Nystatin Fladistin Ovulae Ovulae 500 mg+ 100.000 iu Dexa Medica
Flagystatin Ovulae Ovulae 501 mg+ 100.000 iu Sanofi Aventis
7.1.2 Povidone lodine Betadine Solution 1% Mahakam
7.2 Antiseptik Saluran Kemih
7.2.1 Pipemidic Acid Urinter Capsule 400 mg Interbat
7.3 Preparat Sistem Urogenital Lain Glaxo Smith
7.3.1 Dutasterid Avodart Capsule 0.5 mg
7.3.2 Tamsulosin Hydrochlorida Harnal Capsule 0.2 mg; 0.4 mg Kline
Astellas
7.3.3 Solifencin Succinate Vesicare Tablet 5 mg; 10 mg Astellas
7.3.4 Bethanecol Urocab Tablet 10 mg Mayne Pharma
7.4 Preparation for Vaginal Conditions Canesten SD / Bayer Consumer
7.4.1 Clotimazole Tablet SD 500mg, VT 100mg
Canesten VT Care
Lembar ke -12
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
7.4.2 Metronidazole Flagyl Forte Tablet 250mg Sanofi Aventis
7.4.3 Susp 125mg
Supp 0.5g
7.4.3 Metronidazole, Nystatin Flagystatin Vag Cream 25g Sanofi Aventis
Ovule 10's
7.4.5 Estriol Ovestin Cream 1mg/g Schering-Plough
7.5 Urinary Antiseptics
7.5.1 Pipemidic Acid Urixin Film Tab 400mg Abbott
Tablet 100's
7.6 Drugs Acting on the Uterus
7.6.1 Isoxsuprine HCI Duvadilan Tablet 20mg Solvay Pharma
Ampul 10mg/2
7.6.2 Synthetic Oxytocin Induxin Ampul 10 iu/ml Kalbe Farma
7.6.3 Methylergometrine maleate Metilat Tablet 0.125mg Mestika Farma
7.6.4 Methylergometrine maleate Metvell Film-CoatedTab 0.125mg Novell Pharma
7.6.5 Methylergometrine maleate Myomergin Ampul 0.2mg/ml Ethica
7.7 Drugs for Erectile Dysfunction
7.7.2 Sildenafil Citrate Viagra Tablet 50mg, 100mg Pfizer
7.7.3 Sildenafil Citrate Vimax Tablet 50mg, 100mg Sandoz
7.7.4 Doxazosin Mesylate Cardura Tablet 1mg, 2mg Pfizer
7.7.5 Tamsulosin HCI Harnal D Dipersible Tab 0.2mg Astellas
Merck Sharp &
7.7.6 Finasteride Proscar Tablet 5mg
7.7.8 Tamsulosin HCI Harnal Ocas Tablet 0.4mg Dohme
Astellas
7.8 Other Drugs Acting on the Genito-Urinary System
7.8.3 Essential ketoacids Ketosteril Tablet 630mg Fresenius Kabi
8. HORMON
8.1 Estrogen ; Progesteron & Preparat Sintetik

8.1.1 Medroxyprogesterone Acetate Gentin f1 inj 0,5 ml Harsen


Provera Tab 100 mg Pfizer
8.2 Hormon Kortikosteroid
Dexametason Indexon Tab 0,5 mg Interbat
Kalmethasone Tab 0,5 mg Hexpharm Jaya
Dexamethasone Tab 0,5 mg Indofarma
Metilprednisolon Hexilon Tab 4 mg Kalbe farma
Medrol Tab 4 mg Pfizer
Lembar ke -13
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Methylon
Methylprednisolone Tab 4 mg Bernofarm
Tab 4 MG Dexa Medica
Prednisone Ogb
Lexacort Tab 5 mg Molex Ayus
Triamcinolone Amtocort Tab 4 mg Pharos
Lexacort Tab 5 mg Molex Ayus
Steroid Tibolone Livial Tab 2.5 mg MSD
9. Sistem Endokrin dan Metabolik
9.1 Oral Antidiabetic Agents
9.1.1 Per 1/250mg Glimepiride 1mg, metformin
Pioglitazone Actos Tablet 15mg Takeda
9.1.4 HCI 250mg. Per 2/500mg Glimepiride 2mg, Amaryl M Film-Coated Tab 1/250mg Sanofi Aventis
9.1.7 Pioglitazone
metformin HCI HCI500mg Deculin Tablet 15mg, 30mg Dexa Medica
9.1.8 Repaglinide Dexanorm Tablet 0.5mg ; 1mg Dexa Medica
9.1.9 Chlorpropamide Diabinese Tablet 100mg ; 250mg Pfizer
9.1.11 Glicazide Diamicron NR Tablet 30mg Servier
9.1.13 Gliquidone Fordiab Tablet 30mg Hexpharm
Novartis Jaya
9.1.14 Vildagliptin Galvus Tablet 50mg
50mg/500mg ; 50mg/850mg ; Novartis
9.1.15 Vildagliptin, Metformin HCI Galvusmet Tablet Indonesia
9.1.16 Glicazide Glidabet Tablet 50mg/1000mg
80mg Indonesia
Hexpharm Jaya
9.1.17 Pioglitazone Gliabetes Tablet 30mg Sanbe
9.1.19 Metformin HCI
Per 1.25mg/250mg tab Glibenclamide Glucophage Film-Coated Tab
Per 1.25mg/250mg 500mg ; 850mg ; 1000mg Merck
9.1.20 Metformin HCI
1.25mg, metformin HCI 250mg. Per Glucophage XR Tablet
film-coated tab Per 500mg Merck
9.1.21 Glipizide GITStab Glibenclamide 2.5mg,
2.5mg/500mg Glucotrol XR GITS tab
2.5mg/500mg film- 5mg ; 10mg Pfizer
9.1.22 Glucovance 100's Merck
9.1.24 metformin
Metformin HCI
HCI 500mg. Per Glufor coated
Tablet tab Per 500mg ; 850mg Pyridam
5mg/500mg tab Glibenclamide 5mg, 5mg/500mg film- Boehringer
9.1.28 Gliquidone Glurenorm Tablet 30mg
9.1.31 metformin HCI
Glibenclamide 500mg Libronil coated
Kaplet tab 5mg Ingelheim
Hexpharm Jaya
9.1.32 Gliclazide Linodiab Tablet 80mg Pyridam
9.1.33 Glimepiride Mapryl Tablet 1mg ; 2mg ; 3mg Ikapharmindo
9.1.34 Gliclazide Meltika
Metformin HCL Tablet 80mg Ikapharmindo
9.1.35 Metformin HCI Tablet 500mg ; 850mg Dexa Medica
9.1.37 Gliclazide OGB Dexa
Nufamicron Tablet 80mg Nufarindo
9.1.38 Saxagliptin Onglyza Tab Salut Selaput 5mg AstraZeneca
9.1.39 Glimepiride Metrix Tablet 1mg ; 2mg ; 3mg ; 4mg Kalbe Farma
9.1.40 Metformin HCI Nevox / Nevox XR Nevox
Nevox tab
XR 500mg ; 850mg Kalbe Farma
500mgx30's
Extended-release tab
Lembar ke -14
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
9.1.41 Glimepiride Norizec Tablet 1mg ; 2mg ; 3mg Medifarma/UAP
9.1.42 Glibenclamide Padonil Tablet 5mg Phapros
9.1.44 Per 15/500mgHCI
Pioglitazone Pioglitazone 15mg, Pionix Tablet 15mg ; 30mg Kalbe Farma
9.1.45 metformin HCI 500mg. Per15/850mg Pionix-M Tablet 3x10's Kalbe Farma
9.1.49 Gliclazide
Pioglitazone 15mg, metformin HCI 850mg Xepabet Tablet 80mg Metiska Farma
9.2 Preparat Teroid
9.2.1 L-thyroxine Na Thyrax Tablet 100mcg x 100's Schering-plough
9.3 Obat Anti Obesitas
9.3.1 Orlistat Xenical Kapsul 120mg Roche
9.4 Insulin
9.4.1 Insulin Glulisine Adipra Vial 100 UI/ml Sanofi Aventis
Solostar 100 UI/ml
9.4.2 Insulin Lispro Humalog Inj 100 UI/ml Eli Lilly
9.4.3 Premix Insulin Humulin 30/70 Vial 100 UI/ml Eli Lilly
Catridge 100 UI/ml
9.4.4 Insulin Glargine Lantus Vial 100 UI/ml Sanofi Aventis
Sansulin N / Solostar 100 UI/ml
9.4.5 Rekombinan insulin manusia Catridge Sansulin N 100 UI/ml Sanbe
Sansulin R Catridge Sansulin R 100 UI/ml
9.5 Obat Metabolisme Tulang
9.5.1 Alendronate Na Alovell Tablet 10mg Novell Pharma
9.5.2 Calcitriol Calcit Kapsul Lunak 0.25mcg Soho
9.5.3 Calcitriol Ecatrol Kapsul Lunak 0.25mcg Ethica
9.5.4 Raloxifene HCI Evista Tablet 60mg Eli Lilly
9.5.5 Alendronate Na Nichospor Tab Salut Selaput 10mg Nicholas
9.5.6 Alendronate Na Osteofar Tablet 10mg Fahrenheit
9.5.9 Risedronate Na Retonel Tab Salut Selaput 5mg Dexa Medica
Novartis
9.5.10 Zoledronic Acid Zometa Vial 4mg
10. Sistem Syaraf Pusat Indonesia
10.1 Analgesik & Antipiretik
10.1.1 Acetylsalicylic acid Aspilets Tablet 80mg Medifarma
Bayer Consumer
10.1.2 Aspirin Aspirin Bayer Tablet 500mg
10.1.4 Paracetamol Farmadol Tablet 500mg Care
Fahrenheit
10.1.6 Mefenamic acid Sanmol
Ponstan Child Tablet 500mg Pfizer
10.1.9 Paracetamol Chewable / Sanmol Tablet 120mg, 500mg Sanbe
10.1.11 Paracetamol Sanmol Forte
Effervescent Tablet 500mg Sanbe
Lembar ke -15
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Syrup 120mg
Tetes 60mg
10.1.14 Paracetamol Tempra Forte Syrup 160mg, 100ml
Tetes 80mg
10.2 Analgesik Anti Inflamasi Non Steroid Novartis
10.2.3 Diclofenac K Cataflam D Tablet 25mg, 50mg Novartis
10.2.4 Diclofenac K Cataflam Fast Bubuk 900mg Indonesia
10.2.5 Celecoxib Celebrex Kapsul 100mg, 200mg Indonesia
Pfizer
Piroxcicam, Methyl Salicylate, Menthol, Taisho
10.2.6 Counterpain-PXM Gel 15g
10.2.9 Eugenol
Ibuprofen Dofen 400 Tablet 400mg Pharmaceutical
Dexa Medica
10.2.11 Piroxcicam Feldene Gel Gel 15g Pfizer
10.2.15 Meloxicam Mexpharm Tablet 7.5mg, 15mg Kalbe Farma
Supp 15mg
10.2.17 Meloxicam
Methampyrone, Thiamine HCI, Pyridoxine, Movix Tablet 7.5mg, 15mg Lapi
10.2.18 Neuralgin RX Kapsul 10mg Kalbe Farma
10.2.19 HCI, Cyanocobalamine,
Methampyrone, Caffeine
Vit B1, Vit B6, Vit B12, Neurobat A Drag 10 x 10 Interbat
10.2.22 Metamizole Na Novalgin Tablet 500mg Sanofi Aventis
Syrup 50mg
Tetes 500mg
Ampul 500mg
10.2.24 Ketoprofen Profenid Kapsul 200mg Sanofi Aventis
10.2.25 Tablet 100mg
Gel 2.5% x 30g x 1
Supp 100mg
10.2.27 Ketoprofen Pronalges Tablet 50mg, 100mg Dexa Medica
Kapsul 200mg
Supp 100mg Novartis
10.2.32 Emugel Diclofenac Diethylammon Voltaren Tab Salut Enterik
Tab bersalut lepas 25mg, 50mg
75mg Indonesia
lambat
Tab Retard 100mg
Ampul 75mg
Supp 50mg, 100mg Novartis
10.2.33 Diclofenac diethylammon Voltaren Emulgel Emugel 1%x10gx1 ; 20gx1 ; 50gx1
10.3 Minor Tranquillisers / Anxiolitik Indonesia
10.3.1 Alprazolan Apazol Tablet 0,5mg,1mg Dexa Medica
10.3.6 Diazepam Valisanbe Tablet 2mg, 5mg Sanbe
Lembar ke -16
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
10.4 Major Tranquillisers / Anti Psikotik
10.4.1 Sertraline HCI Zoloft Tablet 50mg Pfizer
10.4.3 Haloperidol Dores Kapsul 5mg Pyridam
Risperidone OGB Tablet 1.5mg
10.4.4 Risperidone Tablet 2mg Dexa Medica
10.4.5 Risperidone Dexa
Risperdal Consta Vial 25mg Therapeutics
10.4.6 Haloperidol Serenace Ampul 5mg Pfizer
10.4.7 Trifuloperazine HCI Stelazine Tablet 1mg, 5mg Pharos
10.5 Hipnotik & Sedatif
10.5.1 Estazolam Esilgan Tablet 1mg, 2mg Takeda
10.5.2 Midazolam Sedacum Ampul 5mg, 15mg Dexa Medica
10.6 Anti Konvulsi
10.6.1 Valproic Acid Depakene Syrup 250mg Abbott
10.6.2 Phenytoin Na Dilantin Tablet 250mg Pfizer
10.6.3 Pregabalin Lyrica Kapsul 50mg, 75mg, 150mg Pfizer
Novartis
10.6.7 Carbamazepine Tegretol Kapsul 300mg
10.7 Anti Parkinson Indonesia
10.7.1 Levodopa Levazide Tablet 100mg, 25mg Pyridam
10.7.2 Levodopa Levoben Tablet 100mg, 25mg Mersifarma TM
10.8 Anti Depresan
10.8.1 Sertraline HCI Sernade Film-Coatedtab 50mg Novell Pharma
10.8.2 Sertraline HCI Zoloft Tablet 50mg Pfizer
10.9 Nootropik & Neurotonik
10.9.3 Mecobalamin Kalmeco Kapsul 250mcg, 500mcg Kalbe Farma
Ampul 500mcg
10.9.9 Mecobalamin Methycobal Kapsul 250mcg, 500mcg Eisai
Ampul 500mcg
10.10 Anti Emetik
10.10.2 Ondansentron HCI Cedantron Tablet 8mg Soho
Metoclopramide Ampul 4mg, 8mg
10.10.4 Metoclopramide Tablet 10mg Dexa Medica
OGB Inj 10mg
10.10.6 Metoclopramide HCI Primperan Tablet 5mg, 10mg Soho/Delagrange
Syrup 5mg
Tetes Ped 1mg
Ampul 10mg
Lembar ke -17
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Mahakam Beta
10.10.7 Ondansentron Vometron Tablet 4mg, 8mg
Inj 4mg, 8mg Farma
10.10.8 Domperidone Vosedon Tablet 10mg Sanbe
Susp 5mg
10.11 Antivertigo
10.11.1 Betahistine diHCI Betaserc Tablet 8mg, 24mg Abbott
10.11.3 Betahistine mesylate Merislon Tablet 6mg, 12mg Eisai
10.11.4 Cinnarizine Merron 25 Tablet 25mg Mersifarma TM
10.11.7 Cinnarizine Vertizine Tablet 25mg Bernofarm
11. Sistem Muskuloskeletal
11.1 Obat Relaksan Otot
11.1.1 Eperisone HCl Eperisone HCl OGB Tablet 50 mg Medicon Prima
Zonal Tablet 50 mg Kalbe Farma
11.2 Obat Gangguan Neuromuskular
11.2.1 Pyridostigmine Br Mestinon Tablet 60 mg Combiphar
11.3 Preparat Gout
11.3.1 Allopurinol Alloopurinol OGB Tablet 100 mg ; 300 mg Hexpharm
Reucid Tablet 100 mg ; 300 mg Otto
11.3.2 Colchicine Recilfar Tablet 250 mg Fahrenheit
12. Anti Tuberkulosis Dan Anti Infeksi
12.1 Anti TUBERKOLOSIS
Etambutol Santibi tab 500 mg Sanbe
Tibitol tab 250 mg Mersifam

Rifampicin Rifamtibi caps 400 mg Sanbe


TB RIFS Srp 100 mg - 5 ml Meprofam
Pyrazinamide Tb Zet Tab 500 mg Meprofam
Sanazet Tab 500 mg Sanbe
Pehadoxin tab 1500 mg pharos
Tb vit 6 tab/srp 400 mg , 24 mg,125 ml Mefropam
Rifampicin + INH Rimactazid Kaptab 450 mg + 300 mg Sandos
Rifampicin + INH+ PYRAZINAMIDE Rimcure 3 FDC tab 150 mg + 75 mg + 400 mg Sandoz
Rifampicin + INH+ PYRAZINAMIDE Rimstar 4 FDC tab 150 mg + 75 mg + 400 mg,275 mg Sandoz
Ethabutol
Streptomycin streptomycin inj 1 gr, 5 gr meiji
Lembar ke -18
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
Nistatin Fungatin tetes 100.000 IU/ML Ferron
Nymico tetes 100.000 IU/ML Sanbe
Nystin tetes 12 ml Lapi

Ketoconazole Profungal Tab 200 mg Kalbe farma


Thicazol Tab 200 mg Ethica
12.2 Anti Virus
Acyclovir Herax Tab 200 mg, 400 mg Novell Pharma
Poviral Tab 200 mg, 400 mg Hexpharm jaya
Glaxo Smithkline
Zovirax Tablet Tab 200 mg
Indonesia
Valacyclovir HCI Herclov Kaps 500 mg Sanbe
GlaxoSmithKline
Valtrex Tab 500 mg
12.3 Anti Parasit Indonesia
Johnson &
Mebendazole Vermox 500 tab 500 mg Bayer Consumer
Pyrantel Pamoate Upixon susp 360.25 mg johnson
12.4 Anti Amuba Care
Anti Amuba
Metronidazole Biatron 500 Tab 500 mg Pharos
Fladex Tab 500 mg Dexa Medica
Flagyl/flagyl forte Susp 125 mg Sanofi Aventis
13. Sistem Respirasi
13.1 Anti Asma & PPOK
13.1.1 Aminophyiline phaminov Amp 24 mg Phapros/Rajawali
Mahakam Beta
Phyllocontin Tab 225 mg
13.1.2 Budesonide Obucort Swinghaler 200 mcg fharma
Otsuka
Pulmicort Turbuhaler/Respule 200 mcg Astra Zeneca
Salbufen
Salbufen Tab 4 mg Pharos
Salbutamol sulfate Sir 100 ml Pharos
Glaxosmihtkline
Expectorant
Ventolin Nebules Nebules 2.5 mg Glaxosmihtkline
Indonesia
Ventolin tablet/sirup Tab + Sir 2 mg
Salbutamol OGB Tab 2 mg Indonesia
Indofarma
13.14 Salbutamol sulfate + Theophiline Teosal Tab/sir 1 mg + 150 mg Dexa
GlaxoMedica
Smiht
13.1.5 Salmeterol,Fluticasone Propianote Seretide Inhaler/diskus 50 mcg +125 mcg Boehringerbingel
13.1.6 Tiotropium Br Spiriva Respimat Inhaler 2.5 mcg Kline
Boehringerbingel
heim
Spiriva inhaler 18 mcg
heim
Lembar ke -19
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
13.2 Obat Batuk & Pilek
Ambroxol HcL Epexol/Epexol forte tab/sir,forte,drops 30 mg + 15 mg Sanbe
Interpec tab/sir,forte 30 mg Interbat
Silopect/silopec forte Tab/sir,forte 30 mg Pyridam
Transbroncho Tab/sir,forte 30 mg Kalbe farma
13.1.8 Bromhexine HCI Dexolut Tab 8 mg Dexa Medica
Lexapol Tab 8 mg Molex Ayus
Mucohexin
Woods' Peppermint Tab 8 mg Sanbe
Sir 50 ml Kalbe farma
Expectorant
13.1.9 Codein HCI Codein HCI Tab 10 mg Apotek
13.2.0 Codein 30 Mg+
Codein 30 Mg+ Phenyltoloxamine
Phenyltoloxamine 10
10 mg+
mg Codipront
Codipront Cum Capsl+Syrup 30 mg+ 10 mg Kimia fharma
13.2.1 Capsl+Syrup 30 MG+10 mg+100 mg Kimia fharma
Guaiphenesin Expectorant
Benacol DTM Sir 60 ml kalbe farma
Dextral/Dextral
kaps/sir 15 mg+60 ml Molex AYUS
Forte
Dexmolex Sir 100 ml Molex AYUS
Mixadin
Woods'Peppermint Tab 25 mg kalbe farma
Sir 50 ml kalbe farma
Antitussive Syrup
13.2.3 Loratadine + Pseudoephedrine Aldisa SR Kaps lepas lambat 5 mg Sanbe
Rhinos SR Caps 5 mg Dexa Medica
13.24 N-acetylcysteine Fluimucil Capsl 200 mg Zambon
Alpara Tab 500 mg Molex Ayus
Fludexin Tab 100 mg Dexa Medica
Mixaflu Tab 100 mg kalbe farma
Mixagrip Kapsl 100 mg kalbe farma
Novartis
1.3.2.6 Pseudoephedrine HCI Triaminic
Triaminic Pilex Sir 60 ml Novartis
Sir 60 ml Indonesia
Expektorant Novartis
Indonesia
Triaminic Batuk Sir 60 ml Novartis
Neo Traminic Tetes 7.5 mg Indonesia
Librofed Tab 2.5 mg Indonesia
kalbe farma
Tremenza Tab 2.5 mg Sanbe farma
13.3 Dekongestan Nasal & Preparat Nasal Lain Merk Sharp
1.3.3.1 Mometasone Furoate Nasasonex Nasal Nasal spray 50 mcg
Nasonex Semprot hidung 50 mcg dohme
schering plought
1.3.3.2 Oxymethazoline Liadin Semprot hidung 0.05 % Merc
Lembar ke -20
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
14. Vitamin & Mineral
14.1 Vitamin
14.1.1 SYNTHETIC VITAMIN A ACETATE
Vit A Vit A Soft Capsule Apotek
14.1.2 VIT B COMPLEKS
Becombion Syrup, Drop 15 mL Merck
Neurobion Tablet 500 mg Merck
Neurobion 5000 Ampul 3 mL Merck
Neurodex
Vitamin B Complek Tablet 200 mg Dexa Medica
Tablet 50 mg Kimia Farma
14.1.3 VITAMIN C Kimia Farma
Redoxon Double Bayer Consumer
Vit C, Zn Redoxon tablet 500 mg
Action Double tablet 250 mg
Bayer
Care Consumer
Zevit
ActionCKids
Time- Tempo
Care Scan
Capsule 1000 mg
14.1.5 CALCIUM LACTATE Released Pasific
Ca carbonate Osteocal Tablet 1250 mg Interbat
14.1.6 CALCIUM+VIT D
Ca
VIThydrogen
A + VITphosphate,
C + VIT D3 cholecalciferol
+ VIT E + VIT Cavit D3 Tablet 500 mg Merck
14.2 Multivitamin
B COMP +NICOTINAMIDE +CA
14.2.1 Gingseng axtr G115, dimethylaminoethanol
PANTOTENATE + BIOTIN Boehringer
bitartrate,
Vit B1, BB6,Vit A
B12, Vit E Vit +B1,
palmiotate, ASB6,
FOLAT
B6, Neurovit E Tablet 250 mg Kimia Farma
Ingelheim /
DLL
B12, Vit C, Vit D, Vit E, nicotinamide, Ca Pharmaton Formula Capsule 500 mg
Vit E, Vit C, Vit B1, B2, niacinamide, B6, Pharmaton
pantothenate, Fe,Ca,
Ca,pantothenic
MG sulfate, lecithin, Zegavit Caplet 500 mg Kalbe Farma
B12,
Vit folic acid, acid, Zn Lugano
CAA,
Beta Vit D,
fluroideB1,
caroten, Vit
B2,B1,
CA B3,B2,
B5,B6,
lactate, Ca b12,
B6, Vitvit
B12, C,D
pantothenate, A-D PlexPlus
Vidoran Syrup 15 mL Kalbe
TempoFarma
Scan
nicotinamide, dexpanthenol, curcuma extr,
copper sulphate, folic acid, Fe, nicotinamide, Syrup 120 mL - 225 mL
(curcuma
Folamil & Lysine) Caplet 500 mg Pasific/bode
Dexa Medica
Lysine HCl
14.3 ElektrolitK&iodide,
Mineral Na, Vit B1, B12, B2, B^ HCl, Vit
14.3.1 C, Vit D
Glucose Anhydrous, Nacl, Na Bicarbonate, Indofarma -
Oralit, Pedialyte Sachet Solution 200 mL - 500 mL
14.3.2 CaCl2 Abbott
KCl KSR Tablet 600 mg Merck

14.3.3 K L-ASPARTATE Tablet 300 mg Merck


K L-ASPARTATE Aspar K
14.3.4
Lembar ke -21
Lampiran Surat Keputusan SALINAN
Direksi Perum Percetakan Uang RI
Nomor : SKEP- 728/IX/2015
Tanggal : 15 September 2015
DAFTAR OBAT PERURI
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
NaCl NaCl 0,9 % Solution 0,90 % Apotek
14.3.5 Magnesium Sulfate Merck Consumer
Fe, folinic acid Sangobion Syrup Drops 15 mL Merck
Fe, B comp, biotin, nicotinamide Sangobion Drops Syrup 100 mL Health Consumer
Prod
Fe, manganese sulfate, copper sulfate, folic Merck
Health Consumer
Prod
Sangobion Capsule 1000 mcg
acid
Fe sulfate heptahydrate Sulfas Ferrosus Capsule 300 mg Health Prod
Kimia Farma
14.3.6 Vitamin E
Santa-E Caplet, Tablet 100 IU - 200 IU Sanbe
D-alfa tocopherol Lanturol-200/400 Capsule 200 IU - 400 IU Landson
15. ALAT KONTRASEPSI
Medroksiprogesteron Asetat 50 mg/ml, Tunggal Idaman
Cyclofem Vial 0,5 ml Inj IM interval 30 hr
estradiol sipionat 10 mg
Medroksiprogesteron asetat 50 mg/ml Depoprogestin Vial 3 ml hari
- 1 ml Abdi
Harsen
Tiap 1 tablet sekitar waktu makan
Linestrenol Exluton caps Organon
Levonorgestrel 75 mg/kapsul susuk Indoplant Susuk malam
1 susuk KB panjang
set 2 implant jangka4 cm dan diameter 2 Triyasa
3 tahun
Etonogestrel
Levonorgestrel680,15
mg/susuk KB
mg, etinilestradiol 0,03 Implanon Susuk mm ditempatkan dalam jarum insenter Organon
Microgynon caps Tiap
sekalihari 1
pakaitablet mulai hari pertama
Makan malam mulai pada hari pertama haid Schering
Schering
mg
Drospirenon 3 mg Yasmin caps 1 tablet per setiap
menstruasi hari dan
haridi1konsumsi
tablet pada Schering
Indonesia
Ethinyloestradiol dan cyproterone
Plastik polietilen dengan acetate
lilitan kawat Diane caps Dipasang di dalam
Nova T pack jam yang sam setiaprongga rahim, efektif Indonesia
harinya.
Polietilenberinti
tembaga berbentuk
perakT dengan lilitan Dipasang di dalam rongga rahim, efektif Schering
selama 5 tahun
Copper T pack Kimia Farma
tembaga Kondom selama 8 tahun

Ditetapkan di : J a k a r t a
Untuk Salinan, Pada Tanggal : 15 September 2015
Sesuai dengan aslinya
Departemen Operasional SDM Direksi,
ttd

Wirasmo Prasetio
Kadep Direktur Utama
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
VII. Anti Emetik
VII. 1 Granisetron Hcl Inj Opigran Injeksi 1 mg/ml; 3 mg/3 ml Otto

VIII. Anti Neoplastik


VIII. 1 5-Fluorouracil Curacil Injeksi 500 mg Kalbe Farma
VIII. 2 Asparaginase Leunase Sol 10000KU Kyowa Hakko
VIII. 3 Anastrozole Atimidex Tablet 1 mg Astra zeneca
VIII. 4 Bicalutamide Casodex Tablet 50 mg; 150 mg Astra zeneca
VIII. 5 Bleomycin Bleocyn Injeksi 15 mg Kalbe Farma
VIII. 6 Bevasizumab Avastin Injeksi 25 mg/ml Roche
VIII. 7 Busulfan Myleran Tablet Glaxo Smith Kline
VIII. 8 Calcium Folinat Calcium Folinat Ebewe Injeksi 100 mg/10 ml Ferron
VIII. 9 Capecitabine Xeloda Tablet 500 mg Roche
VIII. 10 Carboplatin Carboplatin Kalbe Injeksi 150 mg; 450 mg Kalbe Farma
VIII. 11 Cisplatin Cisplatin Kalbe Injeksi 10 mg/ 10 ml; 50 mg/50 ml Kalbe Farma
VIII. 12 Cyclofosfamid Cyclofosfamid Aklbe Tablet/injeksi 50 mg ; 1 g Kalbe Farma
VIII. 13 Cyproterone acetate Androcur Tablet 50 mg Bayer
VIII. 14 Cytarabin DBL Cytarabin Injeksi 1g Tempo Rx Farma
VIII. 15 Chlorambucyl Leukeran Tablet 2 mg Glaxo Smith Kline
VIII. 16 Dactinomicyn Cosmegen Injeksi 500 mcg Merck Sharp Dome
VIII. 17 Dacarbacyn Dacarbacyn Injeksi 200 mg Tempo Rx Farma
VIII. 18 Daunorubicyn Daunocin Injeksi 20 mg/4 ml Novell
VIII. 19 Docetaxel Brexel Injeksi 20 mg ; 80 mg Kalbe Farma
VIII. 20 Doxorubicin HCl Doxotil Injeksi 10 mg/5 ml ; 50 mg/25 ml Dipa Pharma Lab
VIII. 21 Etopocid Etopocid DBL Injeksi 100 mg/5 ml Tempo Rx Farma
VIII. 22 Exemestane Aromasin Tablet 25 mg/ml Pfizer
VIII. 23 Epirubicyn Epirubicyn Kalbe Injeksi 10 mg/ 5 ml Kalbe Farma
VIII. 24 Gefitinib Iressa Tablet 250 mg Astra zeneca
VIII. 25 Gemcitabine HCl Cytogem Injeksi 200 mg Ferron
VIII. 26 Goserelin Acetate Zoladex/Zoladex LA Injeksi 3.6 mg ; 10.8 mg Astra zeneca
VIII. 27 Hydroxyurea Hydroxyurea Medac Capsul 500 mg Dipa Pharma Lab
VIII. 28 Ifosfamid Holoxan Injeksi 1g;2g Transfarma
VIII. 29 Imatinib Mesylate Glivec Tablet 100mg3.75
2.5 mg mg ; 1.88 mg ; Novartis
VIII. 30 Letrozole Femara Tablet 11.25 mg Novartis
VIII. 31 Leuprorelin Tapros Injeksi 40 mg Takeda
VIII. 32 Medroxi progesteron acetate Provera Tablet 50 mg Pfizer
VIII. 33 Megestrol Acetate Megaplex Tablet 2 mg ; 10 mg Combiphar
VIII. 34 Methotrexate Methotrexat Kalbe Injeksi 2 mg Kalbe Farma
VIII. 35 Mitomisin D Mytomycin D Injeksi 50 mg Kyowa Hakko
VIII. 36 Melfalan Alkeran Tablet 400 mg Glaxo Smith Kline
VIII. 37 Mercaptopurin Purinethol Tablet 50 mg Wellcome Lab
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI
VIII. 38 Mesna Uromitexan Injeksi 30 mg/5 ml; 100 mg/16.7 ml Transfarma
VIII. 39 Oxaliplatin Rexta Injeksi 50 mg Kalbe Farma
VIII. 40 Paclitaxel Paxus Injeksi 30 mg/5 ml; 100 mg/16.7 ml Kalbe Farma
VIII. 41 Procarbazin Matulane Capsul 50 mg Sigma-Tau-Pharma
VIII. 42 Tamoxifen Tamofen Tablet 20 mg Kalbe Farma
VIII. 43 Temozolomide Temodal Tablet 20 mg ; 100 mg Merck Sharp Dome
VIII. 44 Vinkristin Vincristine Kalbe Injeksi 1 mg ; 2 mg Kalbe Farma
VIII. 45 Vinblastin Vinblastin Injeksi 10 mg Tempo Rx Farma

IX. Antikoagulan, Antiplatelet & Fibrinolitik


IX.1 Enoxaparin Lenovox Injeksi 20 mg ; 40 mg ; 50 mg Sanovi Aventis
IX.2 Human antithrombin III Kybernin P Injeksi 50 IU/ml Dexa Medica
IX.3 Fondaparinux Arixtra Injeksi 2.5 mg'; 0.5 ml Glaxo smith Kline
IX.4 Streptokinase Streptase Injeksi 1.500.000 UI Dexa Medica

X. Preparat Affecting Metabolisme Tulang


X.1 Raloxifene Hcl Evista Tablet 60 mg Eiflilly
X.2 Zelodronic acid Zometa Injeksi 4 mg Novartis

XI. Relaksan Otot


XI. 1 Clostridium botulinum toxin type A BTXA Injeksi 100 UI Kalbe Farma
NO.KODE ZAT AKTIF OBAT MEREK OBAT SEDIAAN DOSIS FARMASI KETERANGAN
VII. Topical Korticosteroid Lotion
VII. 1 Momethasone Elocon Lotion 0.10% Merck Sharp Dermatitis
furoate Dohme
VIII.Anti Anemia
VIII. 1 Fe Gluconate Sangobion Capsule 250 mg Merck Kasus anemia dengan Hb ≤ 11
15. ALAT KONTRASEPSI
Medroksiprogesteron Asetat 50 mg/ml, estradiol Tunggal Idaman
Cyclofem Vial 0,5 ml Inj IM interval 30 hr
sipionat 10 mg Abdi Y
Medroksiprogesteron asetat 50 mg/ml Depoprogestin Vial 3 ml - 1 ml Harsen Y
Linestrenol Exluton caps Tiap hari 1 tablet sekitar waktu makan malam Organon Y
Levonorgestrel 75 mg/kapsul susuk Indoplant Susuk 1 set 2 implant jangka 3 tahun Triyasa Y

1 susuk KB panjang 4 cm dan diameter 2 mm


Etonogestrel 68 mg/susuk KB Implanon Susuk Organon Y
ditempatkan dalam jarum insenter sekali pakai

Levonorgestrel 0,15 mg, etinilestradiol 0,03 mg Microgynon caps Tiap hari 1 tablet mulai hari pertama haid Schering
Y

Drospirenon 3 mg Yasmin caps Makan malam mulai pada hari pertama Schering Indonesia
menstruasi setiap hari 1 tablet Y
1 tablet per hari dan di konsumsi pada jam yang
Ethinyloestradiol dan cyproterone acetate Diane caps Schering Indonesia
sam setiap harinya. Y
Plastik polietilen dengan lilitan kawat tembaga Dipasang di dalam rongga rahim, efektif selama 5
Nova T pack Schering
berinti perak tahun Y
Dipasang di dalam rongga rahim, efektif selama 8
Polietilen berbentuk T dengan lilitan tembaga Copper T pack Kimia Farma Y
tahun
? Kondom ? ? ?
Pemberian obat obatan

1 a. Obat-obatan diberikan dalam bentuk obat jadi, obat kemasan atau obat racikan dan harus berdasarkan resep dokter sesu
b. Obat-obatan yang diberikan oleh dokter sesuai dengan DOP (Daftar Obat Peruri)
c. Obat-obatan diluar DOP dapat diberikan apabila
1. komposisinya sama/mendekati
2. Kelas obat sama (Generik/paten)
3. Harga relatif sama (maksimal margin 5%)
d. Resep obat hanya dapat diambil pada Apotik yang ditunjuk oleh Perusahaan
e. Pengambilan obat atas resep dokter bukan pada Apotik yang ditunjuk oleh perusahaan diizinkan apabila :
1) Apotik yang ditunjuk tutup
2) Obat harus segera diminum/digunakan sesuai keterangan dokter
3) Sedang dalam menjalani rawat inap
4) Berada diluar kota atau luar negeri
5) Obat tidak tersedia di Apotik yang ditunjuk oleh Perusahaan
f. Pengambilan obat dari resep dokter umum maksimum untuk 5 hari.
g. Pengambilan obat dari resep dokter specialis maksimum untuk 7 hari.
h. Dalam hal pengambilan obat untuk penyakit menahun (kronis) dan ibu hamil dapat diberikan untuk 30 hari.
i. pemberian resep iter maksimal 2 kali
dasarkan resep dokter sesuai indikasi medis pada saat berobat.

an apabila :

ntuk 30 hari.