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Keputusan Direktur Rumah Sakit Cendana

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Tentang : Formularium Rumah Sakit Cendana

FORMULARIUM RUMAH SAKIT CENDANA

BENTUK NAMA
NO NAMA OBAT KEKUATAN NAMA DAGANG
SEDIAAN PERUSAHAAN

1 2 3 4 5 6

1 Analgesik Non - Narkotik

Tablet 500 mg Paracetamol Promedrahardjo

500 mg Farmadol Fahrenheit

Sanmol Sanbe Farma

120 mg/5ml
Paracetamol Syrup
Paracetamol Novapharin
120 mg/5ml
Sanmol Sanbe Farma
Drop 60 mg/0.6ml
Paracetamol OGB Novell, Berno
Infus 1000 mg/100ml
Tramset Fahrenheit
Paracetamol + Tramadol Tablet 325 mg+37,5 mg
Natrium Diklofenak OGB KF
Tablet 50 mg
Na diclofenac
Gel 20 g Voltaren Sandoz

Cataflam Novartis
K- Diclofenac Tablet 50 mg
Ketorolac OGB Novell, Berno
10 mg
Tablet
Torasic Kalbe Farma
10 mg
Ketorolac
Ketorolac Hexpharm Jaya
 Ampul 30 mg/ml
Torasic Kalbe Farma

10 mg Piroksikam OGB Novell

Piroksikam Tablet
Tramal Pharos
Capsul 50 mg
Tramal Pharos
100 mg/2ml
Tramadol Ampul
Tramadol IndoFarma
100 mg/2ml
Tramal Pharos
Suppo 100 mg
Ibuprofen Tablet 200 mg Proris Pharos

-1-
 Ibuprofen OGB Indofarma,
400 mg Fahreinheit
Bufect Sanbe Farma
Syrup 100 mg/5 ml
Proris Pharos
Supp 125 mg
Supp 100 mg Profenid Sanofi
Ketoprofen
Asam mefenamat Hexpharm Jaya
Asam Mefenamat  Tablet 500 mg
Meloxicam OGB MBF, Dexa,
7,5 mg Berno, Novell
Meloxicam Tablet
Meloxicam OGB MBF, Dexa,
  15 mg Berno, Novell

Metamizole Na Injeksi 500 mg/1 ml Antrain Interbat

75 mg Pregabalin OGB Dexa

Pregabalin Capsul
150 mg Provelyn Kalbe Farma

2 Antirematik, antipirai

Allopurinol OGB Berno

100 mg
  Allopurinol Tablet
Allopurinol OGB Berno
300 mg

Anestetik Lokal
3
Vial 50 mg/2 ml Pehacain Phapros
Lidocain Hcl

Anestetik Umum

Miloz Novell
4 Ampul 15 mg/3 ml
Midazolam
Miloz Novell
5 mg/5 ml
Neostigmin Ampul 0,5 mg/ml Prostigmin Combiphar

5 Anti Alergi
Loratadin OGB Nulab
Loratadine Tablet 10 mg
Cetirizine OGB Novell, Dexa,
Cetirizine Tablet 10 mg Nulab
4 mg CTM PIM
Klorfeniramin maleat Tablet Pharmaceuticals

6 Antibiotik Gol Penisilin

  Amoxycillin Tablet 500 mg Amoxycillin OGB Dexa, Berno

-2-
 Amoxsan Sanbe Farma
Capsul 500 mg
Amoxycillin OGB Berno

125 mg/ 5ml

Amoxsan Sanbe Farma
Dry Syrup
Amoxsan Forte Sanbe Farma
250 mg/ 5ml
Amoxycillin + Asam OGB Indofarma
Amoxycillin + Asam  Tablet 500 mg + 125 mg Clavulanat (Co-
Clavulanat (Co- Amoxiclav)
Amoxiclav) Claneksi Sanbe Farma
Syrup 125 mg/ 5ml

Antibiotik Gol Kuinolon

Levofloxacin Dexa, Novell, Berno

500 mg
Cravit Kalbe Farma
Tablet
9 Levoflaxacin
Cravit Kalbe Farma
250 mg
Levofloxacin OGB MBF, Dexa,
Infus 500 mg/100 ml Infion, Novell, Berno
Ciprofloxacin OGB Novell, Dexa
Tablet 500 mg
Ciprofloxacin
Ciprofloxacin OGB Dexa, Novell,
Infus 200 mg/ 100 ml Berno

Antibiotik Gol Makrolida

10
Azithromycin OGB Nulab
Azitromicin Tablet 500 mg

11 Antibiotik Gol Sefalosporin

  Cefadroxil Hexpharm Jaya

Cefadroxil Capsule 500 mg

Renasistin Fahreinheit

Cefixime Cefixime OGB Novell, Dexa,

Berno

100 mg
Cefspan Kalbe
Capsule

Cefixime OGB Novell, Dexa

200 mg
Cefspan

Dry Syrup 100 mg/ 5ml Cefixime OGB Novell, Dexa

-3-
 Ceftriaxon OGB HJ
Ceftriaxon Vial 1 gr
Meropenem Vial 1g Meropenem OGB MBF, Dexa,
Novell, Berno

Merofen Dankos Farma

12 Antibiotik Gol Tetrasiklin

Doxyciclin OGB Dexa

  Doxyciclin Capsul 100 mg

13 Antibiotik Lain-lain

Metronidazole OGB Berno

Tablet 500 mg
  Metronidazole
Metronidazole OGB Dexa, Novell,
Infus 500 mg/100 ml Berno

Anti Tuberkulosis

OGB Berno
Rifampicin Tablet 450 mg Rifampicin
14 IndoFarma
4FDC Tablet 400 mg Rifastar
OGB Dexa
Pyrazinamide Tablet 500 mg Pyrazinamide
OGB Berno,
Ethambutol Tablet 500 mg Ethambutol Indofarma

15 Anti Fungi

Ketokonazol OGB Dexa

Ketokonazol Tablet 200 mg
 
Bernofarm
Itraconazole Capsul 100 mg Itraconazole

Clindamycin Capsul 300 mg Clindamycin

16 Anti Virus

-4-
 Acyclovir Tablet 400 mg Acyclovir

Methisoprinol Syrup 250 mg / 5 ml Isprinol Novell

17 Anti Vertigo/Anti Migrain

Flunarizine Tablet Kalbe

5 mg Frego
Kalbe
  10 mg Frego
Betahistine OGB Novell
Betahistine Tablet 6 mg

Antikoagulan, Anti platelet, Thrombolitik

Acetosal Tablet 80 mg Ascardia Pharos

19
80 mg Aspilet Darya Varia

Clopidogrel OGB MBF, Dexa

Clopidogrel Tablet 75 mg

20 Hemostatik

Kalnex Kalbe
Tablet 500 mg
200 mg/5 ml Asam Traneksamat OGB Novell, Berno
Asam Traneksamat Ampul
  500 mg/5 ml Asam Traneksamat OGB Novell, Berno
Ampul
500 mg Dycinon Corsa Industries
Ethamsylate Tablet

21 Produk Darah dan Pengganti Plasma

Gelatin Polisuksinat Infus 500 ml Gelafusal Dexa Medika
dalam Ringer Asetat

22
  Obat untuk Gigi dan Mulut
Povidon Iodine Gargle 1% 190 ml Betadine Mahakam

oint 10 g Betadine Mahakam

23 Diuretik

-5-
 40 mg Farsix Fahrenheit
Tablet
  Furosemide
Farsix Fahrenheit
Injeksi 10 mg/ml
25 mg
Hydrochlorothiazide Tablet Hydrochlorothiazide

25 Anti Diabetik Oral

Metformin Hcl OGB Dexa, HJ

Metformin Hcl Tablet 500 mg

Glucophage Merck

Glimepiride OGB Nulab, Dexa,

  1 mg Berno
Glimepirid Tablet
Glimepiride OGB Nulab, Dexa,
3 mg Berno, Novell
100 mg Acarbose Dexa Medica
Akarbose Tablet

26 Anti Diabetik Parenteral

300 IU/3 ml NOVORAPID Novo Nordis

  Insulin Rapid acting Injeksi

29 Kortikosteroid

Methylprednisolone OGB MBF, Dexa,

Berno
4 mg
Hexilon Dankos Farma
 
Tablet
Methylprednisolone OGB MBF, Dexa,
Methylprednisolon 8 mg Berno
Methylprednisolone OGB MBF, Dexa,
16 mg Berno
Methylprednisolone OGB MBF, Dexa,
125 mg/2 ml Berno
Vial
Hexlon Dankos Farma
125 mg/2 ml
Dexaharsen Harsen

Tablet 0, 5 mg
Cortidex Sanbe Farma

Deksamethason
Dexamethasone OGB Berno

 Ampul 5 mg/ml
Cortidex Sanbe Farma

4 mg Kenacort Taisho
Tablet
Triamsinolon acetonid

Flamicort DexaMedica
Vial 10 mg/ml

-6-
 Flamicort DexaMedica
40 mg/ml

31 Anti Angina

Nifedipin OGB Dexa

Nifedipin Tablet 10 mg
Cedocard Fahrenheit
Tablet 5 mg
  Farsorbid Fahrenheit
Isosorbid dinitrat Injeksi 10 mg/10 ml
Isosorbid OGB KF, Indofarma,
Injeksi 10 mg/10 ml Fahreinheit

Ace Inhibitor
33
Captopril OGB Dexa
12,5 mg
  Captopril Tablet
Captopril OGB Dexa
25 mg

35 Calsium Channel Blocker

Amlodipin OGB Nulab, Dexa,

5 mg MBF, Novell, Berno
  Amlodipin Tablet
Amlodipin OGB Nulab, Dexa,
10 mg MBF, Novell, Berno

Golongan Angiotensi
36
Losartan K OGB Novell
Tablet 50 mg
  Losartan K
Angioten Kalbe
Tablet 50 mg

Obat Kolesterol
40
Atorvastatin
20 mg
Atorvastatin Tablet
Atorvastatin
40 mg
  Simvastatin
20 mg
Simvastatin Tablet
Cholestat
20 mg

Vasodilator
41
  Citicolin Tablet 500 mg Citicolin

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 Brainact
500 mg
Citicolin

Injeksi 250 mg/2ml

Anti Bakteri Topikal

42
Gentamisin
Tube 0,1 %
Gentamisin
Gentamisin
  EO 0,3%
Erlamycetin
Kloramfenikol EO 1%

Kombinasi Anti Bakteri dan Anti Radang Topikal

43
Betametason 0,1 % + Betason N Kimia Farma
  Neomycin 0,5 %
Tube 5g

Anti Fungi Topikal

44
Ketokonazole Tube 2% Ketoconazole OGB Dexa, Novell

Tube 2% Formyco Sanbe Farma

 
Miconazole nitrate Tube 2% Dactarin Taisho

Anti Virus Topikal

45
Asiklovir Tube 5% Acyclovir cr OGB KF
 

Antibiotik + Kortokosteroid Untuk Mata (Topikal)

48
Dexametason 1 mg+ Xitrol CENDO
  Neomycin 3,5 mg + EO 3,5 g
Polymixine 6000 IU
Anti Ansietas dan Anti Insomnia
58
Alprazolam OGB Dexa, KF
Tablet
0,5 mg
Alprazolam
Alprazolam OGB Dexa, KF
Tablet
1 mg
5 mg Valisanbe Sanbe Farma
  Tablet
Injeksi 10 mg Stesolid Alpharma
Diazepam
5 mg/ml , 2,5 ml Stesolid Alpharma
Suppo

Antasida dan Antiulkus

62

-8-
 Omeprazole OGB Novell, Nulab
Capsul 20 mg
Omeprazole
Omeprazole OGB MBF, Dexa,
Ampul 40 mg/ml Novell, Berno
Rantin
150 mg
Tablet
Ranitidin OGB Dexa, Berno
Ranitidin 150 mg
Rantin
  Injeksi 50 mg/2 ml
Inpepsa Fahrenheit
Sukralfat Susp 500 mg/5 ml
Lancid
30 mg
Lansoprazole Capsule
Lansoprazole OGB Nulab, Novell

Noprostol
Misoprostol Tablet 0,2 mg

Anti Emetik
63
4 mg Ondansetron OGB MBF, Berno,
Novell
Tablet
Ondansetron OGB MBF, Berno,
8 mg Novell
Vomceren Mahakam

8 mg
Ondansetron

Narfoz

Ondansetron OGB MBF, Berno,

4 mg/2 ml Novell, Dexa
Vomceren
  Ampul
Narfoz

Ondansetron OGB MBF, Berno,

8 mg/2 ml Novell, Dexa
Vomceren

Domperidon OGB Novell, Berno

Tablet
10 mg
Domperidone
5 mg/5 ml Domperidon OGB Berno, HJ
Syrup

Anti Diare
66
Attalpulgit+Pectin Tablet 600 mg
New Diatab  
Pencahar
67
Suppos 10 mg Dulcolax Boehringer
  Bisakodil

69 Anti Asma

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 2 mg Salbutamol OGB Fahrenheit,
Tablet Indofarma, KF
Salbutamol
2,5 mg Ventolin GSK
Neb
  Salbutamol + 1,2 mg+130 mg Teosal Dexa Medica
Tablet
theophylline
Pulmicort Astra Zeneca
Salmeterol + Flutikason Inh 0,5 mg/1 in 2 ml

Ekspektoran
70
injeksi 10mg/ml  Diphenhidramin Phapros
  Diphenhidramin

Mukolitik

71 Ambroxol Tablet
Ambroxol Sanbe Farma
30 mg

Syrup
15 mg/ 5ml Ambroxol OGB Berno
Erdostein Capsul 300 mg
Erdostein

Anti Influenza + Dekongestan

72
Terfenadine + 40 mg + 30 mg Rhinofed Dexa Medica
Syr
Pseudoephedrine Hcl
Larutan Elektrolit dan Nutrisi
74
Tablet 20 mg Zink Disp Kiimia Farma

Zink
10 mg/5ml Zinkid IndoFarma
Syrup
500 ml Asering Otsuka
Ringer Laktat Kolf
Nacl 0,9 % Sanbe Farma, B
0,9 % 100 ml Braun
Nacl 0,9 % Sanbe Farma, B
0,9 % 500 ml Braun
Nacl 0,9 % Otsuka
0,9 % 25 ml
Dextrose Kolf 40 % 25 ml
Dextrose 40 % Otsuka

-10-
 Multivitamin & Suplemen
75

  Vit B comp + vit C     Becom-C Sanbe Farma

  Becom-C Sanbe Farma

Kapsul   Biosanbe Sanbe Farma

  Prenamia Sanbe Farma

Penambah darah + Fe
  Maltfer Fol Combiphar
Syr
  Maltofer Combiphar

Drop   Ferriz Nicholas

Extrak plasenta
Tablet   Ferriz Nicholas
Laktafit Dexa Medica
Multivitamin Injeksi 15 mg
Cernevit Kalbe Farma
 
Suplemen Tablet
Liproqy Sanbe Farma
 
Lipofood Mepro
Astaxanthin Kapsul  
Medithin Konimex
4 mg 250 IU
Fucoidan Kapsul
100 mg Fastro Landson

PPC 95, Gingseng Fucotrap Solas

extract, Multivitamin
mineral, Asam Amino. Softcaps
400 mg PROVITAL LANDSON

PROVITAL PLUS LANDSON

Neurosanbe Sanbe Farma

Tablet  
Vit neurotropik
Neurosanbe Sanbe Farma
5000
Neurosanbe Sanbe Farma
Injeksi Plus
Neurosanbe Sanbe Farma
3 ml/10
Kaplet
500 mg Imboost Force Soho

Ekstrak Echinacea
Imunos Lapi

Syrup
500 mg/5ml Imboost Force Soho

Biofos Mepro
Nattokinase Kaplet
Probiotik Sachet 100 mg Natto-10 LAPI
109cfu/gr
Lacto-B Novell

-11-
 Sericocalyx folium + L-Bio Lapi
Tab
ortoshiponis herba
Renax Interbat

  Procalma Mepro
Multivitamin + DHA Softcaps
 
Lactafar Fahrenheit

Folamil Genio Dexa Medica

Ekstrak Ikan Gabus Kapsul
Vipalbumin Royal Medica
Extrak Billberry Tablet 500 mg/cap
Cendo Berry CENDO

  Calostrum Mepro
Sirup
 
Supralysin Mepro
Multivitamin + Lysin
Apialys Lapi

Drop
  Supralysin Mepro

LAIN - LAIN
76
  Piracetam OGB Dexa, Berno
800 mg
Piracetam OGB Dexa, Berno
Tablet
800 mg
1200 mg Piracetam OGB Dexa, Berno
Piracetam
Fepiram Ferron

Injeksi
3 gr/15 ml Piracetam OGB Dexa, Berno,
Novell
Fepiram Ferron

Tablet
500 mg Mecobalamin OGB Novell
Mecobalamin
Injeksi Lanabal Landson

Paracetamol + N- 500mg Mecobalamin OGB Novell

Acethilsisten Kaplet
Sistenol Dexa Medica
500 mg + 200 mg
Acetylsistein Tablet Effervescent
600 mg Siran F Dexa Medica

Megestrol acetate Acetin

Suspensi Sanbe Farma
Tracetate
Fahrenheit
40 mg/ml
Keto Acid Caplet
  Prorenal Novell

Nalokson HCl Aminefron Dexa Medica

Injeksi
Serum Anti Tetanus Injeksi 0,04mg.ml Nokoba Fahrenheit

-12-
 ATS
1500 IU Biofarma
Tetagam
Dexa Medica
250 IU
2000 IU Eprex
Epoetin Alfa Syringe Janssen (KF)
Epotrex
Novell
Hemapo
Epoetin Beta Syringe 4000 IU Kalbe Farma
Recormon
Na Ibandronat Injeksi 2000 IU Roche

NARKOTIKA
77
  MST Continous
Morfin Sulfat Tablet 10 mg Mahakam
MST Continous
Fentanyl Ampul 10 mg Mahakam
Fentanyl
2 ml Jansen (KF)
Codein
Codein Tablet 10 mg Kimia Farma
Codein
15 mg Kimia Farma
Codein
Codein+Feniltoloksamin Tablet 20 mg Kimia Farma

Codein+Feniltoloksamin Codipront
Syrup 30 mg + 10 mg Kimia Farma
+ Guaiafenesin
Codipront Cum
11,11 mg + 3,67 mg + Expectorant
Petidine Ampul Kimia Farma
55,55 mg

OBAT PROGRAM TUBERKULOSIS

78
Tablet Kategori 1 Kimia Farma
Rifampisin+Isoniazid+Py 150 mg+75 mg+400
razinamid+Ethambutol mg+275 mg
Tablet;Inj Kategori 1 Kimia Farma
Rifampisin+Isoniazid+Py
razinamid+Ethambutol; 150 mg+75 mg+400
Streptomycin Inj mg+275 mg
Tablet 150 mg+75 mg+400 Kategori 2 Kimia Farma
Rifampisin+Isoniazid+Et
mg+275 mg; 1 g
hambutol
Tablet 150 mg+150 mg+400 Paket Lanjutan Kategori Kimia Farma
Rifampisin+Isoniazid+Et
mg 2
hambutol
Kombinasi Dosis Tetap
Tablet Kimia Farma
Anak
  Rifampisin+Isoniazid 75 mg+50 mg+150 mg
OBAT PROGRAM HIV/AIDS
79
Efavirenz Tablet
200 mg Evafirenz Kimia Farma

200 mg Evafirenz Kimia Farma

Tablet
Efavirenz+Lamivudin+T
enofovir 600 mg Evafirenz Kimia Farma
600 mg + 300 mg + Efavirenz+Lamivudin+Ten Kimia Farma
  Lamivudin Tablet 300 mg ofovir

-13-
Lamivudin+Zidovudin Tablet 150 mg Lamivudin Kimia Farma

Nevirapin Tablet 150 mg + 300 mg Lamivudin+Zidovudin Kimia Farma

Tenofovir Tablet 200 mg Nevirapin Kimia Farma

Zidovudin Tablet 300 mg Tenofovir Kimia Farma

100 mg Zidovudin Kimia Farma

Ditetapkan di : Bogor
Pada tanggal : 1 November 2016
Rumah Sakit Medika Dramaga
Direktur

dr. R. Gioseffi Purnawarman,SpOG, MHKes

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