MONITORING PENGGUNAAN OBAT FORMULARIUM RSD

( ADA TIDAKNYA PERESEPAN SETIAP HARI )

BULAN : TAHUN :
TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Ambroxol 30 mg AMBROXOL 30 MG
2 Amidaron 200 mg TYARIT TABLET
3 Amidaron 150 mg/ml TYARIT INJEKSI
4 Atapulgit NEW DIATAB
5 URSOLIC
Asam ursodeoxycholic acid
6 URDAHEX
7 Asam Pipemidat 400 mg URINTER
8 Asetil salisilat 500 MG ASPIRIN
9 ECLID
Acarbose 50 mg, 100 mg
10 GLUCOBAY
11 Beraprost Na 20 mcg DORNER
Budesonid 160mcg ,formoterol fumarat 4,5
SYMBICORT INH
12 mcg
13 PULMICORT 200 MCG
Budesonid 100 mcg, 200 mcg
14 PULMICORT 100 MCG
15 DULCOLAX SUPPO
16 DULCOLAX TABLET
Bisakodil 5 MG, 10 MG
17 STOLAX
18 STOLAX
19 Buspiran XIETY
20 Clozapine SIZORIL
21 chlorpromazin CEPEZET
22
Clonidin 150 mg/ml CATAPRES
23
24 Chloramphenicol injeksi CHLORAMEX
25 CITICOLINE
26 Citicholin 250 mg, 500 mg BRAINACT INJEKSI
27 SERFAC
28 PROVULA
Clomifen sitrat 50 mg
 Clomifen sitrat 50 mg
29 PROFERTIL
TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
30 Ca polystyrene sulfonate KALITAKE
31 PROLIVER
32 Curcuminoid HEPATIN
33 CURLIV
34 Bromheksin nebules BISOLVON
35 Diazepam rectal 5 mg, 10 mg STESOLID
36 VALISANBE
Diazepam injeksi
37 VALDIMEX
38 Dexamethason + CTM ( kombinasi ) DEXTEEM PLUS
39 HERBESSER
Diltiazem 25 mg / ml
40 HERBESSER
41 Donepezil Hcl FORDESIA
42 Eperisone Hcl 50 mg FORRES
43 Erdostein 300 mg VESTEIN
44 Erdostein 175 mg/5ml VECTRIN
45 Extrak ikan air tawar VIP ALBUMIN
46 PHENTAL
Fenobarbital
47 SIBITOL
48 Fluoxetin 10 mg , 20 mg KALXETIN
49 Gabapentin 300 mg NEPATIC
50 Gliseril Guaiakolat 100 mg ( GG ) GENERIK
51 GRANON
Granisetron 1 mg dan 2mg
52 OPIGRAN
53 Human Tetanus TETAGAM
54 CYTODROX
Hidroxyurea 500 mg
55 HYDREA
56 Ipatropin bromida inh 200 mcg/puff BEROTEC
57 Ipatropin bromida inh 200 mcg/puff +
COMBIVENT
58 Salbutamol 0,04 %
59 Isosuprin 20 mg HYSTOLAN
60 Jelly Cateter K DAN J JELLY CATETER
 61 Karbazokrom Na Sulfonat 25 MG, 50 MG ADONA
62 Kombinasi diosmin, Hisperidin ARDIUM
TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Kombinasi Hyoscin etyl bromida 10 mg,
SCOPAMIN PLUS
63 paracetamol 500 mg
64 Karbon Aktif NORIT
65 ALGOUTH
66 Kolkisin 500 mg RECOLFAR
67 L-CYSINE
68 ERICAF
Kombinasi : Ergotamin 1 mg, Kafein 50 mg
69 ANTI MIGRAIN
70 Karbamazepin BAMGETOL
Kombinasi : Benserazid 25 mg, Levodopa
LAPARSON
71 100 mg
72 SOHOBION
73 Komb vitamin B1, B6, B12 NEUROSANBE
74 NEURODEX
75 NEURODEX
Komb vitamin B1, B6, B12 TABLET
76 NEUROSANBE
77 Kombinasi : As.Folat 400ug, vit B1,
FORNEURO
78 Vit E natural, vit B1,
79 kombinasi theofillin + salbutamol TEOSAL
80 Lisinopril 10 mg NOPERTEN
81 LOLIDEX
L-Ornitihin L-Aspartat ( LOLA )
82 HEPAMERZ GRANULATE
83 TYRAX
Levotiroxin 50 MCG, 100 MCG
84 EUTYROX
85 Laktulose OPILAX
86 Loperamid LODIA
87 Metyl prednisolon 8 mg METYLPREDNISLN 8 MG
88 PIRALEN
Metoclopramid
89 SOTATIC
91 Metotrexat 2,5 mg TEXORATE 2,5 mg
92 Mikofenolat Mofetil 500 MG (mmf ) CELLCEPT 500 MG
 93 Metronidazol + Nystatin Ovula FLADYSTIN
94 Mysoprostol 200 mg INVITEC
95 Microniced Natural Progesteron 100 UTROGESTAN
TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
96 APECUR
97 Multivitamin sirup ZAMEL DROP
98 VISEBAD
99 Magrotilin SANDEGRIL
100 Netilmisin sulfat 100 mg, 200 mg HYPOBAC
101 RAIVAS
Norephinefrin 1 mg/ml
102 VASCON
103 PERDIPIN
Nicardipin 10 mg /ml
104 TENSILO
105 Minocycline Hcl 50 mg, 100 mg NOMIKA
106 Noretisteron 5 mg NORELUT
107 Nicergoline 10 mg SEROLIN
108 NYSTATIN
109 nystatin tablet, drop FUNGATIN
110 NYSTATIN 100.000 IU/ml
111 N-Asetyl sistein + Paracetamol SISTENOL
112 Octreotide asetat 100 mcg SANDOSTATIN
113 PANTOPRAZOL INJ
114 Pantoprazol injeksi PANSO
115 PRANZA
116 Potasium Diklofenak 25 mg, 50 mg KALIUM DIKLOFENAK
117 Paracetamol rectal DUMIN
TRAMIFEN
118 Parcetamol 325 mg + Tramadol 37,5 mg
SINCRONIC
119 Piracetam 400 mg, 800 mg, 1200 mg Piracetam 400, 800,1200 mg
120 Piracetam 100 mg/5ml NEUROTAM
121 PIRACETAM 1 GR , 3 GR
Piracetam 1 gram, 3 gram
122 NEUROTAM
123 GENERIK,
Piracetam 1200 mg inf
 Piracetam 1200 mg inf
124 NEUROTAM
125 pramipeksol 0.125 MG , 0,25 MG SIFROL
126 Pregabalin 7,5mg , 15mg PROVELYN

TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Pseudoefedrin 60 mg
127 TRIFEDRIN
+ Tripolidin 1,25 mg ( kombinasi )
128 Quetiapine SEROQUEL XL
129 Ranitidin Hcl 84 mg/5ml RANIVEL
130 Rivanoxana 10 MG PRADAXA
131 KALMECO
Sianokobalamin 500 mg
132 SIMCOBAL
133 MALTOFER sirup
Preparat besi
134 MALTOFER drop
135 Sertralin DEPHRAL
136 ULSAFAT
Sucralfat 500 mg/5 ml
137 MUSIN
138 Somatostatin UCB SOMATOSTATIN 250 MG
139 Tiamazol 5 mg, 10 mg TYROZOL
140 Tamsulosin HCL HARNAL
141 Warfarin 2 mg SIMARC
142 ZINCPRO
Zinc 20 mg
143 ZINC
144 AMINEFRON
α Keto isoleusin
145 AMINORAL
146 Human Albumin 20%, 25 % HUMAN ALBUMIN 20%,25 %

KEPALA INSTALASI FARMASI PENANGGUNG JAWAB PELAYANAN FARMASI

Drs. A.ARIEF HARYADI., MPH.,Apt ZULAIHA HAMIM. S.Farm.,Apt

NIP: 19610317 199103 1 005 NIP: 19840925 201001 2 013
 MONITORING PENGGUNAAN OBAT FORMULARIUM RSD EDISI REVISI 1
( ADA TIDAKNYA PERESEPAN SETIAP HARI )
BULAN : TAHUN :
TANGGAL
NO NAMA GENERIK NAMA PATEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PSEUDOEFEDRIN HCL 60MG + TRIPOLIDIN HCL 2,5
TREMENSA
1 MG
2 AMBROXOL 30 MG MUCERA 30 MG
3 SUCRALFAT 500 MG/ML IMPEPSA
4 SOMATOSTATIN SANDOSTATIN
5 ZINC 10MG/5ML ZINKID
6 MYCOPHENOLATE MOFETIL 500 MG CELLCEPT
7 KALIUM DIKLOFENAK 25 MG, 50 MG EXAFLAM
8 TRIAMCINOLON 40 MG/ML FLAMICORT
9 ETORICOXIB 90 MG, 120 MG ORINOX
10 MULTIVITAMIN ANAK DHAVIT
11 MULTIVITAMIN ANAK CURMUNOS

UTROGESTAN
12 PROGESTERON TERMIKRONISASI 100 MG, 200 MG
13 FLUNARISIN 5 MG, 10 MG FREGO
14 LEVETIRACETAM 500 MG LEVITAM
15 BETAHISTIN MESILAT 6 MG VERTIKAF
16 SUMATRIPTAN TRIPTAGIC
17 FONDAPARINUX 2,5 MCG DIVITI
18 METHISOPRINOL MAXPRINOL
19 N-ACE N-ACE
20 VASOPRESSIN FARPESSIN
21 SALBUTAMOL SUPRASMA
22 ESOMEPRAZOL ESOMAX
23 METRONIDAZOL + NYSTATIN TROGYSTATIN
24 VITAMIN K1 PROHEM
25 VITAMIN K1 NEO K
26 PARACETAMO 325MG + TRAMADOL 37,5MG TRAMSET
27 ASETOSAL 80 MG, 100 MG ASCARDIA
28 NICARDIPIN NICARDEX
29 NIMODIPIN NIMOTROP

KEPALA INSTALASI FARMASI PENANGGUNG JAWAB PELAYANAN FARMASI

ENDAH NURRAHMI SANDIAH. S.Si.,Apt JUNAIDI S.Farm.,Apt

NIP: 19751221 200501 2 012 NIP: 19850721 200902 1 001