FORMULARIUM OBAT KLINIK PRATAMA MITRA MEDIKA

KELAS TERAPI NAMA GENERIK FORMULASI ( BENTUK SEDIAAN,KEKUATAN BPJS UMUM

1.ANALGESIK ANTIPIRETIK, ANTI INFLAMASI NON STEROID, ANTIPIRAI peresepan maximal Nama Dagang
1.1 ANALGESIK NON NARKOTIK
Asam Mefenamat Tablet 500 mg 8 tablet Anastan, Omestan, Glenistan
Ibuprofen Tablet 400 mg 8 tablet Etafen, Farsifen
sirup 100mg/5ml 1 fls Farsifen Syr, Novaxiven syr
sirup forte 200mg/5ml Salfenal Forte syr
Natrium diclofenac tablet 50 mg 6 tablet Voltadex
Paracetamol Tablet 500 mg 8 tablet Hufagesic, Novagesic, Pacetik
sirup 120mg/5ml 1 fls hufagesic syr, Oratemp kids syr
sirup forte 160mg/5ml 1 fls Fasidol forte
drops 100 mg/ml Hufagesic drop syr
Kalium diclofenac tablet 50 mg 8 tablet Erphaflame, Genflam
Meloxicam tablet 15 mg 3 tablet
tablet 7,5 mg 6 tablet
Antalgin Tablet 500 mg 8 tablet Infalgin
1.2 ANTIPIRAI
Allopurinol tablet 100 mg; 300 mg 3 tablet Allodan 100 mg
Allofar 300 mg
2. ANESTETIK
2.1 ANTIEPILEPSI, ANESTETIK
Diazepam Inj 5 mg/ml
Atorpine Inj 0,25 mg/mL
2.2 ANESTETIK LOKAL
Etil Klorida Semprot 100 ml
Lidokain Inj 2%
cream kombinasi Tetracaine Litramed cream
kombinasi epinephrine Lignospan 1:80.000
3. ANTIALERGI
Chlorpheniramine maleat tablet 4 mg 8 tablet Alleron
cetirizin tablet 10 mg 3 tablet Cetirizin
sirup 5 mg/5ml Hufarizine syr
Loratadine tablet 10 mg 3 tablet Loratadine
4. ANTIBAKTERI, ANTIVIRUS, ANTIFUNGI, ANTIAMUBA
4.1 Beta Lactam
Amoxycillin tablet 500 mg 9 tablet Omemox, Hufanoxil
sirup 125mg/5ml 1 fls Hufanoxil DS, Yusimox DS

Cefadroxyl Kapsul 500mg 6 kapsul Lostacef kap

Sirup 125mg/5ml, sirup Forte 250mg/5ml Lostafef dry syr
Lostacef Forte dry syr
Cefixime kapsul 100mg Cefixime kapsul

4.2 Sulfamethoxaole-Trimetoprim
kotrimoksazol tablet Trimethoprim 160mg 6 tablet cotrimoxazole tab
Sulfamethoxazole 800 mg
sirup sulfamethoxazole 200mg, trimetoprim 40mg/5ml 1 fls

4.3 Makrolida
Eritromisin kapsul 500mg
4.4 kloramfenikol
kloramfenikol Tetes mata 0,5% , Salep Mata 1%, Tetes Telinga 1% 1 fls Reco Tetes Mata
1 tube Erlamycetin, Reco salep mata
1 tube Erlamycetin Tetes Telinga
Tiamfenikol kapsul 500 mg 9 tablet Dionicol 500 mg
4.5 Kuinolon
Ciprofloxacin tablet 500mg 6 tablet Etaflox 500mg, Hufaflox 500 mg
Novaflox 500 mg
4.6 AMINOGLIKOSIDA
Gentamycin cream 0,1% 1 tube Genalten
Kanamicin inj serb 1 gr
4.7 Lincosamides
Clindamycin kapsul 150mg;300mg 9 kapsul Clindamycin 150 mg; 300mg
4.8 ANTIAMUBA
Metronidazole tablet 500 mg 9 tablet Grafazole 500
4.9 ANTELMINTIK
Albendazole tablet kunyah 400mg 4 tablet
4.10 ANTIFUNGI
Ketoconazole tablet 200 mg 6 tablet Ketoconazole 200mg
cream 2 % 1 tube Ketoconazole 2%
Miconazole cream 2 % 1 tube Miconazole 2 %
4.11 ANTIVIRUS
Acyclovir tablet 200mg;400mg 20 tablet Acyclovir 200mg;400mg
cream 5% 1 tube Acyclovir cr
4.12 ANTI PARASIT
Phermethrine cream 50 mg 1 pot 5 gram Scabimite

5. VERTIGO
Betahistin mesilate tablet 6 mg 6 tablet Histigo

Flunarizine tablet 10 mg 2 tablet Seremic

6. KORTIKOSTEROID
Dexamethasone tablet 0,5mg 8 tablet Danason, trodex, hufadexta-m,
Gendextim
Prednisone tablet 5mg 8 tablet Trifacort, ifison
Metylprednisolone tablet 4mg;8mg 6 tablet Metilgen
Triamcinolone tablet 4mg Omenacort
oral Base 1mg Bufacom
7. KORTIKOSTEROID TOPIKAL
Betametasone cream 0,05%; 0,1% 1tube Nisagon, gentason-N
Hidrocortisone cream 2,5% 1tube Hidrocortisone
Flucinolone cream 1 tube Prodermis, Gencinol-N
8. Obat yang mempengaruhi Koagulasi
Asam tranexamat tablet 500mg 6 tablet Nexitra 500mg

9. SISTEM SALURAN CERNA

9.1 DISPEPSIA & REFLUKS GASTROINTESTINAL
Antasida (Alumunium hidroksida;magnesium hidroksida) tablet kunyah 200mg;200 mg 8 tablet Hufamag plus, stomach
DOEN & Cimetikon
 sirup Hufamag susp, Stomach

9.2 ANTITUKAK LAMBUNG

9.2.1 ANTAGONIS RESEPTOR H2
Ranitidin tablet 150mg 6 tablet Ranitidin

9.2.2 PENGHAMBAT POMPA PROTON

Omeprazole kapsul 20 mg 6 tablet Lokev

9.3 ANTIEMETIK
Domperidon Tablet 10mg 8 tablet Hufadon tablet, Omedom
sirup 5mg/5ml Hufadon susp, Omedom
9.4 ANTIDIARE
9.4.1 ADSORBEN
Antalpugit tablet: antalpulgit 600mg 8 tablet Akita, New Antides

9.4.2 ANTIMOLTILITAS
Loperamide tablet 2mg 6 tablet Loperamid

9.5 ANTISPASMODIK
Hyosine butylbromid-Paracetamol tablet 10 mg/500mg 6 tablet spasminal

9.6 PENCAHAR
Bisacodyl tablet 5mg 3 tablet Laxana 5 mg

10. HEMOROID
Ambeven kapsul 3 kapsul Ambeven

11. ANTIDIABETIK ORAL

11.1 SULFONILUREA
Glimepirid tablet 1mg; 2mg 30 tablet Glimepirid 1mg;2mg;3mg

Glikazid tablet 80mg; 100 mg 30 tablet Glucodec

11.2 BIGUANIDA
Metformin tablet 500mg 90 tablet Metformin 500mg
11.3 PENGHAMBAT ABSORBSI GULA
Akarbose Tablet 50 mg; 100 mg
12. KARDOIVASKULAR
12.1 JANTUNG
Digoxin tablet 0,25mg 6 tablet Digoxin 0,25 mg

Isosorbide Dinitrate tablet 5 mg 3 tablet ISDN 5 mg

12.2 ANTIHIPERTENSI
12.2.1 BETA BLOKER
Bisoprolol tablet 2,5 mg ; 5mg 30 tablet Bisoprolol 5mg

12.2.2 PENGHAMBAT ACE

Captopril tablet 12,5mg; 25mg 10 tablet Captopril 12,5mg; 25 mg

Lisinopril tablet 5mg;10mg 30 tablet Lisinipril 5mg; 10mg

Perindopril arginin Tablet 5mg Bioprexum
12.2.3 ANTAGONIS RESEPTOR ANGIOTENSIN II
Candesartan tablet 8mg;16mg 30 tablet Candesartan 8mg;16mg

12.2.4 CALSIUM CHANEL BLOKER

Amlodipin tablet 5mg;10mg 30 tablet Zevask 5mg

12.3 DIURETIKA
12.3.1 THIAZIDE
Hidroklorotiazid tablet 25mg 3 tablet Hidroklorotiazid 25mg
12.3.2 HEMAT KALIUM
Spironolacton tablet 25mg 3 tablet Spironolacton 25mg
12.3.3 LOOP DIURETIK
Furosemide tablet 40 mg 3 tablet Furosemide 40 mg
12.4 ANTIPLATELET
ASETOSAL tablet 80mg; 100 mg 10 tablet Aspilet, Aptor

13. HIPERLIPID
13.1 STATIN
Simvastatin tablet 10mg 3 tablet Simvastatin 10 mg

13.2 FIBRAT
Gemfibrozil Kapsul 300mg Gemfibrozile 300mg
14. SISTEM SALURAN NAFAS
14.1 ANTI ASMA & BRONKODILATOR
14.1.1 BRONKODILATOR
Salbutamol tablet 2mg; 4mg 8 tablet salbutamol 2mg;4mg

14.1.2 INHALASI & VEBULISASI

Budesonide Respules 0,5 mg/ml Pulmicort
Budesonide/formoterol turbuhaler 160/4,5 mcg/dose Symbicort
Salbutamol nebules 2,5 mg Ventolin
Fenoterol Hydrobromide 100 mcg/puff Berotec
Salmeterol-fluticasone Diskus 50/100 mcg Seretide

14.2 MUKOLITIK
Ambroxol tablet 30mg 8 tablet Hufaxol
sirup 15mg/5ml
14.3 ANTITUSIF & EKSPECTORAN
14.3.1 ANTITUSIF
Dextrometorfan Tablet 10 mg Kombinasi 8 tablet Grantusif, Dextral

14.3.2 EKSPEKTORAN
Guafenesin tablet 50mg; 100mg 8 tablet Paraflu, Flutamol
Amonnium Kloride Sirup OBH 1 fls OBH syr

14.4 DEKONGESTAN
Tipolidin+Pseudoefedrin tablet: tripolidin 2,5 mg,Pseudoefedrin 60 mg Lapifed, oratifed
Pseudoefedrin tablet 7,5 mg; 30 mg 8 tablet Demacolin, Colpica
Phenylpropanolamine HCl tablet 12,5 mg 8 tablet Omecold
15. VITAMIN, SUPLEMEN MAKANAN
B6 tablet 10 mg 8 tablet
VIT C tablet 25 mg 8 tablet Hufavicee
B1, B6, B12 Tablet 100 mg, 200 mg, 200 mcg 3 tablet Hufaneuron, Omeneuron
Metamizole sodium, B1, B6, B12 Tablet 500 mg, 50 mg, 100 mg, 100 mcg Hufralgin
B12 tablet 25 mg 8 tablet
B COMPLEX Tablet 8 tablet Nusaplex, Panvit-C, Hufavice
Curcuma Tablet Curcuma
Zat Besi kapsul 3 kapsul Etabion, Hufabion
Kalsium Tablet 3 tablet Trimakalk
Multivitamin Tablet, sirup Hufavicee, Tyalisin Syr
Mecobalamin kapsul 500 mikrogram 3 tablet Mecobalamin
Zinc tablet 20 mg 3 tablet zinc sulfate
Lactobacilus Serbuk Lacto-B
16. INJEKSI
Lidocaine Inj. ampul
Lidocaine + Epinefrin Inj. ampul Pehacain injeksi
Epinefrine inj ampul
Ketorolac inj ampul
Cyanocobalamin inj vial
Thiamine + Pyridoxine + Cyanocobalamin inj ampul Neurobion 5000
Ranitidine inj ampul
Dexamethasone inj ampul
Epinefrin Inj 0,1%
Deksametason inj 5 mg/ml

17. ANTISEPTIK
Hidrogen peroksida cairan
klorheksidin larutan 1%
Povidon Iodin larutan 100mg/ml
Povidone Iodine 1% obat kumur 1% Betadine Mouthwash and Gargle
18. DESINFEKTAN
Etanol 70%

19. OBAT DAN BAHAN UNTUK GIGI

Eugenol cairan
formokresol cairan
kalsium hidroksida pasta
klorfenol kamfer mentol (CHKM) cairan
Klorheksidin larutan 0,2%
Natrium Hipoklorit Cairan konsentrat 5%
Pasta pengisi saluran akar Pasta
Povidon Iodin larutan obat kumur 1% Betadine gargle
Bahan Tumpatan sementara Serbuk
Komposit Resin Pasta aktivasi sinar
Akuades cairan 500 ml

20. INFUS
Dextrose 5% Infus 500 ml
NaCl Infus 100ml; 500ml
Ringer Laktat Infus 500 ml

DIREKTUR KLINIK MITRA MEDIKA,

dr.Nurina
NIK.198311132009052001