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Formularium Rs Royal

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FORMULARIUM RS.

 ROYAL PRIMA

1. GASTROINTESTINAL & HEPATOBILIARY SYSTEM


1.1 ANTACIDS, ANTIREFLUX AGENTS & ANTIULCERANTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Antasida Doen
Kombinasi :
Alluminium Hydroxyde + Magnesium
Hydroxyde
- Tablet Antasida Doen OGB
Magtral Otto
Sanmag Sanbe

- Syrup Antasida Doen OGB


Lagesil Lapi

- Syrup Forte Sanmag Forte Sanbe


2 Esomeprazole
- Tablet 20 mg, 40 mg Nexium Astr

- Injeksi Nexium Astr


3 Lansoprazole
- Capsul 30 mg Acilaz Otto
Lansoprazole OGB
Lapraz Sanbe
Laz Dexa

4 Misoprostol
- Tablet 200 mcg Cytotec
Gastrul Fahreinheit
5 Omeprazole
- Capsul 20 mg Omeprazole OGB
Pumpitor Sanbe
Rocer Otto

- Injeksi 40 mg Gastrofer Dexa


Omeprazol OGB
Ozid Darya
Pumpitor Sanbe
Rocer Otto
6 Pantoprazole
- Tablet 20 mg, 40 mg Pepzol MBF

- Injeksi 40 mg Ottozol Otto


Pantoprazole OGB
Pumpisel Sanbe
Topazol Lapi
Vomizole Dexa
7 Rabeprazole

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FORMULARIUM RS. ROYAL PRIMA

- Tablet 10 mg, 20 mg Pariet Esai

8 Ranitidine
- Tablet 150 mg Ranitidin OGB
Rantin Kalbee

- Injeksi 50 mg Ranitidine OGB


Ulceranin Otto

- Syrup 75 mg / 5 mL Ranivel Novel


11 Sucralfate
- Tablet 500 mg Musin Otto
Ulsidex Dexa

- Susp 500 mg / 5 mL (100 mL, 200 mL) Inpepsa Fahreinheit


Musin Otto
Ulsafat Combiphari

1.2 GIT REGULATORS, ANTIFLATULENTS & ANTI-INFLALAMMATORIES

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1 Domperidone
- Tablet 10 mg Domperidone OGB
Gerdilium Otto
Vometa Dexa

- Syrup 1 mg / mL, 60 mL Domperidon OGB


Gerdilium Otto
Vometa Dexa

- Drop 5 mg / mL, 10 mL Domperidon OGB


Gerdilium Otto
Vometa Dexa
2 Metoclopramide
- Tablet 5 mg Metoclopramide OGB

- Tablet 10 mg Metoclopramide OGB


Sotatic Fahreinheit

- Injeksi 5 mg / mL Metoclopramide OGB


Piralen Otto
Primperan Ethica

1.3 ANTISPASMODICS

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1 Kombinasi :
Chlordiazepoxide + Clidinium Br

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FORMULARIUM RS. ROYAL PRIMA

- Tablet 5 mg / 2,5 mg Braxidin Sanbe

2 Hyoscine-n-butylbromide
- Tablet 10 mg Hyoscine N-Butil Brom OGB
Scopamin Otto

- Injeksi 20 mg/ml Hyoscine N-Butil Brom OGB


Scopamin Otto

Kombinasi :
Hyoscine-n-butylbromide + Paracetamol
- Tablet 10 mg + 500 mg Buscopan Plus Boehringer

1.4 ANTIDIARRHEALS

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1 Activates Attapulgite
- Tablet 600 mg New DiaTablets Medifarma
2 Dictahedral Smectite
- Sach Smecta

3 Kaolin + Pektin
- Tablet 550 mg + 20 mg Neo Diaform Corsa

- Suspensi Sirup 700 mg + 50 mg Neo-Kaolana Sanbe


Kanina Ifars
4 Kombinasi 1 :
a. Probiotik
b. Vit C, Vit B1, Vit B2, Vit B6
c. Niacin, Protein, Fat, Energy
- Sach Liprolach Kalbee
Probiokid Sanbe
Kombinasi 1 + Rice Starch
- Sach L-Bio Lapi
5 Loperamide HCL
- Tablet 2 mg Lodia Sanbe
Lopamid
6 Zn Sulfate Heptahydrate
- Syrup 10 mg / 5 mL L-Zinc Lapi
Zincpro Combiphariphar

1.5 LAXATIVES, PURGATIVES

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1 Bisacodyl
- Tablet 5 mg Dulcolax Boehringer

- Supp 5 mg, 10 mg Dulcolax Supp Boehringer

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FORMULARIUM RS. ROYAL PRIMA

2 Laktulosa
- Suspensi 3,33 mg / 5 mL Opilax Otto
3 Kombinasi :
Na Lauril SO4 45 mg + Na Sitrat 450 mg +
Asam sorbat 5 mg + Sorbitol 4,465 mg + PEG
- Enema 5 mL Microlax Pharos
4 Kombinasi :
Phenolphthalein 55 mg + Liqd paraffin 1200 mg +
Glycerin 378 mg
- Susp 30 mL, 60 mL Laxadine Galenium

1.6 DIGESTIVES

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1 Kombinasi :
Pakreatin 170 mg + Dimetilpoliksilosan 80 mg
- Tablet salut Gasflat Fahreinheit
2 Sulfasalazin
- Tabletlet Salut 500 mg Sulfitis Fahreinheit
3 Kombinasi 1 :
a. Probiotik
b. Vit C, Vit B1, Vit B2, Vit B6
c. Niacin, Protein, Fat, Energy
- Sach Liprolach Kalbee
Probiokid Sanbe
Kombinasi 1 + Rice Starch
- Sach L-Bio Lapi

1.7 CHOLAGOGUES, CHOLELITHOLTICS & HEPATIC PROTECTORS

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1 Asam Ursodeoksikolat
- Capsulul 250 mg Urdafalk Darya Varia
Urdahex Kalbee
2 Curkuminoid
-Tablet 200 mg Curcuma Soho
3 Kombinasi :
Curkuminoid 2 mg +
Vitamin B1, B2, B6, B12, Betacaroten,
Dexphantenol.
- Syrup 60 mL Curcuma Plus Soho
4 Kombinasi :
a. Probiotik
b. Vit C, Vit B1, Vit B2, Vit B6
c. Niacin, Protein, Fat, Energy
d. Rice Strach L-Bio Lapi
5 Kombinasi :
a. Lecithin + nicotinamide

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FORMULARIUM RS. ROYAL PRIMA

b. vit B1, vit B2, vit B6, vit B12, vit E


- Capsul Lesichol Landson

1.8 ANORECTAL PREPARATION

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1 Antihemorroid
- Suppossitoria Antihemorroid Kimia Farma
2 Micronized purified flavonoid fraction
- Tablet 500 mg Ardium Servier
3 Diosmin + Hesperidin
- Tablet 500 mg Rhodium Fahreinheit
4 Policresulen + Cinchocaine HCL
- Suppossitoria Faktu Supp Pharos

1.9 ANTIEMETICS

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1 Granisetron
- Injeksi 1 Mg, 3 Mg Granisetron OGB
Granon Dexa
Opigran Otto
2 Ondasetron
- Tablet 4 mg, 8 mg Ondansetron OGB
Vometraz Dexa

- Injeksi 4 mg, 8 mg Cendoantron Soho


ODR Lapi
Ondansetron OGB
Trovensis Sanbe
Vometraz Dexa

- Syrup 4 mg/5mL Cendoantron Soho


ODR Lapi

2. CARDIOVASCULAR & HAEMATOPOIETIC SYSTEM

2.1 ANTI-ANGINAL DRUGS

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1 Amiodarone Hcl
- Tablet 200 mg Cardarone Sano
Tyarit Fahreinheit

- Injeksi 150 mg / 3 mL Cardarone Sano


Tyarit Fahreinheit
2 Amlodipine Besylate

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FORMULARIUM RS. ROYAL PRIMA

- Tablet 5 mg, 10 mg Amlodipine OGB


Opivask Otto
Tensivask Dexa
3 Diltiazem Hydrochloride
- Capsul 100 mg Diltiazem OGB
Herbesser CD 100 Tanabe

-Capsul 200 mg Herbesser CD 200 Tanabe

- Injeksi 50 mg Herbesser Tanabe


4 Isosorbide Dinitrate
- Tablet 5 mg, 10 mg Farsorbid Fahreinheit
Isoket GSK
Isosorbid dinitrat OGB
5 Nifedipine
- Tablet 10 mg Nifedipin 10 mg OGB
- Tablet 20 mg Adalat Oros 20 mg Bayer
- Tablet 30 mg Adalat Oros 30 mg Bayer

2. 2 ACE INHIBITORS

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1 Captopril
- Tablet12,5 mg, 25 mg Captopril OGB
Captensin Kalbee
2 Imidapril HCL
- Tablet Tanapress Tana
3 Lisinopril
- Tablet 5 mg, 10 mg Noperten Dexa
4 Ramipril
- Tablet 2,5 mg, 5 mg Cardace Sanofi
Ramipril OGB

2. 3 CARDIAC DRUGS

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1 Amidarone HCL
- Tablet 200 mg Tyarit Fahreinheit
2 Digoxin
- Tablet 0,25 mg Digoxin OGB
Fargoxin Fahreinheit

- Injeksi 0,5 mg Fargoxin Fahreinheit


3 Dobutamine Hcl
- Injeksi 250 mg Dobuject Dexa
Dobutamin Kimia Farma
Doburan Novel
4 Dopamine

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FORMULARIUM RS. ROYAL PRIMA

- Injeksi 10 mg/ml, 40 mg/ml Dopamine Kimia Farma


Indop Fahreinheit
5 Epinephrine
- Injeksi 1 mg Epinephrine Ethi

2.4 BETA-BLOCKERS

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1 Bisoprolol
- Tablet 2,5 mg Concor Merc

- Tablet 5 mg Bisoprolol OGB


Concor Merc

Kombinasi :
Bisoprolol hemifumarate + Hydrochlorothiazide
- Tablet 2,5 mg, 5 mg Bipro Fahreinheit

2 Propranolol Hcl
- Tablet 10 mg, 40 mg Propanolol OGB

2. 5 CALCIUM ANTAGONISTS

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1 Amlodipine Besylate
- Tablet 5 mg, 10 mg Amlodipine OGB
Opivask Otto
Tensivask Dexa
2 Diltiazem Hydrochloride
- Capsul 100 mg Diltiazem OGB
Herbesser CD 100 Tanabe

- Capsul 200 mg Herbesser CD 200 Tanabe

- Injeksi 50 mg Herbesser Tanabe


3 Nicardipine Hcl
- Injeksi 10 mg Nicardipine OGB
Nicardex Dexa
Perdipine Aste
4 Nifedipine
- Tablet 10 mg Nifedipine OGB

-Tablet 20 mg Adalat Oros 20 mg Bayer

- Tablet 30 mg Adalat Oros 30 mg Bayer

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FORMULARIUM RS. ROYAL PRIMA

2.6 ANGIOTENSIN II ANTAGONISTS

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1 Candesartan Cilexetil
- Tablet 8 mg, 16 mg Blopress Take
Canderin Dexa
Candesartan OGB
2 Irbesartan
- Tablet 150 mg Irbesartan OGB
Iretensa Fahreinheit
Kombinasi :
Irbesartan 150 mg + Hydrochlorothiazide 12,5 mg
- Tablet Co Aprovel Aven

3 Losartan K
- Tablet 50 mg Acetensa Fahreinheit
4 Olmesartan Medoxomil
- Tablet 20 mg, 40 mg Olmetec Pfizer

5 Valsartan
- Tablet 80 mg, 160 mg Diovan Novartisrtis
Valesco Dipa

2.7 OTHER ANTI HYPERTENSIVES

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1 Clonidine Hcl
- Tablet Catapress Boehringer

- Injeksi Catapress Boehringer


2 Doxazosin Mesylate
- Tablet 1 mg, 2 mg, 4 mg Cardura Pfizer

3 Methyldopa
- Tablet 250 mg Dopamet Actavis

4 Terazocin Hcl
- Tablet 1 mg, 2 mg Hytrin Abbott

2.8 DIURETICS

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1 Furasemide
- Tablet 40 mg Furosemide OGB
Lasix Sanofi

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FORMULARIUM RS. ROYAL PRIMA

- Injeksi 10 mg/mL Furosemide OGB


Lasix Sanofi
2 Hidroclortiazida (HCT)
-Tablet 25 mg, 50 mg Hidroclortiazida Kimia Farma
3 Kombinasi :
Irbesartan 150 mg + Hydrochlorothiazide 12,5 mg
- Tablet Co-Aprovel Aven

4 Mannitol
- Infus Mannitol Otsu

5 Spironolacton
- Tablet 25 mg, 100 mg Spironolacton OGB

2.9 PERIPHERAL VASODILATORS & CEREBRAL ACTIVATORS

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1 Citicholine
- Tablet 500 mg Brainact Kalbee
Citicholin 500 mg OGB

- Injeksi 500 mg Brainact Kalbee


Berclov Sanbe
Citicholin OGB
2 Flunarizine
- Tablet 5 mg, 10 mg Flunarizin OGB
Frego Kalbee
3 Isoxsuprine HCl
- Tablet 20 mg Duvadilan Kimia Farma
Hystolan Dexa Medica

2.10 VASOCONSTRICTORS

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1 Norepinephrine
- Injeksi 4 mg Norepinephrine OGB
Raivas Dexa

2.11 DYSLIPIDEMIC AGENTS

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1 Atorvastatin Ca
- Tablet 10 mg, Lipitor Pfizer

- Tablet 20 mg Atorvastatin OGB

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FORMULARIUM RS. ROYAL PRIMA

Lipitor Pfizer
Atofar Fahreinheit

- Tablet 40 mg Lipitor Pfizer

- Tablet 40 mg Lipitor Pfizer


2 Fenofibrate
- Tablet 100 mg, 300 mg Trolip Dexa
3 Gemfibrozil
- Tablet 300 mg Gemfibrozil OGB
4 Rosuvastatin
- Tablet 10 mg, 20 mg Crestor Astr
5 Simvastatin
- Tablet 10 mg Simvastatin 10 mg OGB

- Tablet 20 mg Simvastatin 20 mg OGB

2.12 HAEMOSTATICS

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1 Menadione(Drag:Na bisulfite; Injeksi:HCl)
- Tablet Vitamin K OGB

- Injeksi Vitamin K OGB


2 Tranexamic Acid
- Tablet 500 mg Asam Tranexamat OGB
Kalnex Kalbee

- Injeksi 50 mg, 100 mg Asam Tranexamat OGB


Transamin Otto

2.13 ANTICOAGULANTS, ANTIPLATELETS & FIBRINOLYTICS (THROMBOLYTICS)

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1 Acetylsalicylic acid
- Tablet 80 mg Aspilet Chewable Dava

- Tablet 100 mg Aptor


Cardio Aspirin Bayer
2 Cilostazol
- Tablet 50 mg Antiplat Dexa
Cilostazol
Pletaal Otsuka
3 Clopidogrel
- Tablet 75 mg Clopidogrel OGB
Clopisan Sandoz
Plavix Sano

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FORMULARIUM RS. ROYAL PRIMA

4 Enoxaparin Na
- Injeksi 20 mg/0,2 mL, 40 mg/0,4 mL, 60 mg/0,6 mL Lovenox Aven
5 Fondaparinux Na
- Injeksi 2,5 mg / 0,5 mL Arixtra GSK
6 Heparin Na
- Injeksi 5000 IU / mL, 5 mL Inviclot Fahreinheit
7 Parnaparin
- Injeksi 4,250 Axa IU/0,4 mL, 6,400 Axa IU/0,6 mL Fluxum Fahreinheit
8 Warfarin N
- Tablet 2 mg Simarc-2 Fahreinheit

2.14 OTHER CARDIOVASCULAR DRUGS

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1 Atropine Sulfate
- Injeksi 0,25 mg Atropin Sulfat Ethica

3. RESPIRATORY SYSTEM

3.1 ANTIASTHMATICS & COPD PREPARATIONS

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1 Aminophylline
- Tablet Aminophylline Ethi

- Injeksi 24 mg/ml Aminophylline Ethi


2 Budesonide
- Capsul 3 mg Budenofalk Dava

- Inhaler 200 mcg / dose Obucort Swinghaler Boehringer

3 Ephedrine HCl
- Injeksi 50 mg Ephedrine Ethi

4 Epinephrine
- Injeksi Epinephrine Ethi

6 Fluticasone propionate
- Nebul 0,5 mg / 2 mL Flixotide Nebules GSK

7 Procaterol Hcl Hemihydrate


- Tablet 25 mcg, 50 mcg Meptin Otsu

- Syrup 25 mcg / 5 mL Meptin Otsu

- Inhaler 10 mcg / dose Meptin Swinghaler Otsu

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FORMULARIUM RS. ROYAL PRIMA

8 Salbutamol
- Tablet 2 mg, 4 mg Salbutamol OGB
Lasal Lapi

- Syrup / Syrup Exp Lasal Lapi


Salbron
Ventolin GSK

- Inh Ventolin GSK

- Nebul 5 mg Ventolin GSK


Velutin Novel

9 Terbutaline Sulfate
- Tablet 2,5 mg, Syrup Lasmalin Lapi
Nairet Otto
10 Theophylline
- Tablet 300 mg Retaphryl Kimia Farma

3.2 COUGH & COLD PREPARATIONS

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1 Ambroxol Hcl
- Tablet 30 mg Ambroxol 30 mg OGB
Epexol Sanbe
Mucera Otto

- Syrup 15 mg Ambroxol 15 mg OGB


Epexol Sanbe
Mucera Otto

- Syrup 30 mg Ambroxol 15 mg OGB


Epexol Sanbe
Mucopect Boehringer

- Drops Mucopect Boehringer


Epexol Sanbe
2 Bromhexine Hcl
- Tablet 8 mg Bisolvon Boehringer

- Syrup 4 mg / 5 mL Bisolvon Kids Boehringer

- Syrup Tiap 5 mL :
Bromhexine HCl 4 mg Guaiafenesin 100 mg Bisolvon Extra Boehringer

- Syrup Tiap 5 mL :

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FORMULARIUM RS. ROYAL PRIMA

Bromhexine HCl 4 mg, Paracetamol 150 mg,


CTM 2 mg, Phenylephrine HCl 5 mg Bisolvon Flu & Batuk Boehringer

- Injeksi 4 mg Bisolvon Boehringer

3 Codein HCl
- Tablet 10 mg, 20 mg Codein Kimia Farma

Kombinasi 1 :
Codeine + Phenyltoloxamine
- Cap 30 mg + 10 mg Codipront Kapsul Kimia Farma

- Syrup 11,11 + 3,67 / 5 mL Codipront Syrup 60 mL Kimia Farma

Kombinasi 2:
(Kombinasi 1) + Guaifenesin
- Cap (30 mg + 10 mg ) + 100 mg/ 5 mL Codipront Cum Exp Kimia Farma

Kombinasi 3 :
(Kombinasi 2) + Extrac Thyme
- Syrup (11,11 mg + 3,67 + 5,55 mg) + 5,55 mg / Codipront Cum Exp Kimia Farma
5 mL
4 Dextromethorphan HBr (DMP)
- Tablet 15 mg, Syrup Dextromethorphan OGB

- Kombinasi 1 : Tiap Tablet


DMP 15 mg + Phenylephrin HCl 5 mg + CTM2 mg +
+ Glyceryl Guaiacolate (GG) 50 mg. Dextrosin Tablet Otto
Tuzalos Sanbe
- Kombinasi 2 : Tiap 5 mL syrup
DMP 15 mg + Phenylpropanolamin HCl 12,5 mg +
Diphenhydramine HCl 5 mg + GG 50 mg. Dextrosin Tablet Otto

- Kombinasi 3 : Tiap 5 mL syrup


DMP 10 mg + Diphenhydramine HCl 12,5 mg +
Ammon Cl 100 mg + Na Citrate 50 mg +
Menthol 1 mg Sanadryl DMP Sanbe
5 Erdosteine
- Tablet 300 mg Vectrine Dexa

- Syrup 175 mg / 5 mL Vectrine Dexa


6 Glyceryl guaiacolate
- Tablet 100 mg Glyceryl Guaiacolate Mutifa
7 Diphenhydramine HCl kombinasi :
a. Diphenhydramine HCl + Ammon Cl +
K guaiacolsulfonate + Na citrate + Menthol
- Syrup (12,5 mg + 100 mg + 30 mg + 50 mg + 1 mg) Sanadyrl Sanbe

a. Diphenhydramine HCl + DMP + Ammon Cl + Sanadyrl DMP Sanbe

Page 13
FORMULARIUM RS. ROYAL PRIMA

+ Na citrate + Menthol
- Syrup (12,5 mg + 10 mg + 50 mg + 1 mg)
8 N-acetylcysteine
- Capsul 200 mg Fluimucil Zam

- Effervescen tablet 600 mg Fluimucil Zam

- Dry Syrup 100 mg / 5 mL Fluimucil Zam


9 Pseudoefedrin HCl
- Drop 7,5 mg / 0,8 mL Alco Drop Interbat
Neo Triaminic Novartisrtis
Rhinos Neo Drop Dexa
Kombinasi 1 :
Pseudoefedrin + Fexofenadine
- Tablet ( 60 mg + 120 mg ) Telfast Plus Sanofi

Kombinasi 2 :
Pseudoefedrin + Loratadine
- Capsul ( 5 mg + 120 mg ) Rhinos SR Dexa

Kombinasi 3 :
Pseudoefedrin + Terfenadin
- Syrup (15 mg + 20 mg ) / 5 mL Rhinofed Dexa
Kombinasi 3 :
Pseudoefedrin + Triprolidine HCl Tremenza Sanbe
- Syrup (60 mg + 2,5 mg) / 5 mL Rhinos Jr Dexa
10 Tripolidin kombinasi :
Triprolidine + Pseudoephedrine HCl
- Tablet 2,5 mg + 60 mg Tremenza Sanbe

- Syrup 1,25 mg + 30 mg / 5 mL Lapifed Lapi


Tremenza Sanbe
Triprolidine + Pseudoephedrine HCl + GG
- Syrup 1,25 mg + 30 mg + 100 mg / 5 mL Lapifed Expectorant Lapi
11 Kombinasi :
Succus Liquiritae + Ammonium Chlorida
- Syrup O.B.H OGB

3.3 NASAL DECONGESTANT & OTHER NASAL PREPARATIONS

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1 Fluticasone Furoate
- Nasal spray 27,5 mcg / spray Avamys GSK
2 Nacl
- Nasal Spray 6,5 mg / mL, 30 mL Breathy Nasal Spray Novell
3 Oxymetazoline HCL
- Nasal drop 0,025% Illiadin drop Merc

Page 14
FORMULARIUM RS. ROYAL PRIMA

- Nasal Spray 0,05% Illiadin Spray Merc


4 Triamcinolone acetonide
-Nasal Spray 55 mcg / spray Nasacort Aq Aven

4. CENTRAL NERVOUS SYSTEM

4.1 ANXIOLYTICS

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1 Alprazolam
- Tablet 0,5 mg, 1 mg Alprazolam OGB
Xanax Pfizer
2 Clobazam
- Tablet 10 mg Clobazam OGB
Frisium Sanofi
3 Diazepam
- Tablet 2 mg, 5 mg Diazepam Kimia Farma
Valisanbe Sanbe

- Injeksi 2 mg Stesolid Actavis


Valium Roche

- Rectal 5 mg/ml, 10 mg/ml Stesolid Actavis


4 Lorazepam
- Tablet 0,5 mg, 2 mg Merlopam Mersi

4.2 HYPNOTICS & SEDATIVES

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1 Estazolam
- Tablet 1 mg , 2 mg Esilgan Take
2 Midazolam
- Injeksi 5 mg / mL Sedacum Dexa

4.3 ANTIDEPRESSANTS

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1 Amitriptyline
- Tablet Amitriptyline OGB
2 Fluoxetine HCl
- Tablet 10 mg Kalxetin Kalbe

- Tablet 20 mg Kalxetin Kalbe


Nopres Dexa
3 Maprotiline HCl
- Tablet 50 mg Sandepril Mersi

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FORMULARIUM RS. ROYAL PRIMA

4 Sertraline HCl
- Tablet 50 mg Fridep Mersi

4.4 ANTIPSYCHOTICS

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1 Clozapine
-Tablet 25 mg, 100 mg Clozapine OGB
2 Haloperidol
- Tablet 0,5 mg, 1,5 mg, 5 mg Haloperidol OGB
3 Olanzapine
-Tablet 5 mg, 10 mg Olandoz Sandoz
4 Risperidone
-Tablet 2 mg Risperidone OGB

4.5 ANTICONVULSANTS

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1 Carbamazepine
- Tablet 200 mg Carbamazepine OGB
Tegretol Novartisrtis
2 Divalproex Na
- Tablet 250 mg Depakote Abbott

- Tablet 500 mg Depakote ER Abbott

3 Gabapentin
- Tablet 100 mg Gabexal Sandoz

- Tablet 300 mg Gabapentin OGB


Gabexal Sandoz
4 Oxcarbazepine
- Tablet 300 mg, 600 mg Trileptal Novartisrtis
5 Phenobarbital Na
- Tablet 30 mg Phenobarbital OGB

- Injeksi 100 mg Phental Combiphar


Sibital Mers
6 Phenytoin Na
- Cap 100 mg Phenytoin OGB

- Injeksiection 100 mg / 2 mL Phenytoin OGB


Dilantin Pfizer
7 Pregabalin
- Capsul 75 mg Lyrica Pfizer
Pregabalin OGB
8 Asam Valproat
-Tablet 250 mg Depakote Abbott

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FORMULARIUM RS. ROYAL PRIMA

-Tablet 500 mg Depakote ER Abbott

-Syrup 250 mg / mL Asam Valproat OGB


Depakene Abbott

4.6 ANTIPARKINSONIAN DRUGS

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1 Levodopa
Kombinasi 1 : Levodopa 100 mg + Benserazide 25 mg
- Tablet Leparason Dexa
Levopar Meprofarm
Kombinasi 2 : Levodopa 100 mg + Cabidopa 12,5 mg +
Entacapone 200 mcg
- Tablet Stalevo Novartisrtis

2 Pramipexole HCl
- Tablet 0,125 mg, 0,25 mg Sifrol Boehringer
3 Trihexyphenidyl Hcl
- Tablet 2 mg Trihexyphenidyl (THP) OGB
Hexymer Mersi

4.7 ANTIVERTIGO DRUGS

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1 Betahistine Mesylate
- Tablet 6 mg Betahistin Mesilat Dexa
Mertigo Dexa
Merislon Eisai
- Tablet 12 mg Merislon Eisai
2 Flunarizine
- Tablet 5 mg, 10 mg Frego Kalbee

4.8 ANALGESICS (OPIOID)

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1 Fentanyl
- Injeksiection 50 mcg / mL Fentanyl Jans

-TTS 25 mcg / jam, 50 mcg / jam Durogesic Johnson n Johnson


2 Morphine
- Tablet 10 mg MST Continus MBF

- Injeksiection 10 mg Morphine Kimia Farma

3 Pethidine

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FORMULARIUM RS. ROYAL PRIMA

- Injeksiection 100 mg Pethidine Kimia Farma


4 Tramadol HCL
- Cap 50 mg Orasic Otto
Tramadol OGB

- Injeksiection 50 mg, 100 mg Orasic Otto


Tramadol OGB
Kombinasi :
Tramadol HCL 37,5 mg + Paracetamol 325 mg
- Tablet Tramifen Otto

4.9 ANALGESICS (NON-OPIOID) & ANTIPYRETICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Acetylsalicylic Acid
-Tablet 80 mg Aspilets Medifarma

-Tablet 100 mg Aptor Nicholas


2 Ibuprofen
- Tablet 200 mg Ibuprofen 200 mg OGB

- Tablet 400 mg Ibuprofen 400 mg OGB

- Syrup 100 mg/mL Farsifen Ifars


Proris Pharos
Rhelafen Lapi

- Syrup 200 mg/mL Proris Forte Pharos


Rhelafen Forte Lapi
3 Paracetamol
- Tablet 500 mg Paracetamol OGB
Sanmol Sanbe

- Syrup 120 mg / 5 mL Ottopan Otto


Paracetamol OGB
Sanmol Sanbe

- Syrup 160 mg / 5 mL Tempra PT. Taisho

- Syrup 250 mg / 5 mL Tempra Forte PT. Taisho

- Oral Drop 100 mg / mL Ottopan Otto


Paracetamol OGB
Sanmol Sanbe
Tempra PT. Taisho

- Rectal 125mg, 250 mg Dumin Actavis

Page 18
FORMULARIUM RS. ROYAL PRIMA

- Infusus 1000 mg Farmadol Fahreinheit


Paracetamol OGB
Sanmol Sanbe
Kombinasi 1 :
Paracetamol + N-Acetyleysteine
- Tablet Sistenol Dexa
Kombinasi 2 :
Paracetamol + Vit. B. Complex
- Tablet Dolo-Neurobion Merck

4.10 NONSTEROIDAL ANTI-INLAMMATORY AGENTS (NSAIDs)

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Asam mefenamat
- Cap 500 mg Asam mefenamat OGB
Mefinal Sanbe
Opistan Otto
2 Celecoxib
- Tablet 100 mg, 200 mg Celebrex Pfizer
3 Dexketoprofen Trometamol
- Tablet Fendex Fahreinheit

- Injeksiection Ketesse Ferr


4 Etorixocib
- Tablet 90 mg, 120 mg Arcoxia 90 mg MSD
5 Ibuprofen
- Tablet 200 mg Ibuprofen 200 mg OGB

- Tablet 400 mg Ibuprofen 400 mg OGB

- Syrup 100 mg/mL Farsifen Ifars


Proris Pharos
Rhelafen Lapi

- Syrup 200 mg/mL Proris Forte Pharos


Rhelafen Forte Lapi
6 Kalium Diklofenak
- Tablet 25 mg Cataflam Novartis
Kalium Diklofenak OGB

- Tablet 50 mg Cataflam Novartis


Cataflam D Novartis
Kalium Diklofenak OGB
-Powder 50 mg / sacchet Cataflam Fast Novartis

-Drops 15 mg Cataflam Drop Novartis


7 Ketoprofen
- Tablet 50 mg, 100 mg Ketoprofen OGB

Page 19
FORMULARIUM RS. ROYAL PRIMA

- Injeksiection Kaltrofen Kalbe

- Suppositoria Profenid Sano


Pronalges Dexa

- Gel 30 gram Kaltrofen Kalbe


8 Ketorolac Tromethamine
- Tablet 100 mg Ketorolac OGB
Farpain Fahreinheit

- Injeksiection 30 mg Ketorolac OGB


Lactopain Lapi
Rativol Sanbe
Remopain Dexa
Toramine Otto
9 Metampiron
Kombinasi 1 :
Metampiron + Diazepam (500 mg + 2 mg) Analsik Sanbe
Kombinasi 2 :
Metampiron + Vit B. Complex Neuralgin RX Kalbee
10 Mefenamat Acid
- Cap 500 mg Asam mefenamat OGB
Mefinal Sanbe
Opistan Otto
11 Meloxicam
- Tablet 7,5 mg, 15 mg Meloxicam OGB
Movix
Moxic Otto
12 Metamizole Na
- Syrup 50 mg / mL Novartislgin Sanofi

- Injeksiection 5 mg Novartislgin Sanofi


Novartisldo Yarindo
13 Natrium Diclofenac
- Tablet 25 mg Flamar Sanbe

- Tablet 50 mg Diclofenac Na OGB


Flamar Sanbe
-Tube 1%, 20 gram Voltadex Dexa
Kombinasi :
Diclofenac Na + Sustained-release
- Tablet 75 mg, 100 mg Deflamat CR Actavis
14 Parecoxib Na
- Injeksieksi 40 mg Dynastat Pfizer
15 Piroxicam
- Tablet 10 mg, 20 mg Piroxicam OGB
16 Tinoridine HCL
- Cap 50 mg Nonflamin Take

Page 20
FORMULARIUM RS. ROYAL PRIMA

4.11 ANTIMIGRAINE PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Flunarizine
- Tablet 5 mg, 10mg Flunarizin OGB
Frego Kalbee

4.12 NOOTROPICS & NEUROTONICS / NEUROTROPHICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Citicholine
- Tablet 500 mg Brainact Kalbee
Citicoline OGB

- Injeksi 125 mg Citicoline OGB


Beclov Sanbe

- Injeksi 250 mg/2ml Brainact Kalbee


Beclov Sanbe
Serfac Otto

- Injeksi 1000 mg Serfac Otto


2 Mecobalamin
-Capsul 500 mcg Lapibal Lapi
Mecobalamin OGB
Methycobal Eisa

- Injeksi 500 mcg/ml Mecobalamin OGB


Methycobal Eisa
3 Piracetam
- Capsul 400 mg, 800 mg, 1200 mg Piracetam OGB

- Syrup 500 mg / 5 mL Latropil Lapi

- Injeksi 1 gr, 3 gr Piracetam OGB

- Infus 12 gr / 60 mL Neurotam Kalbee Farma

5. MUSCULO-SKELETAL SYSTEM

5.1 DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS)

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Tocilizumab
- Injeksieksi 80 mg, 400 mg Actemra Roche

Page 21
FORMULARIUM RS. ROYAL PRIMA

5.2 HYPERURICEMIA & GOUT PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Allupurinol
- Tablet 0,5 mg Recolfar Fahreinheit

- Tablet 100 mg Allopurinol 100 mg OGB


Reucid Otto

- Tablet 300 mg Allopurinol 300 mg OGB


Alluric
Reucid Otto

5.3 MUSCLE RELAXANTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Atracurium Besylate
- Injeksi 50 mg Atracurium Hameln Combiphariphar
Tramus Dexa
2 Eperisone Hcl
- Tablet 50 mg Eperisone OGB
Eprinoc Sanbe
Myonal Eisai
3 Rocuronium
- Infus 50 mg / 5 mL Noveron Novell
4 Tizanidine HCl
- Tablet 2 mg Sirdalud Novartisrtis

5.4 NEUROMUSCULAR DISORDER DRUGS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Neostigmine methylsulfate
- Injeksi 0,5 mg Neostigmin Combiphariphar

5.5 OTHER DRUGS ACTING ON THE MUSCULO-SKELETAL SYSTEM

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Calsium Lactat
- Kaplet Calsium OGB
2 Calsium Kombinasi :
Calsium Hydrogen Phospat (CHP)
CHP 500 mg + Vit D3 200 IU Calsifar Ifars
CHP 500 mg + Cholecalciferol 133 IU Cavit D3 Merck

Coral Calsium 500 mg + Natural soy isoflavone 20 mg, Cal-95 Lapi


Vit D3 200 Iu + Vit K1 25 mcg + Mg 100 mg +
Zn 5 mg + Boron 1 mg

Page 22
FORMULARIUM RS. ROYAL PRIMA

3 Glucosamin
-Tablet 500 mg Glucosamin Soho
Kombinasi
Glucosamin + Condroitin + Vitamin + Mineral Oste Forte Soho
4 Natrium Hyaluronat
- Injeksieksi 20 mg Suplasyn Dipa

- Injeksieksi 25 mg Adant Dispo Meiji

- Injeksieksi 60 mg Suplasyn One Shoot Dipa

- Injeksieksi 180 mg Durolane Kalbee

6. HORMONES

6.1 OESTROGENTS & PROGESTERONES & RELATED SYNTHETICS DRUGS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Allylestrenol
- Tablet 5 mg Pregnolin Dexa
Premaston Kalbee
2 Dydrogesterane
- Tablet 10 mg Duphaston Abbott

3 Ethinylestradiol
- Tablet 50 mcg Lynoral Schering-Plough
4 Norethisterone
- Tablet 5 mg Norelut Dexa
5 Progesterone
- Tablet/Supp 100 mg Ultrogestan Lapi

- Supp 200 mg, 400 mg Cygest Actavis

6.2 CORTICOSTEROID HORMONES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Dexamethasone
- Tablet 0,5 mg Dexamethason OGB

- Injeksi 5 mg Dexamethason OGB


2 Methylprednisolon
- Tablet 4 mg, 8 mg Lameson Lapi
Methylprednisolon OGB
Prednicot Otto
Sanexon Sanbe

- Tablet 16 mg Medixon Ferron

Page 23
FORMULARIUM RS. ROYAL PRIMA

- Injeksi 125 mg Lameson Lapi


Methylprednisolon OGB
Prednicot Otto
Sanexon Sanbe
3 Triamcinolone acetonide
- Tablet Kenacort Taisho
Trilac Novel

- Injeksi 10 mg/mL, 40 mg/mL Flamicort Dexa

- Salep Kenacort Taisho

6.3 TROPHIC HORMONES & RELATED SYNTHETIC DRUGS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Bromocriptine mesylat
- Tablet 2,5 mg Cripsa Caprifarmindo
2 Clomiphene Citrate
- Tablet 50 mg Profertil Kalbee Farma

7. CONTRACEPTIVE AGENTS

7.1 ORAL CONTRACEPTIVE

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Kombinasi :
Levonorgestrel & Ethinylestradiol
- Tablet (0,15 mg + 0,03 mg) Andalan Pil KB Harsen

7.2 OTHER CONTRACEPTIVES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Copper Wire With a Polyethylene Core w/ Safe Load
- Alat KB Copper-T Kimia Farma

2 Copper Wire With Silver Core


- Alat KB Novartis-T Bayr

8.ANTI-INFECTIVES SYSTEMIC

8.1 AMINOGLYCOSIDES

Page 24
FORMULARIUM RS. ROYAL PRIMA

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Amikacin Sulfate
- Injeksi 500 mg Amikacin OGB
Mikasin Dankos
2 Gentamicin sulfate
- Salep 0,1 % Gentamicin 0,1% OGB

- Cream Garamycin Sche


Sagestam Sanbe
Ottogenta Otto

- Injeksi 80 mg/mL Gentamicin OGB


Ottogenta Otto
Sagestam Sanbe
3 Netilmicin Sulfat
- Injeksieksi 300 mg/1,5 mL Hypobhac Phapros
4 Streptomycin
- Injeksieksi 1 gram Streptomycin Meiji

8.2 CEPHALOSPORINS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Cefadroxil
- Capsul 500 mg Cefadroxil OGB
Cefat Sanbe
Lapicef Lapi
Opicef Otto

- Syrup 125 mg/5 mL Cefadroxil OGB


Cefat Sanbe
Lapicef Lapi
Opicef Otto

- Syrup 250 mg/ 5 ml Cefadroxil OGB


Cefat Sanbe
Lapicef Lapi
Opicef Otto

- Drops 150 mg / mL Renasistin Fahreinheit


2 Cefditoren Pivoxil
- Tablet 200 mg Meiact Meij
3 Cefepime Hcl
- Injeksieksi 1 gram Biocepime Otto
Cefepim OGB
Vipime Kalbee

4 Cefixime

Page 25
FORMULARIUM RS. ROYAL PRIMA

- Capsul 100 mg Cefixime OGB


Cefila Lapi
Cefspan Kalbee
Sporetic Sanbe
Starcef Dexa

- Capsul 200 mg Cefixime OGB


Cefila Lapi

- Syrup 100 mg / 5 mL, 30 mL Cefixime OGB


Cefila Lapi
Cefspan Kalbee
Sporetic Sanbe
5 Cefoperazone Na
- Injeksi 1 gr Cefoperazone OGB
6 Cefoperazone + Sulbactam
- Injeksi 1 gr Bactraz Otto
Cebactam Lapi
7 Cefotaxime Na
- Injeksi 500 mg Claforan Sanofi
Kalfoxim Kalbee
Taxegram Sanbe

- Injeksi 1 g Biocef Otto


Cefotaxime OGB
Claforan Sanofi
Clatax Fahreinheit
Lapixime Lapi
Taxegram Sanbe
8 Cefpirome
- Injeksieksi 1 gram Cefrin Dexa
9 Ceftazidime
- Injeksi 1 Biozim Otto
Ceftazidime OGB
10 Ceftriaxone
- Injeksi 1 gram Bioxon Otto
Broadced Kalbee
Ceftriaxone OGB
Cefxon Lapi
Elpicef Fahreinheit
Terfacef Sanbe
11 Cefuroxime Na
- Tablet 500 mg Celocid Dexa

- Injeksi 1 g/vial Anbacim Sanbe


12 Netilmicin
- Injeksi Hypobac Phap

Page 26
FORMULARIUM RS. ROYAL PRIMA

8.3 PENICILLINS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Amoxicillin
- Capsul 500 mg Amoxicillin OGB
Amoxsan Sanbe
Lapimox Lapi
Opimox Otto

- Syrup 125 mg, Syrup 250 mg Amoxicillin OGB


Amoxsan Sanbe
Opimox Otto

- Oral Drop Amoxicillin OGB


Amoxsan Sanbe

- Vial 1 gr Amoxsan Sanbe


2 Kombinasi : Amoxicillin + Clavulanate Acid
- Capsul (500 mg + 125 mg) Co Amoxiclav OGB
Clavamox Kalbee
Clamixin Otto
Claneksi Sanbe
Daxet Fahreinheit

- Syrup (125 mg + 31,25) / 5 mL Aclam Lapi


Clamixin Otto
Claneksi Sanbe

- Syrup (250 mg + 62,5 mg) / 5 mL Aclam Forte Lapi


Claneksi Forte Sanbe
3 Ampicillin
- Tablet 500 mg Ampicillin OGB

- Syrup 125 mg/5 mL Ampicillin OGB

- Injeksieksi 1gr Sanpicillin Sanbe

4 Penisillin
- Injeksi Penicillin Meij
5 Sulbenicillin Disodium
- Injeksi 1 gr Kedacillin Take

6 Kombinasi : Piperacillin + Tazobactam


- Injeksieksi (4 gram + 500 mg) Tazocin Pfizer

8.4 OTHER BETA-LACTAMS

Page 27
FORMULARIUM RS. ROYAL PRIMA

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Meropenem
- Injeksi 500 mg Meropenem OGB
Merofen Kalbee
Merotik Lapi
Ronem Fahreinheit

- Injeksi 1000 mg Meropenem OGB


Merosan Sanbe
Opimer Otto
Rindonem Yarindo
Ronem Fahreinheit
Tripenem Dexa

8.5 CHLORAMPHENICOLS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Chloramphenicol
- Capsul 250 mg Chloramphenicol OGB
Colsancetine Sanbe

- Syrup 125 mg Chloramphenicol OGB

- Injeksieksi 1 gram Colsancetine Sanbe


2 Thiamphenicol
- Tablet 500 mg Biothicol Sanbe

- Syrup 125 mg / 5 mL Biothicol Sanbe


Lacophen Lapi

- Syrup 500 mg / 5 mL (Forte) Biothicol Sanbe

8.6 MACROLIDES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Azithromycin Dihydrate
- Tablet 500 mg Aziyhromycin OGB
Azomax Dexa

- Syrup 200 mg / 5 mL Azomax Dexa


Zithromax Pfizer

2 Clarithromycin
- Tablet 500 mg Abbotic XL Abbott
Bicrolid Sanbe

-Dry Syrup 125 mg / 5 mL Abbotic Abbott

Page 28
FORMULARIUM RS. ROYAL PRIMA

3 Eritromycin
- Capsul 500 mg Eritromycin OGB
ErySanbe Sanbe

- Syrup 200 mg / 5 mL Eritromycin OGB


ErySanbe Sanbe
Opithrocin Otto

8.7 QUINOLONES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Ciprofloxacin Hcl
- Tablet 500 mg Baquinor Forte Sanbe
Ciprofloxacin OGB

- Infus Baquinor Sanbe


Ciprofloxacin Dexa
2 Levofloxacin
- Tablet 500 mg Cravit Kalbee
Cravox Lapi
Difloxin Otto
Levofloxacin OGB

- Infus 500 mg Cravox Lapi


Difloxin Otto
Levocin Sanbe
Levofloxacin OGB

- Infus 750 mg Cravox Lapi


Farlev Fahreinheit
3 Moxifloxacin Hcl
- Tablet 400 mg Avelox Bayr
Maxiflon Guardian
4 Ofloxacin
- Tablet 200 mg Ofloxacin OGB

8.8 TETRACYCLINS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Doxycyline Monohydrate
- Capsul 100 mg Doxycyline OGB
Doxicor Phma
Siclidon Sanbe
2 Tetracycline
- Capsul 500 mg Tetracycline OGB
TetraSanbe Sanbe

Page 29
FORMULARIUM RS. ROYAL PRIMA

8.9 ANTIBACTERIAL CombipharINATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Kombinasi :
Trimethoprim + Sulfamethoxazole
- Capsul (80 + 400) Bactrim Roche
Sanprima Sanbe
- Capsul Forte (160 + 800) Bactrim Forte Roche
Sanprima Forte Sanbe

- Syrup (40 mg + 200 mg) / 5 mL Bactrim Roche


Sanprima Sanbe

8.10 OTHER ANTIBIOTICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Clindamycin
- Tablet 150 mg, 300 mg Clindamycin OGB
Prolic Sanbe
2 Fosfomycin Na
- Injeksi 1 gram, 2 gram Formicin Meiji
3 Linezolid
- Infus 600 mg Zyvox Pfizer
4 Metronidazole
- Tablet 500 mg Flagyl Sanofi
Metronidazole OGB
Trogyl Otto

- Supp 0,5 gram Flagyl Sanofi

- Infus 500 mg Flagyl Sanofi


Metronidazole OGB
Trichodazol Sanbe
Trogyl Otto
5 Vancomycin
- Injeksi 500 mg Vancep Fahreinheit

8.11 ANTI-TB AGENTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Ethambutol Hcl
- Tablet 500 mg Ethambutol OGB
2 Isoniazid (INH)
- Tablet 100 mg, 300 mg Isoniazid (INH) Kimia Farma
INH Ciba Sandoz

- Tablet 400 mg INH 400 OGB

Page 30
FORMULARIUM RS. ROYAL PRIMA

- Tablet 400 mg + Vit B6 Inoxin Dexa


4 Pyrazinamide
- Tablet 500 mg Pyrazinamide 500 OGB
5 Rifampicin
- Tablet 450 mg, 600 mg Rifampicin OGB
Rifamtibi Sanbe
Kombinasi 1 :
Rifampicin + INH

- Tablet (450 + 300) Rimactazid Sandoz

- Tablet (75 mg + 50 mg) Rimactazid Paed Sandoz

Kombinasi 2 :
Rifampicin + INH + Pyrazinamid
- Tablet (150 mg + 75 mg + 400 mg) Rimcure 3FDC Sandoz

- Tablet (75 mg + 50 mg + 150 mg) Rimcure Paed Sandoz

Kombinasi 3 :
Rifampicin + INH + Pyrazinamid + Ethambutol Rimstar 4FDC Sandoz
- Tablet (150 mg + 75 mg + 400 mg + 275)

8.12 ANTIFUNGALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Boraks Gliserin
- Cairan 5 % 10 ml Boraks Gliserin Mutifa
2 Fluconazole
- Capsul 50 mg Diflucan Pfizer

- Capsul 150 mg Flucoral Kalbee

- Infusus 200 mg Diflucan Pfizer


3 Gelantin Violet
- Lar 1% 10 ml Gentian Violet Muti

4 Itraconazole
- Capsul 100 mg Itzol Lapi
5 Ketoconazole
- Tablet 200 mg Formyco Sanbe
Ketoconazole OGB
6 Micafungin Na
- Injeksi 50 mg Mycamine Astellas
7 Nystatin
- Susp 100,000 IU/mL Enystin Kalbee
Mycostatin Taisho

Page 31
FORMULARIUM RS. ROYAL PRIMA

Nymiko Sanbe
Nystin Lapi

8.13 ANTIVIRALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Acyclovir
- Tablet 200 mg, 400 mg Acyclovir OGB
Acifar Ifars
2 Ganciclovir
- Vial 500 mg Cymevene Roche

3 Ribavirin
- Tablet 200 mg Copegus Roch
4 Telbivudine
- Tablet 600 mg Sebivo Novartisrtis

8.14 ANTIHELMINTICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Albendazole
- Tablet 400 mg Albendazole 400 mg OGB
2 Pyrantel Pamoat
- Tablet 125 mg, 250 mg Combipharantrin Pfizer
Pyrantel Pamoat OGB

- Syrup 10 mL Combipharantrin Pfizer

8.15 ANTIMALARIALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Chloroquine Phospate

- Tablet 250 mg Resochin Bayer


Riboquin Dexa
2 Sulfadoxine + Pyrimethamine
- Tablet (500 mg + 25 mg) Fansidar Roch
3 Quinine
- Tablet 2 mg Kina Kimia Farma

9. ONCOLOGY
9.1 CYTOTOXIC CHEMOTHERAPY

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Bleomycin
- Injeksieksi 15 mg Bleocin Kalbee

Page 32
FORMULARIUM RS. ROYAL PRIMA

2 Cyclophosphamide
- Tablet 50 mg Cyclophosphamide Kalbee

- Injeksieksi 200 mg Cyclophosphamide Kalbee


3 Doxorubicin HCl
- Injeksieksi 10 mg Doxorubicin Actavis
Sandobicin Sanbe
4 Methotrexat
- Tablet 2,5 mg Methotrexat Kalbee

- Tablet 50 mg Methotrexat Kalbee


5 Oxaliplatin
- Injeksieksi 50 mg Oxaliplatin Sanbe
Rextra Kalbee
6 Vincristine
- Injeksieksi 1 mg Vincristine Kalbee

10. GENITO-URINARY SYSTEM


10.1 PREPARATIONS FOR VAGINAL CONDITIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Metronidazole
- Suppositoria0,5 gram, 1 gram Flagyl Sanofi
2 Kombinasi :
Metronidazole + Nystatin
- Ovula (500 mg + 100,000 IU) Flagystatin Sanofi
Neo Gynoxa Kalbe

10.2 URINARY ANTISEPTICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Pipemidic acid
- Capsul 400 mg Urotracin Sanbe

10.3 DRUGS ACTING IN THE UTERUS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Isoxsuprine HCl
- Tablet 20 mg Hystolan Dexa
Duvadilan Kimia Farma

- Injeksi 10 mg / 2ml Duvadilan Kimia Farma


2 Misoprostol
-Tablet 200 mcg Cytotec
Gastrul Fahreinheit
3 Methylergometrine maleat

Page 33
FORMULARIUM RS. ROYAL PRIMA

- Tablet 125 mcg Bledstop Sanbe


Methergin Novartis

- Injeksieksi 200 mcg / mL Bledstop Sanbe


Methergin Novartis
4 Synthetic oxytocin
- Injeksieksi 10 IU / mL Pitogin Ethica
Syntocinon Novartisrtis

10.4 DRUGS FOR ERECTILE DYSFUNCTION

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Sidenafil Citrate
- Tablet Viagra Pfizer

10.5 DRUGS FOR BLADDER & PROSTATE DISORDERS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Doxazosin Mewsylate
- Tablet 1 mg Cardura Pfizer
2 Dutasteride
- Capsul 500 mcg Avodart GSK

Kombinasi (Dutasteride+ Tamsulosin HCL Duodart GSK


- Capsul (500 mcg + 400 mcg)
3 Tamsulosin
- Tablet 0,2 mg Harnal D Astellas

- Tablet 0,4 mg Harnal Ocas Astellas


4 Terazosin HCl
- Tablet 1 mg Hytrin Abbott
Hytroz Dexa

10.6 OTHER DRUG ACTING ON THE GENITO-URINARY SYSTEM

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Asam - asam amino (a-ketoisoleucine Ca salt,
a-ketoleucine salt, a-hydroxymethionin Ca Salt,
a-ketovaline Ca-Salt, L-tryptophan, L-threonin,
L-histidine, L-tyrosine, L-lysine
- Tablet Aminefron Dexa
Ketorteril Fresenius Kabi

11. ENDOCRINE & METABOLIC SYSTEMS


11.1 INSULINS PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

Page 34
FORMULARIUM RS. ROYAL PRIMA

1 Insulin Aspart
- Injeksi. 100 IU/ml Novorapid Flexpen Novo
2 Insulin Aspart; Protaminated Insulin Aspart
- Pen Injeksieksi 100 IU/mL, 3 mL Novomix 30 Flexpen Novo
3 Insulin Detemir
- Pen Injeksieksi 100 IU/mL, 3 mL Levemir Flexpen Novo

4 Insulin Glargine
- Pen Injeksieksi 100 IU/mL, 3 mL Lantus Solostar Sanofi
5 Insulin Glulisine
- Pen Injeksieksi 100 IU/mL, 3 mL Apidra Solostar Sanofi
6 Isophane Human Insulin
-Vial Injeksieksi 100 IU/ml, 10 mL Humulin N Elly
7 ReCombipharinant Human Insulin
-Vial Injeksieksi 100 IU/ml, 10 mL Humulin R Elly
8 Regular soluble human insulin 30% & Isophane
human
insulin susp 70 %
- Pen Injeksieksi. 100 IU/ml, 3 mL Humulin 30/70 Elly
9 Insulin Lispro
- Pen Injeksieksi. 100 IU/ml, 3 mL Humalog Elly

11.2 ANTIDIABETICS AGENTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Acarbose
- Tablet 50 mg, 100 mg Acarbosa OGB
2 Glibenclamide
- Tablet 5 mg Glibenclamide OGB
Renabetic Fahreinheit
Kombinasi :
Glibenclamide + Metformin
- Tablet 1,25 mg / 250 mg Glucovance 250 Merck
- Tablet 2,5 mg / 500 mg Glucovance 500 Merck
3 Gliclazide
- Tablet 30 mg Diamicron Servier

- Tablet 60 mg Diamicron MR 60 Servier

- Tablet 80 mg Glucodex Dexa


4 Glimepiride
- Tablet 1 mg, 2 mg, 3 mg Amaryl Sanofi
Glimepiride OGB
Gluvas Dexa
Kombinasi :
Glimiperide + Metformin
- Tablet 1 mg / 250 mg Amaryl M1 Aven
- Tablet 2 mg / 500 mg Amaryl M2 Aven
5 Gliquidone
- Tablet 30 mg Gliquidone OGB

Page 35
FORMULARIUM RS. ROYAL PRIMA

Glurenorm Boehringer
6 Linagliptin
- Tablet 5 mg Trajenta Boehringer
7 Metformin
- Tablet 500 mg Metformin OGB
Glucophage Merck
Glucophage XR Merck
- Tablet 850 mg Metformin OGB
8 Pioglitazone
- Tablet 15 mg, 30 mg Deculin Dexa

Kombinasi : Pioglitazone + Metformin


- Tablet (15 mg + 850 mg) Actosmet Takeda
9 Sitagliptin
- Tablet 25 mg, 100 mg Januvia MSD

11.3 THYROID HORMONES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Levothyroxine Na
- Tablet 50 mcg, 100 mcg Euthyrox Merck
2 L-Thyroxine Na
- Tablet 100 mcg Thyrax Schering-Plough

11.4 ANTITHYROID AGENTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Thiamazole
- Tablet 5 mg, 10 mg Thyrozol Merck

11.5 AGENTS AFFECTING BONE METABOLISM

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Alfacalcidol
- Tablet 0,5 mcg, 1 mcg Bone-One Dipa
2 Calcitriol
- Tablet 0,25 mcg Kolkatriol Phapros

- Tablet 0,5 mcg Kolkatriol Forte Phapros


3 Ibandronic acid
- Injeksieksi prefiled syringe 3 mg / 3 mL Bonviva Roche
4 Risedronate Na
- Tablet 35 mg Actonel Sanofi
5 Zoledronic Acid

Page 36
FORMULARIUM RS. ROYAL PRIMA

- Soln 5 mg / 100 mL Aclasta Novartisrtis

12. VITAMINS & MINERALS

12.1 VITAMIN A, D, DAN E

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Vitamin E
- Tablet 100 mg Santa-E Sanbe
2 Cod liver oil + Vitamin A, D, E + EPA + DHA +
Orange Jus + Vit C + Vit B6
- Syrup 150 mL Seven Seas Merck

12.2 VITAMIN B-COMPLEX / WITH C

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Asam Folat
- Tablet 400 mcg Folavit Sanbe
Starfolat Dexa
- Tablet 400 mcg Asam Folat Kimia Farma
2 Fe-Sulfate Heptahydrate
- Tablet Sulfas Ferrosus Kimia Farma
3 Fursultiamine HCl + Vit B2
- Tablet Alinamin F Take
- Injeksieksi 25 mg/10 mL Alinamin F Take
4 Pyridoxine Hcl
- Tablet Vitamin B6 OGB
- Injeksieksi Vitamin B6 OGB
5 Thiamine
- Tablet Vitamin B1 OGB
- Injeksieksi Vitamin B1 OGB
6 Kombinasi :
a. Vit B1, Vit B2, Vit B6
- Tablet Vit. B-Complex OGB
7 Kombinasi :
Vit B1, Vit B6, Vit B12
- Tablet 200 mcg Neurodex Dexa
Neurobion Merck
- Tablet 5000 mcg Neurobion Forte Merck
- Injeksi 5000 mcg Neurobion Merck
Neurosanbe Sanbe
8 Kombinasi :
a. Vit B1 5 mg, Vit B2 2 mg, Vit B5 3 mg,
Vit B6 2,5 mg, B12 3 mcg
- Syrup BeCombipharion Merck
9 Kombinasi :

Page 37
FORMULARIUM RS. ROYAL PRIMA

a. Vit B1 Mononitrate, Vit B2, Vit B6, Vit B12 +


Vit C + Nicotinamide + Ca Pantothenate +
- Tablet Cebex Otto
10 Vit B12 (Cynocobalamin)
- Tablet Vitamin B12 Kimia Farma
- Injeksieksi Vitamin B12 Kimia Farma

12.3 VITAMIN C

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Ascorbic Acid
- Tablet 50 mg Vitamin C OGB
- Injeksieksi Vitamin C OGB

12.4 CALCIUM/WITH VITAMINS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Ca-Carbonate
- Tablet Calsium OGB
Osteocal Nicholas
Kombinasi :
Ca-Carbonate+ Vit D3 + Mg + Boron Citrat +
Zn Sulfat monohydrat + Cupric Sulfat + Chromium +
Asam Folat + Vit b6 + Vit B12 + Silica + DHA
- Tablet Osfit DHA Kalbee Farma
2 Calcium Hydrogen Phospate
- Tablet 500 mg Calcifar Plus Ifars
Kombinasi :
Ca hydrogen phosphate+ Cholecalciferol
- Tablet 500 mg / 133 UI Cavit D3 Merc
3 Kombinasi :
Coral Ca + Natural Soy Isoflavone + Vit D3 +
Vit K1 + Mg + Zn + Boron
- Tablet Cal-95 Lapi
4 Kombinasi :
Ossein Hydroxyapatite + Ca + Phosphorus
- Tablet Ossoral Dexa
5 Kombinasi :
Genistein (Bonistein) + Ca Phosphat) + Vit K1 +
Vit D3
- Tablet Hi Bone Otto

12.5 VITAMINS & / OR MINERALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Kombinasi 1 :
a. Dibasic Ca phosphate

Page 38
FORMULARIUM RS. ROYAL PRIMA

b. Ca lActaviste vit B6 20 mg, vit C 25 mg, vit D3


c. vit B6, vit C, vit D3
- Tablet Elkana Sanbe
Kombinasi 1 +
d. Nicotinamide, Choline, Inositol
e. L-Lysine HCl, Calcium, Sodium
f. DHA, AA, GOS
- Syrup Elkana CL Sanbe
2 Kombinasi :
a. Vit B1, Vit B2, Vit B 12
b. Nicotinamide
c. Pantothenic Acid
- Tablet Becom C Sanbe
3 Lutein + Lycopen + Vit E + Vit C + Zn + Selenium +
Betacaroten
- Tablet Lycoxy Dexa
4 Kombinasi :
a. Echinacea (EFLA 894)
b. Zinc picolinate
c. Selenium
- Tablet Imunos Lapi
- Syrup Imunos Lapi
5 Kombinasi :
a. Zn picolinate
b. Zn gluconate
c. Copper Gluconate
- Capsul Zinc Phma
12.6 VITAMINS & MINERALS (PEDIATRIC)

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Kombinasi ;
a. Vit B1, Vit B2, Vit B6, Vit B12
b. Curcuminoid
c. Lysine Hcl
d. Niacinamide
e. Pantothenic Acid
- Syrup Curcuma Plus Soho
2 Kombinasi :
a. Vit A, Vit C, Vit D
b. Vit B1, Vit B2, Vit B6, Vit B12
c. Nicotinamide
d. Lysine Hcl
e. Pantothenol
f. I-Glutamic Acid
- Syrup Apialys Lapi
- Drop Apialys Lapi
3 Colostrum Bonviva + DHA + Cod Liver Oil + Lysin +
Vit A + Vit D + Vit B1, B2, B6, B12 + Nicotinamide +

Page 39
FORMULARIUM RS. ROYAL PRIMA

Dexpanthenol + Zn
- Syrup Biostrum Lapi
4 Ferrazone + Vit. B1, B2, B3, B6, B7
- Drop Sangobion Merck
- Syrup Sangobion Merck
5 Kombinasi :
Polinaceae + Black elder Berry + Zinc + Vit C
- Syrup Starmuno Kalbe
6 Kombinasi :
a. Vit A, Vit C, Vit D, Vit E
b. Vit B1, Vit B2, Vit B3, Vit B6
c. Cod liver oil
- Syrup BeCombipharion Plus Merc

12.7 VITAMINS & MINERALS (PRE 7 POST NATAL)/ANTIANEMICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Kombinasi :
a. Vit B1, Vit B2, Vit B 12, Vit D3, Vit K
b. Folic Acid
c. Ca Pantothenate
d. Ca Carbonate
e. Nikotinamide
f. Beta Carotene
g. Biotin
h. Copper Gluconate
I. Fe Polymaltose Complex (IPC)
j. DHA From Algae
k. Arachidronic Acid
- Capsul Folamil Genio Dexa
2 Kombinasi 1:
a. Vit A, Vit B1, Vit B2, Vit B6, Vit B12
b. Vit C, Vit D3, Vit E
c. Nicotinamide
d. Ca Pantothenate
e. Fe Fumarate
f. K Iodide
g. Copper
h. Manganese, Zn
i. Folic Acid
- Tablet Folac Otto
Promavit Lapi
3 Kombinasi :
Ext. Trigonella foenum + Trigonella foenum + Ext.
daun katuk + Vit B12
- Tablet Lactamor Kalbe
4 Kombinasi ;

Page 40
FORMULARIUM RS. ROYAL PRIMA

Ca, Vit D3, Tuna Fish oil


- Tablet Osfit DHA Kalbe
5 Kombinasi :
a. Fe Fumarate
b. Folic Acid
c. Vit B12, Vit C, Vit D3
d. Ca Carbonate
- Tablet Prenamia Sanbe

13. NUTRITIONS
13.1 ENTERAL / NUTRITIONAL PRODUCTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Kombinasi :
a. Natural fish oil providing DHA
b. EPA, vit E
- Tablet ProlActavis with DHA for Mother Nove
2 Kombinasi :
a. Carbohydrate, Fat, Protein
b. Vit, Mineral, Energy
- Milk Powder Nutrensol Fahreinheit
3 Kombinasi :
a. Total fat, Saturated fat
b. Protein, Carbohydrate, Fiber, Sugar
c. Na, K, Inulin, Biotin, Cl
d. Omega-3 fatty/Omega-6 fatty acids
e. Energy
- Milk Powder Entramix Kalbe

13.2 PARENTERAL NUTRITION

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Glukose
- Infus 5 %, btl 500 ml Glukosa 5 % Wida
Ecosol glukosa 5 % Bbmi

- Infus 10 %, btl 500 ml Glukosa 10 % Wida

- Infus 40 %, btl 25 ml Ecosol glukosa 10 % Bbmi


Otsu-D40 Otsu
2 Natrium Chloride
- Infus 0,9 %, btl 500 ml Nacl 0,9 % Wida
Ecosol Natrium Bbmi

- Infus 0,9 %, btl 1000 ml Nacl 0,9 % Wida


Ecosol Natrium Bbmi

Page 41
FORMULARIUM RS. ROYAL PRIMA

3 Ringer LActaviste
- Infus btl 500 ml Ringer laktat Wida
4 Kombinasi :
a. Dextrose 5 %
b. Natrium Chloride 0,9 %
- Infus btl 500 ml Nacl+glukosa, lar Infus Wida
0,9 %/ 5 % steril
5 Kombinasi :
Glukose 5 %+ Natrum Chloride 0,45%
- Infus 500 ml Glukosa 5% + 0,45 % Wida
6 Kombinasi :
Gukose 2,5% + Natrium Chloride 0,45 %
- Infus 500 ml Dextrose 2,5 %+sod.
Wida
Chloride 0,45 %
Otsu-D2,5 1/2 NS Otsu
7 Kombinasi :
Glukose 5%+Natrium Chloride 0,225%
- Infus 500 ml Glukose 5% + Sod.
Wida
Chloride 0,225%
8 Kombinasi :
Amino Acid+Glucose+Electrolytes
- Infus Clinimix Kalbe
9 Kombinasi :
a. Gluccose
b. Amino Acid
c. Essential/non-essential amino acid
d. Branched-chain amino acid
e. Energy
- Infus 500 mL, 1000 mL Aminofluid Otsu
10 Kombinasi :
a. Soybean Oil
b. Egg Phosphatides
c. Glycerol
d. Na. Oleate
e. Energy
- Infus Ivelip Kalbe
11 Kombinasi :
a. Refined Olive oil
b. Refined Soybean oil
c. Energy
- Infus Clinoleid 20 % Kalbe
12 Kombinasi :
a. Amino acid
b. Na, Cl
c. Other Important Amino Acid
- Infus Aminoleban Otsu
Comafusin Hepar Kalbe
13 Kombinasi :
a. amino acid

Page 42
FORMULARIUM RS. ROYAL PRIMA

b. Nitrogen
c. Na
d. Acetate
- Infus Amiparen Otsu
14 Kombinasi :
a. Amino acid
b. Sorbitol
c. Essential /Non-essential Amino acid
- Infus Pan Amin G Otsu
15 Water For Injeksi
- Injeksi Amp 25ml, 1000 mL Steril Water Otsu

13.3 ELECTROLYTES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Calcium Chloride
- Tablet KSR Merc
2 Calcium Gluconate
- Injeksi Calcium Gluconate OGB
3 Kombinasi :
Na + K + Cl + Lactate + Glucose
- Infus 500 mL KA EN 3A Otsu
Tridex 27 A Sanbe
KA EN 3B Otsu
Tridex 27 B Sanbe
4 Kombinasi :
a. Glucose anhydrous
b. NaCl
c. Na bicarbonate
d. CaCl2
- Sach Oralit Kimia Farma
Smecta Soho
5 Magnesium Sulfate
- Injeksi Otsu-MgSo4 Otsu

6 Kombinasi :
Na, K, Cl, citrate, dextrose
- Soln Pedialyte Abbott

13. 4 SUPLEMENTS & ADJUVANT THERAPY

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Fucoidan
- Capsul 50 mg Fucohelix Kalbe
2 Kombinasi :
a. Polinacea
b. Black elderberry
c. Zinc picolinate, vit C

Page 43
FORMULARIUM RS. ROYAL PRIMA

- Tablet, Syrup Starmuno Kalbe


3 Kombinasi :
a. Placenta extr
b. vit B12
c. Ca Phosphate
- Tablet Lactavit Dexa
4 Kombinasi 1:
Echinacea + Zn picolinate
- Tablet Imboost Kimia Farma

- Syrup Imboost Kimia Farma

Kombinasi 1 + Black elderberry extr


- Tablet, Syrup Imboost Forte Kimia Farma
5 Kombinasi :
a. Echinacea purpurea extr
b. Propolis bee
c. Zn picolinate
d. Vit C
- Tablet, Syrup Opinacea Otto
6 Kombinasi :
a. PPC 95%
b. Silymarin phytosome
c. Schizandra extr
d. D-α-tocopherol
- Capsul Hepamax Kalbe
7 Pulverised curcuma roots
- Tablet Curcuma Soho
8 Kombinasi :
a. Echinase
b. Zn-pikolinat
c. Selenium
- Tablet Imunos Lapi
- Syrup Imunos Lapi
9 Natural astaxanthin
- Syrup Ascavin Dexa

10 Kombinasi :
a. β-carotene
b. Vit C, Vit E
c. Zn
d. Copper
e. Selenium, lutein
- Tablet Retivit Sanbe

14. EYE
14.1 EYE ANTI-INECTIVES & ANTISEPTICS

Page 44
FORMULARIUM RS. ROYAL PRIMA

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Gentamycine Sulphate
- Eye Oint Genta Cendo
Gentamycine OGB
Sagestam Sanbe
2 Chloramphenicol
- Eye Oint Chloramphenicol Kimia Farma
Fenicol Cendo

- Eye Dro Fenicol Cendo


3 Ofloxacin
- Eye Dro Floxa Cendo
4 Oxytetracycline
- Eye Oint Oxytetracycline Kimia Farma

14.2 EYE ANTISEPTICS WITH CORTICOSTEROIDS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Dexamethasone
- Eye Dro Polidemisin Sanbe
Kombinasi :
a. Dexamethasone
b. Polymixin Sulphate
c. Neomycine Sulphate
- Eye Dro, Eye Oint Polydex Cendo
Xitrol Cendo
2 Tetracain Hcl
- Eye Dro Pantocain Cendo
3 Kombinasi :
Tobramycine + Dexamethasone
- Eye Dro Tobroson Cendo

14.3 MYDRIATIC DRUGS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Atropine Sulphate
- Eye Dro Tropine Cendo
2 Tropicamide
- Eye Dro Mydriatil Cendo

14.4 MIOTIC DRUGS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Pilocarpine Hcl
- Eye Dro Carpine Cendo

Page 45
FORMULARIUM RS. ROYAL PRIMA

14.5 ANTIGLAUCOMA PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Azetazolamide
- Tablet Glaucon Cendo
2 Timolol Maleate
- Eye Dro Timol Cendo
Triatimol Cendo

14.6 OPTHALMIC DECONGESTANTS, ANESTHETICS, ANTI-InfusLAMMATORIES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Natrium Diklofenac
- Eye Dro Noncort Cendo

14.7 OPTHALMIC LUBRICANTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Kombinasi :
Sodium Chloride + Kalium Chloride
- Eye Dro Lyteers Cendo

14.8 OTHER EYE PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Amfoterisin
- Eye Oint Fungicid Cendo
2 Kombinasi :
Naphazoline Hcl + Antazoline Hcl
- Eye Dro Vasacon Cendo
3 Kombinasi :
a. Calcium Chloride Anhydrous
b. Potassium Iodide
c. Sodium Thiosulphate
- Eye Dro Catarlent Cendo
4 Kombinasi :
a. Bilberry Extract
b. Retinol
c. Vitamin E
d. Beta Carotene
- Tablet Berry Vision Sanbe
5 Kombinasi :
a. Zinc Sulphate
b. Phenylephrine Hcl
c. Vitamin A Palmitate
- Eye Dro Augentonic Cendo

Page 46
FORMULARIUM RS. ROYAL PRIMA

15. EAR & MOUTH/THROAT


15.1 EAR ANTI-InfusECTIVES & ANTISEPTICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Chloramphenicol
- Ear Dro Chloramphenicol Erla

15.2 EAR ANTISEPTICS WITH CORTICOSTEROIDS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Kombinasi :
a. Polymyxin B sulfate
b. Neomycin sulfate
c. Fludrocortisone acetate
d. Lidocaine HCl
- Ear Dro Otopain Interbat
2 Kombinasi :
a. Framycetin sulphate
b. Gramicidin
c. Dexamethasone Na metasulphobenzoate
- Ear Dro Blecidex Ear Drops Sanbe

15.3 OTHER EAR PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Docusate Na
- Ear Dro Forumen Sanbe

15.4 MOUTH/THROAT PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Fradiomycin Sulphate
- Tablet FG.Troches Meji
2 Lar. Benzydamine
- Gargle Tantum Verde Soho
3 Triamcinolone Asetonide
- Tube Kenalog In Orabase Tais

16. DERMATOLOGICALS
16.1 TOPICAL ANTIBIOTICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

Page 47
FORMULARIUM RS. ROYAL PRIMA

1 Fucidic Acid
- Cream Fusycom Combiphar
2 Kombiansi :
Neomycin sulfate + Bacitracin
- Oint, Powder Nebacetin Phar
3 Kombinasi :
a. Bacitracin
b. Llidocaine HCl
c. Neomycin sulfate
d. Polymyxin B sulfate
- Oint Liposin Phar
4 Mupirocin
- Cream 2% / 5 gr, 2% / 10 gr Bactoderm Ikap

5 Na. Fusidic
- Cream, Oint Fuson Pyri

6 Silver Sulfadiazine
- Cream Burnazin Dava

16.2 TOPICAL ANTIFUNGALS & ANTIPARASITES

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Ciclopirox
- Lacquer Loprox Nail Sano

2 Ketokonazole
- Cream Formyco Sanbe
Ketokonazol OGB
Mycoderm Otto

- Soln Zoloral SS Ikap


3 Kombinasi :
Nystatin + Zn oxide
- Cream Myco Z Tais

4 Miconazole Nitrate
- Cream Miconazol OGB

5 Kombinasi :
Salicylic acid + Sulfur precipitated
- Oint 2-4 Zalf Nufa

6 Kombinasi :
Lindane + Usnic acid
- Cream Scabicid Kimia Farma

Page 48
FORMULARIUM RS. ROYAL PRIMA

7 Permethrin
- Cream 5% Scabimite Gale

8 Tioconazole
- Cream Trosyd Pfizer

16.3 TOPICAL ANTIVIRALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Acyclovir
- Cream 5 % Acyclovir OGB

2 Tromantadin Hcl
- Cream Viru-Merz Combiphar

16.4 TOPICAL CORTICOSTEROIDS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Betametasone
- Cream Betametasone Kimia Farma
2 Desoximethasone
- Cream 10 gr Desoximethasone OGB

- Cream 15 gr Esperson Sano


Inerson Intr
3 Fluccinolone Acetonide
- Cream 0,25 mg / gram Cinolon Sanbe

Kombinasi :
Fluccinolone + Neomicyn Sulfate
- Cream 0,25 % / 1 % Cinolon N Sanbe
4 Hydrocortizone
- Cream, Oint Hydrocortizone OGB

5 Mometasone Furoate
- Cream Elocon Sche
Elomox Ifars

16.5 ACNE TREATMENT PREPARATIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Adapalene
- Gel Evalen Ferr
2 Benzoly Peroxide
- Gel Benzolac SDM
Page 49
FORMULARIUM RS. ROYAL PRIMA

Kombinasi :
Clindamycin + Benzoly Peroxide
- Cream Benzolac Cl SDM

3 Clindamycin
- Gel Mediklin SDM
Kombinasi :
Clindamycin + Tretinoin
- Gel Mediklin TR SDM

4 Nicotinamide
- Gel/Cream Niacef SDM

5 Retinoid acid
- Cream Vitacid SDM

6 Triclosan
- Cream Phisohex Aven

16.6 SKIN ANTISEPTICS & DISInfusECTANTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Calium Permanganate
- Powder Calium Permanganate Intr

2 Etanol
- Soln Alkohol Nufa

3 Ethacridin
- Soln Rivanol Muti

4 Hydrogen Peroxide
- Soln Hydrogen Peroxide Intr

5 Policresulen (condensation product of


metacresolsulfonic acid & methanal)
- Solution 10 mL Albothyl Phar

-Gel Albothyl Phar

6 Polidon Iodine
- Gargle 175 mL Betadine MBF

- Solution Braunol B Braun

- Oint 10 gr, 20 gr Betadine MBF

Page 50
FORMULARIUM RS. ROYAL PRIMA

16.7 OTHER DERMATOLOGICALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK

1 Doxepin Hcl
- Cream Sagalon SDM

2 Hydroquinone
- Cream 2% / 14,2 gram Bioquin Ikapharmindo

- Cream 4% / 15 gram Bioquin Ikapharmindo


3 Hypoallergenic ambiphilin cream base
- Cream 20 gram Biocream Merc

4 Kombinasi :
a. Allium Cepa Extract
b. Purified Water
c. Peg-5
d. Xanthan Gum
e. Allantion
- Gel Mederma Merz/Combiphar
5 Kombinasi :
a. Radix Scutellaria
b. Cortex Phellodendri
c. Rizoma Coptidis
d. Sesame Oil
e. Cera Flava
- Cream Sibro Combiphar
6 Kombinasi :
a. Purified Water
b. Triethanolamine
c. Carbomer, Glycerin
d. Hydrolyzeed Collagen
e. Dimethyl Hydantoin
f. Tetrasodium EDTA
g. Haematoccocus Pluvialis Extr
- Gel Asthin Force Soho
7 Kombinasi :
AHA + Squalene + Vit E
- Gel Biomoist Ikap
8 Kombinasi:
a. Palmitoylethanolamide
b. DMS Conscontaining phys lipids
- Gel Physiogel
9 Pseudo-dermal Lipids
- Cream Noroid Soho

Kombinasi :

Page 51
FORMULARIUM RS. ROYAL PRIMA

Pseudo-dermal Lipids + Zn Oxide


- Cream Noroid Derma Rash Soho
10 Sertakonazol Nitrat
- Cream Dernofix Dava

11 Urea
- Cream 10% Carmed SDM
Soft U Derm Forte Gale

17. ANAESTHETICS LOCAL & GENERAL

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Bupivacaine HCL
- Injeksiection 5 mg / mL Decain Spinal Dexa
2 Isoflurane
- Injeksiection Isofluran Dexa
3 Ketamine HCL
- Injeksiection Ketamin Hameln Combiphar
Ketalar Pfizer
4 Lidocain
- Injeksiection Lidocain Ethi
Pehacain Phap
5 Propofol
- Injeksiection Recofol Dexa
6 Sevoflurane
- Inhalation Sevodex Dexa

18. ALLERGY & IMMUNE SYSTEMS


18.1 ANTHISTAMINES & ANTIALLERGICS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Betamethasone
- Tablet Ocuson Sanbe

2 Cetirizine HCL
- Tablet 10 mg Cerini Sanbe
Cetirizine OGB
Tiriz Lapi

- Syrup Cetinal Kalbee


Lerzin Ifars

- Oral Drop Tiriz Lapi


3 Diphenhydramine

Page 52
FORMULARIUM RS. ROYAL PRIMA

- Injeksiection Diphenhydramine OGB

Fexofenadine HCL
- Tablet 120 mg, 180 mg Telfast OD Sano
Telfast HD Sano
Kombinasi :
Fexofenadine HCL + Pseudoephedrine HCL
- Tablet Telfast Plus
4 Loratadine
- Tablet Alloris Sanbe
Loratadine OGB

Kombinasi :
Loratadine + Pseudoephedrine Sulfate
- Tablet Aldisa SR Sanbe
Rhinos SR Dexa
5 Mebhydrolin Napadisylate
- Tablet Interhistin Intr

6 Kombinasi :
Terfenadine + Pseudoephedrine
- Tablet Rhinofed Dexa

18.2 VACCINES, ANTISERA & IMMUNOLOGICALS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Adsorbed purified reCombipharinant
Hepatitis B surface antigen
- Injeksi Engerix B GSK

2 Anti Tetanus
(Hanya untuk terapi tetanus)
- Injeksi A.T.S Biof

3 Human tetanus Ig
- Injeksi Tetagam Dexa

4 Immune globulin IV (human)


- Injeksi Gamunex Dipa

5 Pneumococcal conjugate vaccine


- Injeksi Prevenar Pfizer

6 Kombinasi :
a. Diphtheria toxoid
b. Adsorbed tetanus toxoid
c. Pertussis toxoid
d. Filamentous haemagglutinin
e. Pertactin of purified Capsulular

Page 53
FORMULARIUM RS. ROYAL PRIMA

polysaccharide of Hib covalently


bound to approx tetanus toxoid
- Injeksi 0,5 ml Infanrix HIB GSK
7 Lyophilized live attenuated OKA strain
of varicella-zoster virus
- Injeksi Varilrix GSK
8 Kombinasi :
a. Pertussis toxoid
b. Diphtheria toxoid
c. Tetanus toxoid
d. Poliomyelitis vaccine
- Injeksi Pediacel Sano
9 Serum Anti Bisa Ular
- Injeksi ABU Biof

10 Serum TBC
- Injeksi Mantoux Test Biof

19. ANTIDOTES & DETOXIFYING AGENTS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Ca polystyrene sulfonate
- Sach Kalitake Dipa

20. INTRAVENOUS & OTHER STERIL SOLUTIONS

NO NAMA GENERIK NAMA DAGANG KODE PABRIK


1 Human albumin
- Injeksi 20% 50 mL, 20% 100 mL Human Albumin Behring Dexa
Plasbumin Dipa
- Injeksi 25 % Albuminar Dexa
Plasbumin Dipa
2 Plasma Protein Fraction 5%
- Infus 5 g / 100 mL Plasmanate Dipa
3 Glucosa 50 gram
- Infus 500 mL Cairan D5 Wida
Infusan-D5 Sanbe
4 Glucosa 100 gram
- Infus 500 mL Cairan D10 Wida
Infusan-D10 Sanbe
5 Kalium Chloride
- Injeksi Otsu-KCL Otsu
6 L-analil-L-Glutamin
- Infus 100 ml Glutiven Dexa
7 Gelatin Polysuccinate+ Na Acetat Trihydrate + NaCl+
KCl + CaCl dihydrate + MgCl
- Infus 500 mL Gelafusal Dexa

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FORMULARIUM RS. ROYAL PRIMA

8 Natrium Bicarbonate
- Injeksi 8,4% 25 mL Meylon Otsu
9 Kombinasi :
Na + K + Cl + Ca + Acetat + Anhidrous Dextrosa
- Infus 500 mL Asering Otsu Otsuka
Ring-As Sanbe
10 Kombinasi :
Na + K + Cl + Ca + Mg + Acetat + NaCl + KCL +
CaCl2 + MgOH2 + Na Acetat + Energy
- Infus 500 mL Futrolit Sanbe
11 Kombinasi :
Na + K + Cl + Ca + Mg + Acetat + NaCl + KCL +
CaCl2 + Sorbitol + Acetat + Water + Electrolite .
- Infus 500 mL Tutofusin OPS Kalbe
12 Kombinasi :
Na lactate + KCl + CaCl2 2 H2O
- Infus Totilac Kalbe
13 Kombinasi :
Hydroxyethyl starch (HES) + NaCl
- Infus HES 130/0,4 Sanbe Hes 130 Sanbe
Widahes 130 Wida
- Infus HES 200/0,5 Sanbe Hes 200 Sanbe
14 Kombinasi :
Hydroxyethyl starch (HES) + NaC l+ KCl + CaCl2 +
Na lactat
- Infus 500 mL Fima Hes Kalbe

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