DAFTAR FORMULARIUM OBAT SESUAI FORNAS

NO NAMA GENERIK NAMA DAGANG

1 Acetylcysteine 200mg N-Ace 200mg
2 Activated Attapulgite New Diatab Tab
3 Acyclovir 400mg
4 Albumin 20% Kedrialb 20% 100ml
Isoric 100mg
5 Allopurinol 100mg dan 300mg Puricemia 300mg
Tylonic 100mg
Atarax 1mg
6 Alprazolam
Alganax 0.5mg dan 1mg
7 Ambroxol 30mg Epexol 30mg
8 Aminophiline 200mg
9 Amitriptilin 25mg Tab
Belvas 5mg dan 10 mg tab
10 Amlodipine 5mg dan 10mg
Divask 5mg dan 10mg Tab
11 Amoxicilin 500mg
Miniaspi 80mg
12 Asam Asetil Salisilat (Asetosal) Thrombo aspilet 80mg
Farmasal 100mg
13 Asam Folat Folavit
14 Asam Mefenamat 500mg Mefinal 500mg
Kalnex 500mg tab, 100mg/ml
15 Asam Traknesamat
Kalnex 100mg/ml
Depaken Syr
Depakote Tab 250mg, 500mg
Divalpi
16 Asam Valproat
Ikalep Tab
Ikalep Syr
Valeptik Syr
Atofar 20mg Tab
17 Atorvastatin 20mg
Avesco 20mg Tab

1
18 Azitromicin 500mg
Betaserc 24mg Tab
19 Betahistine 6mg dan 24mg
Vertigosan 6mg Tab
Beta one 5mg Tab
20 Bisoprolol 2,5mg dan 5mg
Opiprol 5mg Tab
Budesonide 160mg, Formoterol
21 Symbicort 80ml, 160ml
Fumarat 4,5 mg
22 Candesartan 16mg Canderin 8mg dan 16mg Tab
23 Captopril 25mg dan 50mg Tab
Bamgetol 200mg
24 Carbamazepine
Tegretol 200mg
25 Cefadroxil 500mg Cefat 500mg
26 Cefixime 100mg
27 Cefotaxime 1 gr/ml
28 Ceftriaxone Soadium 1 gr/ml
29 Cetirizine 10mg
Cepezet 100mg, 50mg/2ml
30 Chlorpromazine HCI
Cepezet 50mg/2ml

Ciprofloxacine 500mg tab dan Baquinor Forte 500mg

31
0,2% Infus Ciprofloxacine 0,2% Infus
Clofirtis 10mg
32 Clobazam
Proclozam 10mg Tab
33 Clonazepam Riklona 2mg Tab
CPG 75mg
34 Clopidogrel Placta 75mg
Therodel 75mg
35 Clozapine 100mg
36 Codein 10mg, 20mg Tab
37 Codein, Feniltoloksamin Codipront Cum Expectoran Caps, Syr
Codein, Feniltoloksamin,
38 Codipront Caps, Syr
Guaifenesin
39 Codein, Parasetamol Coditam
40 Colchicine Recolfar 0,5mg

2
 Dexamethason 0,5mg tablet dan Cortidex 0,5mg Tab, 5mg/ml
41
injeksi
Cortidex 5mg/ml
Valisanbe 5mg Tab, Injeksi
42 Diazepam 5mg Tab, Injeksi
Stesolid Supositoria
43 Diclofenac Sodium 50mg Flamar 50mg
44 Dimenhidrinat Dramamine 50mg
Vometa FT 10mg Tab
45 Domperidon 10mg Tab
Vosedon 10mg Tab
46 Donepenzil HCI Aricept 10mg
47 Ergotamin cafeein Ericaf Tab
48 Ethambutol HCI 500mg
Fibramed 300mg Tab
49 Fenofibrate 300mg Tab
Hyperchol 300mg Tab
Ferro fumarat (vitamin
50 Hemobion Caps
penambah darah)
Gratizin 5mg dan 10mg
Frego 5mg dan 10mg
51 Flunarizine 5 mg dan 10 mg
Silum 5mg dan 10mg
Vertilon 5mg
52 Fluoxetine HCI Kalxetine 20mg
53 Fluphenazine Decanoate Sikzonoate 25mg/ml injeksi
54 Furosemid Lasix 40mg
55 Gabapentin 100mg dan 300mg Alpentin 300mg Tab
56 Glimepiride 2mg/ 3mg/ 4mg Metrix 2mg/ 3mg/ 4mg
57 Haloperidol Lodomer 2mg dan 5mg
58 Ibuprofen 200mg dan 400mg
59 ISDN 5mg Tab
Infus mengandung Paracetamol
60 Sanmol Infus
10 mg/ ml
61 Isoniazid 300mg
62 Kalsium Gluconat
Lancid 30mg
63 Lansoprazole

3
63 Lansoprazole
Lapraz 30mg
Levetiracetam 250mg dan
64 Eterlox 500mg
500mg
Leparson Tab
65 Levodopa 100, Benserazide 25 Madopar
Levoben Tab
66 Levofloxacin 500mg
67 Lidocain HCI injeksi dan gell Xylocain Jelly 2%
68 Lisinopril 5mg
69 Loperaminde 2mg
Ativan 1mg Tab
70 Lorazepam
Merlopam 2mg Tab
71 Meloxicam 7,5mg dan 15mg Ostelox 15mg
72 Metamizole Na Antrain Injeksi
73 Metformin HCl 500mg Diaformin XR 500mg
74 Methilpenidate Prohiper 10mg Tab
75 Methylprednisolone 4mg Sanexon 8mg Tab
76 Metoklopramid
77 Metronidazole 500mg table
78 Morphine Sulfate MST Continus 10mg dan 15 mg Tab
79 Nifedipine Tab
80 Olanzapine 5mg dan 10mg Onzapine 10mg
81 Omeprazole tablet dan injeksi OMZ injeksi
82 Oxcarbazepine prolepsi 300mg
Sanmol 500 mg
83 Paracetamol 500mg dan 650mg
Sanmol Forte 650 mg
84 Phenobarbital Sibital 50mg Tab, 100mg/2ml Injeksi
85 Phenytoin Sodium Ikaphen 100mg, 50mg/ml
86 Pramipexole 0,375mg Pramiferol 0,375mg
87 Prednison 5mg Tab Trifacort 5mg
PGB 150mg Tab
88 Pregabalin
Provelyn 150mg Tab
89 Propanolol 40mg Tab

4
90 Pyrazinamide 500mg
91 Pyridostrigmine bromide Mestinon 60mg Tab
92 Ranitidin 150mg Tab, 25mg/ml
93 Rifampisin 450mg dan 600mg
Rifampisin dan Isoniazid
94
(Kombinasi)
Rifampisin, Isoniazid dan
95
Pirazinamid (kombinasi)

Rifampisin 150mg, Isoniazid

75mg, Pirazinamide 400mg dan
96 PRO TB4
EthambutolHCl 275mg
(Kombinasi)
97 Risperidone1mg dan 2mg Persidal 2mg
Lasal 2mg
98 Salbutamol 2mg dan 4mg
Ventolin Nebu
99 Sertaline Serloft 20mg
100 Simvastatin 10mg dan 20mg
101 Spironolactone Spirola 25mg Tab
Ulsidex 500mg
102 Sucralfate
Inpepsa 500mg/5ml sirup
103 Tamsulosin 0,4mg
104 Telmisartan Micardis 80mg
105 Theophyline Theobron
106 Tramadol Tradosik 50mg/ml
107 Triamcinolone Trilac 10mg/ml Injeksi
108 Trifluoperazine Stelosi 5 mg tab
109 Trihexyphenidyl Hexymer 2mg tab
Neurosanbe dan Neurosanbe 5000 tablet
110 Vit B Komplek
Neurosanbe Injeksi
111 Vit B6 (pyridoxine)
112 Vitamin B 12
113 Zinc Sulfat Becom Zet

5
DAFTAR FORMULARIUM OBAT DILUAR FORNAS
NO NAMA OBAT NAMA DAGANG
1 Ashwagandha Adapt 300mg

Astragalus membranaceus radix 80'0mg, salvia

miltiorrhizae I 60mg, paeoniae lactiflorae rubra radix 160
mg, Ligusticum chuanxiongrhizoma 160rng, angelica
2 Neuro AID
sinensis radix 160 mg, carthamus tinotorius flos 160 rug,
prunus persica semen 160mg, polygalea tenuifolia radix 160
mg, acori tatarinowii rhizoma l16Omg.

3 Baclofen Lioresal 10mg Tab

4 Bromhexine HCL Mucohexin 8mg Tab

5 Buspirone HCl Xiety 10mg

6 Calcium Carbonate Calitoz 500mg

7 Calcium ; vit D Hi-bone

8 Calcitriol 0,25 mcg Calcitriol 0,25 mcg

9 Chlordiazepoxide, clidinum br Braxidin Tab

10 Cilostazol 100mg Pletaal SR 100mg

11 Cinnarizine Perifas 25mg Tab

Brainact Tab
12 Citicolin 500mg tablet
Cholinaar ODT 500mg

13 Citicholine 500 mg injeksi Brainact Injeksi

Cytidine 5-monophosphate 121,5 ; Choline L-bitartrate Neulin PS

14
126,5 . Phosphatidylserine 25
Sifolin capsul

15 Dexketoprofen Trometamol tablet Ketesse 25mg

16 Dexketoprofen Trometamol Injeksi Ketesse inj

1
17 Diacerein Boncerin 50mg

Elkana CL Syr
18 Ekstrak Curcuma
Vitacur syr
Vip albumin Caps
19 Ekstrak Ikan Gabus (Ophiocephalus striatus 500) Kapsul
Labumin Caps

20 Ekstrak Ikan Gabus (Ophiocephalus striatus 500) Sachet Vip albumin Sachet

Eprinoc 50mg Tab

21 Eperisone hydrochloride
Forres 50mg Tab
22 Erdosteine 300mg Erdobat 300mg
23 Escitalopram Oxalate Rinpram 20mg

Esilgan 1mg, 2mg Tab

24 Estazolam
Alena 2mg tab

25 Etoricoxib 90mg, 120mg Coxiron 120 mg

26 Famotidin tablet Famocid 40mg

27 Fluvoxamine Maleat 50mg Luvox 50mg tablet

Osteor Plus Tablet

28 Glucosamin Rosagen Sachet

Syalox tab
Ginselect 50mg, vit A 5.000 IU, vit B1 10. 7 mg,vit B2 5.5mg,
29 vit B6 4.7 mg, vit B12 15 mcg, vit C 30mg, vit D 400 lU, vit E provital plus
15 IU, vit H 600 mcg

30 Ibuprofen 200mg, Parasetamol 350mg Profenal Tab

31 Lactobacillus acidophyllus+Bifidobacterium longun, sachet L Bio

32 Lemborexant tab Dayvigo 5mg

33 Levodopa 100mg ; Carbidopa 25mg ; entacapone 200mg Stalevo tab

2
34 Losartan Potasium Angioten 50mg Tab

Tracetat 160mg tab

35 Megestrol Acetate
Tracetat Syr

36 Mecobalamin Kalmeco 500mg Tab, Injeksi

37 Meloxicam 7.5mg, 15mg Tab Ostelox 15mg

38 Metamizole Sodium 500mg, Diazepam 2mg Analsik Tab

39 Mg Citrat Hi-MG 100mg

40 Mg L aspartate, Potasium L aspartate Renapar

41 Multi Vitamin Pharmaton Formula

42 Piracetem 800mg dan 1200mg Neurotam 1200mg Tab

43 Potasium Chloride(KCl) KSR 600mg Tab

Cataflam Fast 50mg Sachet

44 Potasium Diklofenak
Eflagen 50mg Tab

45 Procaterol HCl tablet Meptin 0,025mg

Dogmatil 50mg
46 Sulpiride 50mg
Dogmatil Forte 200mg

47 Sumatriptan Triptagic 100mg

Tablet mengandung Dexamethason, dexchlorpheniramine

48 Dextamine
maleat

Tablet mengandung Dekstrometorfan IHBr 10mg,

49 Fenilpropanolamin HCL 15mg,Klorfeniramin Maleat 1mg, Tuzalos Tab
Pct 500mg
Tablet mengandung Pseudoephedrine 60 mg +
50 Tremenza Tab
tripolidine 2.5 mg

3
 Tablet mengandung Pseudoephedrine 7,5mg + Paracetamol
51 Demacoline Tab
500mg + CTM 2mg

52 Tizanidine Hcl Zitanid 2mg tablet

Vit A 3500IU, Vit D3 200IU, Vit E 11 2IU vit c 3.51, vit B1 Lyoven injeksi
4.14, Vit B2 46, Vit B3 17.25,Vit B6 4.53, Vit B12 Folic acid
53
414 mcg Biotin 69 mcg, Pantothenic acid 17.25, mcg,Glycine
250,glycochoIic acid 140,Soybean Lecithinnicotinainide 46 Prove Vit injeksi

Elovess Caps
Vit B1 100, vit B12 100mcg, Vit B6 .50, vit E 200IU, Asam
54
Folat 400 mcg
Forneuro

Vit B1 50, vit B2 25; vit B6 10; vit B12 5mcg; Nikotinamida
55 becom c
100, As. Pantotenat 18.4; Vit C 800

56 Vit D3 Prove D3 1000iu

Vit E 30 IU, Vit B1 15; vit B2 15; vit B6 20; vit B12 l0mcg; folic
57 acid 400 mcg, pantotenat acid 20mg, Vit C 750 mg, Zn becom z
22.5mg, niacin 100mg
58 Zolpidem Zolmia 10mg Tab

o-ketoisoleticine, calcium salt 67 . e-ketoleucine,calsium

salt 101 ;a-ketophenylalanine; calsium salt 68; a-
59 hydroxymethionine; calsium salt 59; o-ketovaline, calsium Aminefron
salt 86. L-tryptophane 23; L-Threonine 53; L-Histidine 38; L-
tyrosine 30; L-Lysine acetate 105

OITMENT/SALEP :
1 Desoximetasone cream 0,25%
2 Kenalog oint 5gram
3 Lafalos plus 20mg
4 Thrombophob Gel

Obat tambahan (sirup dan suppo)

1 Laxadine emulsi oral
2 Microlax suppo