KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI

RUMAH SAKIT UNIVERSITAS MATARAM

JL. Majapahit NO. 62 Mataram 83125
Hp. 081775165995 (Call Center), Email : rsum@unram.ac.id

DAFTAR FORMULARIUM
RUMAH SAKIT UNIVERSITAS MATARAM

NO NAMA GENERIK NAMA PATEN SATUAN PABRIK

ANALGESIK ANTIPIRETIK ANTI INFLAMASI NON STEROID (NSAID)
1 ASAM MEFENAMAT LAPISTAN Tablet LAPI
2 ASETOSAL ASPILET 80MG Tablet DARYA
SANMOL FORTE TABLET Tablet SANBE
SANMOL SYR SYR SANBE
3 PARACETAMOL CUPANOL SYR SYR GUARDIAN
SANMOL DROP DROP SANBE
DUMIN RECTAL RECTAL ACTAVIS
4 COLKISIN L-CISIN Tablet LAPI
5 DEXKETOPROFEN TOFEDEX Tablet LAPI
KALTROFEN TABLET Tablet KALBE
6 KETOPROFEN
KALTROFEN GEL Tube KALBE
7 KALIUM DIKLOFENAT CATAFLAM Tablet
OSTELOX 7,5 MG TABLET Tablet SANBE
8 MELOXICAM
OSTELOX 15 MG TABLET Tablet SANBE
ANALGESIK (GOLONGAN OPIOID/ NARKOTIKA)
VALISANBE Tablet SANBE
1 DIAZEPAM STESOLID 2 MG Tablet ACTAVIS
STESOLID 5 MG Tablet ACTAVIS
SINCRONIK Tablet KALBE
2 PARACETAMOL + TRAMADOL
Analtram tablet Tablet LAPI
ANTIBIOTIK
1 AMOXICILLINE LAPIMOX 500 MG Tablet LAPI
CEFAT DRY SYRUP Botol SANBE
2 CEFADROXIL
LAPICEF 500MG Tablet LAPI
CEFILA DRY SYR Botol LAPI
CEFSPAN 200 MG Tablet KALBE
3 CEFIXIME
SPORETIK DRY SYRUP Botol SANBE
NUCEF Tablet GUARDIAN
BAQUINOR 500 MG Tablet SANBE
4 CIPROFLOXACIN
CIFLOZ 500 MG Tablet GUARDIAN
CLANEKSI SIRUP Botol SANBE
CLANEKSI SIRUP FORTE Botol SANBE
ACLAM DRY SYR Botol LAPI
5 CO AMOXICLAV
ACLAM FORTE SYR Botol LAPI
CLANEKSI TAB Tablet SANBE
BACTESYN 750 MG Tablet KALBE

1
 ACLAM 500 MG Tablet LAPI
SAGESTAM KRIM Tube SANBE
SAGESTAM SALEP MATA Tube SANBE
6 GENTAMICIN
SAGESTAM TETES MATA Botol SANBE
GENOLON CREAM Tube GUARDIAN
CHLORAMFECORT-H
Tube
KRIM KF
7 KLORAMFENICOL
CHLORAMPHENICOL
Tube
SALEP MATA KF
CRAVOX 500 MG Tablet LAPI
8 LEVOFLOXACIN
CARIVIT 750 MG TAB Tablet KALBE
9 METRONIDAZOL NULAGYL INFUS Botol GUARDIAN
TARIVID OTIC TETES
Botol
10 OFLOXACACIN TELINGA KALBE
AKIIEN TETES TELINGA Botol SANBE
11 KOMBINASI ANTIBIOTIK OTILON TETES TELINGA Botol SANBE
OBAT ALERGI
CETINAL 10 MG Tablet KALBE
RYDIAN Tablet GUARDIAN
1 CETIRIZINE
CETINAL Tablet KALBE
TIRIZ DROP DROP LAPI
ANTIINFLAMASI STEROID
MOLACORT 0,5 Tablet
1 DEXAMETHASONE
MOLACORT 0,75 Tablet
LAMESON 4 MG Tablet LAPI
2 METHYLPREDNISOLOn LAMESON 8 MG Tablet LAPI
LAMESON 16 MG Tablet LAPI
3 TRIAMSINOLON KENACORT 4 MG TABLET Tablet TASHIO
OBAT KOLESTROL
1 SIMVASTATIN SIMBADO 10 MG Tablet LAPI
TRUVAZ 10 MG TABLET Tablet KALBE
2 ATHORVASTATIN
TRUVAZ 20 MG TABLET Tablet KALBE
3 ASAM URSODEOKSIKOLAT URDAHEX 250 MG Kapsul KALBE
LAPIBROZ Tablet LAPI
4 GEMFIBROZIL
HYPOFIL 300 MG Tablet SANBE
OBAT ANTIFUNGI
BETASON CREAM Tube KF
1 BETAMETASON
BETASON N CREAM Tube BENOPARM
2 BIOPLACETON BIOPLACENTON CREAM Tube KALBE
BURRAGINOL CREAM Tube TAKEDA
3 KOMBINASI
BURRAGINOL N CREAM Tube TAKEDA
CINOLON KRIM TUBE SANBE
4 FUSIONOLON ASETONID
CINOLON N TUBE SANBE
5 FLUCONAZOLE GAVAZOL INFUS Botol GUARDIAN
FUNGASOL TAB Tablet GUARDIAN
6 KETOKONAZOLE
FORMYCO Tube SANBE
7 MOMETASONE FUROATE ELOX CREAM Tube GUARDIAN
8 MYCONAZOLE THECORT CREAM Tube GUARDIAN
9 NYSTATIN MYCO Z Tube THAISHO

2
 NYSTIN DROP Botol LAPI
NYNDIA DROP Botol GUARDIAN
10 NATRIUM FUSIDAT FULADIC CREAM Tube GUARDIAN
11 SULFADIAZIN BURNARIZIN CREAM Tube TAKEDA
ANTIEPILEPSI
1 GABAPETIN NEPATIC 300 MG Tablet DANKOS
2 PREGABALIN PROVELYN 75 MG Tablet KALBE
PROPHYLTHIOURACYL
3 PROPHYLTHIOURACYL (PTU) Tablet DEXA
(PTU)
OBAT SISTEM SARAF
1 CITICOLIN BRAINACT 500 MG Tablet KALBE
2 PIRACETAM GOTROPIL 800 MG Tablet GUARDIAN
OBAT TETESMATA
ANTAZOLINA-PO4, NAFAZOLIN- CENDO VASCON A TM Botol KF
1
HCl, FENILRAKSA(II) CENDO VASCON TM Botol KF
CARBOXUMETHY, CELLULOSA
2 CENDO CENFRESH TM Botol KF
SODIUM
DEXAMETHASONE, NEOMISIN,
3 CENDO XYTROL TM Botol KF
POLIMIKSIN
CENDO GENTA TM Botol KF
4 GENTAMICIN
CENDO GENTAMICIN SM Botol KF
5 NATAMISIN FUKRICIN TETES MATA Botol SANBE
6 NATRIUM DIKLOFENAT FLAMAR TM Botol SANBE
CENDO FENIKOL 0,25 Botol KF
7 KLORAMFENICOL
CENDO FENIKOL 1% SM Botol KF
8 LEVOFLOXACIN CENDO LFX MD AMPUL KF
9 OFLOXACACIN CENDO FLOXA 5 ML Botol KF
CENDO PROTAGENTA
10 POLIVINILPIROLIDON (PVP) AMPUL KF
MDS
POTASIUM CLORIDA, SODIUM
11 TIOSULFAT, KALSIUM KLORIDA CENDO CATRALENT TM Botol KF
AMHYROUS
SODIUM CLORIDA, KALIUM
12 CENDO LYTEERS 15ML Botol KF
KLORIDA
13 TETRACAIN CENDO PANTOCAIN 0,5 Botol KF
14 TIMOLOL MALEAT CENDO TIMOL TM Botol KF
TOBRAMYCIN DAN
15 CENDO TOBROSON Botol KF
DEXAMETHASON
16 VIT. A, OXIMETAZOLIN HC CENDO ASTENOF TM Botol KF
VIT. A, PALMITATE, ZINC
17 CENDO AUGENTONIK TM Botol KF
SULFAT, PHENYLEPHRIN
OBAT RELAKSAN OTOT
1 EPERISON MYONEP TABLET Tablet LAPI
OBAT UNTUK DIARE
DIADIUM Tablet LAPI
1 LOPERAMID
LODIA Tablet SANBE
L-BIO SASET LAPI
2 PROBIOTIK
PROBIOSTIM SASET SANBE
OBAT UNTUK SALURAN CERNA
1 LANSOPRAZOLE LANCID 30 MG Kapsul KALBE
2 REBAMIPID REBAMID Tablet LAPI

3
 3 DIOSIMIN ANADIUM Tablet GUARDIAN
OBAT UNTUK SALURAN NAFAS
EPEXOL SIRUP Botol SANBE
EPEXOL SIRUP FORTE Botol SANBE
1 AMBROXOL EPEXOL DROP Botol SANBE
EXTROPECT SYR Botol GUARDIAN
EXTROPECT TAB Tablet GUARDIAN
LASAL 2MG Tablet LAPI
VENTOLIN INHELER Inheler GLAXO
2 SALBUTAMOL
VENTOLIN NEBU Nebul GLAXO
COMBIVENT 2,5 ML UDV
PSEUDOEFEDRIN +
3 BOTOL
TRIPOLIDIN TREMENZA SYR SANBE
4 TERBUTALIN LASMALIN Tablet LAPI
5 TRIPROLIDIN HCl ALERFED SYR Botol GUARDIAN
OBAT YANG MEMPENGARUHI DARAH
1 CLOPIDOGREEL CPG FILM-COATED 75 MG Tablet KALBE
2 PHYTONADION (VIT. K) VITADION INJ AMPUL KALBE
VENOSMIL TOPICAL 2 %
Tube
3 HIDROSIMIN GEL KALBE
VENOSMIL 200 MG Kapsul KALBE
4 EDOXABAN LIXIANA 15 MG Tablet KALBE
OBAT HORMON DAN KEHAMILAN
1 PROGESTERON UTROGESTAN 100 MG Tablet LAPI
VITAMIN DAN MINERAL
1 CORAL CALCIUM CAL-95 Tablet LAPI
2 CURCUMA PROCUR Tablet GUARDIAN
IMUNOS PLUS SYR Botol LAPI
IMUNOS PLUS KAPLET Kaplet LAPI
3 ECHINACEA + GLUCAN
NUFIT KAPLET Kaplet GUARDIAN
NUFIT SYR Botol GUARDIAN
4 ISOFLAVONE + CALCIUM OPUS Tablet GUARDIAN
KALSIUM, VIATAMIN, TUNA
5 OSFIT DHA Tablet
FISH OIL, DHA, EPA KALBE
6 MECOBALAMIN ETHIGOBAL TABLET Tablet GUARDIAN
SANBE KIDS Botol SANBE
7 VIATAMIN ANAK APIALYS SYR Botol LAPI
APIALYS DROP Botol LAPI
8 VITAMIN IBU HAMIL PRONAVIT Tablet LAPI
9 ZINC ZIRCUM KID SYR Botol

Direktur

Dr. Ahmad Taufik, Sp.OT

NIP. 19810331 200604 1 002