FORMULARIUM 2007

I. ANTIPSIKOTIK A. Typical High potensial Haloperidol Haloperidol tab 0,5 - 1,5 - 5 mg Serenace* tab 0,5 - 1,5 - 5 mg Injeksi 5 mg/ml (short acting) Lodomer tab 0,5 -1,5 - 5 mg Injeksi 25 mg/ml (short acting) Govotil tab 0,5 - 1,5 - 5 mg Haldol Decanoas injeksi 50 mg/ml (long Acting) Trifluoperazin Trifluoperazin tab 5 mg Stelazin* tab 5 mg Trizin tab 5 mg Perfenazin Perfenazin tab 4 mg, 8 mg Trilafon* tab 4 mg, 8 mg Typical Low Potensial Chlorpromazine Chlorpromazine tab 25 mg, 100 mg Largactil* tab 25 mg, 100 mg Promactil tab 100 mg. Thioridazine Melleril* tab 50 mg, 100 mg

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3 mg Rizodal tab 2 mg Clozapin Clozapin tab 25 mg. 10 mg C. 3 mg Risperdal drop Risperdal consta injeksi 25 mg/ml Persidal tab 1 mg. Atypical Generasi Baru Aripiprazol Abilify* tab 10 mg. 15 mg 2 . 100 mg Sizoril tab 25 mg.Sulpiride Dogmatil* forte 200 mg Typical Long Acting Fluphenazine decanoate Modecate* injeksi 25 mg/ml B. 3 mg Noprenia tab 2 mg. Atypical Risperidon Risperidon tab 1 mg. 2 mg Risperdal* tab 1mg. 100 mg Clozaril* tab 25mg. 2 mg. 100 mg. 200 mg Olanzapin Zyprexa* tab 5 mg. 100 mg Quetiapin Seroquel* tab 25 mg. 2 mg.

NON SSRI Trazodone Trazon* tab 50 mg.II. ANTI DEPRESAN A. 100 mg. Triciclyc Tetra Ciclyc Amitriptyline Amitriptyline tab 25 mg Trilin tab 25 mg Imipramin Tofranil tab 25 mg Maprotilin Maprotiline tab 50 mg Ludiomil* tab50 mg Sandepril tab 50 mg Clomipramin Anafranil* tab SSRI Setralin Zoloft* tab 50 mg Fridep tab 50 mg Fluoxetin Prozac* tab 20 mg Elizac tab 20 mg Fluvoxamine Luvox* tab 50 mg. 100 mg 3 .

ANTI MANIA Lithium Carbonate Priadel* tab 400 mg Frimania Tab 400 mg Carbamazepin Carbamazepin tab 200 mg Tegretol tab 200 mg Lepigo tab 200 mg Bamgetol tab 200 mg Oxcarbazepin Trileptal* 300 mg Divalproex Na.5 mg Paroxetin Seroxat tab 20 mg Mirtazapin Remerone tab 300 mg III.Vanlafaxine Effexor* tab Citalopram Cipram* tab 20 mg Tianeptine Stablon* tab 12. Depakote* tab 250 mg 4 .

0. ANTI ANXIETAS Diazepam Diazepam tab 2 mg. 10 mg Valproic Acid Depakene syr 250 mg/5 ml IV.5 mg.25 mg. 5 mg Injeksi 5 mg/ml Valium* tab 2 mg.5 mg V. 1 mg Xanax XR Frixitas tab 0. 5 mg Injeksi 10 mg/ 2 ml Rectal tube 10 mg/ 2.Olanzapine Zyprexa* tab 5 mg.5 mg.25 mg. ANTI EPILEPSI Fenobarbital Fenobarbital tab 30 mg Luminal* tab 30 mg 5 . 5 mg Injeksi 10 mg/ 2 ml Stesolid tab 2 mg. 5 mg Injeksi 5 mg/ml Valdimex tab 2 mg.5 ml Clobazam Clobazam tab 10 mg Frisium* tab 10 mg Alprazolam Alprazolam tab1 mg Xanax* tab 0. 0. 1 mg Atarax tab 0.

cap 100 mg VI. NAPZA Codein 20 mg Naltrexon 50 mg Buprenorphine 2 mg. 8 mg.Carbamazepin Carbamazepin tab 200 mg Tegretol tab 200 mg Lepigo tab 200 mg Bamgetol tab 200 mg Clonazepam Rivotril tab 2 mg Phenytoin Phenytoin cap 100 mg Kutoin cap 100 mg Dilantin tab 50 mg. 8 mg Metadon Subutex sub lig tab 2 mg. ANTI PARKINSON Trihexyphenidil Trihexyphenidil tab 2 mg Artane* tab 2 mg Hexymer tab 2 mg Sulfas Atropin Injeksi Difenhidramin maleat Difenhidramin tab Delladryl injeksi VII. 6 .

Antiinflamasi Metampiron Antalgin tab 500 mg Asam Mefenamat Asam mefenamat tab 500 mg Asimat tab 500 mg Ponstan 500 mg Paracetamol Paracetamol tab 500 mg Sanmol tab 500 mg Tramadol Tramadol tab 50 mg Dolgesic tab 50 mg Diclofenac K Eflagen tab 25 mg.125 mg. 2 mg Halcion tab 0.VIII. ANTI INSOMNIA Esilgan tab 1mg. 1 ml/amp.250 mg IX. X. Antipiretik. 0. 50 mg 7 . Analgesik.1 % Inj. ANTI SYOK Adrenalin inj 1 mg/ml Dexametason Dexametason tab 5 mg/ 5ml Norepenefrin bitartat inj 4 mg/ml Epinefrin HCL 0.

XI. ANTI FUNGI Griseofulvin Griseofulvin tab 125 mg. ANTI BAKTERI Ampisilina Ampisillin tab 500 mg Amoksilin Anhidrat Amoksilin tab 500 mg Syrup 125 mg/ 5 ml Tetrasiklin HCL Tetrasiklin tab 500 mg Tiamfenicol Tiamfenicol tab 500 mg Cyprofloxacin Cyprofloxacin tab 500 mg Cefadroxil Cefadroxil tab 500 mg Trimetropin Sulfametoksazol Cotrimoksazol tab 480 mg Bactrim tab forte Clindamycin Clindamycin tab 150 mg. 500 mg Nistatin Nistatin tab XII. 300 mg Metronidazol Metronidazol tab 500 mg 8 .

25 mg Klonidin Klonidin tab 0. 300 mg Rifampisin Rimpfampisin tab 450 mg. ANTASIDA Antasida doen tab Ranitidin tab 150 mg Cimetidin XV. ANTI TUBERKULOSA Isoniazid INH tab 300 mg Isoniazid tab 100.XIII. 500 mg Tibitol tab 250 mg. Anti Hipertensi Hidrochlortisida Hidrochlortisida (HCT) tab 25 mg Kaptopril Kaptopril tab 12. 500 mg 9 .5mg .15 mg Nifedipin tab Reserpin tab XIV. 600 mg Ethambutol Ethambutol tab 250 mg.

ANTI DIARE Garam Oralit Sachet New Diaform tab Activated Antiapulgite New Diatab tab Loperamida tab. Prednison tab 5 mg Difenhidramina Difenhidramina tab Klorfeniramin maleat Klorfeniramin tab 4 mg CTM tab. ANTI ASMA Aminofilina Aminofilina tab 200 mg Inj 24 mg/ml Efedrin HCL Efedrin tab 25 mg Salbutamol Salbutamol tab 2 mg. 4 mg XVII.5 mg.Pirazinamide Pirazinamide tab 500 mg XV. ANTI ALERGI Dexametason Dexametason tab 0. OBAT BATUK Antitusif 10 . 4 mg XVI. XVIII.

HEMOSTATIK Adona tab 10 mg.Dextrometrofan HBR tab Exspektoran Gliserilguaiakolat Ambroksol tab 30 mg Obat batuk hitam syr. ANTI SPASMOLITIK Papaverin tab Spasminal tab XXI. B12 Mercibion tab Sulbutiamine Arcalion 200 tab XX. 30 mg 11 . B6. VITAMIN NEUROTROPIK Pyridoksin HCL Vit B6 tab Thiamine HCL Vit B1 tab Vit B Complek tab Asam Ascorbat Vit C tab Multivitamin Viliron tab Surbex T Kombinasi B1. XIX.

OBAT-OBAT LAIN Rivanol Betadin solution Betadin gargle Permaganas Kalikus H2O2 NaCl 0. TOPICAL Obat Mata Cendo xitrol tetes mata Gentamicyn tetes mata Oksitetrasiklin 1 % Chloramfenikol tetes mata Obat Kulit Oksitetrasiklin 3 % salep Gentamicyn zalf kulit Mikonazol Salep Hidrokortison Asetat 3 % Bioplacenton zalf kulit Anti Skabies Salep 2-4 Pennethrin krim 5 % Scabisid zalf kulit Obat Telinga Oksitetrasiklin tetes telinga Gentamicyn tetes telinga XXIII.Transamin tab 500 mg XXII.9 % Dextrose 5 % Ringer Laktat 12 .

140. S. Evalina Asnawi.223. SpKJ NIP. !40.113.609 Dr.709 FORMULARIUM 2007 $ 13 . SpKJ NIP.Jakarta. 01 Agustus 2006 Mengetahui Ketua Komite Medik RSJ Soeharto Heeerdjan Ketua Sub Komite Farmasi dan Terapi Dr. Gerald Mario.

$ $ $ $ $ SUB KOMITE FARMASI DAN TERAPI $ $ $ $ $ KOMITE MEDIK RS JIWA SOEHARTO HEERDJAN JAKARTA 14 .

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