DAFTAR USULAN OBAT PSIKIATRI

NO NAMA GENERIK NAMA DAGANG INDIKASI

ANTIEPILEPSI - ANTIKONVULSI

Diazepam Penanganan gaduh gelisah/agresivitas

1
Inj 5mg/ml

Amp 2 ml

Natrium Divalproat Depakote ER (Abbot) Sebagai mood stabilizer

2
Tab 250mg

Tab 500mg

ANSIOLITIK

Alprazolam Terapi pada gangguan panik

1
Tab 0,5 mg Serangan Panik

Lorazepam Merlopam (Mersifarma) Sebagai ansiolitik

2
Tab 0,5 mg Ggn tidur pada psikotik

ANTI DEPRESAN

1 Sertralin

Tab 50mg

2 Fluoxetin

Tab 10mg, 20mg

3 Maprotilin

Tab 50mg
ANTIPSIKOTIK

Aripiprazole Abilify (Otsuka)

1
Tab 10mg

Risperidon
2
Tab 1mg

Tab 2mg

Tab 3mg

Quetiapine XR Astra zeneca)

Tab 200mg
3
Tab 300mg

Tab 400mg

Haloperidol

Tab 0,5mg

Tab 1,5mg
4
Tab 5mg

Inj 5 mg/mL Lodomer (mersifarma) Penanganan gaduh gelisah

inj 50mg/mL Haldol Decanoas

Trifluopherazine
5
Tab 5mg

ANTIPARKINSON

Triheksifenidil Heximer (Mersifarma)

1
Tab 2mg

Difenhidramin Maleat
2
Inj 10mg/mL
2

Amp 2 mL
Ketersediaan pada E katalog /
BPJS Harga Satuan
ada tidak ada

ü Rp 1,913 Amp

ü Rp 5,928 Tab

ü Rp 2,954 Tab

ü Rp 94 Tab

ü Rp 379 Tab

ü
ü Rp 23,034 Tab

ü Rp 240 Tab

ü Rp 287 Tab

ü Rp 440 Tab

ü Rp 15,260 Tab

ü Rp 16,591 Tab

ü Rp 19,865 Tab

ü Rp 55 Tab

ü Rp 59 Tab

ü Rp 60 Tab

ü Rp 101,300 Amp

ü Rp 101 Tab

ü Rp 1,262 Amp
ü
 Keterangan

GENERIK DIAZEPAM INJEKSI 5 MG/ ML (I.V. / I.M.) Stok Tersedia di RSUD RAPB

DEPAKOTE ER DIVALPROEX SODIUM - VALPROIC ACID 500 MG

DEPAKOTE ER DIVALPROEX SODIUM - VALPROIC ACID 250 MG

GENERIK ALPRAZOLAM TABLET/KAPSUL/KAPLET 0,5 MG Stok Tersedia di RSUD RAPB

MERLOPAM 0,5 MG LORAZEPAM TABLET/KAPSUL/KAPLET 0,5 MG

Antipres, Deptral, Fatral, Fridep, Iglodep, Nudep, Serlof, Sernade, Zerlin, Zolof

Nopres, Deprezac, Noxetine, Elizac 20, Prestin, Andep, Ansi 20, Courage, Antiprestin, Kalxetin, Zac, Foransi, Fluoxetine HCL, Ox
Prozac

Ludiomil, Ludios, Maprotiline Hcl, Mavelline, Provaline, Sandepril, Tilsan

 ABILIFY DISCMELT 10 MG ARIPIPRAZOL TAB DISCMELT 10 MG

Risperidone/ Risperidon tablet/kapsul/kaplet 1 mg

Risperidone/ Risperidon tablet/kapsul/kaplet 2 mg

Risperidone/ Risperidon tablet/kapsul/kaplet 3 mg

SEROQUEL XR 200 QUETIAPINE FUMARATE/ QUETIAPIN TAB SR 200 MG

SEROQUEL XR 300 QUETIAPINE FUMARATE/ QUETIAPIN TAB SR 300 MG

SEROQUEL XR 400 QUETIAPINE FUMARATE/ QUETIAPIN TAB SR 400 MG

GENERIK HALOPERIDOL TABLET/KAPSUL/KAPLET 0,5 MG

GENERIK HALOPERIDOL TABLET/KAPSUL/KAPLET 1,5 MG

GENERIK HALOPERIDOL TABLET/KAPSUL/KAPLET 5 MG

Lodomer, Dores, Upsikis, Haloperidol, Haldol Decanoas, Govotil, Serenace, Seradol

HALDOL DECANOAS HALOPERIDOL INJ 50 MG/ML

Stelazin, Stelosi

GENERIK TRIHEXYPHENIDYL HYDROCHLORIDE (HCL)/ TRIHEKSIFENIDIL TABLET/KAPSUL/KAPLET 2 MG

GENERIK DIFENHIDRAMIN/ DIPHENHYDRAMINE INJEKSI 10 MG/ML ( I.V./I.M.)

 DAFTAR USULAN OBAT JANTUNG dan PEMBULUH DARAH

NO NAMA GENERIK

ACS - Secara Umum

1
Asam Asetilsalisilat

Tab 80 mg

Tab 100mg
2
Clopidogrel

Tab 75mg

ACS - WAJIB DUAL PLATELET

1
Fondaparinux

PFS 2,5mg/0,5ml
1
Enoxaparin

PFS 20mg/0,2ml

PFS 40mg/0,4ml

PFS 60mg/0,6ml
2
Heparin

Vial 5000IU/ml
3
Streptokinase

Vial 1.500.000IU/ml

ANTI HT/HF/ANTIARITMIA/SHOCK DLL

1 Captopril

Tab 12,5mg
 Ramipril

Tab 2,5mg

Tab 5mg

Tab 10 mg

2 Lisinopril

Tab 5mg

Tab 10mg

Candesartan

Tab 8mg

Tab 16mg

Irbesartan

Bisoprolol

Tab 1,25mg

Tab 2,5mg

Tab 5mg

Tab 10mg

Carvedilol

Tab 6,25mg

Tab 25mg

HCT

Tab 25mg

Furosemid 40 mg tab/20 mg iv

Tab 40mg

Amp 10 mg/ml

Amlodipin 5/10
Tab 5mg

Tab 10mg

Diltiazem iv/Oral 30/SR 100/200

Tab 30mg

Kaps 200mg

Kaps 100mg

Vial 50mg

Amp 5mg/ml

Verapamil

Tab 80mg

Digoxin tab 0.25/Iv

Tab 0,25mg

Amiodaron iv 150/dan tab 200

Amp 150mg/3ml

Tab 200mg

Dopamin

Amp 40mg/ml

Dobutamin

Amp 50mg/ml

Amp 12,5mg/ml

Norepinefrin iv

Amp 1mg/ml

ISDN tab dan iv/NTG iv

Amp 1mg/ml

Morfin
 Epinefrin iv

Atropin iv

3 ATP/Adenosin iv

Lidokain iv
ANTIBIOTIK (RHD)

Ospen (penoxymetilpenicillin)
1

ANTIKOAGULAN (ORAL)

Warfarin

Tab 2mg
ANTILIPID

4
Simvastatin 10/20

Tab 10mg

Tab 20mg

Atorvastatin 20/40

Tab 20mg

Tab 40mg

Fenofibrat 100/300

Tab 100mg

Tab 300mg
HIOERTENSI PARU

1
DORNER

SILDENAFIL
n PEMBULUH DARAH

Ketersediaan pada E katalog /

NAMA DAGANG BPJS
Harga Satuan

ada tidak ada

ü Rp 105 Tab
Miniaspi
ü
Aptor 100, Cardio Aspirin 100

ü Rp 1,568 Tab

Arixtra
ü Rp 273,800 PFS

Lovenox
ü Rp 51,221 PFS

ü Rp 90,740 PFS

ü Rp 125,384 PFS

Inviclot
ü Rp 43,995 Vial

Fibrion
ü Rp 3,400,000 Vial

ü Rp 69 Tab
 ü Rp 295 Tab

ü Rp 263 Tab

ü Rp 737 Tab

ü Rp 250 Tab

ü Rp 341 Tab

ü Rp 629 Tab

ü Rp 1,048 Tab

ü Rp 1,905 Tab
Concor
ü Rp 626 Tab
Concor
ü Rp 264 Tab

ü Rp 3,097 Tab
Concor

ü Rp 1,914 Tab
V-Bloc
ü Rp 2,800 Tab
Biorec

ü Rp 178 Tab

ü Rp 84 Tab

ü Rp 1,555 Amp
 ü Rp 79 Tab

ü Rp 94 Tab

ü Rp 145 Tab

ü Rp 4,835 Kaps
HERBESER
ü Rp 4,460 Kaps
HERBESER
ü Rp 154,400 Vial
HERBESER
ü Rp 56,628 Amp
FARMABES

ü Rp 385 Tab

ü Rp 104 Tab

ü Rp 8,700 Amp

ü Rp 6,160 Amp

ü Rp 14,643 Amp

ü Rp 91,009 Amp
Dobutamin-Hameln

ü Rp 25,839 Amp

ü Rp 24,409 Amp
 Keterangan

MINIASPI 80 ASAM ASETILSALISILAT (ASETOSAL) TABLET/KAPLET/KAPSUL 80 MG

GENERIK CLOPIDOGREL BISULFATE/ CLOPIDOGREL/ CLOPIDOGREL HYDROGEN SULFATE/ KLOPIDOGREL TABLET/KAPSUL/KAPLE

ARIXTRA FONDAPARINUKS INJ 2,5 MG/0,5 ML

LOVENOX ENOKSAPARIN SODIUM INJ 20 MG/0,2 ML

LOVENOX ENOKSAPARIN SODIUM INJ 40 MG/0,4 ML

LOVENOX ENOKSAPARIN SODIUM INJ 60 MG/0,6 ML

INVICLOT HEPARIN INJEKSI 5000 IU/ML (I.V./S.K.)

FIBRION STREPTOKINASE SERB INJ 1,5 JUTA IU

GENERIK KAPTOPRIL/ CAPTOPRIL TABLET/KAPLET 12,5 MG

GENERIK RAMIPRIL TABLET/KAPSUL/KAPLET 2,5 MG

GENERIK RAMIPRIL TABLET/KAPSUL/KAPLET 5 MG

GENERIK RAMIPRIL TABLET/KAPSUL/KAPLET 10 MG

GENERIK LISINOPRIL DIHYDRATE/ LISINOPRIL/ LISINOPRIL TABLET/KAPSUL/KAPLET 5 MG

GENERIK LISINOPRIL DIHYDRATE/ LISINOPRIL/ LISINOPRIL TABLET/KAPSUL/KAPLET 10 MG

GENERIK KANDESARTAN/ CANDESARTAN/ CANDESARTAN CILEXETIL TABLET/KAPSUL/KAPLET 8 MG

GENERIK KANDESARTAN/ CANDESARTAN/ CANDESARTAN CILEXETIL TABLET/KAPSUL/KAPLET 16 MG

CONCOR 2.5 BISOPROLOL TABLET/KAPSUL/KAPLET 1,25 MG

CONCOR 2.5 BISOPROLOL TABLET/KAPSUL/KAPLET 2,5 MG

GENERIK BISOPROLOL/BISOPROLOL FUMARATE TABLET/KAPSUL/KAPLET SALUT SELAPUT 5 MG

CONCOR 2.5 BISOPROLOL TABLET/KAPSUL/KAPLET 10 MG

V-BLOC KARVEDILOL TABLET/KAPSUL/KAPLET/KAPTAB 6,25 MG, KEMASAN STRIP/ BLISTER

Biorec Karvedilol tablet/kapsul/kaplet 25 mg

GENERIK HIDROKLOROTIAZID/ HYDROCHLOROTHIAZIDE TAB 25 MG

GENERIK FUROSEMID/ FUROSEMIDE TABLET/KAPSUL/KAPLET 40 MG

GENERIK FUROSEMID/ FUROSEMIDE INJ 10MG/ML (I.V./I.M)

GENERIK AMLODIPIN/AMLODIPINE/AMLODIPINE BESYLATE/AMLODIPINE BESILATE TABLET/KAPSUL/KAPLET 5 MG

GENERIK AMLODIPIN/AMLODIPINE/AMLODIPINE BESYLATE/AMLODIPINE BESILATE TABLET/KAPSUL/KAPLET 10 MG

GENERIK DILTIAZEM/ DILTIAZEM HCL TABLET/KAPSUL/KAPLET 30 MG

HERBESSER CD 200 DILTIAZEM KAPSUL LEPAS LAMBAT 200 MG

HERBESSER CD 100 DILTIAZEM KAPSUL LEPAS LAMBAT 100 MG

HERBESSER INJEKSI 50 MG DILTIAZEM SERBUK INJEKSI 50 MG

FARMABES INJ DILTIAZEM INJEKSI INJ 5MG/ML

GENERIK VERAPAMIL HYDROCHLORIDE (HCL)/ VERAPAMIL TABLET/KAPSUL/KAPLET 80 MG

GENERIK DIGOKSIN/ DIGOXIN TABLET/KAPSUL/KAPLET 0,25 MG

AMIODARON INJ 50 MG/ML (150 MG/ 3 ML) (G) AMIODARON INJ 50 MG/ML (150 MG/ 3 ML) (G)

CETADOP DOPAMIN / DOPAMINE HIDROCHLORIDE INJEKSI 40 MG/ML

GENERIK DOBUTAMIN/ DOBUTAMIN HCL/ DOBUTAMINE HCL INJEKSI 50 MG/ML

DOBUTAMINE-HAMELN DOBUTAMIN INJEKSI 12,5 MG/ML

GENERIK NOREPINEPHRINE BITARTATE/ NOREPINEPHRINE BITARTATE MONOHYDRATE / NOREPINEPHRINE/ NOREPINEPHRINE

NOREPINEFRIN INJ 1 MG/ML

GENERIK ISOSORBID DINITRAT INJEKSI 1 MG/ML (I.V) (G).

APLET SALUT SELAPUT 75 MG
(ACS - secara umum)
- Aspilet/Miniaspi 80/Aptor 100 (cewable dan salut selaput)
- Clopidogrel 75 mg
(ACS wajib dual antiplatelet)
Arixtra/Lovenox dan Heparin iv
Streptokinase

(Anti HT/HF/Antiaritmia/Shock dll)

Capto/Rami/Lisino pril
Candesartan/Irbesartan
- Bisoprolol 5/ concor 2.5
- Carvedilol 6.25
- Spironolakton 25
- HCT 25
- Furosemid 40 mg tab/20 mg iv
- Amlodipin 5/10
- Diltiazem iv/Oral 30/SR 100/200
- Verapamil 80 tab
- Digoxin tab 0.25/Iv
- Amiodaron iv 150/dan tab 200
Dopamin iv
Dobutamin iv
Norepinefrin iv
ISDN tab dan iv/NTG iv
Morfin iv
Epinefrin iv
Atropin iv
ATP/Adenosin iv
Lidokain iv

Antibiotik RHD
Ospen (penoxymetilpenicillin)

Antikoagulan oral
- Warfarin 2 mg

Antilipid
- Simvastatin 10/20
- Atorvastatin 20/40
- Fenofibrat 100/300

Hipertensi Paru
Dorner
Sildenafil