DAFTAR OBAT NON BPJS

Antibiotic
No Nama Obat Komposisi Ket
1 Librocef Cefadroxil 500mg
2 Lifadrox Cefadroxil 500mg
3 Fg torcis Neomycin
4 Erira forte Eritromycin
5 Girabloc Ciprofloxacin
6 Trichodazol Metronidazol 500mg
7 Yousimox Amoxicillin 500mg
8 Solpenox Amoxicillin 500mg
9 Santagesic Metronidazol 500mg
10 mycoraL Ketoconazol 500mg

11 Formyco Ketokonazol 500 mg

12 Amiclav Amoxicillin 500 mg, Potassium clavulate 125

mg
13 Colsancetine 250 Clorampenicol

Antinplamasi
No Nama Obat Komposisi Ket
1 Anaton PCT, Dextro, CTM, Penylprop
2 Alaxan Ibu profen & PCT
3 Aknil Ibu profen & PCT
4 Renadinac 50 Na.Dic
5 Alpara PCT, Phenylpropanolamin, CTM, Dextro
6 Alpara PE PCT, phenileprin, CTM, Dextro
7 Bufadol Paracetamol 650
8 Demacolin PCT, Pseudo, CTM
9 Eflagen 50 Na.Dic
10 Gratazon Dexametason
11 Grafachlor Dexa, dexchlor
12 Hexam Meloxicam 15mg
13 Flucadex PCT, GG, Phenylprop, CTM
14 Melocid Meloxicam 7,5mg
15 Flamic Dic. potasium 50mg
16 Flamar Na.Dic 50mg
 17 Grantusif Dextro, GG, Diphenildramine
18 Hufagrip forte PCT, Pseudo, CTM, GG
19 Grafadon Paracetamol 500mg
20 Novaxicam Piroxicam 20mg
21 Ocuson Betametason, Dexchlorpeniramine
22 Novadex Betametason 0,5mg
23 Mefinal Asam mefenamat 500mg
24 Fluzep PCT, dextro, phenylpropanolamin, gg
25 Flutamol PCT, Phenylpropanolamin, CTM, Dextro
36 Flamsy Dic. Potassium
27 Molassic Asam mefenamat 500mg
28 Mefentan Asam mefenamat 500mg
29 Molexflu PCT, Phenileprine, CTM
30 Molacort Dexametasone 0,75mg
31 Flazen Dic. Potassium 50mg
32 Progesic Ibu profen, Paracetamol
33 Pro inz PCT, GG, phenylprop, dextro, CTM
34 Paraflu PCT, CTM, phenylpropanolamin, GG
35 Pycameth Dexametasone
36 Pirofel Piroxicam 10mg
37 Pritacort Dexamethasone, dexchlorpeniramine m.
38 Pronicy Cyproheptadine 4mg
39 Stinopi Paracetamol, acetylcysteine
40 Teamic Asam mefenamat
41 Renadinac 25 Na.Dic 5mg
42 Prefenta Ibuprofen, paracetamol
43 Spasmal Paracetamol, hyoscine butylbromide
44 Cortidex Dexamethasone 0,5mg
45 Calortusin PCT, Phenylpropanolamin, CTM, Dextro

Antihistamin
No Nama Obat Komposisi Ket
1 Cetrol Cetirizine 10mg
2 Cerini Cetirizine 10mg
3 Cerini syr Cetirizine
4 Pritacort Dexamethasone,
dexchlorpeniramine
m.
5 dextafen dexchlorpeniramine
m.
6 Taxime Cefixime
Antihipertensi
 No Nama Obat OBAT PATEN Ket
1 Amlodipine 5 mg Hexavask
2 Amlodipine 10 mg Dilavask, Hexavask
3 Furosemide 40 mg
4 Nifedipine 10 mg
5
6 Farsix
7
8
9
10
11

Gastroenteris + mual
No Nama Obat OBAT PATEN Ket
1 Antasida tab
2 Antasida syr
3 Loperamide tab Lodia
4 Domperidone tab Fometa, vosedon
5 Vit. B6
6 Domperidone syr
7 Metoclopramide HCL 10 mg
8 Ranitidine 150mg Zenti 150
9 Omeprazole 20 mg Teamic, lokev
10 Lanzoprazole Digest, ladenum
11

Kolestrol
No Nama Obat Satuan Ket
1 Simvastatin 10 mg Tab
2 Simvastatin 1 0 mg Tab
3 Loperamide tab Tab

Diabetes
No Nama Obat Satuan Ket
1 Metformin 500 mg Tab
2 Glibencelamid 5 mg Tab
3
Asam Urat
No Nama Obat OBAT PATEN Ket
1 Allopurinol 100 mg Allodan
2 Allopurinol 300 mg Furicemia
3

Vertigo
No Nama Obat Komposisi Ket
1 Mertigo Betahistin
2 Vastigo Betahistin

Salep
No Nama Obat Satuan Ket
1 Gentamicin crim Cream
2 Hydrocotnison crm 2,5 % Cream
3 Oxytetracylin crim 3 % Cream
4 Miconazole crim Cream
5 Betametason crim Cream

Vitamin
No Nama Obat Satuan Ket
1 Vitamin B com tab
2 Vitamin C tab
3 Vitamin B6 Tab
4 Vitamin B12 Tab
5 Livron b Plex Tab
6 Tablet tambah darah Tab
7 Folic acid Tab

Antibiotic Paten Pasien Umum

Nama Obat Komposisi Ket
 No
1 Amiclav Amoxicillin 500 mg, Potassium clavulate 125 mg

2 Amoxan syr Amoxillin 125/5ml

3 Amoxan syr forte Amoxillin 250/5ml
4 Cefat syr Cefadroxil 125 mg/5ml
5 Cefat syr forte Cefadroxil 250 mg/5ml
6 Clidacor 300 Clindamycin 300
7 Colsancetine 250 cap Clorampenicol 250mg

8 Colsancetine syr Cholampenicol 125/5mg

9 Doxicor 100mg Doxycycline 100mg
10 Doxicor 50mg Doxycycline 50mg
11 Erira forte Eritromycin 500 mg
Erysanbe 500 mg Eritromycin 500 mg
12 Girabloc tab Ciprofloxacin
13 Librocef Cefadroxil 500mg
14 Lifadrox Cefadroxil 500mg
15 Sanprima 480 tab Trimethoprim sulfamethoxazole
(cotrimoxazole)
16 Sanprima Forte tab Trimethoprim sulfamethoxazole
(cotrimoxazole)
17 Siclidon 100mg Doxycycline 100mg
18 Solpenox 500 tab Amoxicillin 500mg
19 Taxime 200 Cap Cefixime 200 mg
20 Thianicol 500 Thiampenicol 500 mg
21 Topcillin 500 mg Amoxicillin 500mg
22 Trichodazol Metronidazol 500mg
23 Trogyl 500 mg Metronidazol 500mg
24 Yousimox syr Amoxicillin 125/5ml

Pharingitis/CC Pasien UMUM

No Nama Obat Komposisi Ket
1 Pro Inz PCT, GG, phenylprop, dextro, CTM
 2 Fluzep tab PCT, dextro, phenylpropanolamin, gg
3 Progesic tab Ibuprofen + Pct
4 Tremenza tab Pseudoefedrin + Triprolidine
5 Rhinos SR cap Pseudoefedrine + Loratadine
6 Flucadex PCT, phenileprin, CTM, Dextro
7 Bufadol tab Paracetamol 650
8 Stinopi cap Paracetamol, acetylcysteine
9 Acetin 200 Cap Acetylistine 200 mg
10 Ottopan syr 60 ml Pct 125mg/ 5mk
11 Ottopan drops Pct 60mg/0,6ml
12 Zemindo syr Oxomemazine + Guefenisin
13 Transmuco syr Ambroxol 15mg/5ml
14 Epexol syr Ambroxol 15mg/5ml
15 Epexol drops Ambroxol 15mg/1 ml
16 Vectrin syr Erdosteine
17 Sanmol syr Pct 125/5ml
18 Sanmol Drps Pct 60mg/1ml
19 Sanmol syr Forte 250/5ml
Antiinplamai Pinkiller
No Nama Obat Komposisi Ket
1 Teamec 500 mg Mefenamic Acid 500 mg
2 Mefinal 500 mg Mefenamic Acid 500 mg
3 Progesic tab Pct + Ibuprofen
4 Ifen 400 Ibuprofen 400
5 Bufec 200 tab Ibuprofen 200
6 Eflagen 50 Kalium Dicofenac 50mg
7 Falamar 25 Natrium diclofenac 25mg
8 Flamar 50 Natrium dic 50 mg
9 Flazen 50 Kalium diclofenac 50mg
10 Flamic 50 mg Kalium diclofenac 50mg
11 Hexcam 15 Meloxicam 15mg
12 Melocid 7,5 Meloxicam 7,5 mg
13 Bufec syr 60ml Ibuprofen 100mg/5ml
14 Bufec syr forte Ibuprofen 200mg/5ml
15 Santramol cap Pct + Tramadol
16 Pirofel 10 Piroxicam 10mg
17 Pirofel 20 Piroxicam 20mg

Antiinplamasi
No Nama Obat Komposisi Ket
1 Sanexon 4 mg Methilprednisolon 4mg
 2 Inxilon 4 Methilprednisolon 4mg
3 Mesol 4mg Methilprednisolon 4mg
4 Cortidex 0,5 Dexametason 0,5mg
5 Molacort 0,75 Dexametason 0,75mg
6
7

Anti AsamUrat
No Nama Obat Komposisi Ket
1 Allodan 100 Allopurinol 100 mg Hexparm
2 Allodan 300 Allopurinol 300 mg Hexparm
3 L-Cisin Colchlcine 0,5 mg lapi
4 Puricemia 300 Allopurinol 300 mg Sanbe farma
5 Festaric 40 Febuxostat 40 Dexa
6
7

Anti Kolestrol
No Nama Obat Komposisi Ket
1 Svt 10 Simvastatin 10 Hexparm
2 SVT 20 Simvastatin 20 Hexparm
3 Esvat 10 Simvastatin 10 lapi
4 Esvat 20 Simvastatin 20 Sanbe farma
5 Trolip 100 Fenofibrate 100 mg Dexa

Anti Hypertensi
No Nama Obat Komposisi Ket
1 Hexavask 5 Amlodipine 5 mg Hexparm
2 Hexavask 10 Amlodipine 10 mg Hexparm
3 Dilavask 10 Amlodipine 10 mg Dexa
4 Vardipn 5/80 Amlodipine + valsaltran Otto
5 Vardipn 5/160 Amlodipine + valsaltran
6 Bufacardo 5 Amlodipine 5 mg Zenit
7 Bufacardo 10 Amlodipine 10 mg Zenit
8 Farsix 40 Furosemide 40
Anti Migran + Vit. Nerotropik
No Nama Obat Komposisi Ket
1 Gratizin 5 Flunarizin 5mg Sanbe
2 Gratizin 10 Flunarizin 10mg Sanbe
 3 Pereifas 10 Cinnarizine 10mg Otto
4 Eprinoc 50 Eprison HCL 50 Sanbe
5 Neurosantin 300 Gabapentin 300
6 Neurosanbe tab B1,B6, B12
7 Neurosanbe plus Metampiron + B1,B6, B12
8 Neurosanbe 5000 B1,B6, B125000 mcg
9 Pritagesic tab Metampiron + B1,B6, B12
10 Becom C Vit C 500, B1,B6, B12
11 Becom Zet Vit Bcom + Vit e. zinc
12 Pronita Vitamin tambah darah
13 Biosanbe Vitamin tambah darah
14 Elkana tab Vit Calsium
15 Oxyvit tab Vitmani c + Vit B com
16 Formuno Vitamin daya tahan tubuh
17 Imboost Force Vitamin daya tahan tubuh
18 Cafiplex Vitamin
19 Cafiplex cdez Vitamin
20 Elkana Syr Viatamin Anak
21 Elkana CL Vitamin
22 Kitavit sy Vitamin
23 Lisovit syr vitamin

Anti Asma
No Nama Obat Komposisi Ket
1 Astharol 4 mg Salbutamol 4 Sanbe
2 Salbron syr Salbutamol + Gufenisin Sanbe
3 Astharol ssyr Salbutamol Syr Otto
4 Bicorsan syr Procaterol HCL Sanbe
5 Salbulin CFC Salbutamol sulphate 100mcg/dose
inhalent
6

Anti Histamin
No Nama Obat Komposisi Ket
1 Dextafen tab Dexchlorpheniramine maleate + dexametason Otto
 2 Pritacort Dexchlorpheniramine maleate + dexametason
3 Dextamin Dexchlorpheniramine maleate + dexametason
4 Cerini tab Cetrizin 10 Sanbe
5 Cerini drops Cetirizin
6 Cetrol tab cetrizin
7

Anti Grastro /konstipasi

No Nama Obat Komposisi Ket
1 Tamezol cap Omeprazole 20mg Heparm
2 Digest cap Lansoprazole 30mg Sanbe
3 Lokev Omeprazole 20mg Otto
4 Gastulen Tab cimeticon Sanbe
5 Episan tab Sucralfate
6 Episan syr Sucralfate Sanbe
7 Braxidin tab Chlordiazepoxide HCL + Clidinium Sanbe
8 Lodia Loperamide Sanbe
9 Lidiastop Atippulage
10 Sanmag syr Magnesium +Dried aluminium + cimeticon Sanbe
11 Magtral syr Magnesium +Dried aluminium + cimeticon Otto
12 Magtral syr Forte Magnesium +Dried aluminium + cimeticon Otto
13 Novamag syr Magnesium +Dried aluminium + cimeticon
14 Propepsa syr Sucralfate Gracia
15 Graphalac syr Lactulose
16 L-bio Lactobasilus

Anti Muntah
No Nama Obat Komposisi Ket
1 Vomina syr Domperidone Otto
2 Damaben Drops Metcomperamide Hcl
3 Samneto sy Metcomperamide Hcl
4 Vometa syr Domperidone syr
5 Vometa dros Domperidone
6 Lexapram tab Metcomperamide Hcl