Daftar Obat Mengandung Prekursor [PDF]

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DAFTAR OBAT MENGANDUNG PREKURSOR No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48



Nama Obat Actifed Cough Plus Suppressant 60 ml Actifed Cough Plus Expectorant 60 ml Actifed Syrup 60 ml Allerin Expectorant 60 ml Alpara Syrup 60 ml Alpara Kaplet Anakonidin OBH 30 ml Anakonidin OBH 60 ml Anakonidin Syrup 30 ml Anakonidin Syrup 60 ml Anaton Syrup 60 ml Bodrexin Flu & Batuk Syrup 56 ml Bodrexin Pilek Alergi Syrup 56 ml Bronchitin Expectorant 50 ml Bufagan Expectorant 60 ml Bufakris Syrup 60 ml Calortusin Syrup 60 ml Calortusin Tablet Citocetine Syrup 60 ml Colfin Syrup 60 ml Coparcetine Syrup 60 ml Coparcetine Tablet Decolgen Syrup 60 ml Decolgen Tablet Decolsin Capsule Decolsin Syrup 60 ml Dextral Forte Kaplet Dextral Syrup 60 ml Dextral Kaplet Etaflusin Syrup 60 ml Flucadex Kaplet Flucadex Syrup Fludane Forte Kaplet Fludane Kaplet Fludane Plus Kaplet Fludane Plus Syrup 60 ml Fludane Syrup 60 ml Flumin Plus Syrup 60 ml Flumin Tablet Flutamol Syrup 60 ml Flutamol Kaplet Flutop C Syrup 60 ml Hufagrip Forte Tablet Hufagrip Pilek Syrup 60 ml Hufagrip Syrup 60 ml Hufagrip BP Syrup 60 ml Intunal Kaplet Intunal Forte Kaplet



Zat Aktif Prekursor Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Ephedrine HCl Ephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl



Bentuk dan Kekuatan Sediaan Syrup & 30 mg Syrup & 30 mg Syrup & 30 mg Syrup & 15 mg Syrup & 3.125 mg Kaplet & 12.5 mg Syrup & 7.5 mg Syrup & 7.5 mg Syrup & 7.5 mg Syrup & 7.5 mg Syrup & 3.5 mg Syrup & 7.5 mg Syrup & 7.5 mg Syrup & 8 mg Syrup & 2.5 mg Syrup & 4.17 mg Syrup & 3.75 mg Tablet & 15 mg Syrup & 7.5 mg Syrup & 3.5 mg Syrup & 4 mg Tablet & 8 mg Syrup & 7.5 mg Tablet & 12.5 mg Kapsul & 30 mg Syrup & 15 mg Kaplet & 15 mg Syrup & 15 mg Kaplet & 12.5 mg Syrup & 3 mg Kaplet & 15 mg Syrup & 7.5 mg Kaplet & 12.5 mg Kaplet & 12.5 mg Kaplet & 12.5 mg Syrup & 3.125 mg Syrup & 3.125 mg Syrup & 3.5 mg Tablet & 15 mg Syrup & 3.5 mg Kaplet & 15 mg Syrup & 3.5 mg Tablet & 5 mg Syrup & 15 mg Syrup & 7.5 mg Syrup & 15 mg Kaplet & 12.5 mg Kaplet & 15 mg



Satuan Botol Botol Botol Botol Botol Box Botol Botol Botol Botol Botol Botol Botol Botol Botol Botol Botol Box Botol Botol Botol Box Botol Box Box Botol Box Botol Box Botol Box Botol Box Box Box Botol Botol Botol Box Botol Box Botol Box Botol Botol Botol Box Box



49 50 51 52 53 54 55 56 57 58 59 60 61 62 63



Intunal Syrup 60 ml Inza Kaplet Millsen Syrup 60 ml Mixagrip Flu & Batuk Kaplet Molexflu Syrup 60 ml Molexflu Tablet Nalgestan Tablet Neo Napacin Tablet Neozep Forte Tablet OBH Combi Batuk Flu Menthol 60ml OBH Combi Batuk Flu Jahe 60ml OBH Combi Batuk Flu Madu 60ml OBH Combi Batuk Flu Menthol 100ml OBH Combi Batuk Flu Jahe 100ml OBH Combi Batuk Flu Anak Apel 60ml



Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl Phenylpropanolamine HCl Ephedrine HCL Ephedrine HCL Ephedrine HCL Ephedrine HCL Ephedrine HCL Pseudoephedrine HCL



Syrup & 3.5 mg Kaplet & 30 mg Syrup & 3.5 mg Kaplet & 30 mg Syrup & 3.125 mg Tablet & 12.5 mg Tablet & 15 mg Tablet & 12.5 mg Tablet & 15 mg Sirup & 2.5 mg Sirup & 2.5 mg Sirup & 2.5 mg Sirup & 2.5 mg Sirup & 2.5 mg Sirup & 7.5 mg



Botol Box Botol Box Botol Box Box Box Box Botol Botol Botol Botol Botol Botol



64 OBH Combi Batuk Flu Anak Orange 60ml



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



65 OBH Combi Batuk Flu Anak Strawberry 60ml



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84



Pseudoephedrine HCL Ephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Ephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl



Sirup & 7.5 mg Syrup & 3 mg Syrup & 15 mg Syrup & 7.5 mg Tablet & 15 mg Syrup & 2.5 mg Syrup & 2.5 mg Syrup & 8 mg Syrup & 15 mg Syrup & 15 mg Kaplet & 15 mg Syrup & 7.5 mg Syrup & 7.5 mg Syrup & 10 mg Syrup & 15 mg Syrup & 15 mg Syrup & 15 mg Syrup & 7.5 mg Kaplet & 15 mg



Botol Botol Botol Botol Box Botol Botol Botol Botol Botol Box Botol Botol Botol Botol Botol Botol Botol Box



OBH Combi Batuk Flu Anak Madu 60ml Paracetin Syrup 60 ml Paratenza Syrup 60 ml Paratusin Syrup 60 ml Paratusin Tablet Pimtrakol Cherry Syrup 60 ml Pimtrakol Plus Syrup 60 ml Poncolin Syrup 60 ml Siladex Cough & Cold 30 ml Siladex Cough & Cold 60 ml Tera F Kaplet Termorex Plus Syrup 30 ml Termorex Plus Syrup 60 ml Thymcal Syrup 100 ml Triaminic Batuk & Pilek 60 ml Triaminic Ekspektoran 60 ml Triaminic Pilek 60 ml Neo Triaminic Drops 10 ml Ultraflu Kaplet



DAFTAR OBAT MENGANDUNG PREKURSOR No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43



Nama Obat Actifed Cough Plus Suppressant 60 ml Actifed Cough Plus Expectorant 60 ml Actifed Syrup 60 ml Allerin Expectorant 60 ml Alpara Syrup 60 ml Alpara Kaplet Anakonidin OBH 30 ml Anakonidin OBH 60 ml Anakonidin Syrup 30 ml Anakonidin Syrup 60 ml Anaton Syrup 60 ml Bodrexin Flu & Batuk Syrup 56 ml Bodrexin Pilek Alergi Syrup 56 ml Bronchitin Expectorant 50 ml Bufagan Expectorant 60 ml Bufakris Syrup 60 ml Calortusin Syrup 60 ml Calortusin Tablet Citocetine Syrup 60 ml Colfin Syrup 60 ml Coparcetine Syrup 60 ml Coparcetine Tablet Decolgen Syrup 60 ml Decolgen Tablet Decolsin Capsule Decolsin Syrup 60 ml Dextral Forte Kaplet Dextral Syrup 60 ml Dextral Kaplet Etaflusin Syrup 60 ml Flucadex Kaplet Flucadex Syrup Fludane Forte Kaplet Fludane Kaplet Fludane Plus Kaplet Fludane Plus Syrup 60 ml Fludane Syrup 60 ml Flumin Plus Syrup 60 ml Flumin Tablet Flutamol Syrup 60 ml Flutamol Kaplet Flutop C Syrup 60 ml Hufagrip Forte Tablet



Zat Aktif Prekursor Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Ephedrine HCl Ephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl



44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84



Hufagrip Pilek Syrup 60 ml Hufagrip Syrup 60 ml Hufagrip BP Syrup 60 ml Intunal Kaplet Intunal Forte Kaplet Intunal Syrup 60 ml Inza Kaplet Millsen Syrup 60 ml Mixagrip Flu & Batuk Kaplet Molexflu Syrup 60 ml Molexflu Tablet Nalgestan Tablet Neo Napacin Tablet Neozep Forte Tablet OBH Combi Batuk Flu Menthol 60ml OBH Combi Batuk Flu Jahe 60ml OBH Combi Batuk Flu Madu 60ml OBH Combi Batuk Flu Menthol 100ml OBH Combi Batuk Flu Jahe 100ml OBH Combi Batuk Flu Anak Apel 60ml OBH Combi Batuk Flu Anak Orange 60ml OBH Combi Batuk Flu Anak Strawberry 60ml OBH Combi Batuk Flu Anak Madu 60ml Paracetin Syrup 60 ml Paratenza Syrup 60 ml Paratusin Syrup 60 ml Paratusin Tablet Pimtrakol Cherry Syrup 60 ml Pimtrakol Plus Syrup 60 ml Poncolin Syrup 60 ml Siladex Cough & Cold 30 ml Siladex Cough & Cold 60 ml Tera F Kaplet Termorex Plus Syrup 30 ml Termorex Plus Syrup 60 ml Thymcal Syrup 100 ml Triaminic Batuk & Pilek 60 ml Triaminic Ekspektoran 60 ml Triaminic Pilek 60 ml Neo Triaminic Drops 10 ml Ultraflu Kaplet



Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Ephedrine HCl Phenylpropanolamine HCl Ephedrine HCL Ephedrine HCL Ephedrine HCL Ephedrine HCL Ephedrine HCL Pseudoephedrine HCL Pseudoephedrine HCL Pseudoephedrine HCL Pseudoephedrine HCL Ephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Ephedrine HCl Phenylpropanolamine HCl Pseudoephedrine HCl Pseudoephedrine HCl Ephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Pseudoephedrine HCl Phenylpropanolamine HCl



Colfin Syrup 60 ml Hufagrip Forte Tablet Tera F Kaplet Molexflu Syrup 60 ml Calortusin Tablet Molexflu Tablet



Nama Obat



Phenylpropanolamine HCl Ephedrine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl Phenylpropanolamine HCl



Zat Aktif Prekursor



Syrup & 3.5 mg Tablet & 5 mg Kaplet & 15 mg Syrup & 3.125 mg Tablet & 15 mg Tablet & 12.5 mg



Bentuk dan Kekuatan Sediaan



Botol Box Box Botol Box Box



Satuan



Flutop C Syrup 60 ml



Phenylpropanolamine HCl



Syrup & 3.5 mg



Botol



Anakonidin Syrup 30 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Anakonidin Syrup 60 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Anakonidin OBH 30 ml Anakonidin OBH 60 ml



Pseudoephedrine HCl Pseudoephedrine HCl



Syrup & 7.5 mg Syrup & 7.5 mg



Botol Botol



Bodrexin Flu & Batuk Syrup 56 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Bodrexin Pilek Alergi Syrup 56 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Termorex Plus Syrup 30 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Termorex Plus Syrup 60 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Jumlah



Ket



1



2



3



4



5



7



KOP APOTEK/ KLINIK/ RUMAH SAKIT/ TOKO OBAT SURAT PESANAN OBAT MENGANDUNG PREKURSOR FARMASI No. SP : Harus diisi dengan lengkap Yang bertanda tangan di bawah ini Nama : Harus diisi lengkap dengan gelar Jabatan : Harus diisi No. SIPA utk Apotek/ Klinik/ RS, SIPTTK utk Ass.Apoteker di Toko Obat : Harus diisi dengan Lengkap Mengajukan Pesanan obat mengandung Prekursor Farmasi kepada: Nama PBF Alamat Telp



: PT. Triputra Mulia Farmasindo (Harus diisi jangan disingkat) : Jl. Pilang Raya No.90 Kedawung - Cirebon (Harus diisi) : 0231-225540 (Harus diisi)



Jenis Obat mengandung Prekursor Farmasi yang dipesan adalah: No



Nama Obat mengandung Prekursor Farmasi



Zat Aktif Prekursor Farmasi



Bentuk dan Kekuatan



Satuan



1



Actifed Plus Cough Suppressent



Pseudoephedrine HCl



Syrup & 30 mg



Botol



2



Actifed Plus Expectorant



Pseudoephedrine HCl



Syrup & 30 mg



Botol



3



Actifed Syrup



Pseudoephedrine HCl



Syrup & 30 mg



Botol



4



Allerin Ekspektoran 60 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



5



Alpara Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



6



Alpara Sirup 60 ml



Phenylpropanolamine HCl



Syrup & 3.125 mg Botol



7



Anakonidin OBH 30 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



8



Anakonidin OBH 60 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



9



Anakonidin 30 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



10



Anakonidin 60 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



11



Bufakris Syrup



Ephedrine HCl



Syrup & 4.17 mg Botol



12



Calortusin syrup



Phenylpropanolamine HCl



Syrup & 3.75 mg Botol



13



Calortusin Kaplet



Phenylpropanolamine HCl



Kaplet & 15 mg



Box



14



Coparcetin Sirup



Ephedrine HCl



Syrup & 4 mg



Botol



15



Coparcetine Tablet



Ephedrine HCl



Tablet & 8 mg



Box



16



Decolgen Sirup 60 ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



17



Decolgen Tablet



Phenylpropanolamine HCl



Tablet & 12.5 mg Box



18



Decolsin Kapsul



Pseudoephedrine HCl



Kapsul & 30 mg



Box



19



Decolsin Sirup



Pseudoephedrine HCl



Syrup & 15 mg



Botol



20



Dextral Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



Jumlah Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka



Keterangan Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin



21



Dextral Forte Kapsul



Phenylpropanolamine HCl



Kapsul & 15 mg



22



Dextral Sirup 60 ml



Phenylpropanolamine HCl



Syrup & 12.5 mg Botol



23



Etaflusin Syrup



Ephedrine HCl



Syrup & 3 mg



Botol



24



Flucadex Sirup 60 ml



Phenylpropanolamine HCl



Syrup & 7.5 mg



Botol



25



Flucadex Kaplet



Phenylpropanolamine HCl



Kaplet & 15 mg



Box



26



Fludane Plus Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



27



Fludane Forte Kapsul



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



28



Flumin Kaplet



Phenylpropanolamine HCl



Kaplet & 15 mg



Box



29



Flumin Plus Sirup



Phenylpropanolamine HCl



Syrup & 3.5 mg



Botol



30



Flutop C Sirup



Phenylpropanolamine HCl



Syrup & 3.5 mg



Botol



31



Hufagrip Batuk Pilek Sirup



Pseudoephedrine HCl



Syrup & 15 mg



Botol



32



Hufagrip Flu Sirup



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



33



Hufagrip Forte



Ephedrine HCl



Kaplet & 5 mg



Box



34



Hufagrip Pilek Sirup



Pseudoephedrine HCl



Syrup & 15 mg



Botol



35



Intunal Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



36



Intunal Sirup



Phenylpropanolamine HCl



Syrup & 3.5 mg



Botol



37



Intunal Forte Tablet



Phenylpropanolamine HCl



Tablet & 15 mg



Box



38



Metilergometrin Maleat Tablet



Metilergometrin Maleat



Tablet & 0.125 mg



Box



39



Molexflu Sirup



Phenylpropanolamine HCl



Syrup & 3.125 mg Botol



40



Molexflu Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg Box



41



Nalgestan



Phenylpropanolamine HCl



Tablet & 15 mg



42



Neo Napacin



Ephedrine HCl



Tablet & 12.5 mg Box



43



Neozep Forte



Phenylpropanolamine HCl



Tablet & 15 mg



Box



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



Ephedrine HCL



Sirup & 2.5 mg



Botol



Ephedrine HCL



Sirup & 2.5 mg



Botol



Ephedrine HCL



Sirup & 2.5 mg



Botol



44 45 46 47 48 49



Obh Combi Anak Batuk Plus Flu Strawberry Obh Combi Anak Batuk Plus Flu Apel Obh Combi Anak Batuk Plus Flu Madu Obh Combi Batuk Plus Flu Jahe 100 Ml Obh Combi Batuk Plus Flu Madu 60 Ml Obh Combi Batuk Plus Flu Jahe 60 Ml



Box



Box



Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka



Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin



50 51 52



Obh Combi Batuk Plus Flu Menthol 100 Ml Obh Combi Batuk Plus Flu Menthol 60 Ml Obh Combi Anak Batuk Plus Flu Orange



Ephedrine HCL



Sirup & 2.5 mg



Botol



Ephedrine HCL



Sirup & 2.5 mg



Botol



Pseudoephedrine HCL



Sirup & 7.5 mg



Botol



53



Obh Tropica Extra Menthol 60 ml



Ephedrine HCl



Sirup & 3 mg



Botol



54



Obh Tropica Extra Menthol 100 ml



Ephedrine HCl



Sirup & 3 mg



Botol



55



Obh Tropica Extra Anak Strawberry Pseudoephedrine HCl 60 ml



Sirup & 7.5 mg



Botol



56



Obh Tropica Extra Anak Jeruk 60 ml Pseudoephedrine HCl



Sirup & 7.5 mg



Botol



57



Obh Tropica Plus Menthol 60 ml



Ephedrine HCl



Sirup & 2.67 mg



Botol



58



Obh Tropica Plus Menthol 100 ml



Ephedrine HCl



Sirup & 2.67 mg



Botol



59



Obh Tropica Plus Anak Strawberry 60 ml



Pseudoephedrine HCl



Sirup & 7.5 mg



Botol



60



Obh Tropica Plus Anak Jeruk 60 ml



Pseudoephedrine HCl



Sirup & 7.5 mg



Botol



61



Paratusin Sirup



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



62



Paratusin Tablet



Phenylpropanolamine HCl



Tablet & 15 mg



Box



63



Pimtrakol Cherry



Ephedrine HCl



Syrup & 2 mg



Botol



64



Pimtrakol Lemon



Ephedrine HCl



Syrup & 2 mg



Botol



65



Siladex Cough & Cold 60 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



66



Siladex Cough & Cold 30 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



67



Tera-F



Phenylpropanolamine HCl



Kaplet & 15 mg



Box



68



Termorex Plus 30ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



69



Termorex Plus 60ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



70



Triaminic Batuk 60 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



71



Triaminic Ekspektoran 60 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



72



Triaminic Pilek 60 ml



Pseudoephedrine HCl



Syrup & 15 mg



Botol



Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka Ditulis angka



Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin



Obat mengandung Prekursor Farmasi tersebut akan digunakan untuk memenuhi kebutuhan : Nama Apotek, Toko Obat, Klinik, Rumah Sakit : Harus diisi dengan lengkap Alamat Lengkap : Harus diisi dengan Lengkap No.Ijin Apotek, Toko Obat, Klinik, Rumah Sakit : Harus diisi dengan Lengkap Tempat, Tanggal - Bulan - Tahun TTD Apoteker + Cap Apotek, Toko Obat, Klinik, Rumah Sakit Nama Apoteker diisi lengkap dengan Gelar SIPA Apoteker (Apotek/Klinik/RS), SIPTTK Ass.Apoteker (Toko Obat)



Note: Untuk penamaan obat jangan disingkat dan jangan ditulis Actifed merah, actifed hijau, Hufagrip biru, hufagrip kuning, hufagrip hijau



No



Nama Obat mengandung Prekursor Farmasi



Zat Aktif Prekursor Farmasi



Bentuk dan Kekuatan



Satuan Box



Ditulis angka



Jumlah



1



Molexflu Kaplet



Phenylpropanolamine HCl



Kaplet & 12.5 mg



2



Termorex Plus 30ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Ditulis angka



3



Termorex Plus 60ml



Pseudoephedrine HCl



Syrup & 7.5 mg



Botol



Ditulis angka



Keterangan Ditulis huruf latin Ditulis huruf latin Ditulis huruf latin