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					                                                                            615.1
                                                                            Ind




NATIONAL LIST of ESSENTIAL MEDICINES 2008
                                                                            n




                                            NATIONAL
                                            LIST of
                                            ESSENTIAL
                                            MEDICINES
                                            2008
                                                DEPARTEMEN KESEHATAN R.I.




                                                 MINISTRY of HEALTH
                                                REPUBLIC of INDONESIA
                                                                                    1
        Ministry of Health of The Republic of Indonesia.
        Cataloging in Publication Data.
615.1
Ind     Indonesia. Ministry of Health Republic of Indonesia.
n           National list of essential medicines 2008.--
            Jakarta : Ministry of Health of The Republic of
            Indonesia, 2008.
            1. Judul     1. DRUGS

2
                                                  CONTENT


                                                                                           Page
 Foreword                                                                                     i

 Content                                                                                      ii

 The decree of The Ministry of Health regarding National List of Essential Medicines         iii
 2008

 Chapter I                INTRODUCTION                                                        1

 Chapter II               National List of Essential Medicines 2008                          19

 Chapter III              Restricted Medicine List for Public Health Center 2008             63


 APPENDICES

 Appendix I               Changes of National List of Essential Medicines 2005               88

 Appendix II              The Decree of Ministry of Health Number 239/MENKES/               100
                          SK/III/2008, 5 March 2008, regarding The Establishment of
                          National Committee on Revision of The NLEM 2008

 Appendix III             List of Participants of Technical Meetings and Plenary Session    105
                          of National List of Essential Medicines 2008

 Appendix IV              Statement of Compliance                                           108

 Appendix V               Conflict of Interest Statement                                    109

 Appendix VI              Assessment Form                                                   110


 Index                                                                                      112




National List of Essential Medicines 2008                                                      ii
                    THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA
                           THE DECREE OF THE MINISTER OF HEALTH
                                OF THE REPUBLIC OF INDONESIA
                               NUMBER : 791/MENKES/SK/VIII/2008

                                                  REGARDING

                            THE NATIONAL LIST OF ESSENTIAL MEDICINES 2008

                    THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA

Considers :            a.         in order to increase the quality of health services and to ensure the
                                  availability, equity, affordability of the essential medicines to the
                                  community at all levels, it is therefore, the National List of Essential
                                  Medicines should be revised;
                       b.         the National List of Essential Medicines which mentioned in the Decree
                                  of the Minister of Health No. 497/Menkes/SK/VII/2006 has to be
                                  revised according to progress of medical sciences, health technology,
                                  disease pattern and the health program respectively;
                       c.         Considering point (a) and (b), it is necessary to redetermine the
                                  National List of Essential Medicines by the Ministerial Decree;
  Refers to :          1.         Law No. 23 year 1992 regarding Health (States Paper Year 1992
                                  No. 100. Additional to States Paper No. 3495);
                       2.         Law No. 29 year 2004 regarding Medical Practice (State Paper year
                                  2004 No. 116, Additional to State Papers of the Republic of Indonesia
                                  No. 4431);
                       3.         Law No. 32 year 2004 regarding the Regional Government
                                  Administration (State Paper year 2004 No. 125, Additional to State
                                  Paper No. 4437) as lastly changed by Regulation No. 12 year 2008
                                  regarding the second changing on the Regulation No. 32 year 2004
                                  regarding Regional Government (State Paper year 2008 No. 59,
                                  Additional State Paper No. 4844);
                       4.         Government Regulation No. 32 Year 1996 regarding Health Human
                                  Resource/ Health personnel (State Paper year 1996 No. 49, Additional
                                  to State paper No. 3637);
                       5.         Government Regulation No. 72 Year 1998 regarding the Security of
                                  the pharmaceutical product and Medical Devices (State Paper year
                                  1998 No. 138, Additional to State Paper No. 3781);
                       6.         Government regulation No. 38 year 2007 regarding Division of
                                  governing administration of central government, Provincial
                                  Government, and local government in Municipality/District (State paper
                                  Year 2007 No. 82, Additional State Paper NO. 4737);



National List of Essential Medicines 2008                                                                    iii
                       7.         Presidential Regulation No. 9 year 2005 regarding the authority,
                                  function, Organizational Structure and duty of States Ministries of the
                                  Republic of Indonesia;
                       8.         Presidential Regulation No. 10 Year 2005 regarding Organization Unit
                                  and duty of the First Rank Officers of the States Ministries;
                       9.         The Regulation of Ministry of Health No. 085/Menkes/Per/I/ 1989
                                  regarding the Compulsory of Generic products prescribing at public
                                  health facilities;
                       10.        The decree of the Minister of Health of the Republic of Indonesia no.
                                  1575/Menkes/Per/XI/2005 regarding Organization and Management of
                                  the Ministry of Health as has been changed by the Regulation of the
                                  Minister of Health No. 1295/Menkes/Per/XII/2007;
                       11.        The decree of the Minister of Health No. 189/Menkes/SK/III/ 2006
                                  regarding the National Medicines Policy;
                       12.        The decree of the Minister of Health No. 239/Menkes/SK/III/ 2008
                                  regarding The Establishment of The National Committee on Revision
                                  of The National List of The Essential Medicines 2008.


                                                  Has decided
  To Stipulate         :
  The First            :      THE DECREE OF THE MINISTER OF HEALTH REGARDING
                              NATIONAL LIST OF ESSENTIAL MEDICINES 2008.
  The Second           :      The National List of Essential Medicines 2008 as mentioned in the first
                              dictum is attached in the Appendix hereto.
  The Third            :      The National List of Essential Medicines (NLEM) is the list of the selected
                              medicines that satisfy the priority health care needs of the population and
                              are intended to be available within the context of functioning health
                              systems.
  The Fourth           :      The implementation of NLEM is to increase the appropriateness, safety,
                              rationalization of the medicine use and management and also increase
                              the effectiveness and efficiency of the available budget in order to
                              expand, to distribute evenly and to increase the quality of health services
                              for all community levels.
  The Fifth            :      The implementation of NLEM should be consistent and continuously in
                              level of Health Service Units.
  The Sixth            :      With approval of this decree, therefore the Decree of Minister of Health
                              No. 497/Menkes/SK/VII/2006 regarding the National List of Essential
                              Medicines 2005, hereby cancelled and believed not to be applicable any
                              more.




National List of Essential Medicines 2008                                                                   iv
  The Seventh          :      This decree shall be effective as of the date of stipulation.


                                                        Stipulated in : Jakarta
                                                      On Date : August 21, 2008.
                                                          Minister of Health




                                              Dr. dr. SITI FADILAH SUPARI, Sp.JP (K)




National List of Essential Medicines 2008                                                     v
                                            FOREWORD

The National Medicines Policy (2006) mandates the enforcement to enhance the quality of health
services; to ensure the availability of safe, efficacious and good quality medicines in sufficient
amount and type, affordability and accessibility of medicine particularly essential medicine for the
whole community, to be government’s responsibility.

Essential medicine is selected medicine that mostly needed for health service, including diagnosis,
prevention, therapy and rehabilitation, which enforced to be provided in health care units,
according to their function and level.

This revision’s renewal applied a new approach, whereas the process of addition and deletion
preceded with re-evaluation of existing list of previous National List of Essential Medicines (NLEM)
by The National Committee of NLEM, therefore there were deletion of obsolete medicines and
addition of new medicines in consequence of science improvement. It needs the transparency of
evaluating process which utilize scientific evidence and consider the pediatric formulation.

NLEM revised regularly every three years; the last revision carried out in 2005. Current revision is
conducted by The National Committee of NLEM, which legalized through The Decree of Minister of
Health.

Hopefully, by the prevailing of NLEM 2008, mandate of The National Medicines Policy could be
applied better.

A great thankfulness is given to all parties involved in the process of revision and formulation of
NLEM 2008.

                                                          Jakarta, August 2008
                                                               Director General
                                                  Pharmaceutical Services and Medical Devices




                                                         Dra. Kustantinah, Apt. MAppSc.
                                                                 NIP. 140 100 965




National List of Essential Medicines 2008                                                          i
                                             CHAPTER I



                                            INTRODUCTION


The concept of Essential Medicine in Indonesia was first introduced with the publication of The
National List of Essential Medicines (NLEM) in 1978, followed by the National Medicines Policy
document in 1983. The National List of Essential Medicines, named DOEN (NLEM) is revised
periodically every 3-4 years. DOEN 2008 is a revised edition. The Government’s commitment to do
periodic revisions is a reputation of its own.

In the year 2007, the World Health Organization (WHO) has carried out the first phase of Good
Governance on Medicines (GGM) program in Indonesia by conducting a survey on transparency of
five pharmaceutical functions. One of them is the selection process of essential medicines, which
from the aspect of transparency process is valued to be insufficient. From the meeting of the 30th
WHO Essential Medicine List in Sri Lanka (2007), it was reiterated that the importance of
transparency of the selection process both by expert panel members who do revisions, revision
process, and revision methods which have got to be more rely on evidence based medicine (EBM),
and the importance of the conflict of interest statement from expert panel members.

Recalling some of the above mentioned issues, this year’s (2008) revision has been geared into its
betterment. Because of it, the revision process this time is rather different from the earlier revision
process, some of these improvements are as follows:

        1.      The selection of expert panel members has been tightly scrutinized, including valuation
                against conflict of interest.
        2.      Since the beginning of discussion, program managers who use medicines in the
                environment of the Ministry of Health have been included, not only during the plenary
                meeting. This endeavor is hoped to be a re-learning process to the internal of the
                Ministry of Health to fully understand the concept of essential medicines.
        3.      Besides the opinion and experiences of expert panel members in this revision team, the
                utilization of evidence based medicine (EBM) data are important considerations.
        4.      The entire discussion process gives great attention to medicines for children, including
                its formulation. The WHO essential medicines list for children has been used as one of
                the guidelines. The siding with the individual rights of children is also shown by electing
                pediatricians into the expert panel that numbered to 4 (four) persons.
        5.      Revision of the medicines list has been holistic and total, meaning weighing all
                medicines listed in the NLEM 2005 including notes which may no longer be deemed fit.
                Earlier revisions were more in the evaluation of medicines which are suggested to be
                added on in the previous list.

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National List of Essential Medicines 2008
        6.      Transparency is also displayed with descriptions of arguments why a medicine must be
                deleted or be added from the NLEM 2005, or even be change of dosage form.

A.      National Essential Medicines

        Essential medicines are chosen medicines which are most needed to cater to the diagnoses,
        prophylaxis, therapy, and rehabilitation, which are made available to the health service units
        in accordance to its functions and tiers.

        1.      Criteria of National Essential Medicines
                a.          Selection Criteria
                            Selection of essential medicines is based on these criteria:
                            (1)             Having got the most beneficial risk-benefit ratio.
                            (2)             Guaranteed of quality, including stability and bio-availability.
                            (3)             Practicality in storage and distribution.
                            (4)             Practical in use and delivery, which are adjusted to man power and
                                            health services facilities.
                            (5)             Advantageous in compliance and reception by patients.
                            (6)             Having got the highest benefit-cost ratio based on direct and indirect
                                            expenses for the patient.
                            (7)             If there is more than one choice which have the same therapeutic
                                            effects, then preference is made for:
                                            -    medicines with effects which are known to have scientific data;
                                            -    medicines with pharmacokinetic data which are known to be most
                                                 beneficial;
                                            -    medicines with better stability;
                                            -    easily obtainable;
                                            -    medicines that are most familiar.
                            (8)             Fixed combination medicines have to follow the following criteria:
                                            -    the compounded medicine is useful in the form of that
                                                 combination only;
                                            -    combination medicines have got to show higher efficacy and
                                                 safety than each individual component;
                                            -    ratio of the components of patent combination medicines are
                                                 ratios which are fixed for a large number of patients who need
                                                 those combination medicines;
                                            -    combination medicines have got to increase the benefit-cost ratio;
                                            -    combination antibiotics it must also prevent or lessen the
                                                 occurrences of resistance or other disadvantageous effects.



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National List of Essential Medicines 2008
                b.          Criteria of Additions and Deletions
                            1.       When addition of new medicines are considered, the existing old
                                     medicines with the same indications which may be obsolete should be
                                     taken into account, unless there is a strong reason to keep both of them.
                            2.       Medicines used in special program(s) are suggested by the program
                                     manager and will be assessed by general EM selection criteria.
                            3.       In the revision process, the entire medicine list in the NLEM (2005) is
                                     evaluated by the National Revisions Committee. Deletion of medicines
                                     which are seen as no longer effective may here be decided upon or a
                                     substitution may be done when another better medicine has been
                                     available.


                c.          Guidance on Evidence and Recommendation
                            Proof of evidence and recommendations are adopted from the US Agency for
                            Health Care Policy and Research. The type of study should rely on scientific
                            data, such as depicted in the list below, but the recommendation should depend
                            on the overall judgement of all available data. Testimonials are not considered
                            for assessment.

                            STATEMENTS OF EVIDENCE

                            Ia              Data are obtained from meta-analysis of randomized, controlled clinical
                                            trials.

                            Ib              Data are obtained from at least one randomized, controlled clinical trial.

                            IIa             Data are obtained from at least one non-randomized and well designed
                                            clinical trial.

                            IIb             Data are obtained from at least one quasi-experiment of another type of
                                            study that is well designed.

                            III             Data are obtained from descriptive study that is well designed, like
                                            comparative study, correlation study, and case study.

                            IV              Data are obtained from reports or opinion of expert panels.


        2.      Application of Concept of Essential Medicines
                Essential medicines are the most basic medicines which are needed to cater for health
                services. If other than listed NLEM medicines are needed, a (Hospital) Formulary or
                another limited medicine list may be instituted.
                The NLEM may also be expanded into other documents as the needs arise.

                                                                                                                   3
National List of Essential Medicines 2008
                a.      National List of Essential Medicines (NLEM)
                        National List of Essential Medicines consists of selected, most needed medicines
                        and made to be available at health services units in accordance with its
                        functionality and its levels. NLEM are a national minimum standard to health
                        services.
                        Implementation of NLEM is meant to increase the efficacy, safety, rational use,
                        and medicine management which altogether increase efficiency of available cost,
                        which in turn extends coverage and increase average quality of medicine
                        prescriptions. Application of this National Essential Medicines Policy must be done
                        consistently, and continuously at all levels of health services units.
                        Medicine dosage-form and strength, such as tablets, syrups, injections, and other
                        forms, unit strength, dose, and size of package indicated in the NLEM are binding,
                        in order to create standards. Sizes of packaging for each health service unit are
                        based on logistics efficiency while distribution is related with common usage.

                b.      Therapeutic Guidelines
                        Medication Guidelines should be systematically structured to help physicians to
                        make a correct diagnosis and optimal medication for a certain kind of disease.
                        Guidelines of medication should be suited for every level of health services units,
                        such as guidelines in basic medication at Public Health Center and guidelines in
                        diagnosis and therapy at local hospitals.
                        Medication Guidelines consist of information about all kinds of diseases, especially
                        sicknesses which are occurring frequently - with their respective complaints - and
                        information about dosage form, unit strength, dose of medicines and length of time
                        of medication.

                c.      Hospital Formulary
                        A hospital formulary is a list of medicines which have been agreed upon by key
                        hospital physicians and their inherent (medicine) information which are used in the
                        hospital concerned. A national hospital formulary is written by the Medicine and
                        Therapeutic Committee based on NLEM and elaborated upon by taking into
                        account other medicines proven effective which are needed by specialties in the
                        concerned hospitals. The creation of a hospital formulary has to be based on
                        therapeutic guidelines. The implementation of a hospital formulary must be
                        monitored and its report be used to carry out evaluation and revision so as to keep
                        up with advancements of scientific knowledge and medical science.

                d.      Specialists’ Formulary
                        Specialists’ formularies are books which are consist of comprehensive complete
                        information on medicines needed by certain specialists of a hospital, to be used for
                        patient care with special disease indications.
                        Specialists’ formularies are written to increase compliance of hospital specialists
                        towards their hospital formulary, that has been ranked very low until today. Certain

                                                                                                         4
National List of Essential Medicines 2008
                        specializations may have many sub-specializations, for example the field of
                        obstetrics and gynecology as a specialization that has got many sub-
                        specializations, that special essential medicines list can be made for Obstetrics
                        and Gynecology. The writings of a specialists’ formulary involve specialist
                        professional association with its many sub-branches. With the involvement and
                        active participation of specialists it is expected that they will feel that they are part
                        of the association, so that rational medicine use can be positively applied.

                e.      National Indonesian Medicine Information
                        National medicine information consists of medicines which are on the market and
                        are presented briefly, are relevant to physicians’ needs, pharmacists, and other
                        health services workers. The National Indonesian Medicine Information is
                        published by the Ministry of Health to guarantee objectivity, completeness, and
                        unconfounding. Information on medicines that are covers indications, side-effects,
                        dosages, how to use, and other important information which are most important for
                        patients. The development of this book was based on more scientific data, related
                        to benefits and actual medicine use.

        3.      Management and Medicine Use
                To improve rational medicine use, the use of essential medicines at health service units
                should follow treatment guidelines and proper medicine management be instituted.
                Effective medicine management is required to guarantee medicine availability in the
                right kinds and quantities while fulfilling quality standards. Important aspects of medicine
                management are as follows:
                -       Limitation of numbers and kinds of medicines based on an Essential Medicines
                        List, using generic names, with a correct selection process;
                -       Bulk purchasing should be applied;
                -       Competitive, transparent purchases;
                -       Audit system and reporting from management report.
                Application of Government Regulation Number 38 year 2007 on the coordination of the
                governance between the Central Government and the Provincial Government and other
                regional governments in order to synchronize its health management in the country. So,
                as with medicine management organizations, each state/city has got organizational
                structures and their own medicine management policies. This would open up basic
                differences in each state/city in carrying out medicine management.
                The cycle of medicine distribution is started at the time a medicine is delivered from the
                factory or distributor, and it ends at the time medicine consumption reports are handed
                in to the logistics unit. Effective medicine distribution should have a system design and
                sound management such as: constant medicine supply, taking care of the quality of
                medicines at the time of distribution process, minimizing medicines which are unused
                because of spoilage or being expired, with correct planning in accordance with each
                province’s medicine needs, use of inventory records which are accurate, rationalization
                of medicine depots, and supply of information to estimate medicine needs.


                                                                                                              5
National List of Essential Medicines 2008
                With decentralization in place it is hoped that state government or city or provinces can
                sufficiently supply respective individual medicine needs. The central government, in this
                matter, the Ministry of Health only lends back-up support when state/city or province
                cannot fully supply the medicine needs. The NLEM is a base for planning and supply or
                logistics of medicines in local (district/province/city) and central government.
                Management and use of specialists’ medicines for certain situations, the government
                c.q. Directorate General of Pharmaceutical Services and Medical Devices, Ministry of
                Health can provide these through special channels (special access scheme) in
                accordance with The Decree of Minister of Health Number: 1379.A/Menkes/SK/XI/2002.

        4.      Communication, Information, and Education(CIE)
                CIE on essential medicines are a pre-requisite to improve the use of medicines and
                rational prescribing by health providers. CIE for health providers and the public in
                general to increase rational use of medicines and be maintained continuously should
                use the following links:
                a.      Governmental organizations/private institutions.
                b.      Related professional organization.
                c.      Curriculum of education for health providers.
                d.      Other possible channels.
                Every listed medicine in NLEM must be accompanied by accurate information that is
                objective and understandable by health providers. This information covers indication,
                contraindication, dose, how to use, caution remarks, side-effects, medicine interaction,
                and dosage forms of preparations.

        5.      Research and Development
                Research and development should be done to support the selection process and
                improvement of the NLEM. Research and development are done in line with medical
                science and technology in the subjects of medicine, pharmacy, epidemiology, and
                education. The outcome or result of research and development are utilized as inputs in
                the revision process and improvement of NLEM periodically.

        6.      Monitoring and Evaluation
                Monitoring and evaluation are done to support the success of the application of the
                NLEM through mechanism and output evaluation of potential underlying problems and
                its effective solutions. This can be achieved through co-ordination, supervision,
                monitoring and evaluation of application of the NLEM by the Ministry of Health.
                Monitoring and evaluation are done gradually fitting to functions and levels.

        7.      NLEM Revisions
                NLEM has to be revised and perfected periodically. Revisions are not only for keeping
                up with the advancement of knowledge, but also for practical reasons in the use and
                dispensing which fits health providers and the health service facilities.



                                                                                                      6
National List of Essential Medicines 2008
                Perfection of NLEM is done continuously with input of suggestions from health service
                units and health research, whether governmental or private, conveyed to the Directorate
                General of Pharmaceutical Services and Medical Devices, Ministry of Health, Republic
                of Indonesia. NLEM revisions are done periodically every 3 (three) years.

        8.      Quality Control
                Total medicine quality control covers the phases of product development, good
                manufacturing practices, monitoring of medicine quality in the distribution chain and
                their use, are important elements in applying the essential medicines concept.

        9.      Antibiotics Resistance
                Antibiotic resistance will increase, especially with first-line essential antibiotics, which
                are relatively inexpensive. This condition is dangerous, because ultimately the public
                will lose sensitive antibiotics that are potential in fighting infectious diseases which are
                newly occurring or recurring. The reason is because of irrational use of antibiotics by
                both of health providers or patients.
                In overcoming the problem of antibiotic resistance it takes the following efforts:
                a.      Conducting surveillance of microbe resistance so that antibiotics resistance
                        patterns are obtained.
                b.      Surveillance of antibiotic use
                        Surveillance of antibiotic use is done by research institutions, hospitals, and public
                        health centers, province or district health offices and other health, education and
                        research institutions.
                c.      Containing antibiotic use by health providers by applying antibiotic prescription
                        policy gradually, fitting to the conditions of patients and disease patterns, using
                        first-choice antibiotics from the start, and reserving other antibiotics of subsequent
                        choice for limited use.
                d.      To provide communication, information and education towards all parties using
                        antibiotics whether they be health workers, patients or the public in general about
                        how to use antibiotics rationally and the danger, caused by irrational use of
                        medicines.

        10. Donated Medicines
                Donations in the form of money or medicines from another country, private
                organizations, or other international bodies can support the public health services in a
                country that needs it. In its operation, medicines donation must fulfill the requirements
                as described in WHO Guidelines for Medicines Donations 1999. Health services being
                used must fulfill a certain existing applicable guidelines/standards. This guideline covers
                general principles about selection of medicines, quality of medicines, shelf life,
                packaging and labeling, information and management.




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National List of Essential Medicines 2008
                Four main principles of donated medicines are:
                •       Donated medicines must provide maximum usefulness to recipient country.
                •       Understand the needs and respecting the authority of recipient country.
                •       Does not use double standards for the quality of donated medicines.
                •       Effective communication between donor country and recipient country.

                Donated medicines are best received when they are in accordance with NLEM. In order
                for medicines supply and health logistics can help the operations of health workers, the
                types of medicines and health logistics must coincide with the disease patterns in
                Indonesia.
                For medicines which are not marketed in Indonesia acceptance must follow a special
                channel (special access scheme), in accordance with the existing applicable rule.

B.      Terminologies

        1.      Contents and Format of NLEM
                a.      The National Essential Medicine list is used as the basis for all units of
                        (governmental) health services.
                b.      One type if medicines can be used in several forms of preparations and one form
                        of preparation can consist of a few dosage forms.
                c.      In the NLEM, medicines are categorized according to class, subclass and
                        sometimes sub-subclass therapy, which are in alphabetical order.

        2.      Nomenclature
                a.      Medicine names are written according to the last edition of Indonesian
                        Pharmacopoeia. If it does not appear in the Indonesian Pharmacopoeia then
                        generic names are used.
                b.      Medicines which are commonly used and do not have an INN (International Non-
                        proprietary Name) are written with common names, for example ‘oral rehydration
                        salt’.
                c.      Combination medicines which do not have a generic name are given agreed
                        names which are generic names for combinations and each is written with the
                        effective ingredients, followed with dosage of each component.
                d.      For some items which need a synonym are written within brackets.




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National List of Essential Medicines 2008
        3.      Explanatory Notes
                a.      Keywords
                        (1)          Dosage Forms
                                     Dosage forms or preparations are forms of medicines according to the
                                     production process in the form of usage, for example: capsule, enteric
                                     coated tablet, intravenous injection etc.
                        (2)          Dosage strength
                                     Strength of preparation is the content or percentage of effective
                                     components in ready made preparations. For dosage strength in the form
                                     of salt or its esther, salt or esther are written down within brackets, for
                                     example ethambutol tablet 250 mg (hydrochloride). As for dosages of
                                     effective components, the names of salts or esther (which are written
                                     within brackets) would be priored by the word ‘as’, for example:
                                     chloroquine tablet 150 mg (as phosphate).
                        (3)          Packaging
                                     Packaging is the smallest container that contains the medicine.
                        (4)          Package Size
                                     Package Size is the total number of preparation units or the smallest
                                     container in one standard packaging, for example 100 vials.

                b.      Other Notes
                        (1)          Information in restricted columns are meant for medicines with certain
                                     restrictive notes:
                                     (a)    Monitoring of side-effects.
                                     (b)    Limitation of indications.
                                     (c)    Only for certain cases.
                                     (d)    Tight screening is required or medical expert considerations needed.
                                     (e)    Nature or medicine mechanism of action requires attention.
                                     (f)    Special treatment required.
                                     (g)    Special facilities needed.
                                     (h)    Combination with other medicine needed.
                                     (i)    Required for certain areas, like endemic areas.
                                     (j)    Uses in accordance with existing health program.
                        (2)          Writing of technical terms or foreign language words are written in italics.
                        (3)          National Medicines Lists are medicine lists that are used by hospitals.
                        (4)          NLEM for Public Health Center (primary health service units) in red
                                     colored paper.




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National List of Essential Medicines 2008
                c.      Abbreviations
                        i.a. injection         : intraartherial injections
                        i.c. injection         : intracutaneous injection
                        infiltr inj            : infiltrated injection
                        infusion sol           : infusion solution
                        inj                    : injection
                        i.m. injection         : intramuscular injection
                        IU                     : international unit
                        i.v. injection         : intravenous injection
                        liq                    : liquid
                        p.v. injection         : paravertebral injection
                        rectal sol             : rectal solution
                        s.c. injection         : subcutaneous injection
                        sacch                  : sacchets/bags/pouches
                        sol                    : solution
                        supp                   : suppository

C.      Renewal of Revision Process
        Discussions were not conducted only limited to incoming requests, but revaluating the whole
        NLEM of 2005. This was done because the list was only updated during previous years and
        some old medicines have become obsolete or new and better medicines have become
        available. Also some uses of older medicines have been renewed and some have made
        other restrictions.
        Expert teams and consultants work together in the discussion that is divided into several
        groups based on therapeutic class. Consultants are responsible for EBM data in accordance
        with his/her competence. Besides information from consultants and expert team, the
        secretariat supported fully with among others, information from Cochrane review and WHO
        Library. From this process, although EBM information is not always totally accepted, but
        discussions are no longer based on level-4 evidence or expert team opinion only.
        Understanding the concept of essential medicines has to be re-socialized. Seemingly, the
        understanding of the essential medicines is withering and explanation about this concept is
        appreciated. ‘Essential Medicine is a floor not a ceiling’ (WHO TRS 946), it is a minimum for
        health care. A medicine is essential when you can’t do without it. The difference of essential
        medicines and program medicines will result in the availability of a specific medicine. This
        problem is overcome by socialization and special policies by the Ministry of Health relating to
        essential medicines and program medicines.
        In the revision process, from the start it has been planned to give attention to medicines for
        children. This policy is not only meant for harmony with the global policy, but Indonesia is
        consistently aiming at decreasing mortality of babies and children, so that it needs this
        emphasis. The involvement of four pediatricians, give sufficient contributions for this problem.
        Also the involvement of the Directorate of Child Health and other directorates are very
        intensive. The addition of medicines for children with dosage forms especially for children,
        like carbamazepine, is provided in the form of syrup.
        In the final discussion of the Plenary Meeting it has been agreed that 78 medicines has been
        deleted from NLEM 2005 and 48 were added to the new list of 2008. Changes in formulations
                                                                                                     10
National List of Essential Medicines 2008
        (forms of preparations, dosages, packaging) was agreed for 21 medicines. It was found that
        33 medicines were given short notes as important to be provided or supplied by the
        government through ways fitting with the existing applicable policies. The total number of
        medicines in the NLEM 2008 is 323 medicine items.

        1.      Revision Process
                Revision processes started by sending letters to government health services institutions
                (hospital types A, B, C, public health center) as well as several chosen private parties,
                special programs in the Ministry of Health and professional organizations. Three months
                later, from 114 installations to whom letters were sent to, 25 had responded. From those
                responses three had ”no suggestion”, 22 were responding with “request for additions to
                the list”, and there was no one responding to delete medicines from the old list.
                Although in the letter sent, it has been informed that suggestion has got to come
                together with supporting data and functions, only 10 installations were sending
                supporting data. Besides suggestions from the installations, the expert team and
                consultants, may give suggestions with supportive data.
                This process is a yardstick in carrying out the assessment, it is needed to build
                transparency process and accountability in the future. The process consists of creation
                of a committee, criteria of recruitment of expert team members, tasks and obligations of
                expert team members, revision processes, holding discussion meetings and
                socialization of NLEM.

        2.      Committee Members
                a.      Organization
                        (1)          Organizational structure is a National Committee consisting of:
                                     (a) Expert team
                                     (b) Consultants
                                     (c) Program manager and
                                     (d) Operational Secretariat
                        (2)          Membership of National Committee lasts until a next committee is formed
                                     for the next NLEM revision meeting. The Committee is legalized by the
                                     Minister of Health by a Decree wherein its duties are stated.
                        (3)          Names of expert team members and selected consultants are indexed
                                     without titles, only differentiated into MDs, general practitioner, specialists,
                                     or pharmacists.
                        (4)          Not all therapeutic classes need to be represented as a member or
                                     consultant in the Committee.
                        (5)          If an expert in a special field is needed, he/she can be invited to become a
                                     resource person to give an expert opinion in the revision process. They
                                     will not become a part of the expert team and also do not take part in
                                     decision making.
                        (6)          Duties of expert team members and consultants listed in the Ministerial
                                     Decree are:
                                                                                                                  11
National List of Essential Medicines 2008
                                    (a)     Expert Team members are evaluating medicines listed in NLEM
                                            2005 and also evaluate suggested medicines which are applied for
                                            deletion or inclusion in the new list.
                                    (b)     Consultants are joining the discussions and may give scientific or
                                            practical inputs which may be needed to be useful to be taken into
                                            consideration by the expert team members.
                                    (c)     Expert team members and consultants together give
                                            technical/scientific justification to Ministry of Health through
                                            Directorate of Pharmaceutical Services and Medical Devices to
                                            accept the new NLEM 2008 nationally, while assisting the
                                            Directorate of Rational Medicine Use in practicing its concept.
                        (7)          Program manager is a representative of a directorate in the Ministry of
                                     Health who owns special therapeutic programs and manages the logistics
                                     of medicines.
                        (8)          The Operational Secretariat are Directorate of Rational Medicines Use,
                                     Directorate General of Pharmaceutical Services and Medical Devices.

                b.      The selection process of Expert Team and Consultants
                        (1)          Pre-requisites of Expert Team and Consultants
                                     (a) Have integrity and a high professional standard.
                                     (b) Expert team members and consultants are clinicians from several
                                         fields of specialization, Clinical Pharmacology, Dentistry,
                                         Pharmacists, physicians/health service units (public health center).
                                     (c)    In order to get professional expert team members who are impartial,
                                            he or she must not represent professional associations, hospital
                                            departments, or other jobs which are potential in creating conflicts.
                                     (d) Signing a letter of consent, acceptance and availability.
                                     (e) Willing to sign a conflict of interest statement. But somebody who
                                         has a conflict of interest can still be considered to become a member
                                         of the expert team, if integrity can be maintained. He/she may then
                                         not participate in a voting process.
                        (2)          Recruitment processes of Expert Team and Consultants:
                                     (a) The Secretariat sends a form of written availability and willingness,
                                         accompanied by his/her superior permission, 1 (one) month prior to
                                         the commencement of the Meeting.
                                     (b) He or she must submit the filled-in form 1 (one) week after receiving,
                                         together with a conflict of interest statement.
                                     (c)    An acceptance and statement of willingness letter consists of:
                                            -    Explanation of job description of expert team.
                                            -    Schedule of material of discussion which have to be attended.

                                                                                                              12
National List of Essential Medicines 2008
        3.      Revision Methods
                a.      Submission of medicines
                        Revision processes is started by sending submission forms to several health
                        service units (University Hospitals, Special Hospitals, chosen State Hospitals,
                        Provincial Hospitals, Military/Police Hospitals, chosen Private Hospitals, Regional
                        Hospitals, Public Health Center with beds). Provincial Health Units representative,
                        public health center, and program managers (in the directorate of Ministry of
                        Health). Submission Request Forms are sent 3 (three) months before the first
                        Meeting.
                b.      Compilation of Submissions
                        Compiled submissions are categorized or grouped in therapeutic classes.
                c.      Material of Revisions
                        Material of Revisions are put in a matrix, which is put side by side with the WHO
                        List 2007 and the latest NLEM 2005 edition. It is followed with the submitted
                        medicines. Revised Materials will be handed to expert team members 1 (one)
                        week before technical discussion meeting.
                d.      Discussion Criteria
                        Submissions to be discussed are suggestions which come with arguments and
                        accompanied with scientific evidence.
                e.      Methods of Revision Materials
                        (1)          Revision can be the whole assessment or one of the following processes:
                                     (a) Only assessment of submission requests. Deleting or accepting
                                          submissions.
                                     (b) Taking into account the whole NLEM and incoming requests.
                                          Deleting and adding essential medicines whether from requests or
                                          from expert team member’s and consultants’ opinion.
                        (2)          Types of discussions meeting:
                                     (a) Preliminary Meeting consists of
                                            •   Information about the understanding of essential medicines
                                                (definitions, criteria, (approximate) number of essential
                                                medicines in NLEM etc).
                                            •   Implementation of NLEM (in relation with program medicines,
                                                guideline for procurement of PKD Medicines, DPHO- AsKes
                                                and others).
                                            •   NLEM Revision Procedure.
                                            •   Procedure in technical discussion (preparation of NLEM
                                                revision draft) and plenary meetings.
                                            •   Attendance: expert team, consultants, program managers,
                                                operational secretariat.


                                                                                                         13
National List of Essential Medicines 2008
                                     (b) Technical discussion meetings
                                            •    Discussion meetings of the pro and contra whether to accept or
                                                 refute a submission.
                                            •    Discussion on benefit-risk of additions or deletions of essential
                                                 medicines which are on the old list.
                                            •    Putting in focus those medicines which are submitted, but were
                                                 not included in the WHO list. These were specially scrutinized.
                                            •    Suggestion to put food supplements into NLEM will not be
                                                 considered.
                                            •    If the Expert Team fails to make a decision on some choices, a
                                                 resource person outside the expert team members will be
                                                 invited.
                                            •    Attendance for the meeting are:
                                                 o Expert team
                                                 o Consultants
                                                 o Related program managers of Ministry of Health
                                                 o Related resource persons.
                                            •    Result of technical discussion meetings is NLEM revision draft.
                                     (c)    Plenary Meeting
                                            •    Aims at making agreements, formalizing, and socializing
                                                 revised draft of the NLEM.
                                            •    Meeting Chairman is the head of the expert team.
                                            •    Formalization of NLEM draft to become the new revision is the
                                                 Directorate of Pharmaceutical Services and Medical Devices
                                                 task or someone who is appointed by the institute.
                                            •    When the result of plenary meeting has been legalized it may
                                                 not be altered, except editorial revisions.
                                            •    Plenary meeting members should be responsible as part of the
                                                 decision making process and are also expected in the active
                                                 participation to deploy the new NLEM.
                                            •    Plenary meeting attendees are:
                                                 o Those who attended the preliminary meeting and
                                                       technical discussions;
                                                 o Medical Committees of University Hospitals,
                                                       Military/Police Hospitals, chosen Private Hospitals and
                                                       other hospitals and medal schools who submitted
                                                       suggestions for revision;
                                                 o Attendees from Faculty of Medicine
                                                 o Attendees from Faculty of Pharmacy;
                                                 o Attendees from School of Nursery;
                                                 o Provincial Health Office submitting revision suggestion(s);


                                                                                                               14
National List of Essential Medicines 2008
                                                 o    Professional organizations (IBI, IDI, PPNI, ISFI,
                                                      specialists’ associations);
                                                 o    Pharmaceutical Industries (BUMN and Pharmaceutical
                                                      Wholesalers Association)


        4.      Explanation of changes made
                Medicine changes made in NLEM 2008 whether generic names or their formulations,
                based on therapeutic classes are as follows:

                1.      Analgesics, Antipyretics, Non-steroidal Anti-inflammatory Medicines,
                        Medicines used to treat gout
                        1.1          Opioid Analgesics
                                     Sufentanyl in the form of citrate 50 mcg/ml, was taken out from the list,
                                     because of poor availability in the market.
                        1.2          Non-opioid Analgesics
                                     Methampyron i.m. inj. 250 mg/ml was taken out from the list for safety
                                     reason, where in the form of injection may cause anaphylactic shock.
                                     Suggestion to add ketoprofen supp. 100 mg and paracetamol supp. 120
                                     mg and 240 mg were accepted, recalling that ketoprofen supp. is used for
                                     post-surgical patients who cannot yet receive oral medicine forms, while it
                                     is non-irritant to the stomach. While paracetamol supp. is needed to
                                     prevent febrile convulsion cases, post-surgery in children, in line with
                                     pediatric procedures. Availability and procurement of paracetamol supp.,
                                     are limited to district level hospitals.
                        1.3          Anti-gout
                                     Colchicine tablets 500 mcg has been listed in NLEMs from the start. But
                                     with the availability of many NSAIDs, its efficacy is valued not much
                                     different from other NSAID medicines, while their safety is lower than
                                     colchicine. Thus colchicine was taken out from the list. The WHO Model
                                     List 2007 did not contain colchicines either.


                2.      Anesthetics
                        2.1          Local Anesthetics
                                     Lidocaine inj 5% + glucose 7.5% 2 ml amp was suggested to be added,
                                     especially for spinal anesthesia, in areas where bupivacaine are difficult to
                                     get. Besides, toxic effects against the heart is smaller. Lidocaine inj. 1%
                                     (HCl) + epinefrin 1 : 200,000 in packaging of 20 and 30 ml were deleted
                                     from the list, because the packaging is seen to be too large, so it would
                                     cause spoilage if not finished.



                                                                                                               15
National List of Essential Medicines 2008
                        2.2          General Anesthetics and Oxygen
                                     Suggested liquid isoflurane liq. 3 – 3.5 % 250 ml are accepted, because of
                                     advantages to the heart and are used for patients with specific certain
                                     conditions. Midazolam inj. i.v. 1 mcg/ml and i.v. inj. 5 mg/ml are choice
                                     medicine for patients with fragile vital signs, as sedative, hypnotic, and
                                     pre-anaesthetics. While liquid enflurane ih., btl 250 ml was taken out of
                                     the list with the reason being less advantageous if compared with
                                     isoflurane and halothane. While Thiopental powder. inj. i.v. 1,000 mg/ml
                                     was taken out from the list because of safety consideration.

                5.      Antiepileptic-Anticonvulsants
                        Suggestion of addition in the dosage form of syrup and chewable tablet for
                        pediatric patients are accepted. So, in this class were listed: fenitoin syrup 50
                        mcg/5 ml, carbamazepin 100 mg/ml bottle 120 ml, chewable tablets 100 mg.
                        Phenobarbital tab 50 mg was added, because it was still effective and cheap.

                6.      Anti-infective
                        In several previous revisions of NLEMs, cephalosporines were always suggested
                        to be added, but only this time the National Committee, gave way to cephazolin
                        with limitation to special use of surgery prophylaxis inj. 1 g/vial. Cephazolin is a
                        chosen medicine for surgery prophylaxis to prevent surgical wounds infection. The
                        same thing happens to Ceftriaxone inj. 1 g/vial, that is a chosen medicine for
                        meningitis and is used for resistant cases of typhoid fever with chloramphenicol
                        and cyprofloxacin. The delay of entry of cephalosporine antiinfectives is caused by
                        the fast growing anti-infective resistance in hospitals, especially.
                        Expert team agreed to accept the inclusion of vancomycine inj. 500 mg to
                        overcome MRSA (methicillin resistant S. aureus) infection, a serious nasocomial
                        infection. Amphotericine*) inj. i.v. vial 50 mg was requested and accepted for
                        inclusion, because it is the only systemic antifungal, mainly for pulmonary fungal
                        infection. In the list it was marked *) that means “needing special expertise in its
                        use”.
                        For anti-amoebic diloxanide furoate tab 500 mg was included, recalling the
                        importance of treatment of cysts that does not show physical symptoms. In the
                        anti-malarial case arthesunate inj. i.v. 60 mg/ml was added, that was valued to be
                        having better efficacy compared to artemether inj., although from the side of usage
                        artemether is more practical for public health center (primary health service units).
                        In the antiviral protease inhibitor group lopinavir were added because they were
                        needed for HIV/AIDS, although their prices are higher. In anti-tuberculosis
                        medicines, besides a few single medicines are provided, listed were some
                        combination medicines for use by program needs. But in the case of dosage
                        forms, it was left to program needs, whether they be in the form of FDC (fixed
                        dose combination), or combipack. Single preparations are maintained for use in
                        health services which are not yet able to carry out direct observed treatment
                        shortcourse (DOTS) program.

                                                                                                            16
National List of Essential Medicines 2008
            8.          Antineoplastic, Immunosuppressive and Medicines used in Palliative Care
                        Chlormetin and levamisol were taken out of the list, because they were no longer
                        in use as anticancer medicines, because of their efficacy and safety. Addition of
                        daunorubicin HCl powder inj. was suggested and accepted by expert team, as well
                        as chlorambucil tablet 2 mg and melfalan tablet 2 mg. Daunorubicin is a main
                        medication in Acute Lymphocyte Leukemia that is often found in children.
                        Chlorambucil is low priced, registered in Indonesia and is in accordance with the
                        WHO Model List. Melfalan is a cheap medicine and is needed in the treatment of
                        multiple myeloma.

            14.         Dental Medication and Oral Health
                        From this therapeutic class many are evaluated as obsolete, even their uses are
                        no longer being taught by Dental Schools, for example sulpha cones preparation
                        and iodoform paste. There are some which are causing environmental damage,
                        like the use of amalgam, because of that it is agreed upon that composite be used.

            17.         Cardiovascular Medicines
                        In this therapeutic category a few changes in subclass or deletions of medicines
                        were applied because they are no longer in production and are no longer available
                        in the market like procainamide, reserpine, quinidine. In the subclass of
                        antiarrythmic added were amiodarone and digoxin. In the antihypertension class
                        sodium nitroprusid inj. was added to be used for its specific efficacy in surgery
                        needing hypotension technique and septic shock.

            18.         Dermatological Medicines
                        Many medicines were deleted because of obsolescence, for example gentian
                        violet, liver oil ointment. These liquids like lotio kummerfeldi, if needed, can be
                        entered into a hospital formulary.
                        New additions which are accepted are permethrine as an antiscabicide that is less
                        toxic to children, in place of Gamexan. Other addition is Liquor Veilli (diluted
                        salicylic acid), a simple effective medicine for wet dermatitis.

            20.         Electrolytes and Nutrients
                        Oral rehydration salt in 1000 ml sacchets are deleted from the list, because the
                        packaging is too large, inefficient to store and it does not maintain freshness for
                        long time. Only 200 ml sachets are available.
                        In the case of parenteral nutrition liquid namely liquid nutrients i.v. all of them were
                        deleted from the list. The National Committee, especially expert team and
                        consultants, are well aware of the importance of this preparation, but compositions
                        which are available in the market vary and were too many, with uses which may
                        be different.




                                                                                                             17
National List of Essential Medicines 2008
                        For children use and neonates in this therapeutic class liquid nutrients were
                        added: glucose 4% + NaCl 0.18% infusion, and sodium bicarbonate inj. 1.4%
                        isotonic.

            23.         Psychotherapeutic Medicines
                        Alprazolam was deleted because valued to be non-essential and tend to cause
                        overuse and dependence. In subclass therapy antidepression and antimania it
                        was suggested addition of fluoxetine, sertraline and paroxetine. Fluoxetine
                        cap/tab10 mg and cap/tab 20 mg were accepted as choice medicines for category
                        SSRI.
                        In the antipsychotic subclass racemic methylphenidat addition was suggested in
                        the form of regular release and extended release to be used for Attention Deficit
                        Hyperactive Disorder (ADHD). Although evidence has not fully supported, but all
                        these times it has been a choice medicine for ADHD. Addition of chlozapine was
                        accepted because it is a selected medicine for other resistant antipsychotic
                        medicines. This medicine is effective but it is necessary to watch for
                        agranulocytosis side effect. Periodic leucocytes counts must be taken.

            28.         Ear treatment, Nose, and Throat
                        Important changes took place in looking at ear treatment, nose, and throat.
                        Experts considered that treatment of ear infection does not need to use antibiotics
                        or corticosteroids. Other than that antibiotic preparations in the form of nose or ear
                        drops are not listed in the WHO Model List.

D.      Socialization of NLEM 2008
        In applying essential medicines concept, NLEM 2008 must be spread to health service
        facilities in the entire Indonesia. Socialization can be in the form of printed books which are
        delivered to all health service units and publicized in electronic form.




                                                                                                           18
National List of Essential Medicines 2008
                  CHAPTER II
     NATIONAL LIST OF ESSENTIAL MEDICINES
                      2008
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  1. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES,
     MEDICINES USED TO TREAT GOUT
  1.1 OPIOID ANALGESICS
  codeine                                   tablet 10 mg,
                                               bottle 250 tablets

  fentanyl                                  injection i.m./i.v. 0.05 mg/ml   Authority required :
                                               (citrate),                    Anesthetist
                                               box 5 ampoules @ 2 ml

  morphine                                  injection i.m./s.c./i.v. 10
                                               mg/ml (HCl/sulfate),
                                               box 10 ampoules @ 1 ml
                                            tablet 10 mg (HCl/sulfate),
                                               bottle 30 tablets

  pethidine                                 injection i.m./s.c./slow
                                               released i.v 50 mg/ml
                                               (HCl),
                                               box 10 ampoules @ 2 ml

  sufentanyl                                injection 5 mcg/ml (citrate),
                                               box 5 vials @ 10 ml

  1.2 NON-OPIOID ANALGESICS
  acetylsalicylic acid (acetosal) tablet 100 mg, box 10 blisters
                                     @10 tablets
                                  tablet 500 mg, box 10 blisters
                                     @10 tablets

  ibuprofen                                 tablet 200 mg,
                                               bottle 100 tablets
                                            tablet 400 mg,
                                               bottle 100 tablets

  ketoprofen                                suppositoria 100 mg              Restricted use :
                                                                             Post operative patients

National List of Essential Medicines 2008                                                              19
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  methampyrone                              tablet 500 mg,                   Restricted use :
                                               bottle 1000 tablets           To reduce agranulocytosis

  paracetamol                               tablet 100 mg,
                                               bottle 1000 tablets
                                            tablet 500 mg,
                                               bottle 1000 tablets
                                            syrup 120 mg/5 ml,bottle 60 ml
                                            suppositoria 120 mg
                                            suppositoria 240 mg

  phenylbutazone                            coated tablet 200 mg,            Restricted use :
                                            bottle 100/1000 tablets          Only for acute arthritis, to be
                                                                             taken after meals, for one
                                                                             week and to be followed by
                                                                             other safer NSAID as
                                                                             needed.
  sodium diclofenac                         tablet 25 mg, box 10 stripes
                                               @ 10 tablets
                                            tablet 50 mg, box 10 stripes
                                               @ 10 tablets

  1.3. MEDICINES USED TO TREAT GOUT
  allopurinol                               tablet 100 mg, bottle            Note :
                                               100/1000 tablets              - Blocks uric acid production
                                                                               (in 35% of cases)
                                                                             - Not for acute attack

  probenecid                                tablet 500 mg, bottle 100/1000 Note :
                                               tablets                     - Increases uric acid renal
                                                                             excretion (in 65% of cases)
                                                                           - Dosage 2 X ½ tablet,
                                                                             increase water intake
                                                                           - Not for acute attack

  2. ANESTHETICS
  2.1 LOCAL ANESTHETICS
  bupivacaine                               p.v. injection 0.50% (HCl),      Restricted use :
                                               box 5 vials @ 20 ml           Only for spinal anesthesia
                                            injection 0.5% (HCl) +
                                               glukosa 7.5%, box 5
                                               ampoules @ 4 ml


National List of Essential Medicines 2008                                                                 20
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  ethyl chloride                            spray, bottle 100 ml               Note :
                                                                               Air tight package
  lidocaine                                 infiltr injection 1% (HCl),
                                               box 100 amps @ 2 ml
                                            p.v. injection 2% (HCl),
                                               box 100 ampoules @ 2ml
                                            gel 2%, tube 10 g
                                            spray 4%, bottle 50 ml
                                            injection 5% + glukosa 7,5 %,      Restricted use :
                                                ampoule 2 ml                   Only for spinal anesthesia

  2.2 GENERAL ANESTHETICS and OXYGEN
  halothane                                 inhalation liquid,
                                               bottle 50/250 ml

  isoflurane                                inhalation liquid,
                                               bottle 250 ml

  ketamine                                  i.v. injection 10 mg/ml (as
                                                HCl), box 10 vial @ 20 ml
                                            i.v. injection 50 mg/ml (as
                                                HCl), box 10 vial @ 20 ml

  midazolam                                 i.v. injection 1 mg/ml             Restricted use :
                                            i.v .injection 5 mg/ml             Only for special conditions

  nitrous oxide                             inhalation, gas in tube

  oxygen                                    inhalation, gas in tube

  propofol                                  injection 10%,
                                               box 5 ampoules @ 20 ml

  thiopental                                i.v. powder for injection 500
                                               mg/ampoule (as sodium
                                               salt) (for dissolved in 20 ml
                                               WFI), box 25 ampoules

  2.3 MEDICINES USED FOR PREOPERATIVE MEDICATION PROCEDURES
  atropine                                  injection 1 mg/ml (sulfate),
                                               box 50 ampoules @ 1 ml


National List of Essential Medicines 2008                                                                    21
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  diazepam                                  tablet 5 mg,
                                               bottle 1000 tablet
                                            injection 5 mg/ml,
                                               box 100 ampoules @ 2 ml

  morphine                                  i.m./s.k./i.v. injection 10
                                               mg/ml (HCl/sulfate),
                                               box 10 ampoules @ 1 ml

  3 ANTIALLERGICS and MEDICINES USED IN ANAPHYLAXIS
  chlorpheniramine                          tablet 4 mg ( maleate),
                                               bottle1000 tablets
                                            injection 5 mg/ml (maleate),
                                               box 100 ampoules @ 1 ml

  dexamethasone                             injection 5 mg/ml (as sodium
                                               phosphate), box 100
                                               ampoules @ 1 ml

  diphenhydramine                           i.m. injection 10 mg/ml (HCl),
                                               box 100 ampoules @ 1 ml

  epinephrine (adrenaline)                  s.c./i.m. injection 0,1%          Note :
                                               (HCl/bitartrate),              - Drug of choice for
                                               box 100 ampoules @ 1 ml          anaphylactic reaction
                                                                              - Dosage 0,3 mg – 0,5 mg
                                                                                i.m., may be repeated

  4. ANTIDOTES and OTHER SUBSTANCES USED IN POISONING
  4.1 SPECIFIC
  atropine                                  i.m./i.v./s.c injection 1 mg/ml   Restricted use :
                                               (sulfate),                     Caution on package: “only for
                                               box 10 ampoules @ 2 ml         antidotes (large dose)”.

  calcium folinic (leucovorin, Ca) tablet 1 mg, bottle 100 tablets
                                   tablet 15 mg, bottle 10 tablets
                                   injection 3 mg/ml,
                                      box 10 ampoules @ 1 ml

  calcium gluconate                         injection 100 mg/ml,
                                               box 24 ampoules @ 10 ml


National List of Essential Medicines 2008                                                                22
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  deferoxamine                              powder for injection 500
                                              mg/ml (mesilate),
                                              box 10 vials @ 10 ml
  methylthioninium chloride                 injection i.v. 10 mg/ml (as
    (methylene blue)                           dihydrate),
                                               box 10 ampoules @ 10 ml
  naloxone                                  injection 0.02 mg/ml (HCl),
                                               box 10 ampoules @ 2 ml
                                            injection 0.4 mg/ml (HCl),
                                               box 5 ampoules @ 2 ml
  protamine sulfate                         i.m. injection 10 mg/ml,
                                               box 10 vials @ 5 ml
  sodium bicarbonate                        tablet 500 mg,
                                               bottle 1000 tablets
  sodium thiosulfate                        i.v. injection 25%,
                                                box 10 ampoules @10 ml

  4.2 NON-SPESIFIC
  active carbon                             activated powder, sacch 0.5 kg
  apomorphine                               s.c. injection 5 mg/ml (HCl),
                                               box 10 ampoules @ 1 ml

  magnesium sulfate                         powder, sacch 30 g

  5. ANTIEPILEPTICS – ANTICONVULSANTS
  carbamazepine                             tablet 200 mg,
                                               bottle 100/1000 tablets
                                            chewable tablet 100 mg
                                            syrup 100 mg/5 ml,
                                               bottle 120 ml

  diazepam                                  i.m./i.v. injection 5 mg/ml,
                                               box 100 ampoule @ 2 ml
                                            rectal sol 4 mg/ml, tube 2.5 ml

  magnesium sulfate                         i.v. injection 20%,
                                                ampoule 25 ml
                                            i.v. injection 40%,
                                                ampoule 25 ml


National List of Essential Medicines 2008                                                   23
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  phenobarbital                             tablet 30 mg,
                                                bottle 1000 tablets
                                            tablet 50 mg,
                                                bottle 1000 tablets
                                            tablet 100 mg,
                                                bottle 1000 tablets
                                            i.m injection 50 mg/ml,
                                                box 100 ampoules @ 2 ml
                                            i.v.injection 50 mg/ml (as
                                                sodium salt),
                                                box 100 ampoules @ 2 ml

  phenytoin                                 capsule 30 mg (as sodium
                                               salt), bottle 250 capsules
                                            capsule 100 mg (as sodium
                                               salt), bottle 250 capsules
                                            injection 50 mg/ml (as sodium
                                               salt),
                                               box 10 ampoules @ 2 ml
                                            syrup 50 mg/5 ml,bottle 120 ml

  valproate                                 tablet 250 mg (as sodium
                                               salt), bottle 50 tablets
                                            tablet 500 mg (as sodium
                                               salt), bottle 50 tablets
                                            syrup 250 mg/5 ml (as
                                               sodium salt), bottle 120 ml

  6. ANTI-INFECTIVE MEDICINES

  6.1 ANTHELMINTHICS

  6.1.1 Intestinal Anthelminthics
  albendazole                               tablet 400 mg,                   Note :
                                               box 5 stripes @ 6 tablets     - For strongiloides.
                                                                             - Pediatric dose : 20
                                                                                mg/kgBW
  mebendazole                               tablet 100 mg,
                                               bottle 100 tablets
                                            syrup 100 mg/5 ml,bottle 30 ml




National List of Essential Medicines 2008                                                            24
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  praziquantel                              scored tablet 300 mg,
                                              bottle 100/1000 tablets

  pyrantel                                  scored tablet 250 mg
                                              (pamoate),
                                              bottle 250 tablets
                                            suspension 125 mg/5 ml
                                              (pamoate), bottle 30 ml

  6.1.2 Antifilarials
  diethylcarbamazine                        scored tablet 100 mg (citrate),   Note :
                                              bottle 1000 tablets             For endemic area

  6.1.3 Antischistosomals
  praziquantel                              tablet 600 mg,                    Restricted use :
                                               bottle 100 tablets             - Only for Central Sulawesi
                                                                              - Only for South Kalimantan,
                                                                                for Fasciolopsis buski
                                                                                treatment

  6.2 ANTIBACTERIALS
  6.2.1 Beta Lactam medicines
  amoxicillin trihydrate                    scored tablet 500 mg,
                                               box 10 stripes @ 10 tablets
                                            dry syrup 125 mg/5 ml,
                                               bottle 60 ml

  ampicillin                                i.m./i.v. powder for injection
                                              250 mg/vial (as sodium
                                              salt), box 10 vials
                                            i.m./i.v. powder for injection
                                              500 mg/vial (as sodium
                                              salt), box 10 vials
  benzathine benzylpenicillin               i.m. injection 1.2 millions
                                               IU/ml, box 25 vials @ 4 ml
                                            i.m. injection 2.4 millions
                                               IU/ml, box 25 vials @ 10 ml

  benzylpenicillin crystal                  i.m./i.v. injection 10 millions
                                               IU/vial, box 25 vials

National List of Essential Medicines 2008                                                                25
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  cefazolin                                 powder for injection 1 g / vial,   Note :
                                              box 2 vials                      Prophylactics, to prevent
                                                                               operation wound infection

  ceftriaxone                               powder injection 1 g / vial,
                                              box 2 vials

  dicloxacillin                             capsule 250 mg (as sodium
                                               salt), box 25 stripes @ 4
                                               capsules
                                            scored tablet 500 mg (as
                                               sodium salt)
                                            syrup 62.5 mg/5 ml (as
                                               sodium salt), bottle 60 ml
                                            i.m./i.v. powder for injection
                                               500 mg/vial (as sodium
                                               salt) (soluble in 5 ml WFI),
                                               box 20 vials

  phenoxymethylpenicillin                   tablet 500 mg (as potassium
    (penicillin V)                             salt), bottle 1000 tablets
                                            tablet 250 mg (as potassium
                                               salt), box 10 stripes @ 10
                                               tablets
                                            dry syrup 250 mg/5 ml
                                               (as potassium salt),
                                               bottle 60 ml

  procaine benzylpenicillin                 powder for injection i.m. 3
                                              millions IU/vial,
                                              box 100 vials
                                            powder for injection i.m. 1
                                              million IU/vial,
                                              box 100 vials

  6.2.2 Other antibacterials

  6.2.2.1 Tetracycline
  doxycycline                               capsule 100 mg(hyclate/HCl),       Note :
                                              box 10 stripes @ 10              May be used for renal
                                              capsules                         patients




National List of Essential Medicines 2008                                                                  26
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                     RESTRICTION
       NAME (INN)
  oxytetracycline                           i.v. injection 250 mg/3 ml
                                                (HCl), box 10 ampoules
                                                @ 3 ml
                                            i.v. injection 50 mg/ml (HCl),
                                                box 10 vials @ 10 ml

  tetracycline                              capsule 250 mg (HCl),
                                              bottle 1000 capsules
                                            capsule 500 mg (HCl),
                                              box 10 stripes @ 10
                                              capsules

  6.2.2.2 Chloramphenicol
  chloramphenicol                           capsule 250 mg,
                                               bottle 1000 capsules
                                            suspension 125 mg/5 ml (as
                                               palmitate), bottle 60 ml
                                            i.v. powder for injection 100
                                                mg/ml (as succinate
                                                sodium),
                                                box 10 vials @ 10 ml

  6.2.2.3 Sulfa-Trimethoprim
  NLEM co-trimoxazole I (adult)             tablet, box 10 stripes @ 10
    combination of :                           tablets
    sulfamethoxazole 400 mg
    trimethoprim      80 mg

  NLEM co-trimoxazole II                    tablet, bottle 100 tablets
    (paediatric) combination of:
    sulfamethoxazole 100 mg
    trimethoprim       20 mg

  NLEM co-trimoxazole III                   i.v. injection, box 5 ampoules Note :
   combination of :                             @ 5 ml, box 5 vials @ 10 ml Minimized use
   sulfamethoxazole 80 mg/ml
   trimethoprim     16 mg/ml

  sulfadiazine                              tablet 500 mg, bottle100
                                               tablets

  trimethoprim                              scored tablet 200 mg,
                                              bottle 100 tablets

National List of Essential Medicines 2008                                                    27
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  6.2.2.4 Macrolides
  clindamycin                               injection 150 mg/ml (as          Note :
                                               phosphate), box 100           Benefit for bone infections
                                               ampoules @ 2 ml

  erythromycin                              capsule 250 mg (as
                                              stearate),
                                              bottle 100 capsules
                                            syrup 200 mg/5 ml (as ethyl
                                              succinate), bottle 60 ml

  6.2.2.5 Aminoglycosides
  gentamicin                                injection 10 mg/ml (as
                                               sulfate) @ 2 ml
                                            injection 40 mg/ml (as
                                               sulfate),
                                               box 10 ampoules @ 2 ml

  6.2.2.6 Quinolones
  ciprofloxacin                             scored tablet 500 mg (as HCl), Caution :
                                               box 10 blister @ 10 tablets Not for fist line treatment on
                                                                           gram possitive bacteria
                                                                           infection

  vancomycin                                powder injection 500 mg/vial,    Restricted use :
                                              box 1 vial                     Benefit for MRSA infection

  6.2.2.7 Specific Use
  metronidazole                             tablet 250 mg,
                                               bottle 100/1000 tabs
                                            tablet 500 mg,
                                               bottle 100/1000 tabs
                                            suppositoria 500 mg,
                                               box 6 suppositoria
                                            infusion solution 5 mg/ml,
                                               bottle 100 ml

  sulfasalazine                             tablet 500 mg,                   Restricted use :
                                               bottle 500 tablets            Specific for ulcerative colitis



National List of Essential Medicines 2008                                                                      28
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  6.3 SPECIFIC ANTI-INFECTIVE MEDICINES

  6.3.1 Antileprosy medicines
  clofazimine, micronized                   oily capsule 100 mg,
                                               bottle 100 capsules

  dapsone                                   scored tablet 100 mg,
                                              bottle 1000 tablets

  rifampicin                                capsule 300 mg, box 10          Restricted use :
                                              stripes @ 10 capsules         Only for tuberculosis and
                                                                            leprosy

  6.3.2 Antituberculosis medicines
  ethambutol                                tablet 250 mg (HCl),
                                               bottle 100 tablets
                                            tablet 500 mg (HCl),
                                               bottle 100 tablets

  isoniazid                                 tablet 100 mg,
                                               bottle 1000 tablets
                                            tablet 300 mg,
                                               bottle 1000 tablets

  pyrazinamide                              tablet 500 mg,
                                               bottle 100 tablets

  rifampicin                                scored tablet 300 mg,           Restricted use :
                                               box 10 stripes @10 tablets   Only for tuberculosis and
                                            tablet 450 mg,                  leprosy
                                               box 10 stripes @10 tablets
                                            tablet 600 mg,
                                               box 10 stripes @10 tablets

  streptomycin                              powder for injection 1000
                                              mg/vial (as sulfate),
                                              box 100 vials

  combination of :                                                          Note :
    rifampicin                              caplet 150 mg; 75 mg            Dosage form and usage
    isoniazid                               tablet 150 mg; 50 mg            according to National
                                                                            Tuberculosis Program


National List of Essential Medicines 2008                                                               29
       THERAPEUTIC
      CLASS, GENERIC                           DOSAGE FORM                        RESTRICTION
        NAME (INN)
    combination of :                                                          Note :
      rifampicin                            capl 150 mg                       Dosage form and usage
      isoniazid                             tablet 150 mg                     according to National
      ethambutol                            tablet 400 mg                     tuberculosis program.

    combination of :                                                          Note :
      rifampicin                            capl 150 mg; 75 mg;450 mg         Dosage form and usage
      isoniazid                             tablet 75 mg; 50 mg; 300 mg       according to National
      pyrazinamide                          tablet 400 mg; 150 mg;            tuberculosis program.
                                               500mg
    combination of :                                                          Note :
      rifampicin                            capl 150 mg; 450 mg               Dosage form and usage
      isoniazid                             tablet 75 mg; 300 mg              according to National
      pyrazinamide                          tablet 400 mg; 500 mg             tuberculosis program
      ethambutol                            tablet 275 mg; 250 mg;
                                               500mg

    6.3.3 Urinary Antiseptics
    NLEM co-trimoxazole I (adult)           tablet, box 10 stripes @ 10
      combination :                            tablets
      sulfamethoxazole 400 mg
      trimethoprim      80 mg

    methenamine mandelate                   enteric coated tablet 500 mg,
      (hexamine mandelat)                     bottle 100/1000 tablets

    nitrofurantoine                         scored tablet 100 mg,
                                              bottle 100 tablets

    trimethoprim                            scored tablet 200 mg,
                                              bottle 100 tablets

    6.4 ANTIFUNGAL MEDICINES
    6.4.1 Systemic
    amphotericin ∗ )                        i.v injection vial 50 mg/10 ml,
                                                vials @ 10 ml

    griseofulvin, micronized                scored tablet 250 mg,
                                               bottle 100 tablets



∗
    Complementary list

National List of Essential Medicines 2008                                                             30
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  ketoconazole                              tablet 200 mg, bottle 100        Restricted use :
                                               tablet                        Only for cronic mucocuta-
                                                                             neous candidiasis, which are
                                                                             not responsive to nystatin
                                                                             and other fungicides,
                                                                             systemic mycosis infection
                                                                             (candidiasis, parakoksidioido-
                                                                             mikosis etc)

  nystatin                                  coated tablet 500,000
                                              IU/tablet,
                                              bottle 100/1000 tablets
                                            suspension 100,000 IU/ml,
                                              bottle 12 ml

  6.4.2. Topical
   NLEM antifungal medicines                ointment, pot 30 g
    combination of:
    benzoic acid 6%
    salicylic acid 3%

  miconazole                                powder,2% (nitrate),sacch 20 g
                                            cream, 2% (nitrate), tube 10g

  nystatin                                  vaginal tablet 100,000
                                              IU/tablet,
                                              box 10 stripes @10 tablets

  sodium thiosulfate                        liquid 25%, bottle 30 ml


  6.5 ANTIPROTOZOAL MEDICINES

  6.5.1 Antiamoebic and antigiardiasis medicines
  diloxanide                                tablet 500 mg (furoate)

  metronidazole                             tablet 250 mg,
                                               bottle 100 tablets
                                            tablet 500 mg,
                                               bottle 100 tablets




National List of Essential Medicines 2008                                                                31
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  6.5.2 Antimalarial medicines
  6.5.2.1 For prophylaxis
  chloroquine                               tablet 150 mg (as phosphate),
                                               bottle 1000 tablets

  6.5.2.2 For curative treatment
  NLEM antimalarial medicines               tablet, bottle 500 tablets      Restricted use :
    combination of :                                                        For specific area which
    pyrimethamine 25 mg                                                     already resistent to
    sulfadoxine      500 mg                                                 chloroquin (decided by
                                                                            District Health Offices)

  artemether                                injection 80 mg/ml,
                                               box 6 ampoules @ 1 ml

  artesunate                                injection i.v./i.m. 60 mg/ml,
                                               box 8 vials @ 1 ml

  combination of :
    artesunate     50 mg                    tablet, box 2 blisters @ 12
    amodiaquin 200 mg                          tablets (combipack)
                                            box 3 blisters @ 8 tablets

  chloroquine                               tablet 150 mg(as phosphate),
                                               bottle 1000 tablets
                                            syrup 50 mg/5ml, bottle 60 ml

  primaquine                                tablet 15 mg (as phosphate),
                                               bottle 1000 tablets

  quinine                                   tablet 222 mg (bisulfate),      Restricted use :
                                                bottle 1000 tablets         Only for severe malaria
                                            i.v. injection 25% (as HCl),
                                                box 100 ampoules @ 2 ml

  6.6 ANTIVIRAL MEDICINES
  6.6.1 Antiherpes medicines
  aciclovir                                 scored tablet 200 mg
                                            scored tablet 400 mg



National List of Essential Medicines 2008                                                              32
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  6.6.2. Antiretrovirals
  6.6.2.1. Nucleoside reverse transcriptase inhibitor (NRTI)
  lamivudine (3TC)               tablet 150 mg

  stavudine                                 tablet 30 mg, bottle 60 tablets
                                            tablet 40 mg, bottle 60 tablets

  zidovudine                                tablet 300 mg,
                                                bottle 60 tablets
                                            tablet 100 mg,
                                                bottle 100 tablets
                                            syrup 50 mg/5 ml, bottle 10ml
                                            i.v. infusion solution 200
                                                mg/10 ml

  6.6.2.2 Non-nucleoside reverse transcriptase inhibitors (NNRTI)
  efavirenz                    tablet 200 mg,
                                  bottle 90 tablets
                               tablet 600 mg,
                                  bottle 30 tablets

  nevirapine                                tablet 200 mg,
                                               box 6 blisters @ 10 tablets

  6.6.2.3 Protease inhibitors
  lopinavir                                 tablet

  7. ANTIMIGRAINE MEDICINES
  7.1 FOR PROPHYLAXIS
  dihydroergotamine                         tablet 2.5 mg (as mesilate),
                                               box 10 stripes @ 10
                                               tablets

  propranolol                               scored tablet 40 mg (HCl)
                                              bottle 100 tablets

  7.2 FOR TREATMENT OF ACUTE ATTACK
  ergotamine              tablet 1 mg (tartrate),
                             bottle 100 tablets


National List of Essential Medicines 2008                                                   33
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  combination of :                          tablet, box 30/100 tablets
     ergotamine     1 mg
     caffeine      50 mg

  8. ANTINEOPLASTIC, IMMUNOSUPPRESSIVES and MEDICINES USED IN PALLIATIVE
  CARE
  8.1 HORMONES AND ANTIHORMONES
  medroxyprogesterone                       tablet 250 mg,
    acetate                                    bottle 50 tablets
                                            injection 200 mg/ml,
                                               box 1 vial 2.5 ml

  tamoxifen                                 tablet 20 mg (citrate),
                                               bottle 30 tablets

  testosterone                              soft capsule 40 mg
                                              (undecanoate),
                                              box 5 stripes @ 4 capsules

  8.2. IMMUNOSUPPRESSIVE MEDICINES
  azathioprine                              tablet 50 mg,
                                               bottle 100 tablets

  ciclosporin                               soft capsule 25 mg,
                                               bottle 50 capsules
                                            injection 50 mg/ml,
                                               box 10 ampoules @ 5 ml

  8.3 CYTOTOXIC MEDICINES
  asparaginase            powder for injection
                            10,000IU/vial, box 1 vial

  bleomycin                                 powder for injection 15
                                              mg/ampoule (as HCl),
                                              box 1 ampoule

  busulfan                                  coated tablet 2 mg,
                                              bottle 100 tablets

  calcium folinate (leucovorin,             tablet 15 mg, bottle 10 tablets
     Ca)                                    injection 3 mg/ml,
                                               box 5 ampoules @ 1/10 ml

National List of Essential Medicines 2008                                                   34
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                   RESTRICTION
       NAME (INN)
  chlorambucyl                              tablet 2 mg

  cyclophosphamide                          coated tablet 50 mg,
                                               bottle 28 tablets
                                            i.v. powder injection 200
                                               mg/vial, box 1 vial
                                            i.v. powder for injection 500
                                               mg/vial, box 1 vial
                                            i.v. powder injection 1000
                                               mg/vial, box 1 vial

  cysplatin                                 powder for injection 10
                                              mg/vial, box 10 vial
                                            powder for injection 50
                                              mg/vial, box 100 vial

  cytarabine                                i.m./i.v./s.c powder injection
                                               100 mg/vial, box 5 vials

  dacarbazine                               powder for injection 100
                                              mg/vial, box 1 vial

  dactinomycin                              i.v. injection 0.5 mg/vial,
                                                box 1 vial 0.5 mg

  daunorubicin                              powder injection 20 mg/vial
                                              (HCl), box 1 vial @ 4 ml

  doxorubicin                               i.v. powder for injection 10
                                               mg/vial (HCl),
                                               box 1 vial @ 5 ml
                                            i.v. powder for injection 50
                                               mg/vial (HCl),
                                               box 1 vial @ 25 ml

  etoposide                                 injection 20 mg/ml,
                                               box 10 ampoules @ 5 ml
                                            capsule 100 mg,
                                               bottle 10 capsules

  fluorouracyl                              i.v. injection 50 mg/ml,
                                                box 10 ampoules @ 5 ml



National List of Essential Medicines 2008                                                  35
      THERAPEUTIC
     CLASS, GENERIC                             DOSAGE FORM                           RESTRICTION
       NAME (INN)
  melphalan                                 tablet 2 mg                           Note :
                                                                                  Storage at 2-8oC

  mercaptopurine                            tablet 50 mg, bottle 25 tablets

  methotrexate                              tablet 2.5 mg (as sodium salt),
                                                bottle 100 tablets
                                            powder for injection 50 mg/vial
                                                (as sodium salt), box 1 vial
                                            i.v./i.m./i.t. powder for injection
                                                5 mg/vial (as sodium salt),
                                                box 1 vial

  procarbazine                              capsule 50 mg (as HCl),
                                              bottle 100 capsules

  vinblastine                               powder for injection 10
                                              mg/vial (sulfate), box 1 vial

  vincristine                               i.v. powder for injection 1           Caution :
                                               mg/vial (sulfate), box 1 vial      - Not for intrathecal use
                                                                                  - Storage at 2-8oC
  8.4 MEDICINES FOR PALLIATIVE TREATMENT
  morphine                                  tablet 10 mg (sulfate),               Restricted use :
                                               bottle 30 tablets                  Palliative Care Hospital

  9. ANTIPARKINSONISM MEDICINES
  NLEM antiparkinsonism    tablet, bottle 100 tablets
     medicines
  combination of :
     benserazide 25 mg
     levodopa 100 mg

  trihexyphenidyl                           tablet 2 mg (HCl),
                                               bottle 250 tablets

  10. MEDICINES AFFECTING THE BLOOD

  10.1 ANTIANAEMIA MEDICINES
  cyanocobalamine                           injection 500 mcg/ml,
                                               box 100 ampoules @ 1 ml


National List of Essential Medicines 2008                                                                     36
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  fe (II) sulfate 7 H20                     coated tablet 300 mg,
                                              bottle 1000 tablets
                                            syrup, bottle 60 ml
                                            drops, bottle

  folic acid                                tablet 1 mg,
                                               bottle 1000 tablets
                                            tablet 5 mg,
                                               bottle 1000 tablets

  10.2 MEDICINES AFFECTING COAGULATION
  heparin sodium                            i.v./s.c. injection 5000 IU/ml,
                                                box 1 vial 5 ml

  phytomenadione (vitamin K1)               coated tablet 10 mg,
                                               bottle 1000 tablets
                                            injection 10 mg/ml,
                                               box 100 ampoules @ 1 ml
                                            i.m injection 2 mg/ml,            Dose :
                                               ampoule 1 ml                   - New born baby dose 1 mg
                                                                              - Premature baby dose 0,5
                                                                                mg

  protamine sulfate                         injection 10 mg/ml,               Authority required
                                               box 10 vial @ 5 ml

  warfarin                                  tablet 2 mg (as sodium/
                                               potassium salt),
                                               bottle 100 tablets

  11. BLOOD PRODUCTS and PLASMA SUBSTITUTES

  11.1 BLOOD PRODUCTS
  factor VIII (consentrate)                 powder for injection 250 IU/vial Authority required :
                                              + solvent 10 ml, box 1 vial    Used for the treatment of
                                                                             haemophilia A

  factor IX complex                         powder for injection 1000        Authority required :
                                              IU/vial + solvent 25 ml,       Used for the treatment of
                                              box 1 vial                     haemophilia B
                                            powder for injection 500 IU/vial
                                              + solvent 10 ml, box 1 vial

National List of Essential Medicines 2008                                                                 37
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM               RESTRICTION
       NAME (INN)
  protein plasma fraction                                            Authority required :
                                                                     Right procedures needed

  11.2 PLASMA SUBSTITUTES and PLASMA EXPANDERS
  hydroxy ethyl starch                      infusion solution 6%,
                                               bottle 500 ml
                                            infusion solution 10%,
                                               bottle 500 ml

  NLEM plasma substitutes                   infusion solution,       Restricted use :
    combination of:                            bottle 500 ml         - Only for special cases
    polygeline (equivalent 0.63                                      - Need special facility and
      g nitrogen)       17.5 g                                         skill
    sodium chloride 4.25 g                                           - Various combination in
    potassium chloride 0.19 g                                          market could be used
    calcium (bound at
      polypeptide) 0.125 g
    pyrogen free sterile water
      to                500 ml

  12. DIAGNOSTIC AGENTS
  12.1 RADIOCONTRAST MEDIA
  12.1.1 Angiography
  meglumine amidotrizoate                   injection 65%,
                                               box 1 vial @ 50 ml

  12.1.2 Billigraphy
  sodium iopodate                           capsule 500 mg,
                                              bottle 6 capsules

  12.1.3 Histerosalpingography
  meglumine sodium             injection 76%,
    amidotrizoate                 box 1 ampoule 20 ml

  12.1.4 Myelography
  iohexole                                  injection 240 mg I/ml,
                                               box 1 vial 10 ml
                                            injection 300 mg I/ml,
                                               box 1 vial 10 ml
                                            injection 350 mg I/ml,
                                               box 1 vial 20 ml

National List of Essential Medicines 2008                                                          38
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                  RESTRICTION
       NAME (INN)
  iopamidol                                 injection 0.408 g/ml,
                                               box 10 ampoule @ 10 ml
                                            injection 0.612 g/ml,
                                               box 10 ampoule @ 20 ml

  iophendilate                              injection consist of 30.5 %
                                               iodium,
                                               box 1 ampoule @ 3 ml

  12.1.5 Metabolism
  NLEM media contrast                       granule, sacch, with anhydric
    substance                                 acetic acid 10%
    combination of :
    sodium bicarbonate 1.25 g
    simethicone       0.042 g

  barium sulfate                            powder, sacch 200 g
                                            suspension 2.2%,
                                              bottle 250/450 ml
                                            suspension 55%, bottle 2 l
                                            suspension 65%,
                                              bottle 500 ml

  meglumine sodium                          sol 59.7 %, bottle 120 ml
    amidotrizoate

  12.1.6 Urograph
  iopamidole                                injection 0.612 g/ml,
                                               box 10 ampoules @ 20 ml
                                            injection 0.755 g/ml,
                                               box 10 ampoules @ 20 ml

  meglumine sodium                          i.v. injection 76%,
    amidotrizoate                               box 1 ampoule @ 20 ml

  12.2 FUNCTION TEST
  12.2.1 Renal
  sodium aminohypurate                      i.v. injection 200 mg/ml,
                                                box 1 ampoule 10 ml




National List of Essential Medicines 2008                                                 39
      THERAPEUTIC
     CLASS, GENERIC                             DOSAGE FORM                    RESTRICTION
       NAME (INN)
  12.2.2 Liver
  sodium bromsulphtalein                    i.v. injection 5%,
                                                box 1 ampoule 3 ml

  12.2.3 Miscellaneous
  fluorescein                               eye drops 1% (sodium salt),
                                               bottle 5 ml
                                            eye drops 2% (sodium salt),
                                               bottle 5 ml
                                            injection 10%,
                                               box 1 ampoule @ 5 ml
                                            injection 20%,
                                               box 1 ampoule @ 5 ml

  12.3 SKIN TEST
  tuberculin protein purified               i.c. injection 1:10,
     derivative                                 box 1 vial 2 ml

  13. ANTISEPTICS dan DISINFECTANTS
  13.1 ANTISEPTICS
  chlorhexidine                             sol 5.0% (gluconate),          For diluted
                                                bottle 2.5 l

  hydrogen peroxyde                         concentrate solution,          Storage :
                                               bottle 1000 ml              - Storage in glass bottle with
                                                                             glass cap, air tight, saved
                                                                             from light.
                                                                           - For diluted until 3%.
  policresulen (metacresol                  liquid, bottle 10 ml / 50 ml
     sulphonate and methanal
     condensate)

  povidone-iodine                           solution 10%, bottle 1000 ml

  13.2 DISINFECTANTS
  calcium hypochlorite                      powder, sacch 20 g             ‘Samijaga’ program

  chlorine base compound                    powder (for 0.1% sol),
                                               bottle 100 g

  ethanol 70%                               sol, bottle 100 ml /1000 ml

National List of Essential Medicines 2008                                                              40
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  paraformaldehyde                          tablet 1 g, bottle 100 tablets
                                            sol 5%, bottle 1000 ml

  saponificated cresol 50%                  liquid, bottle 1000 ml
    (lysol)

  14. MEDICINES and DENTAL MATERIAL USED FOR ORAL HEALTH
  14.1 MEDICINES USED FOR DENTAL and ORAL HEALTH,
  NLEM dental anesthetics                   injection, box 20/50/100
    combination of:                             ampoules @ 2 ml
    lidocaine HCl 2%
    epinephrine     1 : 80,000

  calcium hydroxide                         paste, box 2 tubes

  chlorhexidine                             liquid 0,2% (gluconate)          Note :
                                                                             For making dilutions

  chlorphenol camphor menthol               liquid, bottle 10 ml

  ethyl chloride                            spray 0.05-0.2 ml,
                                               bottle 100 ml

  eugenol                                   liquid, bottle 10 ml

  fluorine                                  tablet 0.5 mg,
                                               bottle 100 tablets

  lidocaine                                 injection 2% (HCl), box 100
                                                ampoules @ 2 ml
                                            paste 5% (HCl), tube 10 g
                                            spray 15% (HCl), bottle 60 ml

  nystatin                                  suspension 100,000 UI/ml,
                                              bottle 12 ml

  sodium hypochlorite                       concentrate liquid 5%,           Note :
                                              bottle 10 ml                   For making dilutions

  14.2 DENTAL MATERIAL USED FOR ORAL HEALTH
  gelatin sponge                            cubicles 1x1x1 cm, tin 50 pcs


National List of Essential Medicines 2008                                                           41
      THERAPEUTIC
     CLASS, GENERIC                               DOSAGE FORM               RESTRICTION
       NAME (INN)
  glass ionomer ART                         powder bottle10 g
     (Atraumatic Restorative                sol, bottle 6 g (4.8 ml)
     Treatment)                             cocoa butter 5 g

  gutta percha points                       box 120 sticks

  resin composite                           set

  root canal filling                        paste, bottle

  surgical ginggival pack                   set

  temporary filling                         sol and powder, bottle 100 g

  15. DIURETICS
  furosemide                                tablet 40 mg,
                                                bottle 250 tablets
                                            i.v./i.m. injection 10 mg/ml,
                                                box 25 ampoules @ 2 ml

  hydrochlorothiazide                       tablet 25 mg,
                                               bottle 1000 tablets

  mannitol                                  infusion liquid 20%,
                                               bottle 500 ml

  spironolactone                            tablet 25 mg,
                                               box 10 stripes @10 tablets
                                            tablet 100 mg,
                                               box 10 stripes @10 tablets

  16. HORMONES, OTHER ENDOCRINE MEDICINES and CONTRACEPTIVES
  16.1 ANTIDIURETIC HORMONES
  desmopressin                              spray

  vasopressin                               i.m./s.c. injection 20 IU/ml,
                                               box 10 ampoules @ 1 ml




National List of Essential Medicines 2008                                                 42
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                     RESTRICTION
       NAME (INN)
  16.2 ANTIDIABETIC
  16.2.1 Oral Antidiabetic
  glibenclamide                             tablet 2.5 mg,
                                               bottle 100 tablets
                                            tablet 5 mg, bottle 100 tablets

  glipizide                                 tablet 5 mg,
                                               box 5 blisters @ 20 tablets

  metformin                                 tablet 500 mg,
                                               bottle 100 tablets

  16.2.2 Injectable Antidiabetic
  intermediate insulin                      injection 100 IU/ml,
                                                box 1 vial @ 10 ml

  regular insulin                           injection 100 IU/ml,
                                                box 1 vial @ 10 ml

  regular insulin : intermediate            injection 100 IU/ml,
     insulin (30 : 70)                          box 1 vial @ 10 ml

  16.3 SEX HORMONE and FERTILITY RELATED MEDICINES
  16.3.1 Androgens
  testosterone                              oil injection 200 mg/ml
                                                (enantate), box 1 vial @1 ml

  16.3.2 Estrogens
  conjugated estrogens                      tablet 0.625 mg,
                                               box stripes 28 tablets

  ethinylestradiol                          tablet 0.05 mg,
                                               bottle 100 tablets
                                            tablet 0.5 mg,
                                               bottle 100 tablets

  16.3.3 Progestogens
  hydroxy progesterones                     i.m. injection 125 mg/ml,
                                                box 1 ampoule 2 ml


National List of Essential Medicines 2008                                                    43
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  norethisterone                            tablet 5 mg, bottle 30 tablets

  16.3.4 Contraceptives                                                        Note :
                                                                               According to National Family
  16.3.4.1 Oral Hormonal Contraceptives                                        Planning Program
  combination :                pill                                            coordinated by National
    levonorgestrel 150 mcg                                                     Family Planning Coordination
    ethinylestradiol 30 mcg                                                    Board (BKKBN)

  16.3.4.2 Injectable Hormonal Contraceptives
  medroxyprogesterone           depot injection 150 mg
    acetate

  16.3.4.3 Intra-uterine Devices
  copper - containing device     set / pcs

  16.3.4.4 Implantable Contraceptives
  levonorgestrel                            implant 2 rods (3-4 years)

  16.4 THYROID and ANTITHYROID HORMONES
  lugol solution           bottle 30 ml                                        Note :
                                                                               Dilute before use
  propylthiouracyl                          scored tablet 100 mg,
                                               bottle 1000 tablets

  thyroxine sodium                          tablet 0.1 mg, bottle 50 tablets

  16.5 CORTICOSTEROID HORMONES
  dexamethasone           tablet 0.5 mg,
                              bottle 1000 tablets
                          injection 5 mg/ml (as sodium
                             phosphate), box 100
                             ampoule @ 1 ml

  hydrocortisone                            tablet 10 mg
                                            powder for injection 100
                                               mg/vial (sodium succinate),
                                               box 100 vial @ 2 ml

  prednisone                                tablet 5 mg,
                                               bottle 1000 tablets

National List of Essential Medicines 2008                                                                 44
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  17. CARDIOVASCULAR MEDICINES
  17.1 ANTI-ANGINAL MEDICINES
  atenolol                                  tablet 50 mg, box 10 stripes
                                               @ 10 tablets

  diltiazem HCl                             tablet 30 mg, box 10 stripes
                                               @ 10 tablets

  isosorbide dinitrate                      sublingual tablet 5 mg,
                                              bottle 60 tablets

  nitroglycerine                            sublingual tablet 0.5 mg,
                                              bottle100/1000 tablets

  17.2 ANTIARRHYTHMIC MEDICINES
  amiodarone               tablet 200 mg, box 30 tablets
                           injection 150 mg/3 ml,
                              box 6 ampoule @ 3 ml

  digoxin                                   tablet 0.0625 mg,                 Pediatric dose :
                                               bottle 100 tablets             Tablet 0,0625 mg for
                                            tablet 0.25 mg,                   pediatrics
                                               bottle 100 tablets
                                            injection 0.25 mg/ml,
                                               box 1 ampoule @ 2 ml

  disopyramide                              capsule 100 mg (phosphate),
                                               bottle 100 capsules

  epinephrine (adrenaline)                  injection 0.1% (as bitartrate),   Note :
                                               box 100 ampoules @ 1 ml        For intracardial or resusitation

  lidocaine                                 i.v. injection 2% (HCl),
                                                box 100 ampoules @ 2 ml

  propranolol                               tablet 10 mg (HCl),
                                                bottle 100 tablets
                                            i.v. injection 1 mg/ml (HCl),
                                                box 10 ampoules @ 1ml




National List of Essential Medicines 2008                                                                   45
       THERAPEUTIC
      CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
        NAME (INN)
    verapamil                               tablet 40 mg (HCl),               Special use :
                                               bottle 30 tablets              For supraventricular
                                            injection 2.5 mg/ml (HCl),        arrhythmia.
                                               box 10 ampoules @ 2 ml

    17.3 ANTIHYPERTENSIVE MEDICINES
    atenolol                                tablet 50 mg, bottle 50 tablets

    captopril                               scored tablet 12.5 mg,            Caution :
                                              box 10 stripes @ 6 tablets      - Not for pregnant women
                                            scored tablet 25 mg, box 10       - Having cough side effect
                                              stripes @ 6 or 10 tablets

    clonidine ∗ )                           i.m. injection 0.15 mg/ml         Note :
                                               (HCl), box 1 ampoule 1 ml      For severe hypertension

    hydrochlorothiazide                     tablet 25 mg,
                                               bottle 100 tablets

    lisinopril                              tablet 5 mg,
                                               box 3 stripes @ 10 tablets
                                            tablet 10 mg,
                                               box 3 stripes @ 10 tablets
                                            tablet 20 mg, CD
                                               box 3 stripes @ 10 tablets

    methyldopa                              coated tablet 250 mg,
                                              bottle 100 or 1000 tablets

    nifedipine                              tablet 10 mg

    sodium nitroprusside *)                 injection, vial

    17.4 PLATELET ANTIAGGREGATION
    acetylsalicylic acid (acetosal)         tablet 80 mg, box 10 blisters
                                               @ 10 tablets




∗
    Complementary list
National List of Essential Medicines 2008                                                                  46
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  17.5 ANTI THROMBOTIC MEDICINES
  streptokinase                             injection 750,000 IU/vial       Restricted use :
                                            injection 1,500,000 IU/vial     - Authority required
                                                                            - Need special facility and
                                                                              skill

  17.6 MEDICINES USED IN HEART FAILURE
  captopril                                 scored tablet 12.5 mg,          Caution :
                                              box 10 stripes @10 scored     - Not for pregnant women
                                              tablets                       - Having cough side effect
                                            scored tablet 25 mg,
                                              box 10 stripes @ 10
                                              scored tablets
  digoxin                                   tablet 0.0625 mg,               Pediatric dose :
                                               bottle 100 tablets           Tablet 0,0625 mg for
                                            tablet 0.25 mg,                 pediatrics
                                               bottle 100 or 1000 tablets
                                            injection 0.25 mg/ml,
                                               box 1 ampoule @ 2 ml

  furosemide                                tablet 40 mg,
                                               box 20 stripes@ 10 tablets
                                            injection i.v./i.m. 10 mg/ml,
                                               box 25 ampoules @ 2 ml

  17.7 MEDICINES USED for SHOCK ATTACK

  17.7.1 Medicines used for Cardiogenic Shock
  dobutamine                                injection 50 mg/ml; vial 5 ml
                                            injection 25 mg/ml;
                                               ampoule 10 ml

  dopamine                                  injection 40 mg/ml (HCl),
                                               box 5 ampoules @ 5 ml

  epinephrine (adrenaline)                  injection i.v. 0.1 %
                                               (as HCl/ bitartrate),
                                               box 100 ampoules @ 1 ml




National List of Essential Medicines 2008                                                                47
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  17.7.2 Medicines used for Anaesthetic Shock
  ephedrine                    injection 50 mg/ml (HCl),                    Note :
                                  box 100 ampoules @ 1 ml                   Used as long acting
                                                                            vasopressor
  norepinephrine                            injection 4 mg/ml,
                                               ampoule 2 ml

  17.8 LIPID-LOWERING AGENTS
  simvastatin                               scored tablet 10 mg,
                                              box 30 tablets

  18. DERMATOLOGICAL MEDICINES
  18.1 ANTIACNE MEDICINES
  retinoic acid                             cream 0.05%, tube 20 g

  18.2 ANTI-INFECTIVE MEDICINES
  silver sulfadiazine                       cream 1%, pot 500 g             Special use :
                                                                            Large area burn wounds
  NLEM anti-infective medicines             ointment, tube 5 g
    combination of :
    bacitracin      500 IU/g
    polymixin B 10,000 IU/g

  18.3 ANTIFUNGAL MEDICINES
  NLEM antifungal medicines                 ointment, pot 30 g              Note :
    combination of :                                                        General antifungal ointment
    benzoic acid 6%
    salicylic acid 3%

  miconazole                                powder 2% (nitrate),
                                               sacch 20 g
                                            cream 2% (nitrate), tube 10 g

  sodium thiosulfate                        liquid 25%, bottle 30 ml

  18.4 ANTI-INFLAMMATORY and ANTIPRURITIC MEDICINES
  betamethasone                             ointment 0.1% (as valerate),
                                               tube 5 g
                                            cream 0.1% (as valerate),
                                               tube 5 g
National List of Essential Medicines 2008                                                                 48
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM               RESTRICTION
       NAME (INN)
  hydrocortisone                            cream 2.5% (acetate),
                                               tube 5 g

  liquor veilli (salicylic acid             solution                 Note :
     solution 0,1 %)                                                 - Fresh prepared (r.p.=
     combination of :                                                  recentus paratus)
     salicylic acid         0.1 %                                    - For wet dermatitis
     boric acid             0.5 %
     glycerine             10 %

  18.5 SCABICIDES and PEDICULICIDES
  permethrin                                cream 5 %, tube
  2-4 ointment,                             ointment, pot 30 g
     combination of :
     salicylic acid     2%
     sulfur precipitate 4 %

  18.6 CAUSTIC MEDICINES
  silver nitrate                            sol 20%, bottle 10 ml    Note :
                                                                     For hypergranulation

  18.7 MEDICINES AFFECTING SKIN DIFFERENTIATION and PROLIFERATION
  coal tar                                  sol 5 %, bottle 100 ml

  podophyllum resin                         alcoholic sol 25 %,      Authority required :
                                               bottle 30 ml          - Should be applicated by
                                                                       practitioners
                                                                     - Should be cleaned 1-4
                                                                       hours after used, make
                                                                       sure that no residues
                                                                     - Only for severe thickening,
                                                                       causing danger of
                                                                       absorptions
                                                                     - Not for pregnant women
                                                                       because of terratogenic
                                                                       effect
                                                                     - Not for use by patients
                                                                     - Not for take away home
  salicylic acid                            ointment 2%, pot 30 g
                                            ointment 5%, pot 30 g
                                            ointment 10%, pot 30 g

National List of Essential Medicines 2008                                                        49
      THERAPEUTIC
     CLASS, GENERIC                             DOSAGE FORM                        RESTRICTION
       NAME (INN)
  urea                                       cream 10 %, tube 40 g

  18.8 MISCELLANEOUS
  liquor carbonis detergents                 suspension 2%, bottle 30 ml
                                             suspension 5%, bottle 30 ml

  liquor faberi                              liquid

  salicyl powder                             powder 2%, box 100 g

  19. PERITONEAL DIALYSIS SOLUTIONS
  NLEM haemodialysis solution                sol, bottle 1 gallon

  NLEM peritoneal dialysis                   infusion sol,
  solution                                      24 bottle @ 1000 ml

  20. ELECTROLYTE, NUTRITION SOLUTIONS, and OTHERS
  20.1 ORAL
  oral rehydration salts                     powder, 100 sacch                  - Drink slowly to prevent
   combination of :                            each sacch for 200 ml              vomiting
   sodium chloride                  0.52 g     water                            - 1 sacchet to be dissolved
   potassium chloride               0.30 g                                        in 200 ml water
   trisodium citrate
       dihydrate                    0.58 g
   anhydric glucose                 2.70 g

  potassium chloride                         ready-to-dissolve tablet 300      - Dissolve before use
                                               mg, air tight tube 10 tablets   - Storage in air tight
                                                                                 container

  sodium bicarbonate                         tablet 500 mg, ottle 1000
                                               tablets

  20.2 PARENTERAL
  calcium gluconate                          i.v. injection 10%,
                                                box 24 ampoules @ 10 ml

  darrow glucose ana (DG ana)                infusion sol, bottle 500 ml

  dextrose                                   infusion sol 5 %, bottle 500 ml


National List of Essential Medicines 2008                                                                 50
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  glucose                                   infusion sol 5%, bottle 500 ml
                                            infusion sol 10%,
                                               bottle 500 ml
                                            infusion sol 40%, bottle 25 ml

  half strength darrow glucose              infusion sol, bottle

  intralipid liquid                         infusion sol 10%,                 Restricted use :
                                               bottle 100/500 ml              - Only for special cases
                                            infusion sol 20%,                 - Need special facility and
                                               bottle 100/500 ml                skill

  mannitol                                  infusion sol 20 %,
                                               bottle 500 ml

  NLEM nutritious solution                  infusion sol, bottle 500 ml       Note :
    combination of :                                                          For pediatric use
    glucose              5%
    sodium chloride 0.225 %

  nutritious solution                       infusion sol, bottle 500 ml
    combination of :
    glucose                        4%
    sodium chloride                0.18 %

  potassium chloride                        i.v. injection 1 meq/ml,
                                               box 1 ampoule 10 ml

  ringer lactate                            infusion sol, bottle 500 ml

  sodium bicarbonate                        i.v. injection 8.4%,              Note :
                                               bottle 25 ml                   Need to check blood gas
                                            injection 1.4% isotonik, bottle   level

  sodium chloride                           infusion sol 0,9%,                Note :
                                               bottle 500 ml                  Need to check sodium level.
                                            infusion sol 3%, bottle 500 ml
                                            injection 15%, vial 50 ml

  20.3 MISCELLANEOUS
  water for injections                      box, ampoule/vial @ 10
                                              ml/20 ml


National List of Essential Medicines 2008                                                                   51
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                  RESTRICTION
       NAME (INN)
  21. OPHTHALMOLOGICAL PREPARATION
  21.1. LOCAL ANESTHETICS
  bupivacaine             injection 0.5% (HCl),
                             box 5 ampoules @ 20 ml
  tetracaine                                eye drops 0.5% (HCl),
                                              bottle 5 ml

  21.2 ANTI-INFECTIVE AGENTS
  amphotericin              eye ointment 3%, tube 3.5 g

  gentamicin                                eye ointment 0,3%, tube 3.5 g
                                            eye drops 0.3%, bottle 5 ml

  idoxuridine                               eye drops 0.1%, bottle 5 ml
                                            eye ointment 0.5%, tube 4 g

  oxytetracycline                           eye ointment 1% (HCl),
                                              tube 3.5 g

  sulfacetamide                             eye drops 15% (sodium),
                                              bottle 5 ml

  21.3 ANTI-INFLAMMATORY AGENTS
  betamethasone            eye drops 1 mg/ml (sodium),
                             bottle 5 ml

  21.4 MYDRIATICS
  atropine                                  eye drops 0.5% (sulfate),
                                              bottle 5 ml
                                            eye drops 1% (sulfate),
                                              bottle 5 ml

  homatropine                               eye drops 2% (as hydro
                                              bromide), bottle 15 ml

  21.5 MIOTICS and ANTIGLAUCOMA MEDICINES
  acetazolamide             tablet 250 mg,
                               bottle 100 tablets
                            i.m/i.v. powder for injection
                               500 mg/vial (as sodium
                               salt), box 10 vials + 10
                               ampoules WFI @ 5 ml
National List of Essential Medicines 2008                                                 52
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  pilocarpine                               eye drops 2% (HCl/nitrate),
                                              bottle 5 ml
                                            eye drops 4% (HCl/nitrate),
                                              bottle 5 ml

  timolol                                   eye drops 0.25% (maleate),
                                              bottle 5 ml
                                            eye drops 0.5% (maleate),
                                              bottle 5 ml

  21.6 MISCELLANEOUS
  combination of :                          sol 2%, bottle 5 ml           Note :
    hydroxypropyl                                                         For dry eyes syndrome
       methylcellulose 5 mg
    dextran (70)        1 mg
    glycerine           2 mg
    benzalkonium
       chloride 0.01% w/v

  sodium chromoglycate                      eye drops 2%, bottle 15 ml

  22. OXYTOCICS and UTERIC RELAXANTS

  22.1 OXYTOCICS
  methyl ergometrine                        coated tablet 0.125 mg
                                               (maleate),
                                               bottle 100 tablets
                                            injection 0.200 mg/ml,
                                               box 100 ampoules @ 1 ml

  oxytocin                                  injection 10 IU/ml,
                                               box 100 ampoules @ 1 ml

  22.2 UTERIC RELAXANTS
  magnesium sulfate                         injection 20%,
                                               box 10 vials @ 20 ml
                                            injection 40%,
                                               box 10 vials @ 20 ml




National List of Essential Medicines 2008                                                         53
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  23. PSYCHOTHERAPEUTIC MEDICINES
  23.1 MEDICINES USED in GENERALIZED ANXIETY and SLEEP DISORDERS
  diazepam                                  tablet 2 mg,
                                               bottle 1000 tablets
                                            tablet 5 mg,
                                               bottle 1000 tablets
                                            i.m. injection 5 mg/ml,
                                               box 100 ampoules @ 2 ml

  23.2 MEDICINES USED in DEPRESSIVE DISORDERS
  amitriptyline             coated tablet 25 mg (HCl),
                              box 10 blisters @ 10
                              tablets

  fluoxetine                                capsule/tablet 10 mg,
                                              box 30 tablets
                                            capsule/tablet 20 mg,
                                              box 30 tablets

  lithium carbonate                         tablet 200 mg, box 10 stripes   Caution :
                                               @ 10 tablets                 - If possible, need to check
                                                                              blood concentration level
                                                                            - Safety windows is 0,8-1,2
                                                                              mmol eq/l

  23.3 MEDICINES USED for OBSESSIVE COMPULSIVE DISORDERS
  clomipramine                              tablet 25 mg (HCl),
                                               bottle 1000 tablets

  23.4 MEDICINES USED in PSYCHOTIC DISORDERS
  chlorpromazine            coated tablet 25 mg (HCl),
                               bottle 1000 tablets
                            coated tablet 100 mg (HCl),
                               bottle 1000 tablets
                            i.m. injection 25 mg/ml (HCl),
                               box 100 ampoules @ 1 ml




National List of Essential Medicines 2008                                                                  54
       THERAPEUTIC
      CLASS, GENERIC                           DOSAGE FORM                     RESTRICTION
        NAME (INN)
    clozapine ∗ )                           tablet 25 mg, box 50 tablets   Caution :
                                            tablet 50 mg, box 50 tablets   - Need to check blood
                                                                             leucocyte regularly
                                                                             (agranulocytosis)
                                                                           - Drug of choice in psychotic
                                                                             disorder treatment which
                                                                             already resistent to other
                                                                             antipsychotics.
    fluphenazine                            tablet 2.5 mg (HCl),
                                               bottle 100 tablets
                                            i.m. injection 25 mg/ml
                                               (decanoate),
                                               box 10 vials @ 1 ml
    haloperidol                             tablet 0.5 mg,                 Note :
                                                bottle 100/1000 tablets    Second generation
                                            tablet 1.5 mg,                 antipsychotic
                                                bottle 100/1000 tablets
                                            tablet 2 mg, box 100 tablets
                                            tablet 5 mg,
                                                bottle 100/1000 tablets
                                            drops 2 mg/ml,
                                                bottle 15 ml/100 ml
                                            i.m. injection 2 mg/ml (HCl)
                                               box 5 ampoules @ 1 ml
                                            i.m. injection 5 mg/ml (HCl)
                                               box 5 ampoules @ 1 ml
                                            injection 50 mg/ml (as
                                                decanoate)
                                                box 5 ampoules @ 1 ml
                                                (long acting)
    risperidone                             tablet 1 mg, box 5 stripes @
                                               10 tablets
                                            tablet 2 mg, box 5 stripes @
                                               10 tablets

    23.5. MEDICINES USED for ADHD
    (dl) methylphenidate*)     regular release tablet 10 mg,  Authority required :
                                  box 30 tablets              Need special skill
                               extended release tablet 20 mg,
                                  box 30 tablets

∗
    Complementary list
National List of Essential Medicines 2008                                                              55
       THERAPEUTIC
      CLASS, GENERIC                           DOSAGE FORM                       RESTRICTION
        NAME (INN)
    24. MUSCLE RELAXANTS (PERIPHERALLY-ACTING) and CHOLINESTERASE
        INHIBITORS
    24.1 NEUROMUSCULAR INHIBITORS
    atracurium              injection 25 mg/2,5 ml,
                                ampoule 2.5 ml

    rocuronium                              i.v injection 10 mg/ml;
                                                vial 5 ml

    succinylcholine                         powder i.v./i.m. injection 100   Authority required :
                                              mg/ vial (chloride),           - Restricted use (only for
                                              box 10 vials                     special cases)
                                                                             - Need special facillities and
                                                                               skill

    24.2 MEDICINES USED for MIASTENIA GRAVIS
    neostigmine ∗ )            injection 0.5 mg/ml (methyl
                                  sulfate),
                                  box 50 ampoules @ 1 ml

    pyridostigmine                          tablet 60 mg (bromide),
                                               box 10 stripes/blisters @
                                               10 tablets

    25. GASTROINTESTINAL MEDICINES

    25.1 ANTACIDS and OTHER ANTIULCER MEDICINES
    NLEM antacid I              chewable tablet, bottle 1000
     combination of:              tablets
     aluminium hydroxide 200 mg
     magnesium hydroxide 200 mg

    NLEM antacid II                         suspension, bottle 60 ml
     combination of :
     aluminium
        hydroxide 200 mg/5 ml
     magnesium
        hydroxide 200 mg/5 ml




∗
    Complementary list
National List of Essential Medicines 2008                                                                56
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  ranitidine                                tablet 150 mg,
                                                box 3 stripes @10 tablets

  25.2 ANTIEMETIC MEDICINES
  chlorpromazine                            coated tablet 25 mg (HCl),
                                               bottle 1000 tablets
                                            i.m. injection 25 mg/ml (HCl),
                                               box 100 ampoules @ 1 ml
                                            i.m injection 5 mg/ml (HCl),
                                               box 100 ampoules @ 2 ml

  dimenhydrinate                            tablet 50 mg, bottle 1000        Note :
                                                tablets                      - Adult dose : ½ - 1 tablet
                                                                             - Use ½ - 1 hour before
                                                                               meals to get better efficacy
  metoclopramide                            tablet 10 mg (as HCl),
                                               bottle 100 tablets
                                            injection 5 mg/ml (as HCl),
                                               box 10 ampoules @ 2 ml
                                            syrup 5 mg/5 ml, bottle 50 ml
                                            drops 0.1 mg/drop,
                                               bottle 10 ml

  25.3 ANTIHAEMORRHOID MEDICINES
  NLEM antihaemorrhoid                      suppositoria, box 100 supps
    combination of :
    bismuth subgallate 150 mg
    hexachlorophene 2.5 mg
    lidocaine           10 mg
    zinc oxide         120 mg
    supp             to 2 g

  25.4 ANTISPASMODIC MEDICINES
  atropine                 tablet 1 mg (sulfate),
                              tin 100 tablets
                           i.m./i.v./s.c. injection 0.25
                              mg/ml (sulfate),
                              box 100 ampoules @ 1 ml
                           i.m./i.v./s.c. injection 1 mg/ml
                              (sulfate),
                              box 50 ampoules @ 1 ml


National List of Essential Medicines 2008                                                                 57
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  belladonna extract                        tablet 10 mg,
                                               bottle 100/1000 tablets

  25.5 MEDICINES USED IN DIARRHOEA
  oral rehydration salts        powder, 100 sacchs,                       - Drink slowly to prevent
   combination of :               each sacch for 200 ml of                  vomitting
   sodium chloride       0.52 g   water                                   - 1 sachet to be dissolved in
   potassium chloride 0.30 g                                                200 ml of water
   trisodium citrate
       dihydrate         0.58 g
   anhydric glucose      2.70 g

  25.6 CATARTIC MEDICINES
  bisacodyl                                 suppositoria 5 mg, box 6
                                              suppositoria
                                            suppositoria 10 mg, box 6
                                              suppositoria

  glycerine                                 liquid, bottle 100 ml

  25.7 ANTI-INFLAMMATORY MEDICINES
  sulfasalazine           tablet 500 mg, box 10 stripes
                             @ 10 tablets

  26. MEDICINES ACTING ON RESPIRATORY TRACT

  26.1 ANTIASTHMATIC
  aminophylline                             scored tablet 200 mg,
                                               bottle 1000 tablets
                                            injection 24 mg/ml,
                                               box 100 ampoules @10 ml

  budesonide                                aerosol 100 mcg/puff,
                                              canister 15 ml
                                            aerosol 200 mcg/puff,
                                              canister 15 ml

  dexamethasone                             tablet 0.5 mg,
                                                bottle 1000 tablets
                                            i.v. injection 5 mg/ml (as
                                                sodium phosphate),
                                                box 100 ampoules @ 1 ml

National List of Essential Medicines 2008                                                             58
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  ephedrine                                 tablet 25 mg (HCl),
                                               bottle 1000 tablets

  epinephrine (adrenaline)                  injection 0.1 % (as
                                               HCl/bitartrate), box 100
                                               ampoules @ 1 ml

  salbutamol                                tablet 2 mg (as sulfate),
                                                bottle 100/1000 tablets
                                            tablet 4 mg (as sulfate),
                                                bottle 100/1000 tablets
                                            ih liquid 0.5 % , bottle 10 ml    Note :
                                            ih/aerosol 100 mcg/dose (as       For intermittent inhalation and
                                                sulfate), tube 200/400        first accute attack.
                                                doses
                                            injection 50 mcg/ml (as
                                                sulfate), box 100
                                                ampoules @ 1 ml
                                            respirator liquid for nebulizer
                                                2.5 mg/2.5 ml NaCl,
                                                box 4x5 nebules

  26.2 ANTITUSSIVES
  codeine                                   tablet 10 ml (HCl/phosphate),
                                               bottle 250 tablets

  dextromethorphan                          tablet 15 mg (HBr),
                                               bottle 1000 tablets
                                            syrup 10 mg/5 ml (HBr),
                                               bottle 60 ml

  26.3 EXPECTORANT
  glyceryl guaiacolate                      syrup 25 mg/5 ml,bottle 60 ml
                                            tablet 100 mg,
                                               bottle 1000 tablets

  obat batuk hitam (OBH)                    liquid, bottle 200 ml
                                            concentrate liquid,
                                               bottle 1000 ml




National List of Essential Medicines 2008                                                                 59
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  27. IMMUNOLOGICALS
  27.1 SERA and IMMUNOGLOBULINS
  antitetanus immunoglobulin                i.m. injection 500 IU, vial        Note :
     (human)                                                                   - Storage at 2-8º C

  antidiphtheria sera (A.D.S)               i.m. injection 10,000 IU/vial,     Note :
                                               box 10 vials @ 5 ml             - Storage at 2-8º C
                                            i.m. injection 20,000 IU/vial,
                                               box 10 vials @ 10 ml

  antirabies sera                           i.m. injection 100 IU/ml,          Indication :
                                               box 10 vial @ 20 ml             - For post-exposure treatment
                                                                                 in rabies area
                                                                               - Storage at 2-8º C

  antitetanus sera (A.T.S)                  for prophylaxis :               Note :
                                            i.m. injection 1500 IU/ampoule, - Storage at 2-8º C
                                               box 10 ampoules @ 1 ml
                                            for curative treatment :
                                            i.m./i.v. injection 10,000
                                               IU/ampoule,
                                               box 10 ampoules @ 2 ml
                                            i.m./i.v injection 20,000
                                               IU/vial, box 10 vials@ 4 ml

  immunoglobulin sera                       injection i.m.,                    Note :
                                                box 10 vial @ 10 ml            - Storage at 2-8º C

  snake antivenom sera                      i.m./i.v. injection, box 10 vial   Note :
    snake antivenom special                     @ 5 ml                         - Only for specific area
     for snake from outside                                                    - Storage at 2-8º C.
     papua
    snake antivenom special
     for papua snake

  27.2 VACCINES
  BCG vaccine                               i.c. injection,                    Note :
                                                  box 5 ampoules @ 2 ml        - Storage below 5º C
                                            i.c. injection,
                                                  box 5 ampoules @ 4 ml



National List of Essential Medicines 2008                                                                 60
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  diphtheria, pertusis and                  i.m injection,                    Note :
     tetanus adsorbed vaccine                  box 10 vial @ 5 ml             - Storage at 2-8º C
     (DPT)

  hepatitis B vaccine                       injection 20 mcg/ml,              Note :
    (recombinant)                              box 1 vial 0.5; 1 ml           - Storage at 2-8º C

  measles vaccine                           s.c injection, box 10 vials (10   Note :
                                               doses) @ 5 ml                  - Storage at 2-8º C

  poliomyelitis vaccine                     drops, box vial 10/20 doses       Note :
                                                                              - Storage at 2-8º C

  rabies vaccine (human)                    s.k./i.c. powder for injection,   Indication :
                                               box 7 vial @ 1 dose + 7        - Storage at 2-8º C
                                               ampoules solvent @ 2 ml        - Used for pre-exposure and
                                            booster : box 5 ampoules @          post-exposure treatment in
                                               1 dose + 5 ampoules              rabies area
                                               solvent @ 4 ml

  tetanus adsorbed vaccine                  i.m.injection, box 1 vial 5 ml    Note :
     (tetanus adsorbed toxoid)                                                - Storage at 2-8º C

  tetanus and diphteria                     i.m. injection,                   Note :
     adsorbed vaccine (TD)                     box 10 vial @ 5 ml             - Storage at 2-8º C

  28. MEDICINES USED FOR EAR, NOSE and THROAT
  carboglycerine           ear drops 10 %, bottle 5 ml

  hydrogen peroxide                         concentrate liquid, bottle        Note :
                                            1000 ml                           - Storage in glass bottle with
                                                                                glass cap, air tight, save
                                                                                from light
                                                                              - For making dilution until
                                                                                3%

  lidocaine                                 spray liquid 4% (HCl),
                                               bottle 50 ml

  oxymetazoline                             nasal drops 0.025% (HCl),
                                              bottle 15 ml
                                            nasal drops 0.050 % (HCl),
                                              bottle 10 ml

National List of Essential Medicines 2008                                                                 61
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  29. VITAMINS and MINERALS
  ascorbic acid             tablet 50 mg,
                               bottle 1000 tablets

  calcium gluconate                         injection 100 mg/ml,
                                               box 24 ampoules @ 10 ml

  calcium lactate                           tablet 500 mg,
                                               bottle 1000 tablets

  ergocalciferol                            capsule 50,000 IU,            Note :
                                              bottle 100 capsules         Therapeutic use for
                                            suspension 10.000 IU/ml,      hypocalcemia (seldom
                                              bottle 60 ml                needed in tropical countries)

  iodine                                    soft capsule 200 mg,
                                               bottle 1500 capsules

  nicotinamide                              tablet 100 mg

  pyridoxine                                tablet 10 mg (HCl),
                                               bottle1000 tablets
                                            tablet 25 mg (HCl),
                                               bottle 1000 tablets

  retinol                                   tablet 5000 IU,
                                               bottle 1000 tablets
                                            soft capsule 50,000 IU,
                                               bottle 50 capsules
                                            soft capsule 100,000 IU,
                                               bottle 50 capsules
                                            soft capsule 200,000 IU (as
                                               palmitate),
                                               bottle 50 capsules

  thiamine                                  tablet 50 mg (HCl),
                                               bottle 1000 tablets

  vitamin B complex                         tablet, bottle 1000 tablets




National List of Essential Medicines 2008                                                                 62
                                CHAPTER III
                         RESTRICTED MEDICINE LIST
                         FOR PUBLIC HEALTH CENTER
                                    2008
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  1. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES,
     MEDICINES USED TO TREAT GOUT
  1.1 OPIOID ANALGESICS
  pethidine                                 injection i.m./s.c./slow         Authority required :
                                               released i.v 50 mg/ml         Used only for nursing Public
                                               (HCl),                        Health Center (PHC)
                                               box 10 ampoules @ 2 ml

  1.2 NON-OPIOID ANALGESICS
  acetylsalicylic acid (acetosal) tablet 100 mg,
                                     box 10 blisters@10 tablets
                                  tablet 500 mg,
                                     box 10 blisters@10 tablets

 ibuprofen                                  tablet 200 mg,
                                               bottle 100 tablets
                                            tablet 400 mg,
                                               bottle 100 tablets

  methampyrone                              tablet 500 mg,                   Restricted use :
                                               bottle 1000 tablets           To reduce agranulocytosis

 paracetamol                                tablet 100 mg,
                                               bottle 1000 tablets
                                            tablet 500 mg,
                                               bottle 1000 tablets
                                            syrup 120 mg/5 ml,bottle 60 ml
                                            suppositoria 120 mg
                                            suppositoria 240 mg

  sodium diclofenac                         tablet 25 mg, box 10 stripes
                                               @ 10 tablets
                                            tablet 50 mg, box 10 stripes
                                               @ 10 tablets



National List of Essential Medicines 2008                                                                   63
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  1.3. MEDICINES USED TO TREAT GOUT
  allopurinol                               tablet 100 mg,                     Note :
                                               bottle 100/1000 tablets         - Blocks uric acid production
                                                                                 (in 35% of cases)
                                                                               - Not for acute attack

  probenecid                                tablet 500 mg,                     Note :
                                               bottle 100/1000 tablets         - Increases uric acid renal
                                                                                 excretion (in 35% patients)
                                                                               - Dosage 2 X ½ tablet,
                                                                                 increase water intake
                                                                               - Not for acute attack

  2. ANESTHETICS
  2.1 LOCAL ANESTHETICS
  ethyl chloride                            spray, bottle 100 ml               Note :
                                                                               Air tight package

  lidocaine                                 infiltr injection 1% (HCl),
                                               box 100 amps @ 2 ml
                                            p.v. injection 2% (HCl),
                                               box 100 ampoules @ 2ml
                                            gel 2%, tube 10 g
                                            spray 4%, bottle 50 ml

  2.2 GENERAL ANESTHETICS and OXYGEN
  ketamine                                  i.v. injection 10 mg/ml (as        Authority required :
                                                HCl), box 10 vial @ 20 ml      Used only for nursing PHC
                                            i.v. injection 50 mg/ml (as
                                                HCl), box 10 vial @ 20 ml

  oxygen                                    inhalation, gas in tube

  thiopental                                i.v. powder for injection 500      Authority required :
                                               mg/ampoule (as sodium           Used only for nursing PHC
                                               salt) (for dissolved in 20 ml
                                               WFI), box 25 ampoules

  2.3 MEDICINES USED FOR PREOPERATIVE MEDICATION PROCEDURES
  atropine                                  injection 1 mg/ml (sulfate),
                                               box 50 ampoules @ 1 ml
National List of Essential Medicines 2008                                                                  64
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  diazepam                                  tablet 5 mg,
                                               bottle 1000 tablet
                                            injection 5 mg/ml,
                                               box 100 ampoules @ 2 ml

  morphine                                  i.m./s.k./i.v. injection 10
                                               mg/ml (HCl/sulfate),
                                               box 10 ampoules @ 1 ml

  3. ANTIALLERGICS and MEDICINES USED IN ANAPHYLAXIS
  chlorpheniramine                          tablet 4 mg ( maleate),
                                               bottle1000 tablets
                                            injection 5 mg/ml (maleate),
                                               box 100 ampoules @ 1 ml

  dexamethasone                             injection 5 mg/ml (as sodium
                                               phosphate), box 100
                                               ampoules @ 1 ml

  diphenhydramine                           i.m. injection 10 mg/ml (HCl),
                                               box 100 ampoules @ 1 ml

  epinephrine (adrenaline)                  s.c./i.m. injection 0,1%          Note :
                                               (HCl/bitartrate),              - Drug of choice for
                                               box 100 ampoules @ 1 ml          anaphylactic reaction
                                                                              - Dosage 0,3 mg – 0,5 mg
                                                                                i.m. may be repeated

  4. ANTIDOTES and OTHER SUBSTANCES USED IN POISONING
  4.1 SPECIFIC
  atropine                                  i.m./i.v./s.c injection 1 mg/ml   Restricted use :
                                               (sulfate),                     - Caution on package: “only
                                               box 10 ampoules @ 2 ml           for antidotes (large dose)”
                                                                              - Used only for nursing PHC

  calcium folinic (leucovorin, Ca) tablet 1 mg, bottle 100 tablets

  sodium bicarbonate                        tablet 500 mg,
                                               bottle 1000 tablets

  sodium thiosulfate                        i.v. injection 25%,
                                                box 10 ampoules @ 10 ml

National List of Essential Medicines 2008                                                                65
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  4.2 NON-SPESIFIC
  active carbon                             activated powder, sacch 0,5 kg

  magnesium sulfate                         powder, sacch 30 g

  5. ANTIEPILEPTICS – ANTICONVULSANTS
  diazepam                   i.m./i.v. injection 5 mg/ml,
                                box 100 ampoules @ 2 ml
                             rectal sol 4 mg/ml, tube 2,5 ml

  phenobarbital                             tablet 30 mg,
                                                bottle 1000 tablets
                                            tablet 50 mg,
                                                bottle 1000 tablets
                                            tablet 100 mg,
                                                bottle 1000 tablets
                                            i.m injection 50 mg/ml,
                                                box 100 ampoules @ 2 ml
                                            i.v.injection 50 mg/ml (as
                                                sodium salt), box 100
                                                ampoules @ 2 ml

  phenytoin                                 capsule 30 mg (as sodium         Restricted used :
                                               salt), bottle 250 capsules    Specific     for   continued
                                            capsule 100 mg (as sodium        treatment for patient who
                                               salt), bottle 250 capsules    referred back to PHC
                                            injection 50 mg/ml (as sodium
                                               salt), box 10 ampoules
                                               @ 2 ml

  6. ANTI-INFECTIVE MEDICINES
  6.1 ANTHELMINTHICS
  6.1.1 Intestinal Anthelminthics
  mebendazole                     tablet 100 mg,
                                     bottle 100 tablets
                                  syrup 100 mg/5 ml,
                                     bottle 30 ml
  pyrantel                                  scored tablet 250 mg
                                              (pamoate),
                                              bottle 250 tablets
                                            suspension 125 mg/5 ml
                                              (pamoate), bottle 30 ml

National List of Essential Medicines 2008                                                              66
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  6.1.2 Antifilarials
  diethylcarbamazine                        scored tablet 100 mg (citrate),   Note :
                                              bottle 1000 tablets             For endemic area

  6.2 ANTIBACTERIALS
  6.2.1 Beta lactam medicines
  amoxicillin trihydrate                    scored tablet 500 mg,
                                               box 10 stripes @ 10 tablets
                                            dry syrup 125 mg/5 ml,
                                               bottle 60 ml

  ampicillin                                i.m./i.v. powder for injection
                                              250 mg/vial (as sodium
                                              salt), box 10 vials
                                            i.m./i.v. powder for injection
                                              500 mg/vial (as sodium
                                              salt), box 10 vials

  benzathine benzylpenicillin               i.m. injection 1,2 millions
                                               IU/ml, box 25 vials @ 4 ml
                                            i.m. injection 2.4 millions
                                               IU/ml, box 25 vials @ 10 ml

  benzylpenicillin crystal                  i.m./i.v. injection 10 millions
                                               IU/vial, box 25 vials

  phenoxymethylpenicillin                   tablet 500 mg (as potassium       Restricted used :
    (penicillin V)                             salt), bottle 1000 tablets     Not used for severe infection
                                            tablet 250 mg (as potassium
                                               salt), box 10 stripes
                                               @ 10 tablets
                                            dry syrup 250 mg/5 ml
                                               (as potassium salt),
                                               bottle 60 ml

  procaine benzylpenicillin                 powder for injection i.m. 3
                                              millions IU/vial,
                                              box 100 vials
                                            powder for injection i.m. 1
                                              million IU/vial,
                                              box 100 vials


National List of Essential Medicines 2008                                                                 67
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                   RESTRICTION
       NAME (INN)
  6.2.2 Other antibacterials
  6.2.2.1 Tetracycline
  oxytetracycline                           i.v. injection 250 mg/3 ml
                                                (HCl), box 10 ampoules
                                                @ 3 ml
                                            i.v. injection 50 mg/ml (HCl),
                                                box 10 vials @ 10 ml

  tetracycline                              capsule 250 mg (HCl),
                                              bottle 1000 capsules
                                            capsule 500 mg (HCl),
                                              box 10 stripes @ 10
                                              capsules

  6.2.2.2 Chloramphenicol
  chloramphenicol                           capsule 250 mg,
                                              bottle 1000 capsules
                                            suspension 125 mg/5 ml (as
                                              palmitate), bottle 60 ml

  6.2.2.3 Sulfa-Trimethoprim
  NLEM co-trimoxazole I (adult)             tablet, box 10 stripes
    combination of :                           @ 10 tablets
    sulfamethoxazole 400 mg
    trimethoprim      80 mg

  NLEM co-trimoxazole II                    tablet, bottle 100 tablets
    (paediatric) combination of:
    sulfamethoxazole 100 mg
    trimethoprim       20 mg

  sulfadiazine                              tablet 500 mg, bottle100
                                               tablets

  trimethoprim                              scored tablet 200 mg,
                                              bottle 100 tablets

  6.2.2.4 Macrolides
  erythromycin                              capsule 250 mg (as stearate),
                                              bottle 100 capsules
                                            syrup 200 mg/5 ml (as ethyl
                                              succinate), bottle 60 ml
National List of Essential Medicines 2008                                                  68
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  6.2.2.7 Specific Use
  metronidazole                             tablet 250 mg,
                                               bottle 100/1000 tabs
                                            tablet 500 mg,
                                               bottle 100/1000 tabs

  6.3 SPECIFIC ANTI-INFECTIVE MEDICINES

  6.3.1 Antileprosy medicines
  clofazimine, micronized                   oily capsule 100 mg,
                                               bottle 100 capsules

  dapsone                                   scored tablet 100 mg,
                                              bottle 1000 tablets

  6.3.2 Antituberculosis medicines
  ethambutol                                tablet 250 mg (HCl),
                                               bottle 100 tablets
                                            tablet 500 mg (HCl),
                                               bottle 100 tablets

  isoniazid                                 tablet 100 mg,
                                               bottle 1000 tablets
                                            tablet 300 mg,
                                               bottle 1000 tablets

  pyrazinamide                              tablet 500 mg,
                                               bottle 100 tablets

  rifampicin                                scored tablet 300 mg,           Restricted use :
                                               box 10 stripes @10 tablets   Only for tuberculosis and
                                            tablet 450 mg,                  leprosy
                                               box 10 stripes @10 tablets
                                            tablet 600 mg,
                                               box 10 stripes @10 tablets

  streptomycin                              powder for injection 1000       Note :
                                              mg/vial (as sulfate),         Special packaging
                                              box 100 vials




National List of Essential Medicines 2008                                                               69
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  combination of :                                                             Note :
    rifampicin                              caplet 150 mg; 75 mg               Dosage form and usage
    isoniazid                               tablet 150 mg; 50 mg               according to National
                                                                               Tuberculosis Program

  combination of :                                                             Note :
    rifampicin                              capl 150 mg                        Dosage form and usage
    isoniazid                               tablet 150 mg                      according to National
    ethambutol                              tablet 400 mg                      tuberculosis program.

  combination of :                                                             Note :
    rifampicin                              capl 150 mg; 75 mg;450 mg          Dosage form and usage
    isoniazid                               tablet 75 mg; 50 mg; 300 mg        according to National
    pyrazinamide                            tablet 400 mg; 150 mg;             tuberculosis program.
                                               500mg
  combination of :                                                             Note :
    rifampicin                              capl 150 mg; 450 mg                Dosage form and usage
    isoniazid                               tablet 75 mg; 300 mg               according to National
    pyrazinamide                            tablet 400 mg; 500 mg              tuberculosis program.
    ethambutol                              tablet 275 mg; 250 mg;
                                               500mg

  6.3.3 Urinary Antiseptics
  NLEM co-trimoxazole I (adult)             tablet, box 10 stripes
    combination :                              @ 10 tablets
    sulfamethoxazole 400 mg
    trimethoprim      80 mg

  nitrofurantoine                           scored tablet 100 mg,
                                              bottle 100 tablets

  trimethoprim                              scored tablet 200 mg,
                                              bottle 100 tablets

  6.4 ANTIFUNGAL MEDICINES
  6.4.1 Systemic
  griseofulvin, micronized                  scored tablet 250 mg,
                                              bottle 100 scored tablets

  nystatin                                  coated tablet 500,000 IU/tablet,
                                              bottle 100/1000 tablets
                                            suspension 100,000 IU/ml,
                                              bottle 12 ml
National List of Essential Medicines 2008                                                              70
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  6.4.2. Topical
   NLEM antifungal medicines                ointment, pot 30 g
    combination of:
    benzoic acid 6%
    salicylic acid 3%

  nystatin                                  vaginal tablet 100,000
                                              IU/tablet, box 10 stripes
                                              @ 10 tablets

  6.5 ANTIPROTOZOAL MEDICINES

  6.5.1 Antiamoebic and antigiardiasis medicines
  metronidazole                             tablet 250 mg,
                                               bottle 100 tablets
                                            tablet 500 mg,
                                               bottle 100 tablets

  6.5.2 Antimalarial medicines
  6.5.2.1 For prophylaxis
  chloroquine                               tablet 150 mg(as phosphate),
                                               bottle 1000 tablets

  6.5.2.2 For curative treatment
  NLEM antimalarial medicines               tablet, bottle 500 tablets      Restricted use :
    combination of :                                                        For specific area which
    pyrimethamine 25 mg                                                     already resistent to
    sulfadoxine      500 mg                                                 chloroquine (decided by
                                                                            District/Municipality Health
                                                                            Offices)

  artemether                                injection 80 mg/ml,
                                               box 6 ampoules @ 1 ml

  artesunate                                injection i.v./i.m. 60 mg/ml,
                                               box 8 vials @ 1 ml




National List of Essential Medicines 2008                                                                  71
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  combination of :
    artesunate     50 mg                    tablet, box 2 blisters @ 12
    amodiaquin 200 mg                          tablets (combipack)
                                            box 3 blisters @ 8 tablets

  chloroquine                               tablet 150 mg(as phosphate),
                                               bottle 1000 tablets
                                            syrup 50 mg/5ml, bottle 60 ml

  primaquine                                tablet 15 mg (as phosphate),
                                               bottle 1000 tablets

  quinine                                   tablet 222 mg (bisulfate),      Restricted use :
                                               bottle 1000 tablets          - Only for severe malaria
                                            i.v. injection 25% (as HCl),    - Used only for nursing PHC
                                                box 100 ampoules @ 2 ml

  7. ANTIMIGRAINE MEDICINES
  7.1 FOR PROPHYLAXIS
  dihydroergotamine                         tablet 2.5 mg (as mesilate),
                                               box 10 stripes@ 10 tablets

  7.2 FOR TREATMENT OF ACUTE ATTACK
  ergotamine              tablet 1 mg (tartrate),
                             bottle 100 tablets

  combination of :                          tablet, box 30/100 tablets
     ergotamine     1 mg
     caffeine      50 mg

  9. ANTIPARKINSONISM MEDICINES
  NLEM antiparkinsonism    tablet, bottle 100 tablets                       Authority required :
     medicines                                                              Parkinsonism diagnostic has
  combination of :                                                          to be ensured
     benserazide 25 mg
     levodopa 100 mg

  trihexyphenidyl                           tablet 2 mg (HCl), bottle 250   Authority required :
                                               tablets                      Parkinsonism diagnostic has
                                                                            to be ensured


National List of Essential Medicines 2008                                                                 72
      THERAPEUTIC
     CLASS, GENERIC                             DOSAGE FORM                   RESTRICTION
       NAME (INN)
  10. MEDICINES AFFECTING THE BLOOD

  10.1 ANTIANAEMIA MEDICINES
  cyanocobalamine                           injection 500 mcg/ml,
    (vitamin B12)                              box 100 ampoules @ 1 ml

  fe (II) sulfate 7 H20                     coated tablet 300 mg,
                                              bottle 1000 tablets
                                            syrup, bottle 60 ml
                                            drops, bottle

  folic acid                                tablet 1 mg,
                                               bottle 1000 tablets
                                            tablet 5 mg,
                                               bottle 1000 tablets

  10.2 MEDICINES AFFECTING COAGULATION
  phytomenadione (vitamin K1)               coated tablet 10 mg,
                                               bottle 1000 tablets
                                            injection 10 mg/ml,
                                               box 100 ampoules @ 1 ml
                                            i.m injection 2 mg/ml,        Dose :
                                               ampoule 1 ml               - New born baby dose 1 mg
                                                                          - Premature baby dose 0,5 mg

  12. DIAGNOSTIC AGENTS
  12.2 FUNCTION TEST
  12.2.3 Miscellaneous
  fluorescein                               eye drops 1% (sodium salt),
                                               bottle 5 ml
                                            eye drops 2% (sodium salt),
                                               bottle 5 ml
                                            injection 10%,
                                               box 1 ampoule @ 5 ml
                                            injection 20%,
                                               box 1 ampoule @ 5 ml

  12.3 SKIN TEST
  tuberculin protein (purified              i.c. injection 1:10,
     derivative)                                box 1 vial 2 ml


National List of Essential Medicines 2008                                                          73
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  13. ANTISEPTICS dan DISINFECTANTS
  13.1 ANTISEPTICS
  hydrogen peroxyde                         concentrate solution,            Storage :
                                              bottle 1000 ml                 - Storage in glass bottle with
                                                                               glass cap, air tight, saved
                                                                               from light
                                                                             - For diluted until 3%

  povidone-iodine                           sol 10%, bottle 1000 ml

  13.2 DISINFECTANTS
  calcium hypochlorite                      powder, sacch 20 g               ‘Samijaga’ program

  ethanol 70%                               sol, bottle 100 ml /1000 ml

  paraformaldehyde                          tablet 1 g, bottle 100 tablets
                                            sol 5%, bottle 1000 ml

  saponificated cresol 50%                  liquid, bottle 1000 ml
    (lysol)

  14. MEDICINES and DENTAL MATERIAL USED FOR ORAL HEALTH
  14.1 MEDICINES USED FOR DENTAL and ORAL HEALTH,
  NLEM dental anesthetics                   injection, box 20/50/100
    combination of:                            ampoules @ 2 ml
    lidocaine HCl 2%
    epinephrine     1 : 80,000

  calcium hydroxide                         paste, box 2 tubes

  chlorphenol camphor menthol               liquid, bottle 10 ml

  ethyl chloride                            spray 0,05-0,2 ml,               Note :
                                              bottle 100 ml                  Air tight package

  eugenol                                   liquid, bottle 10 ml

  fluorine                                  tablet 0,5 mg,                   Authority required :
                                               bottle 100 tablets            For PHC in specific area



National List of Essential Medicines 2008                                                                74
      THERAPEUTIC
     CLASS, GENERIC                               DOSAGE FORM                 RESTRICTION
       NAME (INN)
  lidocaine                                 injection 2% (HCl),
                                               box 100 ampoules @ 2 ml
                                            paste 5% (HCl), tube 10 g
                                            spray 15% (HCl), bottle 60 ml

  nystatin                                  suspension 100.000 UI/ml,
                                              bottle 12 ml

  14.2 DENTAL MATERIAL USED FOR ORAL HEALTH
  gelatin sponge           cubicles 1x1x1 cm, tin 50 pcs

  glass ionomer ART                         powder bottle10 g
     (Atraumatic Restorative                sol, bottle 6 g (4,8 ml)
     Treatment)                             cocoa butter 5 g

  gutta percha points                       box 120 sticks

  resin composite                           set

  root canal filling                        paste, bottle

  temporary filling                         sol and powder, bottle 100 g

  15. DIURETICS
  furosemide                                tablet 40 mg,
                                                bottle 250 tablets
                                            i.v./i.m. injection 10 mg/ml,
                                                box 25 ampoules @ 2 ml

  16. HORMONES, OTHER ENDOCRINE MEDICINES and CONTRACEPTIVES
  16.2 ANTIDIABETIC
  16.2.1 Oral Antidiabetic
  glibenclamide                             tablet 2,5 mg, bottle 100
                                               tablets
                                            tablet 5 mg, bottle 100 tablets

  metformin                                 tablet 500 mg, bottle 100
                                               tablets




National List of Essential Medicines 2008                                                   75
      THERAPEUTIC
     CLASS, GENERIC                                DOSAGE FORM                   RESTRICTION
       NAME (INN)
  16.3 SEX HORMONE and FERTILITY RELATED MEDICINES
  16.3.4 Contraceptives                                                      Note :
                                                                             According to National Family
  16.3.4.1 Oral Hormonal Contraceptives                                      Planning Program
                                                                             coordinated by BKKBN
  combination :                             pill
    levonorgestrel              150 mcg
    ethinylestradiol             30 mcg

  16.3.4.2 Injectable Hormonal Contraceptives
  medroxyprogesterone                       depot injection 150 mg
    acetate

  16.3.4.3 Intra-uterine Devices
  Copper - containing device     set / pcs

  16.4 THYROID and ANTITHYROID HORMONES
  lugol solution           bottle 30 ml                                      Note :
                                                                             Dilute before use

  propylthiouracyl                          scored tablet 100 mg,
                                              bottle 1000 tablets

  16.5 CORTICOSTEROID HORMONES
  dexamethasone                             tablet 0,5 mg,
                                               bottle 1000 tablets
                                            injection 5 mg/ml (as sodium
                                               phosphate),
                                               box 100 ampoule @ 1 ml

  hydrocortisone                            tablet 10 mg
                                            powder for injection 100
                                               mg/vial (sodium succinate),
                                               box 100 vial @ 2 ml

  prednisone                                tablet 5 mg,                     Note :
                                               bottle 1000 tablets           Second line used after
                                                                             dexamethasone




National List of Essential Medicines 2008                                                               76
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  17. CARDIOVASCULAR MEDICINES
  17.1 ANTI-ANGINAL MEDICINES
  atenolol                                  tablet 50 mg, box 10 stripes
                                               @ 10 tablets

  isosorbide dinitrate                      sublingual tablet 5 mg,
                                              bottle 60 tablets

  17.2 ANTIARRHYTHMIC MEDICINES
  propranolol              tablet 10 mg (HCl),
                               bottle 100 tablets
                           i.v. injection 1 mg/ml (HCl),
                               box 10 ampoules @ 1ml

  17.3 ANTIHYPERTENSIVE MEDICINES
  captopril                                 scored tablet 12.5 mg,          Caution :
                                              box 10 stripes @ 6 tablets    - Not for pregnant women
                                            scored tablet 25 mg, box 10     - Having cough side effect
                                              stripes @ 6 or 10 tablets

  hydrochlorothiazide                       tablet 25 mg,
                                               bottle 100 tablets

  17.4 PLATELET ANTIAGGREGATION
   acetylsalicylic acid (acetosal)          tablet 80 mg, box 10 blisters
                                               @ 10 tablets

  17.6 MEDICINES USED IN HEART FAILURE
  captopril                                 scored tablet 12.5 mg, box 10   Caution :
                                              stripes @ 10 scored tablets   - Not for pregnant women
                                            scored tablet 25 mg, box 10     - Having cough side effect
                                              stripes @ 10 scored tablets

  digoxin                                   tablet 0.0625 mg,               Pediatric dose :
                                               bottle 100 tablets           Tablet 0,0625 mg for
                                            tablet 0.25 mg,                 pediatrics
                                               bottle 100 or 1000 tablets
                                            injection 0.25 mg/ml,
                                               box 1 ampoule @ 2 ml


National List of Essential Medicines 2008                                                                77
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  furosemide                                tablet 40 mg, box 20 stripes
                                               @ 10 tablets
                                            injection i.v./i.m. 10 mg/ml,
                                               box 25 ampoules @ 2 ml

  17.7 MEDICINES USED for SHOCK ATTACK,

  17.7.1 Medicines used for cardiogenic shock
  epinephrine (adrenaline)                  injection i.v. 0,1 %
                                               (as HCl/ bitartrate),
                                               box 100 ampoules @ 1 ml

  17.8 LIPID-LOWERING AGENTS
  simvastatin                               scored tablet 10 mg,
                                               box 30 scored tablets

  18. DERMATOLOGICAL MEDICINES
  18.2 ANTI-INFECTIVE MEDICINES
  NLEM anti-infective medicines             ointment, tube 5 g
    combination of :
    bacitracin      500 IU/g
    polymixin B 10,000 IU/g

  18.3 ANTIFUNGAL MEDICINES
  NLEM antifungal medicines                 ointment, pot 30 g              Note :
    combination of :                                                        General antifungal ointment
    benzoic acid 6%
    salicylic acid 3%

  sodium thiosulfate                        liquid 25%, bottle 30 ml

  18.4 ANTI-INFLAMMATORY and ANTIPRURITIC MEDICINES
  betamethasone                             ointment 0.1% (as valerate),
                                               tube 5 g
                                            cream 0.1% (as valerate),
                                               tube 5 g

  hydrocortisone                            cream 2.5% (acetate),
                                               tube 5 g


National List of Essential Medicines 2008                                                                 78
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                    RESTRICTION
       NAME (INN)
  18.5 SCABICIDES and PEDICULICIDES
  2-4 ointment,                             ointment, pot 30 g
     combination of :
     salicylic acid       2%
     sulfur precipitate 4 %

  18.6 CAUSTIC MEDICINES
  silver nitrate                            sol 20%, bottle 10 ml         Note :
                                                                          For hypergranulation

  18.7 MEDICINES AFFECTING SKIN DIFFERENTIATION and PROLIFERATION
  coal tar                                  sol 5 %, bottle 100 ml

  podophyllum resin                         alcoholic sol 25 %,           Authority required :
                                               bottle 30 ml               - Should be applicated by
                                                                            practitioners
                                                                          - Should be cleaned 1-4
                                                                            hours after used, make
                                                                            sure that no residues
                                                                          - Only for severe thickening,
                                                                            causing danger of
                                                                            absorptions
                                                                          - Not for pregnant women
                                                                            because of terratogenic
                                                                            effect
                                                                          - Not for use by patients
                                                                          - Not for take away home

  salicylic acid                            ointment 2%, pot 30 g
                                            ointment 5%, pot 30 g
                                            ointment 10%, pot 30 g

  18.8 MISCELLANEOUS
  liquor carbonis detergents                suspension 2%, bottle 30 ml
                                            suspension 5%, bottle 30 ml

  liquor faberi                             liquid

  salicyl powder                            powder 2%, box 100 g



National List of Essential Medicines 2008                                                             79
      THERAPEUTIC
     CLASS, GENERIC                             DOSAGE FORM                       RESTRICTION
       NAME (INN)
  20. ELECTROLYTE, NUTRITION SOLUTIONS, and OTHERS
  20.1 ORAL
  oral rehydration salts                     powder, 100 sacch                - Drink slowly to prevent
   combination of :                            each sacch for 200 ml            vomiting
   sodium chloride                  0.52 g     water                          - 1 sacchet to be dissolved
   potassium chloride               0.30 g                                      in 200 ml water
   trisodium citrate
       dihydrate                    0.58 g
   anhydric glucose                 2.70 g

  sodium bicarbonate                         tablet 500 mg, bottle 1000
                                               tablets

  20.2 PARENTERAL
  glucose                                    infusion sol 5%, bottle 500 ml
                                             infusion sol 10%,
                                                bottle 500 ml
                                             infusion sol 40%, bottle 25 ml

  ringer lactate                             infusion sol, bottle 500 ml

  sodium chloride                            infusion sol 0.9%,               Note :
                                                 bottle 500 ml                - Need to check sodium
                                             infusion sol 3%, bottle 500 ml     level
                                             injection 15%, vial 50 ml        - Used only for nursing PHC

  20.3 MISCELLANEOUS
  water for injections                       box, ampoule/vial @ 10
                                                ml/20 ml

  21. OPHTHALMOLOGICAL PREPARATION
  21.1. LOCAL ANESTHETICS
  tetracaine              eye drops 0.5% (HCl),
                             bottle 5 ml

  21.2 ANTI-INFECTIVE AGENTS
  oxytetracycline                            eye ointment 1% (HCl),
                                               tube 3.5 g

  sulfacetamide                              eye drops 15% (sodium),
                                               bottle 5 ml

National List of Essential Medicines 2008                                                                   80
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                     RESTRICTION
       NAME (INN)
  21.4 MYDRIATICS
  atropine                                  eye drops 0.5% (sulfate),
                                              bottle 5 ml
                                            eye drops 1% (sulfate),
                                              bottle 5 ml

  21.5 MIOTICS and ANTIGLAUCOMA MEDICINES
  pilocarpine               eye drops 2% (HCl/nitrate),
                              bottle 5 ml
                            eye drops 4% (HCl/nitrate),
                              bottle 5 ml

  22. OXYTOCICS and UTERIC RELAXANTS

  22.1 OXYTOCICS
  methyl ergometrine                        coated tablet 0.125 mg
                                               (maleate), bottle 100 tablets
                                            injection 0.200 mg/ml,
                                               box 100 ampoules @ 1 ml

  oxytocin                                  injection 10 IU/ml,
                                               box 100 ampoules @ 1 ml

  23. PSYCHOTHERAPEUTIC MEDICINES
  23.1 MEDICINES USED in GENERALIZED ANXIETY and SLEEP DISORDERS
  diazepam                                  tablet 2 mg,
                                               bottle 1000 tablets
                                            tablet 5 mg,
                                               bottle 1000 tablets
                                            i.m. injection 5 mg/ml,
                                               box 100 ampoules @ 2 ml

  23.2 MEDICINES USED in DEPRESSIVE DISORDERS
  amitriptyline             coated tablet 25 mg (HCl),
                              box 10 blisters@10 tablets

  23.3 MEDICINES USED for OBSESSIVE COMPULSIVE DISORDERS
  clomipramine                              tablet 25 mg (HCl),
                                               bottle 1000 tablets


National List of Essential Medicines 2008                                                    81
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  23.4 MEDICINES USED in PSYCHOTIC DISORDERS
  chlorpromazine            coated tablet 25 mg (HCl),
                               bottle 1000 tablets
                            coated tablet 100 mg (HCl),
                               bottle 1000 tablets
                            i.m. injection 25 mg/ml (HCl),
                               box 100 ampoules @ 1 ml

  haloperidol                               tablet 0.5 mg,                  Note :
                                               bottle 100/1000 tablets      - Second generation
                                            tablet 1.5 mg,                    antipsychotic
                                               bottle 100/1000 tablets      - Specific for PHC which
                                            tablet 2 mg, box 100 tablets      integrated to mental health
                                            tablet 5 mg,                      care
                                               bottle 100/1000 tablets
                                            drops 2 mg/ml,
                                               bottle 15 ml/100 ml
                                            i.m. injection 2 mg/ml (HCl),
                                               box 5 ampoules @ 1 ml
                                            i.m. injection 5 mg/ml (HCl),
                                               box 5 ampoules @ 1 ml
                                            injection 50 mg/ml (as
                                               decanoate),
                                               box 5 ampoules @ 1 ml
                                               (long acting)

  25. GASTROINTESTINAL MEDICINES

  25.1 ANTACIDS and OTHER ANTIULCER MEDICINES
  NLEM antacid I              chewable tablet,
   combination of:              bottle 1000 tablets
   aluminium hydroxide 200 mg
   magnesium hydroxide 200 mg

  NLEM antacid II                           suspension, bottle 60 ml
   combination of :
   aluminium
      hydroxide 200 mg/5 ml
   magnesium
      hydroxide 200 mg/5 ml




National List of Essential Medicines 2008                                                               82
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                       RESTRICTION
       NAME (INN)
  25.2 ANTIEMETIC MEDICINES
  chlorpromazine                            coated tablet 25 mg (HCl),
                                               bottle 1000 tablets
                                            i.m. injection 25 mg/ml (HCl),
                                               box 100 ampoules @ 1 ml
                                            i.m injection 5 mg/ml (HCl),
                                               box 100 ampoules @ 2 ml

  dimenhydrinate                            tablet 50 mg, bottle 1000        Note :
                                               tablets                       - Adult dose : ½ - 1 tablet
                                                                             - Use ½ - 1 hour before
                                                                               meals to get better efficacy
  25.3 ANTIHAEMORRHOID MEDICINES
  NLEM antihaemorrhoid         suppositoria, box 100 supp
    combination of :
    bismuth subgallate 150 mg
    hexachlorophene      2.5mg
    lidocaine           10 mg
    zinc oxide         120 mg
    supp             to 2 g

  25.4 ANTISPASMODIC MEDICINES
  atropine                 tablet 1 mg (sulfate),
                              tin 100 tablets
                           i.m./i.v./s.c. injection 0.25
                              mg/ml (sulfate),
                              box 100 ampoules @ 1 ml
                           i.m./i.v./s.c. injection 1 mg/ml
                              (sulfate),
                              box 50 ampoules @ 1 ml

  belladonna extract                        tablet 10 mg,
                                               bottle 100/1000 tablets

  25.5 MEDICINES USED IN DIARRHOEA
  oral rehydration salts        powder, 100 sacchs,                          - Drink slowly to prevent
   combination of :               each sacch for 200 ml of                     vomiting
   sodium chloride       0.52 g   water                                      - 1 sachet to be dissolved in
   potassium chloride 0.30 g                                                   200 ml of water
   trisodium citrate
       dihydrate         0.58 g
   anhydric glucose      2.70 g
National List of Essential Medicines 2008                                                                 83
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                  RESTRICTION
       NAME (INN)
  25.6 CATARTIC MEDICINES
  glycerine                                 liquid, bottle 100 ml

  26. MEDICINES ACTING ON RESPIRATORY TRACT

  26.1 ANTIASTHMATIC
  dexamethasone                             tablet 0.5 mg,
                                                bottle 1000 tablets
                                            i.v. injection 5 mg/ml (as
                                                sodium phosphate),
                                                box 100 ampoules @ 1 ml

  ephedrine                                 tablet 25 mg (HCl),
                                               bottle 1000 tablets

  epinephrine (adrenaline)                  injection 0.1 % (as
                                               HCl/bitartrate), box 100
                                               ampoules @ 1 ml

  salbutamol                                tablet 2 mg (as sulfate),
                                               bottle 100/1000 tablets
                                            tablet 4 mg (as sulfate),
                                               bottle 100/1000 tablets

  26.2 ANTITUSSIVES
  codeine                                   tablet 10 mg (HCl/phosphate),
                                               bottle 250 tablets

  dextromethorphan                          tablet 15 mg (HBr),
                                               bottle 1000 tablets
                                            syrup 10 mg/5 ml (HBr),
                                               bottle 60 ml

  26.3 EXPECTORANT
  glyceryl guaiacolate                      syrup 25 mg/5 ml,bottle 60 ml
                                            tablet 100 mg,
                                               bottle 1000 tablets

  obat batuk hitam (OBH)                    liquid, bottle 200 ml
                                            concentrate liquid,
                                               bottle 1000 ml


National List of Essential Medicines 2008                                                 84
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                         RESTRICTION
       NAME (INN)
  27. IMMUNOLOGICALS
  27.1 SERA and IMMUNOGLOBULINS
  antidiphtheria sera (A.D.S)               i.m. injection 10,000 IU/vial,     Note :
                                               box 10 vials @ 5 ml             - Storage at 2-8º C
                                            i.m. injection 20.000 IU/vial,
                                               box 10 vials @ 10 ml

  antirabies sera                           i.m. injection 100 IU/ml,          Indication :
                                               box 10 vial @ 20 ml             - For post-exposure treatment
                                                                                 in rabies area
                                                                               - Storage at 2-8º C

  antitetanus sera (A.T.S)                  for prophylaxis :                  Note :
                                            i.m. injection 1500                - Storage at 2-8º C
                                               IU/ampoule
                                               box 10 ampoules @ 1 ml
                                            for curative treatment :
                                            i.m./i.v. injection 10,000
                                               IU/ampoule,
                                               box 10 ampoules @ 2 ml
                                            i.m./i.v injection 20,000
                                               IU/vial, box 10 vials@ 4 ml

  snake antivenom sera                      i.m./i.v. injection, box 10 vial   Note :
    snake antivenom special                    @ 5 ml                          - Only for specific area
     for snake from outside                                                    - Storage at 2-8º C.
     papua
    snake antivenom special
     for papua snake

  27.2 VACCINES
  BCG vaccine                               i.c. injection,                    Note :
                                                box 5 ampoules @ 2 ml          - Storage below 5º C
                                            i.c. injection,
                                                box 5 ampoules @ 4 ml

  diphtheria, pertusis and                  i.m injection,                     Note :
     tetanus adsorbed vaccine                  box 10 vial @ 5 ml              - Storage at 2-8º C
     (DPT)

  hepatitis B vaccine                       injection 20 mcg/ml,               Note :
    (recombinant)                              box 1 vial 0.5; 1 ml            - Storage at 2-8º C

National List of Essential Medicines 2008                                                                 85
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                        RESTRICTION
       NAME (INN)
  measles vaccine                           s.c. injection, box 10 vials      Note :
                                               (10 doses) @ 5 ml              - Storage at 2-8º C

  poliomyelitis vaccine                     drops, box vial 10/20 doses       Note :
                                                                              - Storage at 2-8º C

  rabies vaccine (human)                    s.c./i.c. powder for injection,   Indication :
                                               box 7 vial @ 1 dose + 7        - Storage at 2-8º C
                                               ampoules solvent @ 2 ml        - Use for pre-exposure and
                                            booster : box 5 ampoules @          post-exposure treatment in
                                               1 dose + 5 ampoules              rabies area
                                               solvent @ 4 ml

  tetanus adsorbed vaccine                  i.m. injection, box 1 vial 5 ml   Note :
     (tetanus adsorbed toxoid)                                                - Storage at 2-8º C

  tetanus and diphteria                     i.m. injection,                   Note :
     adsorbed vaccine (TD)                     box 10 vial @ 5 ml             - Storage at 2-8º C

  28. MEDICINES USED FOR EAR, NOSE and THROAT
  carboglycerine           ear drops 10 %, bottle 5 ml

  29. VITAMINS and MINERALS
  ascorbic acid             tablet 50 mg,
                               bottle 1000 tablets

  calcium lactate                           tablet 500 mg,
                                               bottle 1000 tablets

  pyridoxine                                tablet 10 mg (HCl),
                                               bottle1000 tablets
                                            tablet 25 mg (HCl),
                                               bottle 1000 tablets

  retinol                                   tablet 5000 IU,
                                               bottle 1000 tablets
                                            soft capsule 50,000 IU,
                                               bottle 50 capsules
                                            soft capsule 100,000 IU,
                                               bottle 50 capsules
                                            soft capsule 200,000 IU (as
                                               palmitate),
                                               bottle 50 capsules

National List of Essential Medicines 2008                                                                86
      THERAPEUTIC
     CLASS, GENERIC                            DOSAGE FORM                      RESTRICTION
       NAME (INN)
  thiamine                                  tablet 50 mg (HCl),
                                               bottle 1000 tablets

  vitamin B complex                         tablet, bottle 1000 tablets




                                                                           Minister of Health




                                                                 Dr. dr. SITI FADILAH SUPARI, SpJP (K)




National List of Essential Medicines 2008                                                            87
                                 CHANGES OF NLEM 2005


                                                                                ADDITION (+),
                                                                                DELETION (-),
                 GENERIC NAME
   NO                                           DOSAGE FORM                     CHANGE OF
                     (INN)
                                                                                  DOSAGE
                                                                                   FORM
     1         acetazolamide               tablet 250 mg, bottle 100 tablets    Moved to other
                                           i.m/i.v. powder for injection, 500   therapeutic sub-
                                             mg/vial (as sodium salt),          class
                                             box 10 vials + 10 ampoules
                                             water for injection @ 5 ml

     2         active carbon               activated powder, sacch 0.5 kg       Change of generic
                                                                                name

     3         alprazolam                  tablet 0.25 mg,                               −
                                             box 10 stripes @ 10 tablets
                                           tablet 0.5 mg,
                                             box 10 stripes @ 10 tablets

     4         amiloride                   tablet 5 mg (HCl),                            −
                                             bottle 100 tablets

     5         amiodarone                  tablet 200 mg, box 30 tablets                 +
                                           injection 150 mg/3 ml,
                                             box 6 ampoules @ 3 ml

     6         amphotericin *)             i.v injection vial 50 mg/10 ml,               +
                                              vials @ 10 ml

     7         antitetanus              i.m. injection 500 UI, vial                      +
                 immunoglobulin (human)

     8         artesunate                  i.v/i.m injection 60 mg/ml,                   +
                                              box 8 vials @ 1 ml

     9         atracurium                  injection 25 mg/2,5 ml,                       +
                                             ampoule 2,5 ml

    10         benzoil peroxyde            gel 2.5%, tube 5 g                            −
                                           gel 5%, tube 5 g




National List of Essential Medicine 2008
                                                                                                    88
                                                                                                    88
                                                                                 ADDITION (+),
                                                                                 DELETION (-),
                 GENERIC NAME
    NO                                          DOSAGE FORM                      CHANGE OF
                     (INN)
                                                                                   DOSAGE
                                                                                    FORM
     11        benzylpenicilin             eye ointment 1.000 IU/g, tube 5 g           −

     12        betamethasone               eye drop 1 mg/ml (sodium),                  +
                                             bottle 5 ml

     13        bupivacaine                 infiltrate injection 0.25% (HCl),           −
                                             box 5 vial @ 20 ml

     14        carbamazepine               chewable tablet 100 mg                      +
                                           syrup 100 mg/5 ml, bottle 120 ml

     15        cefazolin                   powder for injection 1 g / vial,            +
                                             box 2 vials

     16        ceftriaxone                 powder injection 1 g / vial,                +
                                             box 2 vials

     17        chlorambucyl                tablet 2 mg                                 +

     18        chloramphenicol             ear drop 3 %, bottle 5 ml                   −

     19        chlorhexidine               sol 1.5 % (gluconate), bottle 2.5 l         −
                                           sol 4.0 % (gluconate), bottle 2.5 l

     20        chlorhexidine               sol 5.0% (gluconate), bottle 2.5 l          +

     21        chlormethine                powder injection 10 mg/vial                 −
                                             (HCl), box 1 vial

     22        clomiphen                   tablet 50 mg (citrate),                     −
                                              bottle 10 tablets

     23        clomipramine                tablet 10 mg (HCl),                         −
                                              bottle 250 tablets

     24        clozapine ∗ )               tablet 25 mg, box 50 tablets                +
                                           tablet 50 mg, box 50 tablets



∗
    Complementary list


National List of Essential Medicine 2008
                                                                                            89
                                                                                            89
                                                                                     ADDITION (+),
                                                                                     DELETION (-),
                 GENERIC NAME
   NO                                                   DOSAGE FORM                  CHANGE OF
                     (INN)
                                                                                       DOSAGE
                                                                                        FORM
    25         codeine                             tablet 10 mg (phosphate),         Change of dosage
                                                     bottle 250 tablet               strength and
                                                                                     packaging
    26         colchicine                          tablet 500 mcg,                           −
                                                     box 3 stripes @ 10 tablets
    27         combination of:                     tablet, box 30/100 tablets                +
                  ergotamine                1 mg
                  caffeine                 50 mg
    28         combination of:                     capsule                                   −
                extr. apii herba 92 mg
                extr. ortosiphonis folium
                                  28 mg
    29         compound thymi syrup                liquid, bottle 100 ml                     −

    30         copper –containing device           set / pcs                                 +

    31         daunorubicin                        powder injection 20 mg/vial               +
                                                   (HCl), box 1 vial @ 4 ml
    32         desmopressin                        spray                             Change of dosage
                                                                                     form
    33         devitalization paste (non           paste, bottle                             −
                arsen)
    34         dextran 70                          Infus sol 6%, bottle 500 ml               −

    35         dextrose                            infusion solution 5 %,                    +
                                                     bottle 500 ml

    36         diethylcarbamazine                  scored tablet 100 mg (citrate),   Change of dosage
                                                     bottle 1000 tablet              strength

    37         digoxin                             tablet 0.0625 mg,                         +
                                                     bottle 100 tablets
                                                   tablet 0.25 mg,
                                                     bottle 100 tablets
                                                   injection 0.25 mg/ml;
                                                     box 1 ampoule 2 ml



National List of Essential Medicine 2008
                                                                                                        90
                                                                                                        90
                                                                                 ADDITION (+),
                                                                                 DELETION (-),
                 GENERIC NAME
   NO                                           DOSAGE FORM                      CHANGE OF
                     (INN)
                                                                                   DOSAGE
                                                                                    FORM
    38         diloxanide                  tablet 500 mg (furoate)                        +

    39         disodium edetate            eye drop 0.35%, bottle 5 ml                    −

    40         dobutamine                  injection 50 mg/ml, vial 5 ml                  +
                                           injection 25 mg/ml,       ampoule
                                             10 ml
    41         edrofonium                  injection i.v. 10 mg/ml (chloride),            −
                                             box 10 vial @ 10 ml

    42         efavirenz                   tablet 200 mg, bottle 90 tablets      Change of
                                           tablet 600 mg, bottle 30 tablets      therapeutic sub-class
                                                                                 and dosage form

    43         enflurane                   inhalation liquid, bottle 250 ml               −

    44         etacridine (rivanol)        solutio 0.1 %, bottle 300 ml                   −
                                           powder, bottle 100 g

    45         ethosuccimide               capsule 250 mg,                                −
                                             bottle 100/1000 capsules
                                           syrup 250 mg/5 ml, bottle 60 ml

    46         ethyl ester from oleum      i.a./i.v. injection 1 ml                       −
                 iodized papaveris            consist of 0,96 ml
                 (iodized oil)                (equivalent with 0.48 g iodine),
                                              box 1 ampoule 10 ml

    47         etonogestrel                implant 1 rods (3 yrs)                         −

    48         fe (II) sulfate 7H2O        syrup, bottle 60 ml                            +

    49         fentanyl                    i.m./i.v. injection 0.05 mg/ml        Change of
                                              (citrate),                         packaging
                                              box 5 ampoules @ 2 ml
    50         fluoxetine                  capsule/tablet 10 mg,                          +
                                             box 30 tablets
                                           capsule/tablet 20 mg,
                                             box 30 tablets



National List of Essential Medicine 2008
                                                                                                   91
                                                                                                   91
                                                                               ADDITION (+),
                                                                               DELETION (-),
                 GENERIC NAME
   NO                                           DOSAGE FORM                    CHANGE OF
                     (INN)
                                                                                 DOSAGE
                                                                                  FORM
    51         framicetin                  sterile kassa 1% (sulfate),                  −
                                             box 10 pieces

    52         gamexan                     cream 1%, bottle 30 ml                       −

    53         gelatin spons               layer 5 x 7 x 1 cm                           −

    54         gentian violet              sol 1%, bottle 10 ml                         −

    55         haloperidol                 i.m. injection 2 mg/ml (HCl)        Change of salt form
                                              box 5 ampoules @ 1 ml
                                           i.m. injection 5 mg/ml (HCl)
                                              box 5 ampoules @ 1 ml

    56         hydrochlorothiazide         tablet 25 mg, bottle 1000 tablets            +

    57         hydrocortisone              tablet 10 mg                                 +

    58         hydrocortisone              cream 1% (acetate), tube 5 g                 −

    59         hydrocortisone acetate      eye drop 1%, bottle 5 ml                     −

    60         intermediate insulin        injection 40 IU/ml,                          −
                                              box 1 vial 10 ml

    61         iodine                      injection 480 mg/ml,                         −
                                             box 1 ampoule 10 ml

    62         iodoform paste              paste                                        −

    63         isoflurane                  inhalation liquid, bottle 250 ml             +

    64         isoprenaline                injection 1mg/ml (HCl),                      −
                                             box 1 ampoule 2 ml

    65         ketoprofen                  suppositoria 100 mg                          +

    66         levamisole                  tablet 50 mg (HCl),                          −
                                             box 4 bls @ 9 tablets




National List of Essential Medicine 2008
                                                                                                92
                                                                                                92
                                                                                  ADDITION (+),
                                                                                  DELETION (-),
                 GENERIC NAME
   NO                                               DOSAGE FORM                   CHANGE OF
                     (INN)
                                                                                    DOSAGE
                                                                                     FORM
    67         levertrane                      ointment 5%                                −

    68         levonorgestrel                  pill 75 mcg, 150 mcg                       −

    69         levonorgestrel                  implant 6 rods (5 yrs)                     −

    70         lidocaine                       injection 5% + glucose 7.5 %,              +
                                                 ampoule 2 ml

    71         lidocaine                       injection 1% (HCl) + epinephrine           −
                                                  1 : 200,000,
                                                  box 10 vials @ 30 ml
                                               injection 2% (HCl) + epinephrine
                                                  1 : 200,000,
                                                  box 10 vials @ 20 ml

    72         liquor faberi                   liquor with menthol 0,1%                   −
                                               liquor with menthol 0,5%

    73         liquor veilli (salicylic acid   solution                                   +
                  solution 0.1 %)
                  combination of :
                  salicylic acid 0.1 %
                  boric acid          0.5 %
                  glycerine         10 %

    74         lisinopril                      tablet 5 mg,                               −
                                                 box 3 stripes @ 10 tablets
                                               tablet 10 mg,
                                                 box 3 stripes @ 10 tablets
                                               tablet 20 mg,
                                                 box 3 stripes @ 10 tablets

    75         lithium carbonate               tablet 200 mg,                     Change of dosage
                                                 box 10 stripes @ 10 tablets      strength

    76         lopinavir                       tablet                                     +

    77         lotio kummerfeldi               liquid, packaging as needed                −




National List of Essential Medicine 2008
                                                                                                 93
                                                                                                 93
                                                                               ADDITION (+),
                                                                               DELETION (-),
                 GENERIC NAME
    NO                                            DOSAGE FORM                  CHANGE OF
                     (INN)
                                                                                 DOSAGE
                                                                                  FORM
     78        mannitol                      infusion sol 20%, bottle 500 ml            −
     79        melphalan                     tablet 2 mg                                +
     80        meningococcus                 powder injection,                          −
                polysaccharide A + C          box 10 vials @ 10 dosage +
                vaccine                       10 ampoules solvent @ 5 ml

     81        methampyrone                  i.m. injection 250 mg/ml,                  −
                                               box 25 vials @ 10 ml
                                               box 100 ampoules @ 2 ml

     82        methyl cellulose,             sol 2 %, bottle 5 ml              Change of
                 changed to be                                                 therapeutic sub-
               combination of                                                  class and the
                 hydroxypropyl methyl-                                         composition is
                 cellulose        5 mg                                         written completely
                 dextran (70)     1 mg
                 glycerine        2 mg
               benzalkonium chloride
               0.01% w/v
     83        (dl) methylphenidate ∗ )      regular release tablet 10 mg,              +
                                                box 30 tablets
                                             extended release tablet 20 mg,
                                                box 30 tablets

     84        methyl prednisolone           tablet 4 mg, bottle 100 tablets            −

     85        metoclopramide                syrup 5 mg/5 ml, bottle 50 ml              +
                                             drop 0.1 mg/drop, bottle 10 ml

     86        midazolam                     i.v. injection 1 mg/ml                     +
                                             i.v. injection 5 mg/ml

     87        NLEM nutritious solution I    infusion sol, bottle 500 ml                −

     88        NLEM nutritious solution II   infusion sol, bottle 500 ml                −



∗
    Complementary list


National List of Essential Medicine 2008
                                                                                                    94
                                                                                                    94
                                                                                ADDITION (+),
                                                                                DELETION (-),
                 GENERIC NAME
   NO                                             DOSAGE FORM                   CHANGE OF
                     (INN)
                                                                                  DOSAGE
                                                                                   FORM
    89         NLEM nutritious solution III infusion sel, bottle 500 ml               −

    90         NLEM nutritious solution IV infusion sel, bottle 500 ml                −

    91         NLEM nutritious solution V   infusion sel, bottle 500 ml               −

    92         NLEM otic medicine            ear drop, bottle 5 ml                    −
                combination of:
                neomycin sulfate 500 mg
                polymixin B sulfate
                   1.000.000 IU/100 ml
    93         neomycin                     tablet 500 mg, bottle 100 tablets         −

    94         nicotinamide                 tablet 100 mg                             +
    95         norepinephrine               injection 4 mg/ml, ampoule 2 ml           +

    96         nutritious solution      infusion sol, bottle 500 ml                   +
                 combination of :
                 glucose           4%
                 sodium chloride 0.18 %
    97         oral rehydration salts       powder, 100 sacch, each sacch             −
                                              for 1000 ml of water

    98         pancuronium                  i.v. injection 2 mg/ml (bromide),         −
                                               box 10 ampoules @ 2 ml

    99         paracetamol                  suppositoria 120 mg                       +
                                            suppositoria 240 mg

   100         patent blue V                s.c. injection 2.5%,                      −
                                              box 1 ampoule 2 ml

   101         permethrin                   cream 5%, tube                            +

   102         perphenazin                  tablet 4 mg (HCl),                        −
                                              bottle 100/1000 tablets
                                            tablet 16 mg (HCl),
                                            bottle 100/1000 tablets



National List of Essential Medicine 2008
                                                                                           95
                                                                                           95
                                                                                 ADDITION (+),
                                                                                 DELETION (-),
                 GENERIC NAME
   NO                                           DOSAGE FORM                      CHANGE OF
                     (INN)
                                                                                   DOSAGE
                                                                                    FORM
   103         phenobarbital               tablet 50 mg, bottle 1000 tablets              +

   104         phenol liquid               bottle 10 ml                                   −

   105         phenytoin                   syrup 50 mg/5 ml, bottle120 ml                 +

   106         phytomenadione              i.m injection 2mg/ml,                          +
                                              ampoule 1 ml

   107         piridostigmine              tablet 10 mg (bromide),                        −
                                             box 10 stripes/bls @ 10 tablets

   108         policresulen (metacresol    liquid, bottle 10 ml / 50 ml          Moved to other
                 sulphonate & methanal                                           therapeutic class
                 condensate)

   109         prednisolon                 eye drop 0,5%, bottle 5 ml                     −
                                           eye ointment 1%, tube 3,5 g

   110         procainamide                injection 100 mg/ml (HCl)                      −

   111         propranolol                 scored tablet 40 mg (HCl),                     +
                                             bottle 100 tablets

   112         propyliodone                injection in oil 500-600 mg/ml,                −
                                              box 1 ampoule 20 ml

   113         propylthiouracyl            tablet 100 mg, bottle 1000 tablets    Change of dosage
                                                                                 strength

   114         propranolol                 tablet 10 mg, box 100 tablets                  −
                                           tablet 40 mg, box 100 tablets
   115         protein plasma fraction                                           Dosage form and
               (including fibrinogen)                                            strength are deleted
   116         quinidine                   tablet 200 mg (sulfate),                       −
                                             bottle 100/1000 tablets

   117         reserpin                    tablet 0,10 mg, bottle 1000 tablets            −
                                           tablet 0,25 mg, bottle 1000 tablets



National List of Essential Medicine 2008
                                                                                                     96
                                                                                                     96
                                                                                 ADDITION (+),
                                                                                 DELETION (-),
                 GENERIC NAME
   NO                                             DOSAGE FORM                    CHANGE OF
                     (INN)
                                                                                   DOSAGE
                                                                                    FORM
   118         resin composite              set                                           +

   119         retinol                      tablet 5000 UI, bottle 50 tablet              +
                                            soft capsule 100,000 UI,
                                              bottle 50 soft capsules

   120         retinol                      injection 100,000 IU/ ampoule,                −
                                              box 100 ampoules @ 1 ml
                                            oily injection 100,000
                                              IU/ampoule (as palmitate),
                                              box 100 ampoules @ 2 ml

   121         regular insulin              injection 40 IU/ml,                           −
                                               box 1 vial 10 ml

   122         regular insulin :            injection 100 IU/ml,                          +
                 intermediate insulin (30     box 1 vial 10 ml
                 : 70)
   123         rocuronium                   i.v. injection 10 mg/ml, vial 5 ml            +

   124         silver amalgam               powder 65 - 75%, bottle 1 oz                  −

   125         silver nitrate               sol 40%, bottle 10 ml                         −

   126         sodium bicarbonate           injection 1,4% isotonic                       +

   127         sodium fucidic               cream 20 mg/g, tube 5 g                       −

   128         sodium nitroprusside *)      injection, vial                               +

   129         stavudin                     tablet 30 mg, bottle 60 tablets      Change of
                                            tablet 40 mg, bottle 60 tablets      therapeutic sub-class
                                                                                 and dosage form

   130         succinyl choline             iv/i.m powder injection 500          Change of generic
                                              mg/vial (chloride), box 10 vial    name

   131         sufentanyl                   injection 50 mcg/ml (citrate),                −
                                              box 5 vial @ 5 ml




National List of Essential Medicine 2008
                                                                                                   97
                                                                                                   97
                                                                               ADDITION (+),
                                                                               DELETION (-),
                 GENERIC NAME
   NO                                            DOSAGE FORM                   CHANGE OF
                     (INN)
                                                                                 DOSAGE
                                                                                  FORM
   132         sulfonic preparation        cones, bottle 100 butir                     −

   133         sulpirid                    capsule 50 mg,                              −
                                             box 10 stripes @ 10 capsules
                                           tablet 200 mg,
                                             box 2 stripes @ 10 tablets

   134         suxamethonium               iv/i.m powder injection 500                 −
                                             mg/vial (chlorida), box 10 vial

   135         thiamine                    injection 100 mg/ml,                        −
                                             box 100 ampoules 1 ml

   136         thiopental                  i.v. powder for injection 500               −
                                              mg/ampoule (as sodium salt)
                                              (for dissolved in 20 ml WFI),
                                              box 25 ampoules

   137         trichloracetic acid         crystal, sacch                              −

   138         tropicamide                 eye drop 1%, bottle 5 ml                    −

   139         tuberkulin protein          i.c. injection 1:10,                        −
                 (purified derivative)        box 1 vial 25 ml

   140         valproate                   tablet 250 mg (as sodium salt),     Change of dosage
                                             bottle 50 tablets                 form and strength
                                           tablet 500 mg (as sodium salt),
                                             bottle 50 tablets
                                           syrup 250 mg/5 ml (as sodium
                                             salt), bottle 120 ml

   141         vancomycin                  powder injection 500 mg/vial,               +
                                             box 1 vial

   142         vecuronium                  powder injection 10 mg/vial                 −
                                             (bromide), box 20 vials

   143         warfarin                    tablet 2 mg (potassium salt), bottle Change of dosage
                                             100 tablets                        strength



National List of Essential Medicine 2008
                                                                                               98
                                                                                               98
                                                                               ADDITION (+),
                                                                               DELETION (-),
                 GENERIC NAME
   NO                                           DOSAGE FORM                    CHANGE OF
                     (INN)
                                                                                 DOSAGE
                                                                                  FORM
   144         zidovudine                  tablet 100 mg, bottle 100 tablets   Change of
                                                                               therapeutic sub-class
                                                                               and dosage form

   145         zinc phosphate cement       Powder and liquid,                           −
                                            set 30 g bottle 1 set




National List of Essential Medicine 2008
                                                                                                 99
                                                                                                 99
                    THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA
                           THE DECREE OF THE MINISTER OF HEALTH
                               OF THE REPUBLIC OF INDONESIA
                                NUMBER: 239/MENKES/SK/III/2008

                                                  REGARDING

                    THE ESTABLISHMENT OF NATIONAL COMMITTEE ON REVISION
                       OF THE NATIONAL LIST OF ESSENTIAL MEDICINES 2008

                    THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA

  Considers          :     a.     in order to enhance the quality of health services, the availability of a
                                  good quality, safe, effective and sufficient quantity of essential
                                  medicines is the responsibility of the government as authorized in the
                                  National Medicines Policy;
                           b.     as according to the point (a) above, it is necessary to support the
                                  implementation of rational use of medicines;
                           c.     as according to the progress of the medical sciences and health
                                  technology, disease pattern, health program and the improvement of
                                  public health status as a result of the currently health development, it
                                  is therefore, the National list of Essential Medicines should be revised;
                           d.     in order to revise the National List of Essential Medicines (NLEM), it is
                                  necessary to establish The National Committee On Revision of the
                                  National List of Essential Medicines 2008 by Ministerial decree.

  Refers to          :     1.     Law No. 23 year 1992 regarding Health (State Paper year 1992 No.
                                  100, additional to State Paper No. 4431);
                           2.     Government Regulation No. 27 year 1998 regarding Safety of
                                  Pharmaceutical Products and Medical Devices (State Paper year 1998
                                  No. 138, Additional to State Papers of the Republic of Indonesia No.
                                  3781);
                           3.     Government Regulation No. 38 year 2007 regarding Division of
                                  Municipality/District Administrative      (State of the Republic of
                                  Indonesian Paper year 2007 No. 82);
                           4.     The Regulation of the President of the Republic of Indonesia No. 9
                                  year 2005 regarding the locality, duty, function, structure of the
                                  organization and the job description of the States Ministries of the
                                  Republic of Indonesia;
                           5.     The Regulation of the President of the Republic of Indonesia No. 10
                                  year 2005 regarding Organization Unit and duty of the First Rank
                                  Officers of the States Ministries of the Republic of Indonesia;
                           6.     The Regulation of the Minister of Health of the Republic of Indonesia
                                  No. 1575/Menkes/Per/XI/2005 regarding the Organization and Ethical
                                  Task of the Health Department of the Republic of Indonesia;
                           7.     The Decree of the Minister of Health of the Republic of Indonesia No.
                                  189/MENKES/SK/III/2006 regarding The National Medicines Policy.




National List of Essential Medicines 2008                                                           100
                                                        Has decided
  To stipulate                       :      THE DECREE OF THE MINISTER OF HEALTH REGARDING
                                            THE ESTABLISMENT OF THE NATIONAL COMMITTEE ON
                                            REVISION OF THE NATIONAL LIST OF ESSENTIAL
                                            MECICINES 2008
  The First                          :      To establish The National Committee on Revision of National
                                            List of Essential Medicines 2008 with organization structure as
                                            set forth in the appendix hereto;
  The Second                         :      The responsibilities of National Committee of NLEM are as
                                            follows:
                                            a.      The Steering Committee
                                                    The Steering Committee is responsible to provide advice
                                                    and direction of the revision according to prevailing laws
                                                    and regulations;
                                            b.      The Expert Team
                                                    The Expert Team is responsible to evaluate the
                                                    medicines in NLEM 2005 and to analyze the proposed
                                                    medicines to be added to or deleted from the NLEM
                                                    2008.
                                            c.      The Consultant
                                                    The consultant is responsible to provide the technical
                                                    support or scientific findings needed by the expert team.
                                            d.      The Expert Team and The Consultant jointly provide the
                                                    technical and the scientific support to the Ministry of
                                                    Health vide Directorate General of Pharmaceutical
                                                    Services and Medical Devices on implementing NLEM
                                                    nationwide and to assist the Directorate of Rational Use
                                                    of Medicine to execute its policy.
                                            e.      The Members
                                                    The Members are responsible to provide input needed
                                                    for evaluation of NLEM 2005 and to analyze the
                                                    proposed medicines to be added to or deleted from
                                                    NLEM 2008.
                                            f.      The Organizing Committee
                                                    The Organizing Committee are responsible in recording,
                                                    documentation and supplying the data, preparing the
                                                    procedures and guidelines, and preparing the
                                                    recommended draft of NLEM 2008, arranging the
                                                    technical meetings and plenary session, preparing the
                                                    draft documentations, and finalizing NLEM 2008 and its
                                                    dissemination.
  The Third                          :      The Revision of NLEM should be conducted during 2008;
  The Fourth                         :      On implementing the duties of The National Committee of
                                            Revision of NLEM are responsible to the Ministry of Health vide
                                            Directorate General of Pharmaceutical Services and Medical
                                            Devices; and report the activities at least 1 (one) month after the
                                            termination of their task.




National List of Essential Medicines 2008                                                               101
  The Fifth                          :      The duty period of The National Committee of Revision of NLEM
                                            started since the stipulation date of this decree and terminated
                                            at the end of 2008.
  The Sixth                          :      The budget of The National Committee of Revision of NLEM and
                                            activities is under Annual National Budget of Directorate of
                                            Rational Use of Medicine in the year of 2008;
  The Seventh                        :      This decree shall be effective as of the date of stipulation, and
                                            there will be reconsideration or amendment as required if there
                                            are shortcomings of mistakes in the stipulation.

                                                                         Stipulated in : Jakarta
                                                                        On Date : March 5, 2008.
                                                                           Minister of Health




                                                               Dr. dr. SITI FADILAH SUPARI, Sp.JP (K)


Circulation to:
1.    The Coordinator Minister of the Public Welfare
2.    The Minister of Home Affair
3.    The Head of National Planning and Development Board
4.    The Head of National Agency of Drug and Food Control
5.    The First Ranks officers in the Ministry of Health.
6.    The Head of Province Health Office all over the Republic of Indonesia.
7.    The Directors of all Teaching Hospitals and Vertical Hospitals within the Ministry of Health all
      over the Republic of Indonesia.
8.    The Head of Municipality or District Health Office all over the Republic of Indonesia.
9.    Whom it may concern, to be implemented as required.




National List of Essential Medicines 2008                                                              102
                                                   APPENDIX     :
                                                   THE DECREE OF THE MINISTER OF HEALTH
                                                   OF THE REPUBLIC OF INDONESIA
                                                   NUMBER : 239/MENKES/SK/III/2008
                                                   DATE    : MARCH 5, 2008

                  THE ESTABLISHMENT OF NATIONAL COMMITTEE ON REVISION
                     OF THE NATIONAL LIST OF ESSENTIAL MEDICINES 2008

Steering Committee :
             1. Director General of Pharmaceutical Services and Medical Devices
             2. Head of National Agency of Food and Drug Control
             3. Director General of Medical Services
             4. Director General of Diseases Control and Sanitation
             5. Deputy 1 of National Agency of Food and Drug Control

Head of Authority : Director General of Pharmaceutical Services and Medical devices

Expert Team :
Chairman                           : Iwan Darmansjah (General Practitioner)
Vice Chairman                      : Rianto Setiabudy (General Practitioner)
Members                            :
                                       1.     Abdul Muthalib (General Practitioner)
                                       2.     Asril Aminullah (General Practitioner)
                                       3.     Bambang Sudarmanto (Specialist)
                                       4.     Dede Gunawan (Specialist)
                                       5.     Djakaria (Specialist)
                                       6.     Gunawan (Specialist)
                                       7.     Hanafi Trisnohadi (Specialist)
                                       8.     Inge Sutanto (General Practitioner)
                                       9.     Nugroho Kampono (Specialist)
                                       10.    Omo Abdul Madjid (Specialist)
                                       11.    Robert Reverger (Specialist)
                                       12.    Sarwono Waspadji (specialist)
                                       13.    Silvia Desiree Fadiel (Dentist)
                                       14.    Sri Rezeki S. Hadinegoro (Specialist)

Counsultant                 :
                                       1.     Arini Setiawati ((Pharmacist)
                                       2.     Atie W. Soekandar (General Practitioner)
                                       3.     Engko Sosialine (Pharmacist)
                                       4.     Irawan Mangunatmaja (Specialist)
                                       5.     Iwan Dwiprahasto (General Practitioner)
                                       6.     Kartono Muhammad (General Practitioner)
                                       7.     Nani Sukasediati (Pharmacist)
                                       8.     Pinky F. Riawan (General Practitioner)
                                       9.     Sri Suryawati (Pharmacist)




National List of Essential Medicines 2008                                                103
Organizing Committee :
Head             : Director of Rational Use of Medicines
Secretary        : Zorni Fadia (General Practitioner)
Seecretary I     : Dita Novianti (Pharmacist)
Members          :
                     1.     Secretary to Director General of Pharmaceutical Services and
                            Medical devices
                     2.     Director of Public Medicines and Medical Supply
                     3.     Director of Maternal Health
                     4.     Director of Child Health
                     5.     Director of Direct Communicable Diseases Control
                     6.     Director of Animal Sourced Diseases Elimination
                     7.     Director of Non-Communicable Diseases
                     8.     Director of Epidemiologic Surveillance, Immunization and
                            Dimension Health
                     9.     Head of Sub Directorate of Standardization and Technical
                            Assistance, Rational Use Medicines Directorate
                     10.    Head of Sub Directorate of Promotion, Rational Use Medicines
                            Directorate

Secretariat                 :
                                1.          Erie Gusnellyanti
                                2.          Liza Fetrisiani
                                3.          Prihadi Mulyono
                                4.          Anwar Wahyudi
                                5.          Nofiyanti
                                6.          Mulyati



                                                                        Stipulated in : Jakarta
                                                                       On Date : March 5, 2008.
                                                                          Minister of Health




                                                                Dr. dr. SITI FADILAH SUPARI, Sp.JP (K)




National List of Essential Medicines 2008                                                         104
  LIST OF PARTICIPANTS OF TECHNICAL
    MEETINGS AND PLENARY SESSION
 NATIONAL LIST OF ESSENTIAL MEDICINES
                  2008


1         Director General of Pharmaceutical Services and Medical Devices
2         Head of National Agency of Food and Drug Control
3         Director General of Medical Services
4         Director General of Diseases Control and Sanitation
5         Deputy I of National Agency of Food and Drug Control
6         Secretary to Director General of Pharmaceutical Services and Medical Devices
7         Director of Rational Use of Medicine
8         Director of Public Medicines and Medical Supply
9         Director of Maternal Health
10        Director of Child Health
11        Director of Direct Communicable Diseases Control
12        Director of Non-Communicable Diseases Control
13        Director of Animal Sourced Diseases Elimination
14        Director of Epidemiologic Surveillance, Immunization and Dimension Health
15        Director of Public Nutrition
16        Director of Mental Health Services
17        Director of Primary Medical Services
18        Director of Specialist Medical Services
19        Director of Public Hospital Dr. M Yunus Bengkulu
20        Director of Public Hospital DR. M. Djamil Padang
21        Director of Public Hospital Ulin Banjarmasin
22        Director of National Public Hospital RS Cipto Mangunkusumo
23        Director of Central Public Hospital Hasan Sadikin Bandung
24        Director of Central Public Hospital Muh. Hussein Palembang
25        Director of Public Hospital dr. Moewardi, Solo
26        Director of Public Hospital dr. Sardjito, Yogyakarta
27        Director of Central Public Hospital Wahidin Sudirohusodo, Makasar
28        Director of Public Hospital Dr. Karyadi, Semarang
29        Director of Public Cardiovascular Hospital Harapan Kita
30        Director of Mental Hospital Cimahi
31        Director of Provincial Public Hospital Wahidin Sudirohusodo Mojokerto-East Java
32        Director of Provincial Public Hospital dr. Soetomo, Surabaya
33        Director of Public Hospital Kab. Tangerang
34        Director of Provincial Public Hospital Arifin Achmad, Pekanbaru
35        Director of Central Public Hospital Sanglah - Denpasar
36        Director of Siloam Karawaci Hospital, Banten
37        Director of Sumber Waras Hospital, Jakarta
38        Director of Husada Hospital, Jakarta
39        Director of Public Hospital Yos Sudarso, Padang
40        Director of PT. Indofarma
41        Director of PT. Kimia Farma
42        Director of PT. Phapros
43        Health Directorate of National Army - POLRI

National List of Essential Medicines 2008
                                                                                            105
44        Head of Provincial Health Office in Nangroe Aceh Darusalam
45        Head of Provincial Health Office in South Sulawesi
46        Head of Provincial Health Office in DKI Jakarta
47        Head of Provincial Health Office in West Java
48        Head of Provincial Health Office in Central Java
49        Head of Provincial Health Office in East Java
50        Head of Provincial Health Office in West Kalimantan
51        Head of Provincial Health Office in Central Kalimantan
52        Head of Provincial Health Office in Western Southeast Nusa Tenggara
53        Head of Provincial Health Office in Eastern Southeast Nusa Tenggara
54        Head of Provincial Health Office in Papua
55        Head of Provincial Health Office in Central Sulawesi
56        Head of Provincial Health Office in North Sulawesi
57        Head of Provincial Health Office in West Sumatera
58        Head of Provincial Health Office in North Sumatera
59        Head of District Health Office in Karang Anyar
60        Head of District Health Office in Sleman
61        Head of District Health Office in Surakarta
62        Head of Public Health Center of Pajang, Surakarta
63        Head of Public Health Center of Tebet, Jakarta
64        Chairman of Indonesian Medical Doctors Association
65        Chairman of Indonesian Midwives Association
66        Chairman of Indonesian Pharmacologist Association
67        Chairman of Indonesian Nursery Association
68        Chairman of Indonesian Pharmacist Association
69        Chairman of Indonesian Anesthesiologist and Reanimation Specialist Association
70        Prof. dr. Iwan Darmansjah, SpFK.
71        Prof. dr. Rianto Setiabudy, SpFK.
72        Prof. dr. Abdul Muthalib, SpPD (K).
73        Prof. dr. Djakaria, SpRad (K).
74        Prof. dr. Nugroho Kampono, SpOG.
75        Prof. Dr. dr. Hanafi Trisnohadi, SpKJ(K)
76        Prof. Dr. dr. Inge Sutanto
77        Prof. Dr. dr. Sarwono Waspadji, SpPD (K)
78        Prof. Dr. dr. Sri Rezeki S. Hadinegoro,SpA (K)
79        Prof. Dr. Arini Setiawati,PhD.
80        Prof. dr. Iwan Dwiprahasto, M.MedSc, PhD.
81        Prof. dr. Asril Aminullah, Sp.A (K)
82        dr. Omo Abdul Madjid, SpOG.
83        dr. Bambang Sudarmanto, Sp.A.
84        dr. Dede Gunawan, SpS (K)
85        dr. Robert Reverger, SpKJ (K)
86        dr. Gunawan Darmansjah, SpAn.
87        dr. Irawan Mangunatmadja , SpA.(K)
88        drg. Silvia Desiree, SpKGA
89        DR. Atie W. Soekandar, Sp.FK.
90        DR. Sri Suryawati
91        dr. Kartono Muhammad
92        dr. Pinky F. Riawan
93        Dra. Engko Sosialine, M. Biomed
94        dr. Zorni Fadia
95        dr. Abdullah Akhmad
96        Dra. Detty Yuliati, Apt.

National List of Essential Medicines 2008
                                                                                       106
97        Dita Novianti, S.Si, Apt, MM
98        Erie Gusnellyanti, S.Si, Apt.
99        dr. Djentot Fibihanindyo Putro
100       Dra. Dara Amelia, Apt.
101       Dra. Ema Viaza, Apt.
102       Rohayati Rahafat, S.Si, Apt.
103       Drs. Suhata
104       Awan Yurianto
105       Suprihandoyo
106       Prihadi Mulyono
107       Anwar Wahyudi
108       Nofiyanti
109       Mulyati
-----------




National List of Essential Medicines 2008
                                            107
                      STATEMENT OF COMPLIANCE
                      CHAIRMAN/VICE CHAIRMAN/
                        EXPERT/CONSULTANT*)


I, as undersigned below

              Name                 :
              Address              :



declare as follows:
     1. Disposed to be the Chairman/Vice Chairman/Expert/Consultant*) of The National
           Committee of NLEM (National List of Essential Medicines) 2008.
     2. Disposed to attend Technical Discussion Meeting of NLEM Revision.
     3. Disposed to sign Conflict of Interest Statement.




                                                      Jakarta, .......................................




                                                      (                                             )



*) Strike out the unnecessary statement




National List of Essential Medicines 2008
                                                                                                   108
             CONFLICT OF INTEREST STATEMENT
       Indonesian National Essential Medicines Committee (2008)


For the evaluation of the Selection of Essential Medicines an evaluation committee is needed that
would guarantee that its members are impartial and free from conflicts of interest that would biased
the outcome of their choice(s) of medicines. Therefore all individuals chosen as National
Committee Members are required to sign a statement as below, as consented:

       1.      No direct family members, including self, have important positions in or have stakes in
               the drug business so as to bias his/her selection.

       2.      Committee Members, including Chairman and Consultants, should not solicit or receive
               money or gratuities that clearly indicate a form of bribery.

       3.      Committee Members should refrain from presenting faked data in the form of
               publications or statements of dubious nature.

       4.      In its deliberations members should use their intellectual judgment, instead of stating
               mere opinions without support of scientific data.

       5.      When in the discussion of a subject, a member feels that he/she might have a conflict of
               judgment, he/she must acknowledge the chairman of the nature of its possible conflict.
               In the case of a serious conflict of interest, he/she will not be allowed to participate in a
               voting procedure.

       6.      Committee Members may not deliberately leak important confidential issues of decision
               to a third party.

I, the undersigned below:

Name: .........................................

Function: Chairman / Vice Chairman / Member / Consultant

Declares that he/she understood the above statement and will obey the written rules above.



----------------------------------------          ----------------------
Committee Member                                   Date




National List of Essential Medicines 2008
                                                                                                       109
            ASSESSMENT FORM
  APPLICATION FOR ADDITION / DELETION OF
   NATIONAL LIST OF ESSENTIAL MEDICINES
                    2008

     NO                                           SUBJECT
       1       Summary
       2       Reason of deletion
       3       Public relation
       4       Comparation with similar medicine on the list
       5       Pharmacological characteristic
       6       Effectiveness evidence
       7       Safety evidence
       8       Benefit – cost ratio
       9       Formulation
      10       The using of the medicine by international guidance
      11       Prevailing laws and regulatiuon which is supporting to delete the medicine
      12       Recommendation
      13       References




National List of Essential Medicines 2008
                                                                                            110
              RECAPITULATION OF APPLICATION
                    FOR NLEM REVISION
                           2008

Application from
Name of Institution :
Address             :
Phone No/Facs       :


                                                                     CHANGE
                                   GENERIC
              THERAPEUTIC                    DOSAGE                                   SUPPORTING
     NO                             NAME            PACKAGING
                 CLASS                        FORM                                      EBM *)
                                    (INN)
                                                                ADDITION   DELETION




Explanation :                                                       ………………….200..
*) Based on trusted literature / reference                          Stamp / signature
*) Enclose the related literature / reference


                                                                    Name       _____
                                                                    NIP.



National List of Essential Medicines 2008
                                                                                               111

				
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