WHO Model List of Essential Medicines

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World map with the words "40 years of the model list of essential medicines 1977-2017"
2017 marks the 40th anniversary of the WHO Model List of Essential Medicines.

The WHO Model List of Essential Medicines (EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system. The list is frequently used by countries to help develop their own local lists of essential medicine.[1] As of 2016, more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list.[2] This includes countries in both the developed and developing world.[1]

The list is divided into core items and complementary items. The core items are deemed to be the most cost effective options for key health problems and are usable with little additional health care resources. The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost-benefit ratio.[3] About 25% of items are in the complementary list.[4] Some medications are listed as both core and complementary.[5] While most medications on the list are available as generic products, being under patent does not exclude inclusion.[6]

The first list was published in 1977 and included 212 medications.[1][7] The WHO updates the list every two years.[8] The 14th list was published in 2005 and contained 306 medications.[9] In 2015 the 19th edition of the list was published and contains around 410 medications.[8] The 20th edition was published in 2017.[10] The national lists contain between 334 and 580 medications.[4]

A separate list for children up to 12 years of age, known as the WHO Model List of Essential Medicines for Children (EMLc), was created in 2007 and is in its 5th edition.[8][11] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[12][13] Everything in the children's list is also included in the main list.[14] The list and notes are based on the 19th edition of the main list. An α indicates a medicine is only on the complementary list.[3]

Contents

Anaesthetics[edit]

General anaesthetics and oxygen[edit]

Inhalational medicines[edit]

Injectable medicines[edit]

Local anaesthetics[edit]

Preoperative medication and sedation for short-term procedures[edit]

Medicines for pain and palliative care[edit]

Nonopioids and nonsteroidal anti-inflammatory drugs (NSAIDs)[edit]

A line drawing of a hexagon with two attachments
A skeletal model of the chemical structure of aspirin

Opioid analgesics[edit]

Medicines for other common symptoms in palliative care[edit]

Antiallergics and medicines used in anaphylaxis[edit]

Antidotes and other substances used in poisonings[edit]

Nonspecific[edit]

Specific[edit]

Anticonvulsive medication[edit]

Anti-infective medicines[edit]

Antihelminthics[edit]

Intestinal antihelminthics[edit]

A hexagon joined to a polygon with two attachments to this double ringed structure
A skeletal model of the chemical structure of albendazole

Antifilarials[edit]

Antischistosomals and other antinematode medicines[edit]

Antibiotics[edit]

Beta Lactam medicines[edit]

Other antibacterials[edit]

Antileprosy medicines[edit]

Antituberculosis medicines[edit]

A small pile of white crystals
Pure crystals of ethambutol

Antifungal medicines[edit]

Antiviral medicines[edit]

Antiherpes medicines[edit]

Antiretrovirals[edit]

Nucleoside/nucleotide reverse transcriptase inhibitors[edit]
Non-nucleoside reverse transcriptase inhibitors[edit]
Protease inhibitors[edit]
Two dark blue capsules with writing on them
Two capsules of atazanavir
Fixed-dose combinations[edit]
Other antivirals[edit]

Antihepatitis medicines[edit]

Medicines for hepatitis B[edit]

Nucleoside/Nucleotide reverse transcriptase inhibitors

Medicines for hepatitis C[edit]

Nucleotide polymerase inhibitors

Protease inhibitors

NS5A inhibitors

Non-nucleoside polymerase inhibitors

Other antivirals

Fixed-dose combinations

Antiprotozoal medicines[edit]

Antiamoebic and antigiardiasis medicines[edit]

Antileishmaniasis medicines[edit]

Antimalarial medicines[edit]

For curative treatment[edit]
For prevention[edit]

Antipneumocystosis and antitoxoplasmosis medicines[edit]

Antitrypanosomal medicines[edit]

African trypanosomiasis[edit]
1st stage[edit]
2nd stage[edit]
American trypanosomiasis[edit]

Antimigraine medicines[edit]

Acute attack[edit]

Prevention[edit]

Antineoplastic and immunosuppressives[edit]

Immunosuppressive medicines[edit]

Cytotoxic and adjuvant medicines[edit]

Hormones and antihormones[edit]

Antiparkinsonism medicines[edit]

Medicines affecting the blood[edit]

Antianaemia medicines[edit]

Medicines affecting coagulation[edit]

Other medicines for haemoglobinopathies[edit]

Blood products and plasma substitutes of human origin[edit]

Blood and blood components[edit]

A straw colored liquid inside a clear plastic bag
Bag containing one unit of fresh frozen plasma

Plasma-derived medicines[edit]

Human immunoglobulins[edit]

Blood coagulation factors[edit]

Plasma substitutes[edit]

Cardiovascular medicines[edit]

Antianginal medicines[edit]

Antiarrhythmic medicines[edit]

Antihypertensive medicines[edit]

Medicines used in heart failure[edit]

Antithrombotic medicines[edit]

Anti-platelet medicines[edit]

Thrombolytic medicines[edit]

Lipid-lowering agents[edit]

Dermatological (topical)[edit]

Antifungal medicines[edit]

Anti-infective medicines[edit]

Anti-inflammatory and antipruritic medicines[edit]

Medicines affecting skin differentiation and proliferation[edit]

Scabicides and pediculicides[edit]

Diagnostic agents[edit]

Ophthalmic medicines[edit]

Radiocontrast media[edit]

Disinfectants and antiseptics[edit]

Antiseptics[edit]

Disinfectants[edit]

Diuretics[edit]

Gastrointestinal medicines[edit]

Antiulcer medicines[edit]

Antiemetic medicines[edit]

Anti-inflammatory medicines[edit]

Laxatives[edit]

Medicines used in diarrhea[edit]

Oral rehydration[edit]

Medicines for diarrhea in children[edit]

Hormones, other endocrine medicines, and contraceptives[edit]

Adrenal hormones and synthetic substitutes[edit]

Androgens[edit]

Contraceptives[edit]

Oral hormonal contraceptives[edit]

Injectable hormonal contraceptives[edit]

Intrauterine devices[edit]

Barrier methods[edit]

Implantable contraceptives[edit]

Intravaginal contraceptives[edit]

Insulins and other medicines used for diabetes[edit]

Ovulation inducers[edit]

Progestogens[edit]

Thyroid hormones and antithyroid medicines[edit]

Immunologicals[edit]

Diagnostic agents[edit]

Sera and immunoglobulins[edit]

Vaccines[edit]

A small vial with writing on it being removed from a cardboard package
A vial of oral cholera vaccine

Muscle relaxants (peripherally-acting) and cholinesterase inhibitors[edit]

Eye preparations[edit]

Anti-infective agents[edit]

Anti-inflammatory agents[edit]

Local anesthetics[edit]

Miotics and antiglaucoma medicines[edit]

Mydriatics[edit]

Anti-vascular endothelial growth factor (VEGF)[edit]

Oxytocics and antioxytocics[edit]

Oxytocics and abortifacients[edit]

Antioxytocics (tocolytics)[edit]

Peritoneal dialysis solution[edit]

Medicines for mental and behavioural disorders[edit]

Medicines used in psychotic disorders[edit]

Medicines used in mood disorders[edit]

Medicines used in depressive disorders[edit]

Medicines used in bipolar disorders[edit]

Medicines for anxiety disorders[edit]

Medicines used for obsessive compulsive disorders[edit]

Medicines for disorders due to psychoactive substance use[edit]

Medicines acting on the respiratory tract[edit]

Antiasthmatic and medicines for chronic obstructive pulmonary disease[edit]

Solutions correcting water, electrolyte and acid-base disturbances[edit]

Oral[edit]

Parenteral[edit]

Miscellaneous[edit]

Vitamins and minerals[edit]

Ear, nose and throat medicines in children[edit]

Specific medicines for neonatal care[edit]

Medicines administered to the neonate[edit]

Medicines administered to the mother[edit]

Medicines for diseases of joints[edit]

Medicines used to treat gout[edit]

Disease-modifying agents used in rheumatoid disorders[edit]

Juvenile joint diseases[edit]

Notes[edit]

^ An α indicates the medicine is only on the complementary list. For these items specialized diagnostic or monitoring or specialist training are needed. An item may also be listed as complementary on the basis of higher costs or a less attractive cost-benefit ratio.[3]
  1. ^ Thiopental may be used as an alternative depending on local availability and cost.
  2. ^ Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect
  3. ^ Alternatives limited to hydromorphone and oxycodone
  4. ^ There may be a role for sedating antihistamines for limited indications (EMLc).
  5. ^ For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders
  6. ^ For surgical prophylaxis
  7. ^ Only listed for single‐dose treatment of uncomplicated ano‐genital gonorrhoea
  8. ^ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  9. ^ Procaine benzylpenicillin is not recommended as first-line treatment for neonatal sepsis except in settings with high neonatal mortality, when given by trained health workers in cases where hospital care is not achievable.
  10. ^ Third-generation cephalosporin of choice for use in hospitalized neonates
  11. ^ Only listed for the treatment of life‐threatening hospital‐based infection due to suspected or proven multidrug‐resistant infection
  12. ^ Only listed for single‐dose treatment of genital Chlamydia trachomatis and of trachoma
  13. ^ For use in combination regimens for eradication of H. pylori in adults
  14. ^ For use only in patients with HIV receiving protease inhibitors
  15. ^ For treatment of latent TB infection (LTBI) only
  16. ^ Terizidone may be an alternative.
  17. ^ Prothionamide may be an alternative.
  18. ^ Ofloxacin and moxifloxacin may be alternatives based on availability and programme considerations.
  19. ^ a b FTC is an acceptable alternative to 3TC, based on knowledge of the pharmacology, the resistance patterns and clinical trials of antiretrovirals.
  20. ^ Potentially severe or complicated illness due to confirmed or suspected influenza virus infection in accordance with WHO treatment guidelines
  21. ^ For the treatment of viral haemorrhagic fevers and in combination with pegylated interferons for the treatment of hepatitis C
  22. ^ For the treatment of hepatitis C, in combination with peginterferon or direct acting anti-viral medicines
  23. ^ To be used in combination with ribavirin
  24. ^ a b To be used in combination with artesunate 50 mg
  25. ^ For use in the management of severe malaria
  26. ^ Not recommended in the first trimester of pregnancy or in children below 5 kg
  27. ^ To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine
  28. ^ Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives.
  29. ^ For use only for the treatment of P. vivax infection
  30. ^ For use only in combination with quinine
  31. ^ Only for use to achieve radical cure of P. vivax and P. ovale infections, given for 14 days
  32. ^ For use only in the management of severe malaria, and should be used in combination with doxycycline
  33. ^ Only in combination with artesunate 50 mg
  34. ^ For use only in Central American regions, for use for P. vivax
  35. ^ For use only in combination with chloroquine
  36. ^ To be used for the treatment of Trypanosoma brucei gambiense infection
  37. ^ To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection
  38. ^ To be used for the treatment of T. b. gambiense infection
  39. ^ Only to be used in combination with eflornithine, for the treatment of T. b. gambiense infection
  40. ^ Deferasirox oral form may be an alternative, depending on cost and availability.
  41. ^ Polygeline, injectable solution, 3.5% is considered as equivalent.
  42. ^ a b c d Includes metoprolol and carvedilol as alternatives
  43. ^ Hydralazine is listed for use in the acute management of severe pregnancy‐induced hypertension only. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines.
  44. ^ Methyldopa is listed for use in the management of pregnancy‐induced hypertension only. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines.
  45. ^ For use in high‐risk patients
  46. ^ In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts
  47. ^ Glibenclamide not suitable above 60 years
  48. ^ Exact type to be defined locally
  49. ^ a b c d e Recommended for some high-risk populations
  50. ^ a b c Recommended for certain regions
  51. ^ Or homatropine (hydrobromide) or cyclopentolate (hydrochloride)
  52. ^ Requires close medical supervision
  53. ^ Ergocalciferol can be used as an alternative.
  54. ^ For use for rheumatic fever, juvenile arthritis, Kawasaki disease

References[edit]

  1. ^ a b c "Essential medicines". World Health Organization. Retrieved 19 January 2017. 
  2. ^ "The WHO Essential Medicines List (EML): 30th anniversary". World Health Organization. Retrieved 26 June 2016. 
  3. ^ a b c "19th WHO Model List of Essential Medicines" (pdf). who.int. World Health Organization. April 2015. p. Annex 1. Retrieved 17 January 2017. 
  4. ^ a b Bansal, D; Purohit, VK (January 2013). "Accessibility and use of essential medicines in health care: Current progress and challenges in India.". Journal of Pharmacology & Pharmacotherapeutics. 4 (1): 13–18. PMC 3643337Freely accessible. PMID 23662019. doi:10.4103/0976-500X.107642. 
  5. ^ "The Selection and Use of Essential Medicines - WHO Technical Report Series, No. 920: 5. Reviews of sections of the Model List: 5.2 Review of core versus complementary listing of medicines". apps.who.int. 2003. Retrieved 6 March 2017. 
  6. ^ Beall, Reed (2016). "Patents and the WHO Model List of Essential Medicines (18th Edition): Clarifying the Debate on IP and Access" (PDF). WIPO. Retrieved 3 May 2017. 
  7. ^ Wirtz, VJ; Hogerzeil, HV; Gray, AL; Bigdeli, M; de Joncheere, CP; et al. (28 January 2017). "Essential medicines for universal health coverage". The Lancet. 389 (10067): 403–476. PMID 27832874. doi:10.1016/S0140-6736(16)31599-9. 
  8. ^ a b c "WHO Model Lists of Essential Medicines". World Health Organization. Retrieved 17 January 2017. 
  9. ^ Prakash, B; Nadig, P; Nayak, A (2016). "Rational Prescription for a Dermatologist.". Indian Journal of Dermatology. 61 (1): 32–38. PMC 4763692Freely accessible. PMID 26955092. doi:10.4103/0019-5154.174017. 
  10. ^ "WHO Model List of Essential Medicines 20th List" (PDF). March 2017. Retrieved 8 June 2017. 
  11. ^ "WHO Model List of Essential Medicines for Children 5th List" (PDF). who.int. World Health Organization. August 2015. Retrieved 17 January 2017. 
  12. ^ Rose, K; Anker, JNVd (2010). Guide to Paediatric Drug Development and Clinical Research. Karger Medical and Scientific Publishers. p. 42. ISBN 9783805593625. 
  13. ^ Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. ISBN 9783642201950. 
  14. ^ Kalle, H (9 February 2017). "Essential Medicines for Children". Clinical Pharmacology & Therapeutics. 101: 718–720. PMID 28182281. doi:10.1002/cpt.661. 

Further reading[edit]