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Essential Medicines

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World map with the words "40 years of the model list of essential medicines 1977–2017"

2017 marked 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.[1] 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][3]

The list is divided into core items and complementary items.[4] 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.[4] The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost–benefit ratio.[4] About 25% of items are in the complementary list.[5] Some medications are listed as both core and complementary.[6] While most medications on the list are available as generic products, being under patent does not preclude inclusion.[7]

The first list was published in 1977 and included 212 medications.[1][8] The WHO updates the list every two years.[9] The 14th list was published in 2005 and contained 306 medications.[10] In 2015, the 19th edition of the list was published and contains around 410 medications.[9] The 20th edition was published in 2017, and contains 433 medications.[11][12] The 21st list was published in 2019.[13][14] The national lists contain between 334 and 580 medications.[5]

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 7th edition.[9][15] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[16][17] Everything in the children's list is also included in the main list.[18] The list and notes are based on the 19th to 21st edition of the main list.[4][11][13] An α indicates a medicine is only on the complementary list.[4][13]

Anaesthetics[]

General anaesthetics and oxygen[]

Inhalational medicines[]

Injectable medicines[]

Local anaesthetics[]

Preoperative medication and sedation for short-term procedures[]

Medical gases[]

Medicines for pain and palliative care[]

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

A line drawing of a hexagon with two attachments

A skeletal model of the chemical structure of aspirin

Opioid analgesics[]

Medicines for other common symptoms in palliative care[]

Antiallergics and medicines used in anaphylaxis[]

Antidotes and other substances used in poisonings[]

Nonspecific[]

Specific[]

Anticonvulsive medication[]

Anti-infective medicines[]

Anthelminthics[]

Intestinal anthelminthics[]

A hexagon joined to a polygon with two attachments to this double ringed structure

A skeletal model of the chemical structure of albendazole

Antifilarials[]

Antischistosomals and other antinematode medicines[]

Antibiotics[]

Access group[]

Watch group[]

Reserve group[]

Antileprosy medicines[]

Antituberculosis medicines[]

A small pile of white crystals

Pure crystals of ethambutol

Antifungal medicines[]

Antiviral medicines[]

Antiherpes medicines[]

Antiretrovirals[]

Nucleoside/nucleotide reverse transcriptase inhibitors[]
Non-nucleoside reverse transcriptase inhibitors[]
Protease inhibitors[]
Two dark blue capsules with writing on them

Two capsules of atazanavir

Integrase inhibitors[]
Fixed-dose combinations[]
Medicines for prevention of HIV-related opportunistic infections[]
Other antivirals[]

Antihepatitis medicines[]

Medicines for hepatitis B[]

Nucleoside/Nucleotide reverse transcriptase inhibitors

Medicines for hepatitis C[]

Pangenotypic direct-acting antivirals

Non-pangenotypic direct-acting antivirals

Other antivirals for hepatitis C

Antiprotozoal medicines[]

Antiamoebic and antigiardiasis medicines[]

Antileishmaniasis medicines[]

Antimalarial medicines[]

For curative treatment[]
For prevention[]

Antipneumocystosis and antitoxoplasmosis medicines[]

Antitrypanosomal medicines[]

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

Medicines for ectoparasitic infections[]

Antimigraine medicines[]

Acute attack[]

Prevention[]

Immunomodulators and antineoplastics[]

Immunomodulators for non-malignant disease[]

Antineoplastics and supportive medicines[]

Cytotoxic medicines[]

Targeted therapies[]

Immunomodulators[]

Hormones and antihormones[]

Supportive medicines[]

Antiparkinsonism medicines[]

Medicines affecting the blood[]

Antianaemia medicines[]

Medicines affecting coagulation[]

Other medicines for haemoglobinopathies[]

Blood products and plasma substitutes of human origin[]

Blood and blood components[]

A straw colored liquid inside a clear plastic bag

Bag containing one unit of fresh frozen plasma

Plasma-derived medicines[]

Human immunoglobulins[]

Blood coagulation factors[]

Plasma substitutes[]

Cardiovascular medicines[]

Antianginal medicines[]

Antiarrhythmic medicines[]

Antihypertensive medicines[]

Medicines used in heart failure[]

Antithrombotic medicines[]

Anti-platelet medicines[]

Thrombolytic medicines[]

Lipid-lowering agents[]

Dermatological (topical)[]

Antifungal medicines[]

Anti-infective medicines[]

Anti-inflammatory and antipruritic medicines[]

Medicines affecting skin differentiation and proliferation[]

Scabicides and pediculicides[]

Diagnostic agents[]

Ophthalmic medicines[]

Radiocontrast media[]

Disinfectants and antiseptics[]

Antiseptics[]

Disinfectants[]

Diuretics[]

Gastrointestinal medicines[]

Antiulcer medicines[]

Antiemetic medicines[]

Anti-inflammatory medicines[]

Laxatives[]

Medicines used in diarrhoea[]

Oral rehydration[]

Medicines for diarrhea[]

Medicines for endocrine disorders[]

Adrenal hormones and synthetic substitutes[]

Androgens[]

Progestogens[]

Medicines for diabetes[]

Insulins[]

Oral hypoglycaemic agents[]

Medicines for hypoglycaemia[]

Thyroid hormones and antithyroid medicines[]

Immunologicals[]

Diagnostic agents[]

Sera and immunoglobulins[]

Vaccines[]

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[]

Eye preparations[]

Anti-infective agents[]

Anti-inflammatory agents[]

Local anesthetics[]

Miotics and antiglaucoma medicines[]

Mydriatics[]

Anti-vascular endothelial growth factor (VEGF)[]

Medicines for reproductive health and perinatal care[]

Contraceptives[]

Oral hormonal contraceptives[]

Injectable hormonal contraceptives[]

Intrauterine devices[]

Barrier methods[]

Implantable contraceptives[]

Intravaginal contraceptives[]

Ovulation inducers[]

Uterotonics[]

Antioxytocics (tocolytics)[]

Medicines administered to the mother[]

Medicines administered to the neonate[]

Peritoneal dialysis solution[]

Medicines for mental and behavioural disorders[]

Medicines used in psychotic disorders[]

Medicines used in mood disorders[]

Medicines used in depressive disorders[]

Medicines used in bipolar disorders[]

Medicines for anxiety disorders[]

Medicines used for obsessive compulsive disorders[]

Medicines for disorders due to psychoactive substance use[]

Medicines acting on the respiratory tract[]

Antiasthmatics and medicines for chronic obstructive pulmonary disease[]

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

Oral[]

Parenteral[]

Miscellaneous[]

Vitamins and minerals[]

Ear, nose and throat medicines[]

Medicines for diseases of joints[]

Medicines used to treat gout[]

Disease-modifying agents used in rheumatoid disorders[]

Juvenile joint diseases[]

Notes[]

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.[4][13]

  1. ↑ Thiopental may be used as an alternative depending on local availability and cost.
  2. ↑ No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
  3. ↑ Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect
  4. ↑ For the management of cancer pain
  5. ↑ Alternatives limited to hydromorphone and oxycodone
  6. ↑ For the management of cancer pain
  7. ↑ There may be a role for sedating antihistamines for limited indications (EMLc).
  8. ↑ as adjunctive therapy for treatment-resistant partial or generalized seizures.
  9. ↑ For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders
  10. ↑ Oxamniquine is listed for use when praziquantel treatment fails.
  11. ↑ For surgical prophylaxis
  12. ↑ cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
  13. ↑ 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.
  14. ↑ single agent trimethoprim may be an alternative for lower urinary tract infection.
  15. ↑ Also listed for single-dose treatment of trachoma and yaws.
  16. ↑ Only listed for acute invasive bacterial diarrhoea (dysentery) or gonorrhoea
  17. ↑ Third-generation cephalosporin of choice for use in hospitalized neonates
  18. ↑ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  19. ↑ Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
  20. ↑ Imipenem/cilastatin is an alternative, except for acute bacterial meningitis, where meropenem is preferred
  21. ↑ Powder for injection:250 mg (as hydrochloride) in vial.
  22. ↑ For use only in patients with HIV receiving protease inhibitors
  23. ↑ For treatment of latent TB infection (LTBI) only
  24. ↑ For use only in combination with meropenem or imipenem/cilastatin
  25. ↑ Terizidone may be an alternative
  26. ↑ Prothionamide may be an alternative
  27. ↑ Ofloxacin and moxifloxacin may be alternatives based on availability and programme considerations.
  28. ↑ Imipenem/cilastatin may be an alternative
  29. ↑ For treatment of chronic pulmonary aspergillosis, histoplasmosis, sporotrichosis, paracoccidioidomycosis, mycoses caused by Talaromyces marneffei and chromoblastomycosis; and prophylaxis of histoplasmosis and infections caused by T. marneffei in AIDS patients
  30. ↑ For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis
  31. ↑ For use in pregnant women and in second-line regimens in accordance with WHO treatemnt guidelines.
  32. ↑ 32.0 32.1 Emtricitabine (FTC) is an acceptable alternative to 3TC, based on knowledge of the pharmacology, the resistance patterns and clinical trials of antiretrovirals.
  33. ↑ Combination also indicated for pre-exposure prophylaxis
  34. ↑ For the treatment of viral haemorrhagic fevers
  35. ↑ For the treatment of cytomegalovirus retinitis (CMVr).
  36. ↑ For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
  37. ↑ When used in combination with sofosbuvir
  38. ↑ When used in combination with daclatasvir
  39. ↑ For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
  40. ↑ To be used in combination with ribavirin
  41. ↑ 41.0 41.1 To be used in combination with artesunate 50 mg
  42. ↑ For use in the management of severe malaria
  43. ↑ Not recommended in the first trimester of pregnancy or in children below 5 kg
  44. ↑ To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine
  45. ↑ Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives.
  46. ↑ For use only for the treatment of P. vivax infection
  47. ↑ For use only in combination with quinine
  48. ↑ Only for use to achieve radical cure of P. vivax and P. ovale infections, given for 14 days
  49. ↑ For use only in the management of severe malaria, and should be used in combination with doxycycline
  50. ↑ Only in combination with artesunate 50 mg
  51. ↑ For use only in Central American regions, for P. vivax infections
  52. ↑ For use only in combination with chloroquine
  53. ↑ For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection
  54. ↑ To be used for the treatment of Trypanosoma brucei gambiense infection
  55. ↑ To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection
  56. ↑ To be used for the treatment of T. b. gambiense infection
  57. ↑ Only to be used in combination with eflornithine, for the treatment of T. b. gambiense infection
  58. ↑ Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
  59. ↑ 59.0 59.1 59.2 Including quality-assured biosimilars
  60. ↑ Gefitinib and afatinib are alternatives
  61. ↑ Pembrolizumab is an alternative
  62. ↑ Apixaban, edoxaban and rivaroxaban are alternatives
  63. ↑ Alternatives are limited to nadroparin and dalteparin
  64. ↑ Deferasirox oral form may be an alternative, depending on cost and availability.
  65. ↑ Polygeline, injectable solution, 3.5% is considered as equivalent.
  66. ↑ 66.0 66.1 66.2 Includes metoprolol and carvedilol as alternatives
  67. ↑ Includes atenolol, metoprolol and carvedilol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients >60 years
  68. ↑ 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.
  69. ↑ 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.
  70. ↑ For use in high‐risk patients
  71. ↑ In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts
  72. ↑ Glibenclamide not suitable above 60 years
  73. ↑ Carbimazole is an alternative depending on local availability
  74. ↑ For use when alternative first-line treatment is not appropriate or available
  75. ↑ Exact type to be defined locally
  76. ↑ 76.0 76.1 76.2 76.3 76.4 76.5 Recommended for some high-risk populations
  77. ↑ 77.0 77.1 77.2 Recommended only for immunization programmes with certain characteristics
  78. ↑ 78.0 78.1 78.2 Recommended for certain regions
  79. ↑ For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae
  80. ↑ Or homatropine (hydrobromide) or cyclopentolate (hydrochloride)
  81. ↑ For use in women actively breastfeeding at least 4 times per day
  82. ↑ Where permitted under national law and where culturally acceptable
  83. ↑ For induction of labour, should only be used where appropriate facilities are available
  84. ↑ Buprenorphine considered to have similar clinical performance and best evidence for effectiveness and safety
  85. ↑ Ergocalciferol can be used as an alternative.
  86. ↑ For use for rheumatic fever, juvenile arthritis, Kawasaki disease


References[]

  1. ↑ 1.0 1.1 1.2 1.3 "Essential medicines". http://www.who.int/medicines/services/essmedicines_def/en/. Retrieved 19 January 2017. 
  2. ↑ "The WHO Essential Medicines List (EML): 30th anniversary". World Health Organization. http://www.who.int/medicines/events/fs/en/. Retrieved 26 June 2016. 
  3. ↑ "Comparison of essential medicines lists in 137 countries". Bull. World Health Organ. 97 (6): 394–404C. June 2019. . . . . //www.ncbi.nlm.nih.gov/pmc/articles/PMC6560372/. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 "19th WHO Model List of Essential Medicines". World Health Organization. April 2015. p. Annex 1. http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf. Retrieved 17 January 2017. 
  5. ↑ 5.0 5.1 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. . . . //www.ncbi.nlm.nih.gov/pmc/articles/PMC3643337/. 
  6. ↑ "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". 2003. http://apps.who.int/medicinedocs/en/d/Js4881e/5.2.html. Retrieved 6 March 2017. 
  7. ↑ Beall, Reed (2016). "Patents and the WHO Model List of Essential Medicines (18th Edition): Clarifying the Debate on IP and Access". http://www.wipo.int/edocs/mdocs/mdocs/en/wipo_gc_ip_ge_16/wipo_gc_ip_ge_16_brief.pdf. Retrieved 3 May 2017. 
  8. ↑ 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. . . 
  9. ↑ 9.0 9.1 9.2 "WHO Model Lists of Essential Medicines". http://www.who.int/medicines/publications/essentialmedicines/en/. Retrieved 17 January 2017. 
  10. ↑ Prakash, B; Nadig, P; Nayak, A (2016). "Rational Prescription for a Dermatologist.". Indian Journal of Dermatology 61 (1): 32–38. . . . //www.ncbi.nlm.nih.gov/pmc/articles/PMC4763692/. 
  11. ↑ 11.0 11.1 WHO model list of essential medicines, 20th list (March 2017, amended August 2017). Geneva. 2017. 
  12. ↑ "Essential Medicines List and WHO Model Formulary". http://www.who.int/selection_medicines/list/en/. Retrieved 5 May 2018. 
  13. ↑ 13.0 13.1 13.2 13.3 World Health Organization model list of essential medicines: 21st list 2019. Geneva. 2019. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO. 
  14. ↑ Executive summary: the selection and use of essential medicines 2019: report of the 22nd WHO Expert Committee on the selection and use of essential medicines. Geneva. 2019. WHO/MVP/EMP/IAU/2019.05. License: CC BY-NC-SA 3.0 IGO. 
  15. ↑ World Health Organization model list of essential medicines for children: 7th list 2019. Geneva. 2019. WHO/MVP/EMP/IAU/2019.07. License: CC BY-NC-SA 3.0 IGO. 
  16. ↑ Rose, K; Anker, JNVd (2010). Guide to Paediatric Drug Development and Clinical Research. Karger Medical and Scientific Publishers. p. 42. . https://books.google.ca/books?id=o8bDJPHqGeYC&pg=PA42. 
  17. ↑ Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. . https://books.google.ca/books?id=jM1gob3MeVYC&pg=PA358. 
  18. ↑ Kalle, H (9 February 2017). "Essential Medicines for Children". Clinical Pharmacology & Therapeutics 101 (6): 718–720. . . 
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