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WHO Model List of Essential Medicines

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. 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 preclude 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 and comprises 433 drugs.[10][11] 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 6th edition.[8][12] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[13][14] Everything in the children's list is also included in the main list.[15] The list and notes are based on the 19th and 20th edition of the main list.[3][10] An α indicates a medicine is only on the complementary list.[3]

Contents

Anaesthetics

General anaesthetics and oxygen

Inhalational medicines

Injectable medicines

Local anaesthetics

Preoperative medication and sedation for short-term procedures

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

Antihelminthics

Intestinal antihelminthics

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

Beta Lactam medicines

Other antibacterials

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

Nucleotide polymerase inhibitors

Protease inhibitors

NS5A inhibitors

Non-nucleoside polymerase inhibitors

Other antivirals

Fixed-dose combinations

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

Antimigraine medicines

Acute attack

Prevention

Antineoplastic and immunosuppressives

Immunosuppressive medicines

Cytotoxic and adjuvant medicines

Hormones and antihormones

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 diarrhea

Oral rehydration

Medicines for diarrhea in children

Hormones, other endocrine medicines, and contraceptives

Adrenal hormones and synthetic substitutes

Androgens

Contraceptives

Oral hormonal contraceptives

Injectable hormonal contraceptives

Intrauterine devices

Barrier methods

Implantable contraceptives

Intravaginal contraceptives

Insulins and other medicines used for diabetes

Ovulation inducers

Progestogens

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)

Oxytocics and antioxytocics

Oxytocics and abortifacients

Antioxytocics (tocolytics)

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

Antiasthmatic 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 in children

Specific medicines for neonatal care

Medicines administered to the neonate

Medicines administered to the mother

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.[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. ^ Third-generation cephalosporin of choice for use in hospitalized neonates
  9. ^ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  10. ^ 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.
  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. ^ Erythromycin may be an alternative. 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. ^ For the treatment of viral haemorrhagic fevers and in combination with pegylated interferons for the treatment of hepatitis C
  21. ^ Potentially severe or complicated illness due to confirmed or suspected influenza virus infection in accordance with WHO treatment guidelines
  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

  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 d "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. doi:10.4103/0976-500X.107642. PMC 3643337. PMID 23662019.
  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. doi:10.1016/S0140-6736(16)31599-9. PMID 27832874.
  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. doi:10.4103/0019-5154.174017. PMC 4763692. PMID 26955092.
  10. ^ a b "WHO Model List of Essential Medicines 20th List" (PDF). March 2017. Retrieved 8 June 2017.
  11. ^ "Essential Medicines List and WHO Model Formulary". World Health Organization. Retrieved 5 May 2018.
  12. ^ "WHO Model List of Essential Medicines for Children 6th List" (PDF). who.int. World Health Organization. August 2017. Retrieved 11 April 2018.
  13. ^ Rose, K; Anker, JNVd (2010). Guide to Paediatric Drug Development and Clinical Research. Karger Medical and Scientific Publishers. p. 42. ISBN 9783805593625.
  14. ^ Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. ISBN 9783642201950.
  15. ^ Kalle, H (9 February 2017). "Essential Medicines for Children". Clinical Pharmacology & Therapeutics. 101 (6): 718–720. doi:10.1002/cpt.661. PMID 28182281.

Further reading