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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 21st list was published in 2019.[12] 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][13] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[14][15] Everything in the children's list is also included in the main list.[16] The list and notes are based on the 19th to 21st edition of the main list.[3][10][12] An α indicates a medicine is only on the complementary list.[3]

Contents

AnaestheticsEdit

General anaesthetics and oxygenEdit

Inhalational medicinesEdit

Injectable medicinesEdit

Local anaestheticsEdit

Preoperative medication and sedation for short-term proceduresEdit

Medicines for pain and palliative careEdit

Nonopioids and nonsteroidal anti-inflammatory drugs (NSAIDs)Edit

 
A skeletal model of the chemical structure of aspirin

Opioid analgesicsEdit

Medicines for other common symptoms in palliative careEdit

Antiallergics and medicines used in anaphylaxisEdit

Antidotes and other substances used in poisoningsEdit

Anticonvulsive medicationEdit

Anti-infective medicinesEdit

AnthelminthicsEdit

Intestinal anthelminthicsEdit

 
A skeletal model of the chemical structure of albendazole

AntifilarialsEdit

Antischistosomals and other antinematode medicinesEdit

AntibioticsEdit

Access groupEdit

Watch groupEdit

Reserve groupEdit

Antileprosy medicinesEdit

Antituberculosis medicinesEdit

 
Pure crystals of ethambutol

Antifungal medicinesEdit

Antiviral medicinesEdit

Antiherpes medicinesEdit

AntiretroviralsEdit

Nucleoside/nucleotide reverse transcriptase inhibitorsEdit
Non-nucleoside reverse transcriptase inhibitorsEdit
Protease inhibitorsEdit
 
Two capsules of atazanavir
Integrase inhibitorsEdit
Fixed-dose combinationsEdit
Medicines for prevention of HIV-related opportunistic infectionsEdit
Other antiviralsEdit

Antihepatitis medicinesEdit

Medicines for hepatitis BEdit

Nucleoside/Nucleotide reverse transcriptase inhibitors

Medicines for hepatitis CEdit

Pangenotypic direct-acting antivirals

Non-pangenotypic direct-acting antivirals

Other antivirals

Antiprotozoal medicinesEdit

Antiamoebic and antigiardiasis medicinesEdit

Antileishmaniasis medicinesEdit

Antimalarial medicinesEdit

For curative treatmentEdit
For preventionEdit

Antipneumocystosis and antitoxoplasmosis medicinesEdit

Antitrypanosomal medicinesEdit

African trypanosomiasisEdit
1st stageEdit
2nd stageEdit
American trypanosomiasisEdit

Medicines for ectoparasitic infectionsEdit

Antimigraine medicinesEdit

Immunomodulators and antineoplasticsEdit

Antiparkinsonism medicinesEdit

Medicines affecting the bloodEdit

Blood products and plasma substitutes of human originEdit

Cardiovascular medicinesEdit

Dermatological (topical)Edit

Antifungal medicinesEdit

Anti-infective medicinesEdit

Anti-inflammatory and antipruritic medicinesEdit

Medicines affecting skin differentiation and proliferationEdit

Scabicides and pediculicidesEdit

Diagnostic agentsEdit

Disinfectants and antisepticsEdit

DiureticsEdit

Gastrointestinal medicinesEdit

Antiulcer medicinesEdit

Antiemetic medicinesEdit

Anti-inflammatory medicinesEdit

LaxativesEdit

Medicines used in diarrhoeaEdit

Oral rehydrationEdit

Medicines for diarrhea in childrenEdit

Medicines for endocrine disordersEdit

Adrenal hormones and synthetic substitutesEdit

AndrogensEdit

ProgestogensEdit

Medicines for diabetesEdit

InsulinsEdit

Oral hypoglycaemic agentsEdit

Medicines for hypoglycaemiaEdit

Thyroid hormones and antithyroid medicinesEdit

ImmunologicalsEdit

Muscle relaxants (peripherally-acting) and cholinesterase inhibitorsEdit

Eye preparationsEdit

Anti-infective agentsEdit

Anti-inflammatory agentsEdit

Local anestheticsEdit

Miotics and antiglaucoma medicinesEdit

MydriaticsEdit

Anti-vascular endothelial growth factor (VEGF)Edit

Medicines for reproductive health and perinatal careEdit

Peritoneal dialysis solutionEdit

Medicines for mental and behavioural disordersEdit

Medicines used in psychotic disordersEdit

Medicines used in mood disordersEdit

Medicines used in depressive disordersEdit

Medicines used in bipolar disordersEdit

Medicines for anxiety disordersEdit

Medicines used for obsessive compulsive disordersEdit

Medicines for disorders due to psychoactive substance useEdit

Medicines acting on the respiratory tractEdit

Antiasthmatics and medicines for chronic obstructive pulmonary diseaseEdit

Solutions correcting water, electrolyte and acid-base disturbancesEdit

Vitamins and mineralsEdit

Ear, nose and throat medicinesEdit

Medicines for diseases of jointsEdit

Medicines used to treat goutEdit

Disease-modifying agents used in rheumatoid disordersEdit

Juvenile joint diseasesEdit

NotesEdit

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. ^ 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.
  8. ^ Only listed for single‐dose treatment of genital Chlamydia trachomatis and of trachoma
  9. ^ Only listed for acute invasive bacterial diarrhoea (dysentery) or gonorrhoea
  10. ^ Third-generation cephalosporin of choice for use in hospitalized neonates
  11. ^ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  12. ^ Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
  13. ^ Imipenem/cilastatin is an alternative, except for acute bacterial meningitis, where meropenem is preferred
  14. ^ For use only in patients with HIV receiving protease inhibitors
  15. ^ For treatment of latent TB infection (LTBI) only
  16. ^ For use only in combination with meropenem or imipenem/cilastatin
  17. ^ Terizidone may be an alternative
  18. ^ Prothionamide may be an alternative
  19. ^ Ofloxacin and moxifloxacin may be alternatives based on availability and programme considerations.
  20. ^ Imipenem/cilastatin may be an alternative
  21. ^ 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
  22. ^ For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis
  23. ^ a b FTC is an acceptable alternative to 3TC, based on knowledge of the pharmacology, the resistance patterns and clinical trials of antiretrovirals.
  24. ^ For the treatment of viral haemorrhagic fevers and in combination with pegylated interferons for the treatment of hepatitis C
  25. ^ For the treatment of cytomegalovirus retinitis
  26. ^ For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
  27. ^ When used in combination with sofosbuvir
  28. ^ When used in combination with daclatasvir
  29. ^ For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
  30. ^ To be used in combination with ribavirin
  31. ^ a b To be used in combination with artesunate 50 mg
  32. ^ For use in the management of severe malaria
  33. ^ Not recommended in the first trimester of pregnancy or in children below 5 kg
  34. ^ To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine
  35. ^ Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives.
  36. ^ For use only for the treatment of P. vivax infection
  37. ^ For use only in combination with quinine
  38. ^ Only for use to achieve radical cure of P. vivax and P. ovale infections, given for 14 days
  39. ^ For use only in the management of severe malaria, and should be used in combination with doxycycline
  40. ^ Only in combination with artesunate 50 mg
  41. ^ For use only in Central American regions, for P. vivax infections
  42. ^ For use only in combination with chloroquine
  43. ^ For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection
  44. ^ To be used for the treatment of Trypanosoma brucei gambiense infection
  45. ^ To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection
  46. ^ To be used for the treatment of T. b. gambiense infection
  47. ^ Only to be used in combination with eflornithine, for the treatment of T. b. gambiense infection
  48. ^ Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
  49. ^ Including quality-assured biosimilars
  50. ^ Gefitinib and afatinib are alternatives
  51. ^ Pembrolizumab is an alternative
  52. ^ Apixaban, edoxaban and rivaroxaban are alternatives
  53. ^ Alternatives are limited to nadroparin and dalteparin
  54. ^ Deferasirox oral form may be an alternative, depending on cost and availability.
  55. ^ Polygeline, injectable solution, 3.5% is considered as equivalent.
  56. ^ a b c d Includes metoprolol and carvedilol as alternatives
  57. ^ 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.
  58. ^ 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.
  59. ^ For use in high‐risk patients
  60. ^ In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts
  61. ^ Glibenclamide not suitable above 60 years
  62. ^ Carbimazole is an alternative depending on local availability
  63. ^ For use when alternative first-line treatment is not appropriate or available, and during the first trimester of pregnancy
  64. ^ Exact type to be defined locally
  65. ^ a b c d e f Recommended for some high-risk populations
  66. ^ a b c Recommended only for immunization programmes with certain characteristics
  67. ^ a b c Recommended for certain regions
  68. ^ For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae
  69. ^ Or homatropine (hydrobromide) or cyclopentolate (hydrochloride)
  70. ^ Where permitted under national law and where culturally acceptable
  71. ^ For induction of labour, should only be used where appropriate facilities are available
  72. ^ Buprenorphine considered to have similar clinical performance and best evidence for effectiveness and safety
  73. ^ Ergocalciferol can be used as an alternative.
  74. ^ For use for rheumatic fever, juvenile arthritis, Kawasaki disease

ReferencesEdit

  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. ^ a b "World Health Organization model list of essential medicines: 21st list 2019". 2019. hdl:10665/325771.
  13. ^ "WHO Model List of Essential Medicines for Children 6th List" (PDF). who.int. World Health Organization. August 2017. Retrieved 11 April 2018.
  14. ^ Rose, K; Anker, JNVd (2010). Guide to Paediatric Drug Development and Clinical Research. Karger Medical and Scientific Publishers. p. 42. ISBN 9783805593625.
  15. ^ Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. ISBN 9783642201950.
  16. ^ Kalle, H (9 February 2017). "Essential Medicines for Children". Clinical Pharmacology & Therapeutics. 101 (6): 718–720. doi:10.1002/cpt.661. PMID 28182281.

Further readingEdit