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. As of 2016, more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list. This includes countries in both the developed and developing world.
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. About 25% of items are in the complementary list. Some medications are listed as both core and complementary. While most medications on the list are available as generic products, being under patent does not preclude inclusion.
The first list was published in 1977 and included 212 medications. The WHO updates the list every two years. The 14th list was published in 2005 and contained 306 medications. In 2015 the 19th edition of the list was published and contains around 410 medications. The 20th edition was published in 2017 and comprises 433 drugs. The 21st list was published in 2019. The national lists contain between 334 and 580 medications.
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. It was created to make sure that the needs of children were systematically considered such as availability of proper formulations. Everything in the children's list is also included in the main list. The list and notes are based on the 19th to 21st edition of the main list. An α indicates a medicine is only on the complementary list.
General anaesthetics and oxygenEdit
- Ephedrineα (not a local anaesthetic, included in this list for prevention of low blood pressure associated with spinal anaesthesia during caesarean section)
Preoperative medication and sedation for short-term proceduresEdit
Medicines for pain and palliative careEdit
Nonopioids and nonsteroidal anti-inflammatory drugs (NSAIDs)Edit
Medicines for other common symptoms in palliative careEdit
Antiallergics and medicines used in anaphylaxisEdit
Antidotes and other substances used in poisoningsEdit
Antischistosomals and other antinematode medicinesEdit
- Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)
- Benzathine benzylpenicillin
- Cefazolin[note 6]
- Phenoxymethylpenicillin (penicillin V)
- Cefixime[note 9]
- Cefotaxime[note 10]
- Ceftriaxone[note 11]
- Clarithromycin[note 12]
- Meropenemα[note 13]
- Ethambutol/isoniazid/pyrazinamide/rifampicin (ethambutol + isoniazid + pyrazinamide + rifampicin)
- Ethambutol/isoniazid/rifampicin (ethambutol + isoniazid + rifampicin)
- Isoniazid/pyrazinamide/rifampicin (isoniazid + pyrazinamide + rifampicin)
- Isoniazid/rifampicin (isoniazid + rifampicin)
- Rifabutin[note 14]
- Rifapentine[note 15]
- Amoxicillin + clavulanic acidα[note 16]
- Cycloserineα[note 17]
- Ethionamideα[note 18]
- Levofloxacinα[note 19]
- Meropenemα[note 20]
- p-aminosalicylic acidα
- Amphotericin B
- Itraconazole[note 21]
- Voriconazole[note 22]
- Potassium iodideα
Nucleoside/nucleotide reverse transcriptase inhibitorsEdit
Non-nucleoside reverse transcriptase inhibitorsEdit
- Efavirenz/emtricitabine/tenofovir[note 23]
- Emtricitabine/tenofovir[note 23]
Medicines for hepatitis BEdit
Nucleoside/Nucleotide reverse transcriptase inhibitors
Medicines for hepatitis CEdit
Pangenotypic direct-acting antivirals
Non-pangenotypic direct-acting antivirals
Antiamoebic and antigiardiasis medicinesEdit
For curative treatmentEdit
- Amodiaquine[note 31]
- Artemether[note 32]
- Artemether/lumefantrine[note 33]
- Artesunate[note 34]
- Artesunate/amodiaquine[note 35]
- Chloroquine[note 36]
- Doxycycline[note 37]
- Mefloquine[note 31]
- Primaquine[note 38]
- Quinine[note 39]
- Sulfadoxine/pyrimethamine[note 40]
Antipneumocystosis and antitoxoplasmosis medicinesEdit
Medicines for ectoparasitic infectionsEdit
Immunomodulators and antineoplasticsEdit
Immunomodulators for non-malignant diseaseEdit
Antineoplastics and supportive medicinesEdit
- Arsenic trioxideα
- Calcium folinateα
- Pegaspargaseα[note 49]
- Realgar–Indigo naturalis formulationα
Hormones and antihormonesEdit
Medicines affecting the bloodEdit
Medicines affecting coagulationEdit
- Enoxaparin[note 53]
- Heparin sodium
- Protamine sulfate
- Tranexamic acid
Other medicines for haemoglobinopathiesEdit
Blood products and plasma substitutes of human originEdit
Blood and blood componentsEdit
- Rho(D) immune globulin
- Anti-rabies immunoglobulin
- Anti-tetanus immunoglobulin
- Human normal immunoglobulinα
Blood coagulation factorsEdit
- Bisoprolol[note 56]
- Hydralazine[note 57]
- Methyldopa[note 58]
- Sodium nitroprussideα
Medicines used in heart failureEdit
- Bisoprolol[note 56]
Anti-inflammatory and antipruritic medicinesEdit
Medicines affecting skin differentiation and proliferationEdit
Scabicides and pediculicidesEdit
Disinfectants and antisepticsEdit
Medicines used in diarrhoeaEdit
Medicines for diarrhea in childrenEdit
Medicines for endocrine disordersEdit
Adrenal hormones and synthetic substitutesEdit
Medicines for diabetesEdit
Oral hypoglycaemic agentsEdit
Medicines for hypoglycaemiaEdit
Thyroid hormones and antithyroid medicinesEdit
- Tuberculin, purified protein derivative (PPD)
Sera and immunoglobulinsEdit
- BCG vaccine
- Cholera vaccine[note 65]
- Dengue vaccine[note 65]
- Diphtheria vaccine
- Haemophilus influenzae type b vaccine
- Hepatitis A vaccine[note 65]
- Hepatitis B vaccine
- HPV vaccine
- Influenza vaccine[note 66]
- Japanese encephalitis vaccine[note 67]
- Measles vaccine
- Meningococcal meningitis vaccine[note 65]
- Mumps vaccine[note 66]
- Pertussis vaccine
- Pneumococcal vaccine
- Poliomyelitis vaccine
- Rabies vaccine[note 65]
- Rotavirus vaccine
- Rubella vaccine
- Tetanus vaccine
- Tick-borne encephalitis vaccine[note 67]
- Typhoid vaccine[note 65]
- Varicella vaccine[note 66]
- Yellow fever vaccine[note 67]
Muscle relaxants (peripherally-acting) and cholinesterase inhibitorsEdit
Miotics and antiglaucoma medicinesEdit
Anti-vascular endothelial growth factor (VEGF)Edit
Medicines for reproductive health and perinatal careEdit
Oral hormonal contraceptivesEdit
Injectable hormonal contraceptivesEdit
Medicines administered to the motherEdit
Medicines administered to the neonateEdit
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
- Glucose with sodium chloride
- Potassium chloride
- Sodium chloride
- Sodium hydrogen carbonate
- Sodium lactate, compound solution
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
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.
- Thiopental may be used as an alternative depending on local availability and cost.
- Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect
- Alternatives limited to hydromorphone and oxycodone
- There may be a role for sedating antihistamines for limited indications (EMLc).
- For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders
- For surgical prophylaxis
- 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.
- Only listed for single‐dose treatment of genital Chlamydia trachomatis and of trachoma
- Only listed for acute invasive bacterial diarrhoea (dysentery) or gonorrhoea
- Third-generation cephalosporin of choice for use in hospitalized neonates
- Do not administer with calcium and avoid in infants with hyperbilirubinemia.
- Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
- Imipenem/cilastatin is an alternative, except for acute bacterial meningitis, where meropenem is preferred
- For use only in patients with HIV receiving protease inhibitors
- For treatment of latent TB infection (LTBI) only
- For use only in combination with meropenem or imipenem/cilastatin
- Terizidone may be an alternative
- Prothionamide may be an alternative
- Ofloxacin and moxifloxacin may be alternatives based on availability and programme considerations.
- Imipenem/cilastatin may be an alternative
- 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
- For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis
- FTC is an acceptable alternative to 3TC, based on knowledge of the pharmacology, the resistance patterns and clinical trials of antiretrovirals.
- For the treatment of viral haemorrhagic fevers and in combination with pegylated interferons for the treatment of hepatitis C
- For the treatment of cytomegalovirus retinitis
- For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
- When used in combination with sofosbuvir
- When used in combination with daclatasvir
- For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
- To be used in combination with ribavirin
- To be used in combination with artesunate 50 mg
- For use in the management of severe malaria
- Not recommended in the first trimester of pregnancy or in children below 5 kg
- To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine
- Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives.
- For use only for the treatment of P. vivax infection
- For use only in combination with quinine
- Only for use to achieve radical cure of P. vivax and P. ovale infections, given for 14 days
- For use only in the management of severe malaria, and should be used in combination with doxycycline
- Only in combination with artesunate 50 mg
- For use only in Central American regions, for P. vivax infections
- For use only in combination with chloroquine
- For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection
- To be used for the treatment of Trypanosoma brucei gambiense infection
- To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection
- To be used for the treatment of T. b. gambiense infection
- Only to be used in combination with eflornithine, for the treatment of T. b. gambiense infection
- Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
- Including quality-assured biosimilars
- Gefitinib and afatinib are alternatives
- Pembrolizumab is an alternative
- Apixaban, edoxaban and rivaroxaban are alternatives
- Alternatives are limited to nadroparin and dalteparin
- Deferasirox oral form may be an alternative, depending on cost and availability.
- Polygeline, injectable solution, 3.5% is considered as equivalent.
- Includes metoprolol and carvedilol as alternatives
- 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.
- 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.
- For use in high‐risk patients
- In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts
- Glibenclamide not suitable above 60 years
- Carbimazole is an alternative depending on local availability
- For use when alternative first-line treatment is not appropriate or available, and during the first trimester of pregnancy
- Exact type to be defined locally
- Recommended for some high-risk populations
- Recommended only for immunization programmes with certain characteristics
- Recommended for certain regions
- For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae
- Or homatropine (hydrobromide) or cyclopentolate (hydrochloride)
- Where permitted under national law and where culturally acceptable
- For induction of labour, should only be used where appropriate facilities are available
- Buprenorphine considered to have similar clinical performance and best evidence for effectiveness and safety
- Ergocalciferol can be used as an alternative.
- For use for rheumatic fever, juvenile arthritis, Kawasaki disease
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