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 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 and 20th 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
Beta Lactam medicinesEdit
- Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)
- Benzathine benzylpenicillin
- Cefazolin[note 6]
- Cefixime[note 7]
- Cefotaxime[note 8]
- Ceftriaxone[note 9]
- Phenoxymethylpenicillin (penicillin V)
- Procaine benzylpenicillin[note 10]
- Imipenem/cilastatinα[note 11]
- Azithromycin[note 12]
- Clarithromycin[note 13]
- Ethambutol/isoniazid (ethambutol + isoniazid)
- 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]
- Cycloserineα[note 16]
- Ethionamideα[note 17]
- Levofloxacinα[note 18]
- p-aminosalicylic acidα
- Amphotericin B
- Potassium iodideα
Nucleoside/nucleotide reverse transcriptase inhibitorsEdit
Non-nucleoside reverse transcriptase inhibitorsEdit
- Efavirenz/emtricitabine/tenofovir[note 19]
- Emtricitabine/tenofovir[note 19]
Medicines for hepatitis BEdit
Nucleoside/Nucleotide reverse transcriptase inhibitors
Medicines for hepatitis CEdit
Nucleotide polymerase inhibitors
Non-nucleoside polymerase inhibitors
Antiamoebic and antigiardiasis medicinesEdit
For curative treatmentEdit
- Amodiaquine[note 24]
- Artemether[note 25]
- Artemether/lumefantrine[note 26]
- Artesunate[note 27]
- Artesunate/amodiaquine[note 28]
- Chloroquine[note 29]
- Doxycycline[note 30]
- Mefloquine[note 24]
- Primaquine[note 31]
- Quinine[note 32]
- Sulfadoxine/pyrimethamine[note 33]
Antipneumocystosis and antitoxoplasmosis medicinesEdit
Antineoplastic and immunosuppressivesEdit
Cytotoxic and adjuvant medicinesEdit
- All-trans retinoic acid (tretinoin)α
- Calcium folinateα
- Zoledronic acidα
Hormones and antihormonesEdit
Medicines affecting the bloodEdit
Medicines affecting coagulationEdit
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 42]
- Hydralazine[note 43]
- Methyldopa[note 44]
- Sodium nitroprussideα
Medicines used in heart failureEdit
- Bisoprolol[note 42]
Anti-inflammatory and antipruritic medicinesEdit
Medicines affecting skin differentiation and proliferationEdit
Scabicides and pediculicidesEdit
Disinfectants and antisepticsEdit
Medicines used in diarrheaEdit
Medicines for diarrhea in childrenEdit
Hormones, other endocrine medicines, and contraceptivesEdit
Adrenal hormones and synthetic substitutesEdit
Oral hormonal contraceptivesEdit
Injectable hormonal contraceptivesEdit
Insulins and other medicines used for diabetesEdit
Thyroid hormones and antithyroid medicinesEdit
- Tuberculin, purified protein derivative (PPD)
Sera and immunoglobulinsEdit
- BCG vaccine
- Cholera vaccine[note 49]
- Diphtheria vaccine
- Haemophilus influenzae type b vaccine
- Hepatitis A vaccine[note 49]
- Hepatitis B vaccine
- HPV vaccine
- Influenza vaccine
- Japanese encephalitis vaccine[note 50]
- Measles vaccine
- Meningococcal meningitis vaccine[note 49]
- Mumps vaccine
- Pertussis vaccine
- Pneumococcal vaccine
- Poliomyelitis vaccine
- Rabies vaccine[note 49]
- Rotavirus vaccine
- Rubella vaccine
- Tetanus vaccine
- Tick-borne encephalitis vaccine[note 50]
- Typhoid vaccine[note 49]
- Varicella vaccine
- Yellow fever vaccine[note 50]
Muscle relaxants (peripherally-acting) and cholinesterase inhibitorsEdit
Miotics and antiglaucoma medicinesEdit
Anti-vascular endothelial growth factor (VEGF)Edit
Oxytocics and antioxytocicsEdit
Oxytocics and abortifacientsEdit
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
Antiasthmatic 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 medicines in childrenEdit
Specific medicines for neonatal careEdit
Medicines administered to the neonateEdit
- Caffeine citrate
- Prostaglandin Eα
Medicines administered to the motherEdit
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
- Only listed for single‐dose treatment of uncomplicated ano‐genital gonorrhoea
- Third-generation cephalosporin of choice for use in hospitalized neonates
- Do not administer with calcium and avoid in infants with hyperbilirubinemia.
- 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 the treatment of life‐threatening hospital‐based infection due to suspected or proven multidrug‐resistant infection
- Only listed for single‐dose treatment of genital Chlamydia trachomatis and of trachoma
- Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
- For use only in patients with HIV receiving protease inhibitors
- For treatment of latent TB infection (LTBI) only
- Terizidone may be an alternative.
- Prothionamide may be an alternative.
- Ofloxacin and moxifloxacin may be alternatives based on availability and programme considerations.
- 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
- Potentially severe or complicated illness due to confirmed or suspected influenza virus infection in accordance with WHO treatment guidelines
- For the treatment of hepatitis C, in combination with peginterferon or 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 use for P. vivax
- For use only in combination with chloroquine
- 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
- 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
- Exact type to be defined locally
- Recommended for some high-risk populations
- Recommended for certain regions
- Or homatropine (hydrobromide) or cyclopentolate (hydrochloride)
- Requires close medical supervision
- Ergocalciferol can be used as an alternative.
- For use for rheumatic fever, juvenile arthritis, Kawasaki disease
- "Essential medicines". World Health Organization. Retrieved 19 January 2017.
- "The WHO Essential Medicines List (EML): 30th anniversary". World Health Organization. Retrieved 26 June 2016.
- "19th WHO Model List of Essential Medicines" (PDF). who.int. World Health Organization. April 2015. p. Annex 1. Retrieved 17 January 2017.
- 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.
- "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.
- 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.
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- "WHO Model List of Essential Medicines 20th List" (PDF). March 2017. Retrieved 8 June 2017.
- "Essential Medicines List and WHO Model Formulary". World Health Organization. Retrieved 5 May 2018.
- "WHO Model List of Essential Medicines for Children 6th List" (PDF). who.int. World Health Organization. August 2017. Retrieved 11 April 2018.
- Rose, K; Anker, JNVd (2010). Guide to Paediatric Drug Development and Clinical Research. Karger Medical and Scientific Publishers. p. 42. ISBN 9783805593625.
- Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. ISBN 9783642201950.
- Kalle, H (9 February 2017). "Essential Medicines for Children". Clinical Pharmacology & Therapeutics. 101 (6): 718–720. doi:10.1002/cpt.661. PMID 28182281.
- WHO Model Formulary 2008 (PDF). World Health Organization. 2009. ISBN 9789241547659.
- The selection and use of essential medicines: Twentieth report of the WHO Expert Committee 2015 (including 19th WHO Model List of Essential Medicines and 5th WHO Model List of Essential Medicines for Children) (PDF). WHO. 2015. ISBN 9789240694941.