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]

2017 marked the 40th anniversary of the WHO Model List of Essential Medicines.

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 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
  • Charcoal, activated

Specific

Anticonvulsive medication

Anti-infective medicines

Anthelminthics

Intestinal anthelminthics
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
Pure crystals of ethambutol

Antifungal medicines

Antiviral medicines

Antiherpes medicines

Antiretrovirals
Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Two capsules of atazanavir
  • Atazanavir
  • Atazanavir/ritonavir
  • Darunavir
  • Lopinavir/ritonavir (LPV/r)
  • Ritonavir
Integrase inhibitors
Fixed-dose combinations
  • Abacavir/lamivudine
  • Dolutegravir/lamivudine/tenofovir (dolutegravir + lamivudine + tenofovir)
  • Efavirenz/emtricitabine/tenofovir[note 32]
  • Efavirenz/lamivudine/tenofovir
  • Emtricitabine/tenofovir[note 32][note 33]
  • Lamivudine/nevirapine/zidovudine
  • Lamivudine/zidovudine
  • Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim
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

  • Dasabuvir
  • Ledipasvir/sofosbuvir
  • Ombitasvir/paritaprevir/ritonavir

Other antivirals for hepatitis C

Antiprotozoal medicines

Antiamoebic and antigiardiasis medicines

Antileishmaniasis medicines
  • Amphotericin B
  • Miltefosine
  • Paromomycin
  • Sodium stibogluconate or meglumine antimoniate

Antimalarial medicines
For curative treatment
For prevention

Antipneumocystosis and antitoxoplasmosis medicines
  • Pyrimethamine
  • Sulfadiazine
  • Sulfamethoxazole/trimethoprim
  • Pentamidineα

Antitrypanosomal medicines
African trypanosomiasis
1st stage
2nd stage
American trypanosomiasis
  • Benznidazole
  • Nifurtimox

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
  • Biperiden
  • Carbidopa/levodopa (levodopa + carbidopa)

Medicines affecting the blood

Antianaemia medicines
  • Ferrous salt
  • Ferrous salt/folic acid
  • Folic acid
  • Hydroxocobalamin
  • Erythropoiesis-stimulating agentsα

Medicines affecting coagulation

Other medicines for haemoglobinopathies

Blood products and plasma substitutes of human origin

Blood and blood components
Bag containing one unit of fresh frozen plasma
  • Fresh frozen plasma
  • Platelet concentrates
  • Packed red blood cells
  • Whole blood

Plasma-derived medicines

Human immunoglobulins

Blood coagulation factors
  • Coagulation factor VIIIα
  • Coagulation factor IXα

Plasma substitutes

Cardiovascular medicines

Antianginal medicines

Antiarrhythmic medicines

Antihypertensive medicines

Medicines used in heart failure

Antithrombotic medicines

Anti-platelet medicines

Thrombolytic medicines
  • Alteplaseα
  • Streptokinaseα

Lipid-lowering agents

Dermatological (topical)

Antifungal medicines
  • Miconazole
  • Selenium sulfide
  • Sodium thiosulfate
  • Terbinafine

Anti-infective medicines
  • Mupirocin
  • Potassium permanganate
  • Silver sulfadiazine

Anti-inflammatory and antipruritic medicines

Medicines affecting skin differentiation and proliferation
  • Benzoyl peroxide
  • Coal tar
  • Fluorouracil
  • Podophyllum resin
  • Salicylic acid
  • Urea

Scabicides and pediculicides

Diagnostic agents

Ophthalmic medicines
  • Fluorescein
  • Tropicamide

Radiocontrast media
  • Amidotrizoate
  • Barium sulfate
  • Iohexol
  • Meglumine iotroxateα

Disinfectants and antiseptics

Antiseptics

Disinfectants
  • Alcohol based hand rub
  • Chlorine base compound
  • Chloroxylenol
  • Glutaral

Diuretics

Gastrointestinal medicines
  • Pancreatic enzymesα

Antiulcer medicines

Antiemetic medicines

Anti-inflammatory medicines
  • Sulfasalazine
  • Hydrocortisoneα

Laxatives
  • Senna

Medicines used in diarrhoea

Oral rehydration

Medicines for diarrhea

Medicines for endocrine disorders

Adrenal hormones and synthetic substitutes
  • Fludrocortisone
  • Hydrocortisone

Androgens

Progestogens

Medicines for diabetes

Insulins
  • Insulin injection (soluble)
  • Intermediate-acting insulin

Oral hypoglycaemic agents

Medicines for hypoglycaemia
  • Glucagon
  • Diazoxideα

Thyroid hormones and antithyroid medicines

Immunologicals

Diagnostic agents
  • Tuberculin, purified protein derivative (PPD)

Sera and immunoglobulins
  • Antivenom immunoglobulin[note 75]
  • Diphtheria antitoxin

Vaccines
A vial of oral cholera vaccine

Muscle relaxants (peripherally-acting) and cholinesterase inhibitors

Eye preparations

Anti-infective agents

Anti-inflammatory agents

Local anesthetics
  • Tetracaine

Miotics and antiglaucoma medicines

Mydriatics

Anti-vascular endothelial growth factor (VEGF)

Medicines for reproductive health and perinatal care

Contraceptives

Oral hormonal contraceptives
  • Ethinylestradiol/levonorgestrel
  • Ethinylestradiol/norethisterone
  • Levonorgestrel
  • Ulipristal

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
  • Glucose
  • Glucose with sodium chloride
  • Potassium chloride
  • Sodium chloride
  • Sodium hydrogen carbonate
  • Sodium lactate, compound solution

Miscellaneous
  • Water for injection

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. 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. 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. 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. 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. Recommended for some high-risk populations
  77. Recommended only for immunization programmes with certain characteristics
  78. 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. "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. Persaud N, Jiang M, Shaikh R, Bali A, Oronsaye E, Woods H, Drozdzal G, Rajakulasingam Y, Maraj D, Wadhawan S, Umali N, Wang R, McCall M, Aronson JK, Plüddemann A, Moja L, Magrini N, Heneghan C (June 2019). "Comparison of essential medicines lists in 137 countries". Bull. World Health Organ. 97 (6): 394–404C. doi:10.2471/BLT.18.222448. hdl:10665/325509. ISSN 0042-9686. PMC 6560372. PMID 31210677.
  4. "19th WHO Model List of Essential Medicines" (PDF). World Health Organization. April 2015. p. Annex 1. Retrieved 17 January 2017.
  5. 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.
  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". World Health Organization (WHO). 2003. 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" (PDF). World Intellectual Property Organization (WIPO). 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. doi:10.1016/S0140-6736(16)31599-9. PMID 27832874.
  9. "WHO Model Lists of Essential Medicines". World Health Organization. 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. doi:10.4103/0019-5154.174017. PMC 4763692. PMID 26955092.
  11. World Health Organization (2017). WHO model list of essential medicines, 20th list (March 2017, amended August 2017). Geneva. hdl:10665/273826.
  12. "Essential Medicines List and WHO Model Formulary". World Health Organization. Retrieved 5 May 2018.
  13. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  14. World Health Organization (2019). 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. hdl:10665/325773. WHO/MVP/EMP/IAU/2019.05. License: CC BY-NC-SA 3.0 IGO.
  15. World Health Organization (2019). World Health Organization model list of essential medicines for children: 7th list 2019. Geneva. hdl:10665/325772. 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. ISBN 9783805593625.
  17. Seyberth, HW; Rane, A; Schwab, M (2011). Pediatric Clinical Pharmacology. Springer Science & Business Media. p. 358. ISBN 9783642201950.
  18. 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
  • World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. hdl:10665/44053. ISBN 9789241547659.
  • World Health Organization (2015). 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). Geneva. hdl:10665/189763. ISBN 9789240694941. ISSN 0512-3054. WHO technical report series ; no. 994.
  • World Health Organization (2017). The selection and use of essential medicines: report of the WHO Expert Committee, 2017 (including the 20th WHO Model List of Essential Medicines and the 6th Model List of Essential Medicines for Children). Geneva. hdl:10665/259481. ISBN 978-92-4-121015-7. ISSN 0512-3054. WHO technical report series ; no. 1006.
  • World Health Organization (2019). The selection and use of essential medicines: report of the WHO Expert Committee on Selection and Use of Essential Medicines, 2019 (including the 21st WHO Model List of Essential Medicines and the 7th WHO Model List of Essential Medicines for Children). Geneva: World Health Organization. hdl:10665/330668. ISBN 9789241210300. ISSN 0512-3054. WHO technical report series;1021.
  • World Health Organization (2019). "Additions and deletions of medicines on the WHO model lists of essential medicines: 1977-2017". hdl:10665/278038. WHO/MVP/EMP/IAU/2019.01. License: CC BY-NC-SA 3.0 IGO. Cite journal requires |journal= (help)

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