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[update], 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 contains 433 medications. 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 7th 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 oxygen
- 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 procedures
Medicines for pain and palliative care
Nonopioids and nonsteroidal anti-inflammatory drugs (NSAIDs)
Medicines for other common symptoms in palliative care
- Docusate sodium
- Hyoscine butylbromide
- Hyoscine hydrobromide
Antiallergics and medicines used in anaphylaxis
Antidotes and other substances used in poisonings
- Calcium gluconate
- Methylthioninium chloride (methylene blue)
- Prussian blue
- Sodium nitrite
- Sodium thiosulfate
- Sodium calcium edetateα
- Lamotrigine[note 8]
- Magnesium sulfate[note 9]
- Valproic acid (sodium valproate)
Antischistosomals and other antinematode medicines
- Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)
- Benzathine benzylpenicillin
- Cefazolin[note 11]
- Cloxacillin[note 12]
- Phenoxymethylpenicillin (penicillin V)
- Procaine benzylpenicillin[note 13]
- Trimethoprim/sulfamethoxazole[note 14]
- Azithromycin[note 15]
- Cefixime[note 16]
- Cefotaxime[note 17]
- Ceftriaxone[note 18]
- Clarithromycin[note 19]
- Meropenemα[note 20]
- Vancomycinα[note 21]
- Polymyxin Bα
- 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 22]
- Rifapentine[note 23]
- Amoxicillin/clavulanic acidα[note 24]
- Cycloserineα[note 25]
- Ethionamideα[note 26]
- Levofloxacinα[note 27]
- Meropenemα[note 28]
- p-aminosalicylic acidα
- Amphotericin B
- Itraconazole[note 29]
- Voriconazole[note 30]
- Potassium iodideα
Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
- Dolutegravir/lamivudine/tenofovir (dolutegravir + lamivudine + tenofovir)
- Efavirenz/emtricitabine/tenofovir[note 32]
- Emtricitabine/tenofovir[note 32][note 33]
Medicines for hepatitis B
Nucleoside/Nucleotide reverse transcriptase inhibitors
Medicines for hepatitis C
Pangenotypic direct-acting antivirals
Non-pangenotypic direct-acting antivirals
Other antivirals for hepatitis C
Antiamoebic and antigiardiasis medicines
For curative treatment
- Amodiaquine[note 41]
- Artemether[note 42]
- Artemether/lumefantrine[note 43]
- Artesunate[note 44]
- Artesunate/amodiaquine[note 45]
- Chloroquine[note 46]
- Doxycycline[note 47]
- Mefloquine[note 41]
- Primaquine[note 48]
- Quinine[note 49]
- Sulfadoxine/pyrimethamine[note 50]
- Amodiaquine + sulfadoxine/pyrimethamine
- Chloroquine[note 51]
- Proguanil[note 52]
Antipneumocystosis and antitoxoplasmosis medicines
Medicines for ectoparasitic infections
Immunomodulators and antineoplastics
Immunomodulators for non-malignant disease
Antineoplastics and supportive medicines
- Arsenic trioxideα
- Calcium folinateα
- Pegaspargaseα[note 59]
- Realgar Indigo naturalis formulationα
- All-trans retinoic acid (tretinoin) (ATRA)α
- Erlotinibα[note 60]
- Rituximabα[note 59]
- Trastuzumabα[note 59]
Hormones and antihormones
Medicines affecting the blood
Medicines affecting coagulation
- Dabigatran[note 62]
- Enoxaparin[note 63]
- Heparin sodium
- Protamine sulfate
- Tranexamic acid
Other medicines for haemoglobinopathies
Blood products and plasma substitutes of human origin
Blood and blood components
- Rho(D) immune globulin (anti-D immunoglobulin)
- Anti-rabies immunoglobulin
- Anti-tetanus immunoglobulin
- Human normal immunoglobulinα
Blood coagulation factors
- Bisoprolol[note 67]
- Hydralazine[note 68]
- Lisinopril/amlodipine (lisinopril + amlodipine)
- Methyldopa[note 69]
- Telmisartan/amlodipine (telmisartan + amlodipine)
- Sodium nitroprussideα
Medicines used in heart failure
- Bisoprolol[note 66]
Anti-inflammatory and antipruritic medicines
Medicines affecting skin differentiation and proliferation
Scabicides and pediculicides
Disinfectants and antiseptics
Medicines used in diarrhoea
Medicines for diarrhea
Medicines for endocrine disorders
Adrenal hormones and synthetic substitutes
Medicines for diabetes
Oral hypoglycaemic agents
Medicines for hypoglycaemia
Thyroid hormones and antithyroid medicines
- Tuberculin, purified protein derivative (PPD)
Sera and immunoglobulins
- BCG vaccine
- Cholera vaccine[note 76]
- Dengue vaccine[note 76]
- Diphtheria vaccine
- Haemophilus influenzae type b vaccine
- Hepatitis A vaccine[note 76]
- Hepatitis B vaccine
- HPV vaccine
- Influenza vaccine[note 77]
- Japanese encephalitis vaccine[note 78]
- Measles vaccine
- Meningococcal meningitis vaccine[note 76]
- Mumps vaccine[note 77]
- Pertussis vaccine
- Pneumococcal vaccine
- Poliomyelitis vaccine
- Rabies vaccine[note 76]
- Rotavirus vaccine
- Rubella vaccine
- Tetanus vaccine
- Tick-borne encephalitis vaccine[note 78]
- Typhoid vaccine[note 76]
- Varicella vaccine[note 77]
- Yellow fever vaccine[note 78]
Muscle relaxants (peripherally-acting) and cholinesterase inhibitors
Miotics and antiglaucoma medicines
Anti-vascular endothelial growth factor (VEGF)
Medicines for reproductive health and perinatal care
Oral hormonal contraceptives
Injectable hormonal contraceptives
Medicines administered to the mother
Medicines administered to the neonate
- Caffeine citrate
- Prostaglandin Eα
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
- Epinephrine (adrenaline)
- Ipratropium bromide
- Salbutamol (albuterol)
Solutions correcting water, electrolyte and acid-base disturbances
- Glucose with sodium chloride
- Potassium chloride
- Sodium chloride
- Sodium hydrogen carbonate
- Sodium lactate, compound solution
Vitamins and minerals
- Ascorbic acid
- Cholecalciferol[note 85]
- Multiple micronutrient powder
- Sodium fluoride
- Calcium gluconateα
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
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.
- No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
- Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect
- For the management of cancer pain
- Alternatives limited to hydromorphone and oxycodone
- For the management of cancer pain
- There may be a role for sedating antihistamines for limited indications (EMLc).
- as adjunctive therapy for treatment-resistant partial or generalized seizures.
- For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders
- Oxamniquine is listed for use when praziquantel treatment fails.
- For surgical prophylaxis
- cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
- 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.
- single agent trimethoprim may be an alternative for lower urinary tract infection.
- Also listed for single-dose treatment of trachoma and yaws.
- 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
- Powder for injection:250 mg (as hydrochloride) in vial.
- 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
- For use in pregnant women and in second-line regimens in accordance with WHO treatemnt guidelines.
- Emtricitabine (FTC) is an acceptable alternative to 3TC, based on knowledge of the pharmacology, the resistance patterns and clinical trials of antiretrovirals.
- Combination also indicated for pre-exposure prophylaxis
- For the treatment of viral haemorrhagic fevers
- For the treatment of cytomegalovirus retinitis (CMVr).
- 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
- Includes atenolol, metoprolol and carvedilol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients >60 years
- 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
- 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)
- For use in women actively breastfeeding at least 4 times per day
- 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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