The WHO Model List of Essential Medicines (aka Essential Medicines List or EML[1]), 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.[2] The list is frequently used by countries to help develop their own local lists of essential medicines.[2] As of 2016, more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list.[1] This includes both developed and developing countries.[2][3]

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 208 medications.[8][2][9] The WHO updates the list every two years.[10] There are 306 medications in the 14th list in 2005,[11] 410 in the 19th list in 2015,[10] 433 in the 20th list in 2017,[12][13] 460 in the 21st list in 2019,[14][15][16] and 479 in the 22nd list in 2021.[17][18] Various national lists contain between 334 and 580 medications.[5][19]

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 8th edition.[10][20][21] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[22][23] Everything in the children's list is also included in the main list.[24] The list and notes are based on the 19th to 22nd edition of the main list.[4][12][14][17] An α indicates a medicine is on the complementary list.[4][14][17] Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists.[17][18]

Anaesthetics, preoperative medicines and medical gases

General anaesthetics and oxygen

Inhalational medicines

Injectable medicines

Local anaesthetics

Complementary:

Preoperative medication and sedation for short-term procedures

Medical gases

Medicines for pain and palliative care

Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs)

A line drawing of a hexagon with two attachments
A skeletal model of the chemical structure of aspirin

Opioid analgesics

Complementary:

Medicines for other common symptoms in palliative care

Antiallergics and medicines used in anaphylaxis

Antidotes and other substances used in poisonings

Non-specific

Specific

Complementary:

Anticonvulsants/antiepileptics

Complementary:

Anti-infective medicines

Anthelminthics

Intestinal anthelminthics

A hexagon joined to a polygon with two attachments to this double ringed structure
A skeletal model of the chemical structure of albendazole

Antifilarials

Antischistosomals and other antinematode medicines

Complementary:

Cysticidal medicines

Complementary:

Antibacterials

Access group antibiotics

Watch group antibiotics

Complementary:

Reserve group antibiotics

Reserve antibiotics are last-resort antibiotics. The EML antibiotic book was published in 2022.[25][26][27]

Complementary:

Antileprosy medicines

Antituberculosis medicines

A small pile of white crystals
Pure crystals of ethambutol

Complementary:

Antifungal medicines

Complementary:

Antiviral medicines

Antiherpes medicines

Antiretrovirals

Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Two dark blue capsules with writing on them
Two capsules of atazanavir
Integrase inhibitors
Fixed-dose combinations of antiretroviral medicines
Medicines for prevention of HIV-related opportunistic infections
Other antivirals

Complementary:

Antihepatitis medicines

Medicines for hepatitis B
Nucleoside/Nucleotide reverse transcriptase inhibitors
Medicines for hepatitis C
Pangenotypic direct-acting antiviral combinations
Non-pangenotypic direct-acting antiviral combinations
Other antivirals for hepatitis C

Complementary:

Antiprotozoal medicines

Antiamoebic and antigiardiasis medicines

Antileishmaniasis medicines

Antimalarial medicines

For curative treatment
For chemoprevention

Antipneumocystosis and antitoxoplasmosis medicines

Complementary:

Antitrypanosomal medicines

African trypanosomiasis
Medicines for the treatment of 1st stage African trypanosomiasis
Medicines for the treatment of 2nd stage African trypanosomiasis

Complementary:

American trypanosomiasis

Medicines for ectoparasitic infections

Antimigraine medicines

For treatment of acute attack

For prophylaxis

Immunomodulators and antineoplastics

Immunomodulators for non-malignant disease

Complementary:

Antineoplastics and supportive medicines

Cytotoxic medicines

Complementary:

Targeted therapies

Complementary:

Immunomodulators

Complementary:

Hormones and antihormones

Complementary:

Supportive medicines

Complementary:

Antiparkinsonism medicines

Medicines affecting the blood

Antianaemia medicines

Complementary:

Medicines affecting coagulation

Complementary:

Other medicines for haemoglobinopathies

Complementary:

Blood products of human origin and plasma substitutes

Blood and blood components

A straw colored liquid inside a clear plastic bag
Bag containing one unit of fresh frozen plasma

Plasma-derived medicines

Human immunoglobulins

Complementary:

Blood coagulation factors

Complementary:

Plasma substitutes

Cardiovascular medicines

Antianginal medicines

Antiarrhythmic medicines

Complementary:

Antihypertensive medicines

Complementary:

Medicines used in heart failure

Complementary:

Antithrombotic medicines

Anti-platelet medicines

Thrombolytic medicines

Complementary:

Lipid-lowering agents

Dermatological medicines (topical)

Antifungal medicines

Anti-infective medicines

Anti-inflammatory and antipruritic medicines

Medicines affecting skin differentiation and proliferation

Scabicides and pediculicides

Diagnostic agents

Ophthalmic medicines

Radiocontrast media

Complementary:

Antiseptics and disinfectants

Antiseptics

Disinfectants

Diuretics

Complementary:

Gastrointestinal medicines

Complementary:

Antiulcer medicines

Antiemetic medicines

Complementary:

Anti-inflammatory medicines

Complementary:

Laxatives

Medicines used in diarrhoea

Oral rehydration

Medicines for diarrhea

Medicines for endocrine disorders

Adrenal hormones and synthetic substitutes

Androgens

Complementary:

Estrogens

No listings in this section.

Progestogens

Medicines for diabetes

Insulins

Oral hypoglycaemic agents

Complementary:

Medicines for hypoglycaemia

Complementary:

Thyroid hormones and antithyroid medicines

Complementary:

Immunologicals

Diagnostic agents

Sera, immunoglobulins and monoclonal antibodies

Vaccines

A small vial with writing on it being removed from a cardboard package
A vial of oral cholera vaccine

Recommendations for all

Recommendations for certain regions

Recommendations for some high-risk populations

Recommendations for immunization programmes with certain characteristics

Muscle relaxants (peripherally-acting) and cholinesterase inhibitors

Complementary:

Ophthalmological preparations

Anti-infective agents

Anti-inflammatory agents

Local anesthetics

Miotics and antiglaucoma medicines

Mydriatics

Complementary:

Anti-vascular endothelial growth factor (VEGF)

Complementary:

Medicines for reproductive health and perinatal care

Contraceptives

Oral hormonal contraceptives

Injectable hormonal contraceptives

Intrauterine devices

Barrier methods

Implantable contraceptives

Intravaginal contraceptives

Ovulation inducers

Complementary:

Uterotonics

Antioxytocics (tocolytics)

Medicines administered to the mother

Medicines administered to the neonate

Complementary:

Peritoneal dialysis solution

Complementary:

Medicines for mental and behavioural disorders

Medicines used in psychotic disorders

Complementary:

Medicines used in mood disorders

Medicines used in depressive disorders

Complementary:

Medicines used in bipolar disorders

Medicines for anxiety disorders

Medicines used for obsessive compulsive disorders

Medicines for disorders due to psychoactive substance use

Complementary:

Medicines acting on the respiratory tract

Antiasthmatics and medicines for chronic obstructive pulmonary disease

Solutions correcting water, electrolyte and acid-base disturbances

Oral

Parenteral

Miscellaneous

Vitamins and minerals

Complementary:

Ear, nose and throat medicines

Medicines for diseases of joints

Medicines used to treat gout

Disease-modifying agents used in rheumatoid disorders (DMARDs)

Complementary:

Juvenile joint diseases

Dental preparations

Notes

An α indicates the medicine is on the complementary list for which specialized diagnostic or monitoring or training is needed. An item may also be listed as complementary on the basis of higher costs or a less attractive cost-benefit ratio.[4][14]

  1. ^ Thiopental may be used as an alternative depending on local availability and cost.
  2. ^ (For use in spinal anaesthesia during delivery, to prevent hypotension).
  3. ^ No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
  4. ^ Not in children less than three months.
  5. ^ Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect.
  6. ^ For the management of cancer pain
  7. ^ Alternatives limited to hydromorphone and oxycodone.
  8. ^ For the management of cancer pain.
  9. ^ a b Alternatives limited to dolasetron, granisetron, palonosetron, and tropisetron
  10. ^ Alternatives limited to cetirizine and fexofenadine
  11. ^ There may be a role for sedating antihistamines for limited indications (EMLc).
  12. ^ Alternatives limited to prednisone
  13. ^ For use as adjunctive therapy for treatment-resistant partial or generalized seizures.
  14. ^ Alternatives limited to diazepam and midazolam
  15. ^ For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders.
  16. ^ For buccal administration when solution for oromucosal administration is not available.
  17. ^ The presence of both 25 mg/5 mL and 30 mg/5 mL strengths on the same market would cause confusion in prescribing and dispensing and should be avoided.
  18. ^ a b c Avoid use in pregnancy and in women and girls of child-bearing potential, unless alternative treatments are ineffective or not tolerated because of the high risk of birth defects and developmental disorders in children exposed to valproate in the womb.
  19. ^ Oxamniquine is listed for use when praziquantel treatment fails.
  20. ^ > 1 month.
  21. ^ Only for the presumptive treatment of epidemic meningitis in children older than two years and in adults.
  22. ^ Alternatives limited to 4th level ATC chemical subgroup (J01CF Beta-lactamase resistant penicillins)
  23. ^ cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
  24. ^ Use in children <8 years only for life-threatening infections when no alternative exists.
  25. ^ 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.
  26. ^ Third-generation cephalosporin of choice for use in hospitalized neonates.
  27. ^ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  28. ^ > 41 weeks corrected gestational age.
  29. ^ Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
  30. ^ Imipenem/cilastatin is an alternative for complicated intraabdominal infections and high-risk febrile neutropenia only, except for acute bacterial meningitis in neonates, where meropenem is preferred
  31. ^ For use only in patients with HIV receiving protease inhibitors
  32. ^ For use only in combination with meropenem or imipenem/cilastatin.
  33. ^ ≥ 5 years
  34. ^ Terizidone may be an alternative
  35. ^ Prothionamide may be used as an alternative.
  36. ^ Imipenem/cilastatin may be an alternative
  37. ^ For treatment of chronic pulmonary aspergillosis, histoplasmosis, sporotrichosis, paracoccidioidomycosis, mycoses caused by Talaromyces marneffei and chromoblastomycosis; and prophylaxis of histoplasmosis and infections caused by Talaromyces marneffei in AIDS patients.
  38. ^ For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis.
  39. ^ Alternatives limited to anidulafungin and caspofungin
  40. ^ Alternatives limited to valaciclovir
  41. ^ also indicated for pre-exposure prophylaxis.
  42. ^ For use in pregnant women and in second-line regimens in accordance with WHO treatment guidelines.
  43. ^ a b Alternatives limited to lamivudine (for emtricitabine)
  44. ^ combination also indicated for pre-exposure prophylaxis
  45. ^ For the treatment of viral haemorrhagic fevers
  46. ^ For the treatment of cytomegalovirus retinitis (CMVr).
  47. ^ For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
  48. ^ For the treatment of cytomegalovirus retinitis (CMVr).
  49. ^ Pangenotypic when used in combination with sofosbuvir
  50. ^ Pangenotypic when used in combination with daclatasvir
  51. ^ For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
  52. ^ To be used in combination with ribavirin
  53. ^ Alternatives limited to tinidazole
  54. ^ a b To be used in combination with artesunate 50 mg.
  55. ^ For use in the management of severe malaria.
  56. ^ Not recommended in the first trimester of pregnancy or in children below 5 kg.
  57. ^ To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine.
  58. ^ Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives.
  59. ^ For use only for the treatment of Plasmodium vivax infection.
  60. ^ For use only in combination with quinine.
  61. ^ Only for use to achieve radical cure of Plasmodium vivax and Plasmodium ovale infections, given for 14 days.
  62. ^ For use only in the management of severe malaria, and should be used in combination with doxycycline.
  63. ^ Only in combination with artesunate 50 mg.
  64. ^ For use only in Central American regions, for Plasmodium vivax infections.
  65. ^ For use only in combination with chloroquine.
  66. ^ For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection.
  67. ^ To be used for the treatment of Trypanosoma brucei gambiense infection.
  68. ^ To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection.
  69. ^ To be used for the treatment of Trypanosoma brucei gambiense infection
  70. ^ Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection.
  71. ^ Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
  72. ^ a b c d e f g h i Including quality-assured biosimilars
  73. ^ Afatinib and gefitinib are alternatives
  74. ^ Pembrolizumab is an alternative, including quality-assured biosimilars
  75. ^ Alternatives limited to enzalutamide
  76. ^ Alternatives limited to 4th level ATC chemical subgroup (L02BG Aromatase inhibitors)
  77. ^ Alternatives limited to flutamide and nilutamide
  78. ^ Alternatives limited to goserelin and triptorelin
  79. ^ Alternatives limited to prednisone
  80. ^ Alternatives limited to trihexyphenidyl
  81. ^ Alternatives limited to benserazide (for carbidopa)
  82. ^ periconceptual use for prevention of first occurrence of neural tube defects
  83. ^ Alternatives limited to epoetin alfa, beta and theta, darbepoetin alfa, methoxy polyethylene glycol-epoetin beta, and their quality-assured biosimilars.
  84. ^ Apixaban, edoxaban and rivaroxaban are alternatives
  85. ^ Alternatives are limited to dalteparin and nadroparin, including their quality-assured biosimilars.
  86. ^ Alternatives are limited to the oral form of deferasirox.
  87. ^ Polygeline, injectable solution, 3.5% is considered an alternative.
  88. ^ a b c Includes carvedilol and metoprolol as alternatives
  89. ^ Alternatives limited to 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives)
  90. ^ Includes atenolol, carvedilol, and metoprolol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients > 60 years.
  91. ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  92. ^ 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.
  93. ^ a b c Alternatives limited to chlorothiazide, chlorthalidone, and indapamide
  94. ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
  95. ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  96. ^ a b Alternatives limited to 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain)
  97. ^ Methyldopa is listed for use only in the management of pregnancy-induced hypertension. Its use in the treatment of essential hypertension is not recommended in view of the evidence of greater efficacy and safety of other medicines.
  98. ^ Alternatives limited to 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
  99. ^ Alternatives limited to 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  100. ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  101. ^ Alternatives limited to bumetanide and torasemide
  102. ^ For use in high‐risk patients. Alternatives limited to atorvastatin, fluvastatin, lovastatin, and pravastatin
  103. ^ Alternatives limited to 4th level ATC chemical subgroup (D01AC Imidazole and triazole derivatives) excluding combinations
  104. ^ Alternatives limited to 4th level ATC chemical subgroup (D07AC Corticosteroids, potent (group III))
  105. ^ Alternatives limited to 4th level ATC chemical subgroup (D07AA Corticosteroids, weak (group I))
  106. ^ Alternatives limited to calcitriol and tacalcitol
  107. ^ Alternatives limited to podophyllotoxin
  108. ^ Alternatives limited to precipitated sulfur topical ointment
  109. ^ Alternatives limited to atropine and cyclopentolate
  110. ^ Alternatives limited to propanol
  111. ^ Alternatives limited to iodine
  112. ^ Alternatives limited to 4th level ATC chemical subgroup (D08AE Phenol and derivatives)
  113. ^ Alternatives limited to bumetanide and torasemide
  114. ^ Alternatives limited to chlorothiazide and chlorthalidone
  115. ^ Alternatives limited to 4th level ATC chemical subgroup (A02BC Proton pump inhibitors) excluding combinations
  116. ^ Alternatives limited to 4th level ATC chemical subgroup (A02BA H2-receptor antagonists) excluding combinations
  117. ^ Alternatives limited to mesalazine
  118. ^ Alternatives limited to bisacodyl
  119. ^ In acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts.
  120. ^ Alternatives limited to norethisterone
  121. ^ Alternatives limited to insulin degludec, insulin detemir, and insulin glargine, including quality-assured biosimilars
  122. ^ Alternatives limited to canagliflozin and dapagliflozin
  123. ^ Glibenclamide not suitable above 60 years. Alternatives limited to 4th level ATC chemical subgroup (A10BB Sulfonylureas)
  124. ^ a b Carbimazole is an alternative depending on local availability
  125. ^ For use when alternative first-line treatment is not appropriate or available; and in patients during the first trimester of pregnancy.
  126. ^ For use when alternative first-line treatment is not appropriate or available
  127. ^ Exact type to be defined locally
  128. ^ a b c Recommended for certain regions
  129. ^ a b c d e f Recommended for some high-risk populations
  130. ^ a b c Recommended only for immunization programmes with certain characteristics
  131. ^ For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae.
  132. ^ Alternatives limited to amikacin, kanamycin, netilmicin, and tobramycin
  133. ^ Alternatives limited to 4th level ATC chemical subgroup (S01AE Fluoroquinolones)
  134. ^ Alternatives limited to chlortetracycline and oxytetracycline
  135. ^ Alternatives limited to 4th level ATC chemical subgroup (S01HA Local anaesthetics) excluding cocaine and combinations
  136. ^ Alternatives limited to carbachol
  137. ^ Alternatives limited to 4th level ATC chemical subgroup (S01ED Beta blocking agents) excluding combinations
  138. ^ Alternatives limited to cyclopentolate hydrochloride or homatropine hydrobromide only for the EMLc
  139. ^ For use in women actively breastfeeding at least 4 times per day
  140. ^ Alternatives limited to methylergometrine
  141. ^ Where permitted under national law and where culturally acceptable.
  142. ^ Only for use for induction of labour where appropriate facilities are available.
  143. ^ Alternatives limited to indometacin
  144. ^ Alternatives limited to prostaglandin E2
  145. ^ Alternatives limited to risperidone injection
  146. ^ Alternatives limited to citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline
  147. ^ Alternatives limited to buprenorphine. The medicines should only be used within an established support programme.
  148. ^ Alternatives limited to beclometasone, ciclesonide, flunisolide, fluticasone, and mometasone
  149. ^ Alternatives limited to beclometasone/formoterol, budesonide/salmeterol, fluticasone/formoterol, fluticasone furoate/vilanterol, and mometasone/formoterol
  150. ^ Alternatives limited to terbutaline
  151. ^ Alternatives limited to aclidinium, glycopyrronium, and umeclidinium
  152. ^ Ergocalciferol can be used as an alternative.
  153. ^ Colecalciferol can be used as an alternative.
  154. ^ Alternatives limited to ofloxacin
  155. ^ For use for rheumatic fever, juvenile arthritis, Kawasaki disease

References

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  2. ^ a b c d "Essential medicines". World Health Organization. Archived from the original on 2 October 2008. Retrieved 19 January 2017.
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  7. ^ Beall R (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.
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  9. ^ Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, et al. (January 2017). "Essential medicines for universal health coverage". Lancet. 389 (10067): 403–476. doi:10.1016/S0140-6736(16)31599-9. PMC 7159295. PMID 27832874.
  10. ^ a b c "WHO Model Lists of Essential Medicines". World Health Organization. The current versions are the 21st WHO Essential Medicines List (EML) and the 7th WHO Essential Medicines List for Children (EMLc) updated in June 2019.
  11. ^ 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.
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Further reading

External links

eEML - Electronic Essential Medicines List