Formulary
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[update], 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] The 14th list was published in 2005 and contained 306 medications.[11] In 2015, the 19th edition of the list was published and contains around 410 medications.[10] The 20th edition was published in 2017, and contains 433 medications.[12][13] The 21st list was published in 2019 and contains 460 medications.[14][15][16] The 22nd list was published in 2021 and contains 479 medications.[17][18] Various 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 8th edition.[10][19][20] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[21][22] Everything in the children's list is also included in the main list.[23] 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]
Blood products of human origin and plasma substitutes
Blood and blood components
Bag containing one unit of fresh frozen plasma
Plasma-derived medicines
Human immunoglobulins
Blood coagulation factors
Plasma substitutes
Medicines for endocrine disorders
Adrenal hormones and synthetic substitutes
Androgens
Estrogens
No listings in this section.
Progestogens
Medicines for diabetes
Insulins
Oral hypoglycaemic agents
Medicines for hypoglycaemia
Thyroid hormones and antithyroid medicines
Immunologicals
Diagnostic agents
Sera, immunoglobulins and monoclonal antibodies
Vaccines
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
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]
- ^ Thiopental may be used as an alternative depending on local availability and cost.
- ^ (For use in spinal anaesthesia during delivery, to prevent hypotension).
- ^ No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
- ^ Not in children less than 3 months.
- ^ 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.
- ^ a b Alternatives limited to dolasetron, granisetron, palonosetron, and tropisetron
- ^ Alternatives limited to cetirizine and fexofenadine
- ^ There may be a role for sedating antihistamines for limited indications (EMLc).
- ^ Alternatives limited to prednisone
- ^ For use as adjunctive therapy for treatment-resistant partial or generalized seizures.
- ^ Alternatives limited to diazepam and midazolam
- ^ For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders.
- ^ For buccal administration when solution for oromucosal administration is not available.
- ^ 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.
- ^ a b 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.
- ^ Oxamniquine is listed for use when praziquantel treatment fails.
- ^ > 1 month.
- ^ Only for the presumptive treatment of epidemic meningitis in children older than two years and in adults.
- ^ Alternatives limited to 4th level ATC chemical subgroup (J01CF Beta-lactamase resistant penicillins)
- ^ cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
- ^ Use in children <8 years only for life-threatening infections when no alternative exists.
- ^ 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.
- ^ Third-generation cephalosporin of choice for use in hospitalized neonates.
- ^ Do not administer with calcium and avoid in infants with hyperbilirubinemia.
- ^ > 41 weeks corrected gestational age.
- ^ Erythromycin may be an alternative. For use in combination regimens for eradication of H. pylori in adults
- ^ 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
- ^ For use only in patients with HIV receiving protease inhibitors
- ^ For use only in combination with meropenem or imipenem/cilastatin
- ^ ≥ 5 years
- ^ Terizidone may be an alternative
- ^ Prothionamide may be an alternative
- ^ 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.
- ^ Alternatives limited to anidulafungin and caspofungin
- ^ Alternatives limited to valaciclovir
- ^ also indicated for pre-exposure prophylaxis.
- ^ For use in pregnant women and in second-line regimens in accordance with WHO treatment guidelines.
- ^ a b Alternatives limited to lamivudine (for emtricitabine)
- ^ 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
- ^ For the treatment of cytomegalovirus retinitis (CMVr).
- ^ Pangenotypic when used in combination with sofosbuvir
- ^ Pangenotypic 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
- ^ Alternatives limited to tinidazole
- ^ a b 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 Plasmodium vivax infection.
- ^ For use only in combination with quinine.
- ^ Only for use to achieve radical cure of Plasmodium vivax and Plasmodium 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 Plasmodium 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 Trypanosoma brucei gambiense infection
- ^ Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection.
- ^ Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
- ^ a b c d e f g h i Including quality-assured biosimilars
- ^ Afatinib and gefitinib are alternatives
- ^ Pembrolizumab is an alternative, including quality-assured biosimilars
- ^ Alternatives limited to enzalutamide
- ^ Alternatives limited to 4th level ATC chemical subgroup (L02BG Aromatase inhibitors)
- ^ Alternatives limited to flutamide and nilutamide
- ^ Alternatives limited to goserelin and triptorelin
- ^ Alternatives limited to prednisone
- ^ Alternatives limited to trihexyphenidyl
- ^ Alternatives limited to benserazide (for carbidopa)
- ^ periconceptual use for prevention of first occurrence of neural tube defects
- ^ Alternatives limited to epoetin alfa, beta and theta, darbepoetin alfa, methoxy polyethylene glycol-epoetin beta, and their quality-assured biosimilars.
- ^ Apixaban, edoxaban and rivaroxaban are alternatives
- ^ Alternatives are limited to dalteparin and nadroparin, including their quality-assured biosimilars.
- ^ Alternatives are limited to the oral form of deferasirox.
- ^ Polygeline, injectable solution, 3.5% is considered an alternative.
- ^ a b c Includes carvedilol and metoprolol as alternatives
- ^ Alternatives limited to 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives)
- ^ Includes atenolol, carvedilol, and metoprolol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients > 60 years.
- ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
- ^ 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.
- ^ a b c Alternatives limited to chlorothiazide, chlorthalidone, and indapamide
- ^ 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)
- ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
- ^ a b Alternatives limited to 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain)
- ^ 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.
- ^ 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)
- ^ Alternatives limited to 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
- ^ Alternatives limited to 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
- ^ Alternatives limited to bumetanide and torasemide
- ^ For use in high‐risk patients. Alternatives limited to atorvastatin, fluvastatin, lovastatin, and pravastatin
- ^ Alternatives limited to 4th level ATC chemical subgroup (D01AC Imidazole and triazole derivatives) excluding combinations
- ^ Alternatives limited to 4th level ATC chemical subgroup (D07AC Corticosteroids, potent (group III))
- ^ Alternatives limited to 4th level ATC chemical subgroup (D07AA Corticosteroids, weak (group I))
- ^ Alternatives limited to calcitriol and tacalcitol
- ^ Alternatives limited to podophyllotoxin
- ^ Alternatives limited to precipitated sulfur topical ointment
- ^ Alternatives limited to atropine and cyclopentolate
- ^ Alternatives limited to propanol
- ^ Alternatives limited to iodine
- ^ Alternatives limited to 4th level ATC chemical subgroup (D08AE Phenol and derivatives)
- ^ Alternatives limited to bumetanide and torasemide
- ^ Alternatives limited to chlorothiazide and chlorthalidone
- ^ Alternatives limited to 4th level ATC chemical subgroup (A02BC Proton pump inhibitors) excluding combinations
- ^ Alternatives limited to 4th level ATC chemical subgroup (A02BA H2-receptor antagonists) excluding combinations
- ^ Alternatives limited to mesalazine
- ^ Alternatives limited to bisacodyl
- ^ In acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts.
- ^ Alternatives limited to norethisterone
- ^ Alternatives limited to insulin degludec, insulin detemir, and insulin glargine, including quality-assured biosimilars
- ^ Alternatives limited to canagliflozin and dapagliflozin
- ^ Glibenclamide not suitable above 60 years. Alternatives limited to 4th level ATC chemical subgroup (A10BB Sulfonylureas)
- ^ a b Carbimazole is an alternative depending on local availability
- ^ For use when alternative first-line treatment is not appropriate or available; and in patients during the first trimester of pregnancy.
- ^ For use when alternative first-line treatment is not appropriate or available
- ^ Exact type to be defined locally
- ^ a b c Recommended for certain regions
- ^ a b c d e f Recommended for some high-risk populations
- ^ a b c Recommended only for immunization programmes with certain characteristics
- ^ For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae.
- ^ Alternatives limited to amikacin, kanamycin, netilmicin, and tobramycin
- ^ Alternatives limited to 4th level ATC chemical subgroup (S01AE Fluoroquinolones)
- ^ Alternatives limited to chlortetracycline and oxytetracycline
- ^ Alternatives limited to 4th level ATC chemical subgroup (S01HA Local anaesthetics) excluding cocaine and combinations
- ^ Alternatives limited to carbachol
- ^ Alternatives limited to 4th level ATC chemical subgroup (S01ED Beta blocking agents) excluding combinations
- ^ Alternatives limited to cyclopentolate hydrochloride or homatropine hydrobromide only for the EMLc
- ^ For use in women actively breastfeeding at least 4 times per day
- ^ Alternatives limited to methylergometrine
- ^ Where permitted under national law and where culturally acceptable.
- ^ Only for use for induction of labour where appropriate facilities are available.
- ^ Alternatives limited to indometacin
- ^ Alternatives limited to prostaglandin E2
- ^ Alternatives limited to risperidone injection
- ^ Alternatives limited to citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline
- ^ Alternatives limited to buprenorphine. The medicines should only be used within an established support programme.
- ^ Alternatives limited to beclometasone, ciclesonide, flunisolide, fluticasone, and mometasone
- ^ Alternatives limited to beclometasone/formoterol, budesonide/salmeterol, fluticasone/formoterol, fluticasone furoate/vilanterol, and mometasone/formoterol
- ^ Alternatives limited to terbutaline
- ^ Alternatives limited to aclidinium, glycopyrronium, and umeclidinium
- ^ Ergocalciferol can be used as an alternative.
- ^ Colecalciferol can be used as an alternative.
- ^ Alternatives limited to ofloxacin
- ^ For use for rheumatic fever, juvenile arthritis, Kawasaki disease
