WHO Model List of Essential Medicines

For the list for children, see WHO Model List of Essential Medicines for Children.

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] 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] The Essential Medicines List (EML) was updated in July 2023 to its 23rd edition. This list contains 1200 recommendations for 591 drugs and 103 therapeutic equivalents.^[20]

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 9th edition.^{[10][21][22][23]} It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.^[24][25] Everything in the children's list is also included in the main list.^[26] The list and notes are based on the 19th to 23rd edition of the main list.^{[4][12][14][17][27]} Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists.^[17][18] The 9th Essential Medicines List for Children was updated in July 2023.^[23][28]

Note: An α indicates a medicine is on the complementary list.^[4][14][17]

Anaesthetics, preoperative medicines and medical gases

General anaesthetics and oxygen

Inhalational medicines

• Halothane
• Isoflurane
• Nitrous oxide
• Oxygen
• Sevoflurane

Injectable medicines

• Ketamine
• Propofol
• Thiopental

Local anaesthetics

• Bupivacaine
• Lidocaine
• Lidocaine/epinephrine (lidocaine + epinephrine)

Complementary:

• Ephedrine^{α[note 1]}

Preoperative medication and sedation for short-term procedures

• Atropine
• Midazolam
• Morphine

Medical gases

• Oxygen^{[note 2]}

Medicines for pain and palliative care

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

A skeletal model of the chemical structure of aspirin

• Acetylsalicylic acid (aspirin)
• Ibuprofen^{[note 3]}
• Paracetamol^{[note 4]} (acetaminophen)

Opioid analgesics

• Codeine
• Fentanyl^{[note 5]}
• Morphine^{[note 6]}

Complementary:

• Methadone^{α[note 7]}

Medicines for other common symptoms in palliative care

• Amitriptyline
• Cyclizine
• Dexamethasone
• Diazepam
• Docusate sodium
• Fluoxetine
• Haloperidol
• Hyoscine butylbromide
• Hyoscine hydrobromide
• Lactulose
• Loperamide
• Metoclopramide
• Midazolam
• Ondansetron^{[note 8]}
• Senna

Antiallergics and medicines used in anaphylaxis

• Dexamethasone
• Epinephrine (adrenaline)
• Hydrocortisone
• Loratadine^{[note 9][note 10]}
• Prednisolone^{[note 11]}

Antidotes and other substances used in poisonings

Non-specific

• Charcoal, activated

Specific

• Acetylcysteine
• Atropine
• Calcium gluconate
• Methylthioninium chloride (methylene blue)
• Naloxone
• Penicillamine
• Prussian blue
• Sodium nitrite
• Sodium thiosulfate

Complementary:

• Deferoxamine^α
• Dimercaprol^α
• Fomepizole^α
• Sodium calcium edetate^α
• Succimer^α

Medicines for diseases of the nervous system

Antiseizure medicines

• Carbamazepine
• Diazepam
• Lamotrigine^{[note 12]}
• Levetiracetam
• Lorazepam^{[note 13]}
• Magnesium sulfate^{[note 14]}
• Midazolam^{[note 15]}
• Phenobarbital
• Phenytoin^{[note 16]}
• Valproic acid (sodium valproate)^{[note 17]}

Complementary:

• Ethosuximide^α
• Levetiracetam^α
• Valproic acid (sodium valproate)^{α[note 17]}

Medicines for multiple sclerosis

Complementary:

• Cladribine^α
• Glatiramer acetate^α
• Rituximab^{α[note 18]}

Medicines for parkinsonism

• Biperiden^{[note 19]}
• Levodopa/carbidopa (levodopa + carbidopa)^{[note 20]}

Anti-infective medicines

Anthelminthics

Intestinal anthelminthics

A skeletal model of the chemical structure of albendazole

• Albendazole
• Ivermectin
• Levamisole
• Mebendazole
• Niclosamide
• Praziquantel
• Pyrantel

Antifilarials

• Albendazole
• Diethylcarbamazine
• Ivermectin

Antischistosomals and other antinematode medicines

• Praziquantel
• Triclabendazole

Complementary:

• Oxamniquine^{α[note 21]}

Cysticidal medicines

Complementary:

• Albendazole^α
• Mebendazole^α
• Praziquantel^α

Antibacterials

Access group antibiotics

• Amikacin
• Amoxicillin
• Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)
• Ampicillin
• Benzathine benzylpenicillin
• Benzylpenicillin
• Cefalexin
• Cefazolin^{[note 22]}
• Chloramphenicol^{[note 23]}
• Clindamycin
• Cloxacillin^{[note 24][note 25]}
• Doxycycline^{[note 26]}
• Gentamicin
• Metronidazole
• Nitrofurantoin
• Phenoxymethylpenicillin (penicillin V)
• Procaine benzylpenicillin^{[note 27]}
• Spectinomycin
• Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim)
• Trimethoprim

Watch group antibiotics

• Azithromycin
• Cefixime
• Cefotaxime^{[note 28]}
• Ceftriaxone^{[note 29][note 30]}
• Cefuroxime
• Ciprofloxacin
• Clarithromycin^{[note 31][note 32]}
• Piperacillin/tazobactam (piperacillin + tazobactam)
• Vancomycin^{[note 33]}

Complementary:

• Ceftazidime^α
• Meropenem^{α[note 34]}
• Vancomycin^α

Reserve group antibiotics

Reserve antibiotics are last-resort antibiotics. The EML antibiotic book was published in 2022.^[29][30][31]

Complementary:

• Cefiderocol^α
• Ceftazidime/avibactam (ceftazidime + avibactam)^α
• Ceftolozane/tazobactam (ceftolozane + tazobactam)^α
• Colistin^α
• Fosfomycin^α
• Linezolid^{α[note 35]}
• Meropenem/vaborbactam (meropenem + vaborbactam)^α
• Plazomicin^α
• Polymyxin B^α

Antileprosy medicines

• Clofazimine
• Dapsone
• Rifampicin

Antituberculosis medicines

Pure crystals of ethambutol

• Ethambutol
• Ethambutol/isoniazid/pyrazinamide/rifampicin (ethambutol + isoniazid + pyrazinamide + rifampicin)
• Ethambutol/isoniazid/rifampicin (ethambutol + isoniazid + rifampicin)
• Ethionamide
• Isoniazid
• Isoniazid/pyrazinamide/rifampicin (isoniazid + pyrazinamide + rifampicin)
• Isoniazid/rifampicin (isoniazid + rifampicin)
• Isoniazid/rifapentine (isoniazid + rifapentine)
• Moxifloxacin
• Pyrazinamide
• Rifabutin^{[note 36]}
• Rifampicin
• Rifapentine

Complementary:

• Amikacin^α
• Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)^{α[note 37]}
• Bedaquiline^α
• Clofazimine^α
• Cycloserine^{α[note 38]}
• Delamanid^α
• Ethionamide^{α[note 39]}
• Levofloxacin^α
• Linezolid^α
• Meropenem^{α[note 40]}
• Moxifloxacin^α
• P-aminosalicylic acid (p-aminosalicylate sodium)^α
• Pretomanid^α
• Streptomycin^α

Antifungal medicines

• Amphotericin B
• Clotrimazole
• Fluconazole
• Flucytosine
• Griseofulvin
• Itraconazole^{[note 41]}
• Nystatin
• Voriconazole^{[note 42]}

Complementary:

• Micafungin^{α[note 43]}
• Potassium iodide^α

Antiviral medicines

Antiherpes medicines

• Aciclovir^{[note 44]}

Antiretrovirals

Nucleoside/nucleotide reverse transcriptase inhibitors

• Abacavir
• Lamivudine
• Tenofovir disoproxil fumarate^{[note 45]}
• Zidovudine

Non-nucleoside reverse transcriptase inhibitors

• Efavirenz
• Nevirapine^{[note 46]}

Protease inhibitors

Two capsules of atazanavir

• Atazanavir/ritonavir (atazanavir + ritonavir)
• Darunavir^{[note 47]}
• Lopinavir/ritonavir (lopinavir + ritonavir)
• Ritonavir

Integrase inhibitors

• Dolutegravir
• Raltegravir^{[note 48]}

Fixed-dose combinations of antiretroviral medicines

• Abacavir/lamivudine (abacavir + lamivudine)
• Dolutegravir/lamivudine/tenofovir (dolutegravir + lamivudine + tenofovir)
• Efavirenz/emtricitabine/tenofovir^{[note 49]}
• Efavirenz/lamivudine/tenofovir (efavirenz + lamivudine + tenofovir)
• Emtricitabine/tenofovir (emtricitabine + tenofovir)^{[note 49][note 50]}
• Lamivudine/zidovudine (lamivudine + zidovudine)

Medicines for prevention of HIV-related opportunistic infections

• Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim (isoniazid + pyridoxine + sulfamethoxazole + trimethoprim)

Other antivirals

• Ribavirin^{[note 51]}
• Valganciclovir^{[note 52]}

Complementary:

• Oseltamivir^{α[note 53]}
• Valganciclovir^{α[note 54]}

Antihepatitis medicines

Medicines for hepatitis B

Nucleoside/Nucleotide reverse transcriptase inhibitors

• Entecavir
• Tenofovir disoproxil fumarate

Medicines for hepatitis C

Pangenotypic direct-acting antiviral combinations

• Daclatasvir^{[note 55]}
• Daclatasvir/sofosbuvir (daclatasvir + sofosbuvir)
• Glecaprevir/pibrentasvir (glecaprevir + pibrentasvir)
• Ravidasvir^{[note 56]}
• Sofosbuvir^{[note 57]}
• Sofosbuvir/velpatasvir (sofosbuvir + velpatasvir)

Non-pangenotypic direct-acting antiviral combinations

• Ledipasvir/sofosbuvir (ledipasvir + sofosbuvir)

Other antivirals for hepatitis C

• Ribavirin^{[note 58]}

Antiprotozoal medicines

Antiamoebic and antigiardiasis medicines

• Diloxanide^{[note 59]}
• Metronidazole^{[note 60]}

Antileishmaniasis medicines

• Amphotericin B^{[note 61]}
• Meglumine antimoniate
• Miltefosine
• Paromomycin
• Sodium stibogluconate

Antimalarial medicines

For curative treatment

• Amodiaquine^{[note 62]}
• Artemether^{[note 63]}
• Artemether/lumefantrine (artemether + lumefantrine)^{[note 64]}
• Artesunate^{[note 65]}
• Artesunate/amodiaquine (artesunate + amodiaquine)^{[note 66]}
• Artesunate/mefloquine (artesunate + mefloquine)
• Artesunate/pyronaridine tetraphosphate (artesunate + pyronaridine tetraphosphate)^{[note 67]}
• Chloroquine^{[note 68]}
• Dihydroartemisinin/piperaquine phosphate (dihydroartemisinin + piperaquine phosphate)^{[note 69]}
• Doxycycline^{[note 70]}
• Mefloquine^{[note 62]}
• Primaquine^{[note 71]}
• Quinine^{[note 72]}
• Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine)^{[note 73]}

For chemoprevention

• Amodiaquine + sulfadoxine/pyrimethamine (Co-packaged)
• Chloroquine^{[note 74]}
• Doxycycline^{[note 75]}
• Mefloquine^{[note 76]}
• Proguanil^{[note 77]}
• Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine)

Antipneumocystosis and antitoxoplasmosis medicines

• Pyrimethamine
• Sulfadiazine
• Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim)

Complementary:

• Pentamidine^α

Antitrypanosomal medicines

African trypanosomiasis

• Fexinidazole^{[note 78]}

Medicines for the treatment of 1st stage African trypanosomiasis

• Pentamidine^{[note 79]}
• Suramin sodium^{[note 80]}

Medicines for the treatment of 2nd stage African trypanosomiasis

• Eflornithine^{[note 81]}
• Melarsoprol
• Nifurtimox^{[note 82]}

Complementary:

• Melarsoprol^α

American trypanosomiasis

• Benznidazole
• Nifurtimox

Medicines for ectoparasitic infections

• Ivermectin

Medicines for Ebola virus disease

• Ansuvimab
• Atoltivimab/maftivimab/odesivimab (atoltivimab + maftivimab + odesivimab)

Medicines for COVID-19

No listings in this section.

Antimigraine medicines

For treatment of acute attack

• Acetylsalicylic acid (aspirin)
• Ibuprofen
• Paracetamol (acetaminophen)^{[note 83]}
• Sumatriptan

For prophylaxis

• Propranolol

Immunomodulators and antineoplastics

Immunomodulators for non-malignant disease

Complementary:

• Adalimumab^{α[note 84]}
• Azathioprine^α
• Ciclosporin^α
• Tacrolimus^α

Antineoplastics and supportive medicines

Cytotoxic medicines

Complementary:

• Arsenic trioxide^α
• Asparaginase^{α[note 18]}
• Bendamustine^α
• Bleomycin^α
• Calcium folinate (leucovorin calcium)^α
• Capecitabine^α
• Carboplatin^α
• Chlorambucil^α
• Cisplatin^α
• Cyclophosphamide^α
• Cytarabine^α
• Dacarbazine^α
• Dactinomycin^α
• Daunorubicin^α
• Docetaxel^α
• Doxorubicin^α
• Doxorubicin (as pegylated liposomal)^α
• Etoposide^α
• Fludarabine^α
• Fluorouracil^α
• Gemcitabine^α
• Hydroxycarbamide (hydroxyurea)^α
• Ifosfamide^α
• Irinotecan^α
• Melphalan^α
• Mercaptopurine^α
• Methotrexate^α
• Oxaliplatin^α
• Paclitaxel^α
• Pegaspargase^{α[note 18]}
• Procarbazine^α
• Realgar Indigo naturalis formulation^α
• Tioguanine^α
• Vinblastine^α
• Vincristine^α
• Vinorelbine^α

Targeted therapies

Complementary:

• All-trans retinoic acid (tretinoin) (ATRA)^α
• Bortezomib^α
• Dasatinib^α
• Erlotinib^{α[note 85]}
• Everolimus^α
• Ibrutinib^α
• Imatinib^α
• Nilotinib^α
• Rituximab^{α[note 18]}
• Trastuzumab^{α[note 18]}

Immunomodulators

Complementary:

• Filgrastim^{α[note 18]}
• Lenalidomide^α
• Nivolumab^{α[note 86]}
• Pegfilgrastim^{α[note 18]}
• Thalidomide^α

Hormones and antihormones

Complementary:

• Abiraterone^{α[note 87]}
• Anastrozole^{α[note 88]}
• Bicalutamide^{α[note 89]}
• Dexamethasone^α
• Hydrocortisone^α
• Leuprorelin^{α[note 90]}
• Methylprednisolone^α
• Prednisolone^{α[note 91]}
• Tamoxifen^α

Supportive medicines

Complementary:

• Allopurinol^α
• Mesna^α
• Rasburicase^α
• Zoledronic acid^α

Therapeutic foods

• Ready-to-use therapeutic food^{[note 92]}

Medicines affecting the blood

Antianaemia medicines

• Ferrous salt
• Ferrous salt/folic acid (ferrous salt + folic acid)
• Folic acid^{[note 93]}
• Hydroxocobalamin

Complementary:

• Erythropoiesis-stimulating agents^{α[note 94]}

Medicines affecting coagulation

• Dabigatran^{[note 95]}
• Enoxaparin^{[note 96]}
• Heparin sodium
• Phytomenadione
• Protamine sulfate
• Tranexamic acid
• Warfarin

Complementary:

• Desmopressin^α
• Heparin sodium^α
• Protamine sulfate^α
• Warfarin^α

Other medicines for haemoglobinopathies

• Deferasirox^{[note 97]}

Complementary:

• Deferoxamine^α
• Hydroxycarbamide (hydroxyurea)^α

Blood products of human origin and plasma substitutes

Blood and blood components

Bag containing one unit of fresh frozen plasma

• Cryoprecipitate, pathogen-reduced^{[note 98]}
• Fresh frozen plasma
• Platelets
• Red blood cells
• Whole blood

Plasma-derived medicines

Human immunoglobulins

• Rho(D) immune globulin (anti-D immunoglobulin)
• Anti-rabies immunoglobulin
• Anti-tetanus immunoglobulin

Complementary:

• Normal immunoglobulin^α

Blood coagulation factors

Complementary:

• Coagulation factor VIII^α
• Coagulation factor IX^{α[note 99]}

Plasma substitutes

• Dextran 70^{[note 100]}

Cardiovascular medicines

Antianginal medicines

• Bisoprolol^{[note 101]}
• Glyceryl trinitrate
• Isosorbide dinitrate
• Verapamil

Antiarrhythmic medicines

• Bisoprolol^{[note 101]}
• Digoxin
• Epinephrine (adrenaline)
• Lidocaine
• Verapamil

Complementary:

• Amiodarone^α

Antihypertensive medicines

• Amlodipine^{[note 102]}
• Bisoprolol^{[note 103]}
• Enalapril^{[note 104]}
• Hydralazine^{[note 105]}
• Hydrochlorothiazide^{[note 106]}
• Lisinopril/amlodipine (lisinopril + amlodipine)^{[note 107]}
• Lisinopril/hydrochlorothiazide (lisinopril + hydrochlorothiazide)^{[note 108]}
• Losartan^{[note 109]}
• Methyldopa^{[note 110]}
• Telmisartan/amlodipine (telmisartan + amlodipine)^{[note 111]}
• Telmisartan/hydrochlorothiazide (telmisartan + hydrochlorothiazide)^{[note 112]}

Complementary:

• Sodium nitroprusside^α

Medicines used in heart failure

• Bisoprolol^{[note 101]}
• Digoxin
• Enalapril^{[note 113]}
• Furosemide^{[note 114]}
• Hydrochlorothiazide^{[note 106]}
• Losartan^{[note 109]}
• Spironolactone

Complementary:

• Digoxin^α
• Dopamine^α

Antithrombotic medicines

Anti-platelet medicines

• Acetylsalicylic acid (aspirin)
• Clopidogrel

Thrombolytic medicines

Complementary:

• Alteplase^α
• Streptokinase^α

Lipid-lowering agents

• Simvastatin^{[note 115]}

Fixed-dose combinations for prevention of atherosclerotic cardiovascular disease

• Acetylsalicylic acid/atorvastatin/ramipril (acetylsalicylic acid + atorvastatin + ramipril)^{[note 116][note 117]}
• Acetylsalicylic acid/simvastatin/ramipril/atenolol/hydrochlorothiazide (acetylsalicylic acid + simvastatin + ramipril + atenolol + hydrochlorothiazide)^{[note 118][note 117][note 119][note 120]}
• Atorvastatin/perindopril/amlodipine (atorvastatin + perindopril + amlodipine)^{[note 116][note 121][note 122]}

Dermatological medicines (topical)

Antifungal medicines

• Miconazole^{[note 123]}
• Selenium sulfide
• Sodium thiosulfate
• Terbinafine

Anti-infective medicines

• Mupirocin
• Potassium permanganate
• Silver sulfadiazine

Anti-inflammatory and antipruritic medicines

• Betamethasone^{[note 124]}
• Calamine
• Hydrocortisone^{[note 125]}

Medicines affecting skin differentiation and proliferation

• Benzoyl peroxide
• Calcipotriol^{[note 126]}
• Coal tar
• Fluorouracil
• Podophyllum resin^{[note 127]}
• Salicylic acid
• Urea

Complementary:

• Methotrexate^α

Scabicides and pediculicides

• Benzyl benzoate^{[note 128]}
• Permethrin

Diagnostic agents

Ophthalmic medicines

• Fluorescein
• Tropicamide^{[note 129]}

Radiocontrast media

• Amidotrizoate
• Barium sulfate
• Iohexol

Complementary:

• Barium sulfate^α
• Meglumine iotroxate^α

Antiseptics and disinfectants

Antiseptics

• Chlorhexidine
• Ethanol^{[note 130]}
• Povidone iodine^{[note 131]}

Disinfectants

• Alcohol based hand rub
• Chlorine base compound
• Chloroxylenol^{[note 132]}
• Glutaral

Diuretics

• Amiloride
• Furosemide^{[note 133]}
• Hydrochlorothiazide^{[note 106]}
• Mannitol
• Spironolactone

Complementary:

• Hydrochlorothiazide^{α[note 134]}
• Mannitol^α
• Spironolactone^α

Gastrointestinal medicines

Complementary:

• Pancreatic enzymes^α

Antiulcer medicines

• Omeprazole^{[note 135]}
• Ranitidine^{[note 136]}

Antiemetic medicines

• Dexamethasone
• Metoclopramide
• Ondansetron^{[note 8]}

Complementary:

• Aprepitant^α

Anti-inflammatory medicines

• Sulfasalazine^{[note 137]}

Complementary:

• Hydrocortisone^α
• Prednisolone^α

Laxatives

• Senna^{[note 138]}

Medicines used in diarrhoea

• Oral rehydration salts + zinc sulfate (Co-packaged)

Oral rehydration

• Oral rehydration salts

Medicines for diarrhoea

• Zinc sulfate^{[note 139]}

Medicines for endocrine disorders

Adrenal hormones and synthetic substitutes

• Fludrocortisone
• Hydrocortisone

Androgens

Complementary:

• Testosterone^α

Estrogens

No listings in this section.

Progestogens

• Medroxyprogesterone acetate^{[note 140]}

Medicines for diabetes

Insulins

• Insulin injection (soluble)^{[note 18]}
• Intermediate-acting insulin^{[note 18]}
• Long-acting insulin analogues^{[note 141]}

Oral hypoglycaemic agents

• Empagliflozin^{[note 142]}
• Gliclazide^{[note 143]}
• Metformin

Complementary:

• Metformin^α

Medicines for hypoglycaemia

• Glucagon

Complementary:

• Diazoxide^α

Thyroid hormones and antithyroid medicines

• Levothyroxine
• Potassium iodide
• Methimazole^{[note 144]}
• Propylthiouracil^{[note 145]}

Complementary:

• Lugol's solution^α
• Methimazole^{α[note 144]}
• Potassium iodide^α
• Propylthiouracil^{α[note 146]}

Medicines for disorders of the pituitary hormone system

• Cabergoline^{[note 147]}

Complementary:

• Octreotide^α

Immunologicals

Diagnostic agents

• Tuberculin, purified protein derivative (PPD)

Sera, immunoglobulins and monoclonal antibodies

• Anti-rabies virus monoclonal antibodies^{[note 18]}
• Antivenom immunoglobulin^{[note 148]}
• Diphtheria antitoxin
• Equine rabies immunoglobulin

Vaccines

A vial of oral cholera vaccine

Recommendations for all

• BCG vaccine
• Diphtheria vaccine
• Haemophilus influenzae type b vaccine
• Hepatitis B vaccine
• Human papilloma virus (HPV) vaccine
• Measles vaccine
• Pertussis vaccine
• Pneumococcal vaccine
• Poliomyelitis vaccine
• Rotavirus vaccine
• Rubella vaccine
• Tetanus vaccine

Recommendations for certain regions

• Japanese encephalitis vaccine^{[note 149]}
• Tick-borne encephalitis vaccine^{[note 149]}
• Yellow fever vaccine^{[note 149]}

Recommendations for some high-risk populations

• Cholera vaccine^{[note 150]}
• Dengue vaccine^{[note 150]}
• Hepatitis A vaccine^{[note 150]}
• Meningococcal meningitis vaccine^{[note 150]}
• Rabies vaccine^{[note 150]}
• Typhoid vaccine^{[note 150]}

Recommendations for immunization programmes with certain characteristics

• Influenza vaccine (seasonal)^{[note 151]}
• Mumps vaccine^{[note 151]}
• Varicella vaccine^{[note 151]}

Muscle relaxants (peripherally-acting) and cholinesterase inhibitors

• Atracurium
• Neostigmine
• Suxamethonium
• Vecuronium^{[note 152]}

Complementary:

• Pyridostigmine^α
• Vecuronium^α

Ophthalmological preparations

Anti-infective agents

• Aciclovir
• Azithromycin
• Erythromycin^{[note 153]}
• Gentamicin^{[note 154]}
• Natamycin
• Ofloxacin^{[note 155]}
• Tetracycline^{[note 156]}

Anti-inflammatory agents

• Prednisolone

Local anesthetics

• Tetracaine^{[note 157]}

Miotics and antiglaucoma medicines

• Acetazolamide
• Latanoprost
• Pilocarpine^{[note 158]}
• Timolol^{[note 159]}

Mydriatics

• Atropine^{[note 160]}

Complementary:

• Epinephrine (adrenaline)^α

Anti-vascular endothelial growth factor (VEGF) preparations

Complementary:

• Bevacizumab^{α[note 18]}

Medicines for reproductive health and perinatal care

Contraceptives

Oral hormonal contraceptives

• Ethinylestradiol/levonorgestrel (ethinylestradiol + levonorgestrel)
• Ethinylestradiol/norethisterone (ethinylestradiol + norethisterone)
• Levonorgestrel
• Ulipristal

Injectable hormonal contraceptives

• Estradiol cypionate/medroxyprogesterone acetate (estradiol cypionate + medroxyprogesterone acetate)
• Medroxyprogesterone acetate
• Norethisterone enantate

Intrauterine devices

• Copper-containing device
• Levonorgestrel-releasing intrauterine system

Barrier methods

• Condoms
• Diaphragms

Implantable contraceptives

• Etonogestrel-releasing implant
• Levonorgestrel-releasing implant

Intravaginal contraceptives

• Ethinylestradiol/etonogestrel (ethinylestradiol + etonogestrel)
• Progesterone vaginal ring^{[note 161]}

Ovulation inducers

Complementary:

• Clomifene^α
• Letrozole^{α[note 162]}

Uterotonics

• Carbetocin
• Ergometrine^{[note 163]}
• Mifepristone + misoprostol (Co-packaged)^{[note 164]}
• Misoprostol^{[note 165]}
• Oxytocin

Antioxytocics (tocolytics)

• Nifedipine

Other medicines administered to the mother

• Dexamethasone
• Multiple micronutrient supplement
• Tranexamic acid

Medicines administered to the neonate

• Caffeine citrate
• Chlorhexidine

Complementary:

• Ibuprofen^{α[note 166]}
• Prostaglandin E1^{α[note 167]}
• Surfactant^α

Peritoneal dialysis solution

Complementary:

• Intraperitoneal dialysis solution (of appropriate composition)^α

Medicines for mental and behavioural disorders

Medicines used in psychotic disorders

• Fluphenazine^{[note 168]}
• Haloperidol^{[note 169]}
• Olanzapine
• Paliperidone^{[note 170]}
• Risperidone^{[note 171]}

Complementary:

• Clozapine^α

Medicines used in mood disorders

Medicines used in depressive disorders

• Amitriptyline
• Fluoxetine^{[note 172]}

Medicines used in bipolar disorders

• Carbamazepine
• Lithium carbonate
• Quetiapine^{[note 173]}
• Valproic acid (sodium valproate)^{[note 17]}

Medicines for anxiety disorders

• Diazepam^{[note 174][note 175]}
• Fluoxetine^{[note 172]}

Medicines used for obsessive compulsive disorders

• Clomipramine
• Fluoxetine^{[note 172]}

Medicines for disorders due to psychoactive substance use

Medicines for alcohol use disorders

• Acamprosate calcium
• Naltrexone

Medicines for nicotine use disorders

• Bupropion
• Nicotine replacement therapy (NRT)
• Varenicline

Complementary:

• Methadone^{α[note 176]}

Medicines acting on the respiratory tract

Antiasthmatic medicines and medicines for chronic obstructive pulmonary disease

• Budesonide^{[note 177]}
• Budesonide/formoterol (budesonide + formoterol)^{[note 178]}
• Epinephrine (adrenaline)
• Ipratropium bromide
• Salbutamol^{[note 179]}
• Tiotropium^{[note 180]}

Solutions correcting water, electrolyte and acid-base disturbances

Oral

• Oral rehydration salts
• Potassium chloride

Parenteral

• Glucose
• Glucose with sodium chloride
• Potassium chloride
• Sodium chloride
• Sodium hydrogen carbonate
• Sodium lactate, compound solution (Ringer's lactate solution)

Miscellaneous

• Water for injection

Vitamins and minerals

• Ascorbic acid
• Calcium
• Colecalciferol^{[note 181]}
• Ergocalciferol^{[note 182]}
• Iodine
• Multiple micronutrient powder
• Nicotinamide
• Pyridoxine
• Retinol
• Riboflavin
• Thiamine

Complementary:

• Calcium gluconate^α

Ear, nose and throat medicines

• Acetic acid
• Budesonide
• Ciprofloxacin^{[note 183]}
• Xylometazoline

Medicines for diseases of joints

Medicines used to treat gout

• Allopurinol

Disease-modifying anti-rheumatic drugs (DMARDs)

• Chloroquine

Complementary:

• Azathioprine^α
• Hydroxychloroquine^α
• Methotrexate^α
• Penicillamine^α
• Sulfasalazine^α

Medicines for juvenile joint diseases

Complementary:

• Acetylsalicylic acid (aspirin)^{[note 184]}
• Adalimumab^{α[note 84]}
• Methotrexate^α
• Triamcinolone hexacetonide^{α[note 185]}

Dental medicines and preparations

• Fluoride
• Glass ionomer cement
• Resin-based composite (low-viscosity)^{[note 186]}
• Resin-based composite (high-viscosity)^{[note 187]}
• Silver diamine fluoride

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. (For use in spinal anaesthesia during delivery, to prevent hypotension).
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 in children less than three months.
4. Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect.
5. For the management of cancer pain
6. Hydromorphone and oxycodone are alternatives
7. For the management of cancer pain.
8. Dolasetron, granisetron, palonosetron, and tropisetron are alternatives
9. Cetirizine and fexofenadine are alternatives
10. There may be a role for sedating antihistamines for limited indications (EMLc).
11. Prednisone is an alternative
12. For use as adjunctive therapy for treatment-resistant partial or generalized seizures.
13. Diazepam and midazolam are alternatives
14. For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders.
15. For buccal administration when solution for oromucosal administration is not available.
16. 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.
17. 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.
18. Including quality-assured biosimilars
19. Trihexyphenidyl is an alternative
20. benserazide is an alternative for carbidopa
21. Oxamniquine is listed for use when praziquantel treatment fails.
22. > 1 month.
23. Only for the presumptive treatment of epidemic meningitis in children older than two years and in adults.
24. Alternatives are 4th level ATC chemical subgroup (J01CF Beta-lactamase resistant penicillins)
25. cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
26. Use in children <8 years only for life-threatening infections when no alternative exists.
27. 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.
28. Third-generation cephalosporin of choice for use in hospitalized neonates.
29. Do not administer with calcium and avoid in infants with hyperbilirubinemia.
30. > 41 weeks corrected gestational age.
31. Erythromycin is an alternative as second choice treatment for pharyngitis in children (EMLc only)
32. For use in combination regimens for eradication of H. pylori in adults.
33. Vancomycin powder for injection may also be used for oral administration
34. 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
35. Tedizolid phosphate is an alternative
36. For use only in patients with HIV receiving protease inhibitors.
37. For use only in combination with meropenem or imipenem/cilastatin.
38. Terizidone is an alternative
39. Prothionamide is an alternative
40. Imipenem/cilastatin is an alternative
41. 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.
42. For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis.
43. Anidulafungin and caspofungin are alternatives
44. Valaciclovir is an alternative
45. also indicated for pre-exposure prophylaxis.
46. > 6 weeks
47. > 3 years
48. For use in pregnant women and in second-line regimens in accordance with WHO treatment guidelines.
49. lamivudine is an alternative for emtricitabine
50. combination also indicated for pre-exposure prophylaxis
51. For the treatment of viral haemorrhagic fevers
52. For the treatment of cytomegalovirus retinitis (CMVr).
53. For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
54. For the treatment of cytomegalovirus retinitis (CMVr).
55. Pangenotypic when used in combination with sofosbuvir
56. Pangenotypic when used in combination with sofosbuvir
57. Pangenotypic when used in combination with daclatasvir or ravidasvir
58. For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
59. > 25 kg.
60. Tinidazole is an alternative
61. Liposomal amphotericin B has a better safety profile than the sodium deoxycholate formulation and should be prioritized for selection and use depending on local availability and cost.
62. To be used in combination with artesunate 50 mg.
63. For use in the management of severe malaria.
64. Not recommended in the first trimester of pregnancy or in children below 5 kg.
65. To be used in combination with either amodiaquine, mefloquine, or sulfadoxine + pyrimethamine.
66. Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate are alternatives
67. > 5 kg
68. For use only for the treatment of Plasmodium vivax infection.
69. > 5 kg
70. For use only in combination with quinine.
71. Only for use to achieve radical cure of Plasmodium vivax and Plasmodium ovale infections, given for 14 days.
72. For use only in the management of severe malaria, and should be used in combination with doxycycline.
73. Only in combination with artesunate 50 mg.
74. For use only in Central American regions, for Plasmodium vivax infections.
75. > 8 years.
76. > 5 kg or > 3 months.
77. For use only in combination with chloroquine.
78. For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection.
79. To be used for the treatment of Trypanosoma brucei gambiense infection.
80. To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection.
81. To be used for the treatment of Trypanosoma brucei gambiense infection
82. Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection.
83. The presence of both 120 mg/5 mL and 125 mg/5mL strengths on the same market would cause confusion in prescribing and dispensing and should be avoided.
84. Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
85. Afatinib and gefitinib are alternatives
86. Pembrolizumab is an alternative, including quality-assured biosimilars
87. Enzalutamide is an alternative
88. Alternatives are 4th level ATC chemical subgroup (L02BG Aromatase inhibitors)
89. Flutamide and nilutamide are alternatives
90. Goserelin and triptorelin are alternatives
91. Prednisone is an alternative
92. Biscuit or paste of nutritional composition as determined by the UN joint statement on the community-based management of severe acute malnutrition and Codex alimentarius guidelines.
93. periconceptual use for prevention of first occurrence of neural tube defects
94. Epoetin alfa, beta and theta; darbepoetin alfa; methoxy polyethylene glycol-epoetin beta; and their quality-assured biosimilars are alternatives
95. Apixaban, edoxaban, and rivaroxaban are alternatives
96. Alternatives are dalteparin and nadroparin, including their quality-assured biosimilars.
97. Deferiprone is an alternative
98. cryoprecipitate (not pathogen-reduced) is an alternative
99. coagulation factor IX complex is an alternative
100. Polygeline, injectable solution, 3.5% is considered an alternative
101. Carvedilol and metoprolol are alternatives
102. Alternatives are 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives)
103. Includes atenolol, carvedilol, and metoprolol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients > 60 years.
104. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
105. Hydralazine is listed for use only in the acute management of severe 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.
106. Chlorothiazide, chlorthalidone, and indapamide are alternatives
107. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
108. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
109. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain)
110. 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.
111. Alternatives are 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)
112. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
113. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
114. Bumetanide and torasemide are alternatives
115. For use in high‐risk patients. Atorvastatin, fluvastatin, lovastatin, and pravastatin are alternatives
116. fluvastatin, lovastatin, pravastatin, and simvastatin are alternatives for atorvastatin
117. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for ramipril
118. atorvastatin, fluvastatin, lovastatin, and pravastatin are alternatives for simvastatin
119. bisoprolol, carvedilol, and metoprolol are alternatives for atenolol
120. chlorthalidone, chlorothiazide, and indapamide are alternatives for hydrochlorothiazide
121. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for perindopril
122. 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) are alternatives for amlodipine
123. Alternatives are 4th level ATC chemical subgroup (D01AC Imidazole and triazole derivatives) excluding combinations
124. Alternatives are 4th level ATC chemical subgroup (D07AC Corticosteroids, potent (group III))
125. Alternatives are 4th level ATC chemical subgroup (D07AA Corticosteroids, weak (group I))
126. Calcitriol and tacalcitol are alternatives
127. Podophyllotoxin is an alternative
128. precipitated sulfur topical ointment is an alternative
129. Atropine and cyclopentolate are alternatives
130. Propanol is an alternative
131. Iodine is an alternative
132. Alternatives are 4th level ATC chemical subgroup (D08AE Phenol and derivatives)
133. Bumetanide and torasemide are alternatives
134. Chlorothiazide and chlorthalidone are alternatives
135. Alternatives are 4th level ATC chemical subgroup (A02BC Proton pump inhibitors) excluding combinations
136. Alternatives are 4th level ATC chemical subgroup (A02BA H2-receptor antagonists) excluding combinations
137. Mesalazine is an alternative
138. Bisacodyl is an alternative
139. In acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts.
140. Norethisterone is an alternative
141. Insulin degludec, insulin detemir, and insulin glargine, including quality-assured biosimilars are alternatives
142. Canagliflozin and dapagliflozin are alternatives
143. Glibenclamide not suitable above 60 years. Alternatives are 4th level ATC chemical subgroup (A10BB Sulfonylureas)
144. Carbimazole is an alternative depending on local availability
145. For use when alternative first-line treatment is not appropriate or available; and in patients during the first trimester of pregnancy.
146. For use when alternative first-line treatment is not appropriate or available
147. bromocriptine is an alternative
148. Exact type to be defined locally
149. Recommended for certain regions
150. Recommended for some high-risk populations
151. Recommended only for immunization programmes with certain characteristics
152. atracurium is an alternative
153. For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae.
154. Amikacin, kanamycin, netilmicin, and tobramycin are alternatives
155. Alternatives are 4th level ATC chemical subgroup (S01AE Fluoroquinolones)
156. Chlortetracycline and oxytetracycline are alternatives
157. Alternatives are 4th level ATC chemical subgroup (S01HA Local anaesthetics) excluding cocaine and combinations
158. Carbachol is an alternative
159. Alternatives are 4th level ATC chemical subgroup (S01ED Beta blocking agents) excluding combinations
160. Cyclopentolate hydrochloride or homatropine hydrobromide are alternatives only for the EMLc
161. For use in women actively breastfeeding at least 4 times per day
162. anastrozole is an alternative
163. Methylergometrine is an alternative
164. Where permitted under national law and where culturally acceptable.
165. Only for use for induction of labour where appropriate facilities are available.
166. Indometacin is an alternative
167. Prostaglandin E2 is an alternative
168. haloperidol decanonate and zuclopenthixol decanonate are alternatives
169. Chlorpromazine is an alternative for the tablet
170. Risperidone injection is an alternative
171. aripiprazole, olanzapine, paliperidone, and quetiapine are alternatives
172. Citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline are alternatives
173. aripiprazole, olanzapine, and paliperidone are alternatives
174. lorazepam is an alternative
175. For short-term emergency management of acute and severe anxiety symptoms only
176. buprenorphine is an alternative. The medicines should only be used within an established support programme.
177. Beclometasone, ciclesonide, flunisolide, fluticasone, and mometasone are alternatives
178. Beclometasone/formoterol, budesonide/salmeterol, fluticasone/formoterol, fluticasone furoate/vilanterol, and mometasone/formoterol are alternatives
179. Terbutaline is an alternative
180. Aclidinium, glycopyrronium, and umeclidinium are alternatives
181. Ergocalciferol is an alternative
182. Colecalciferol is an alternative
183. Ofloxacin is an alternative
184. For use for rheumatic fever, juvenile arthritis, Kawasaki disease
185. triamcinolone acetonide is an alternative
186. of any type for use as dental sealant
187. of any type for use as dental filling material

References

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Further reading

• Serafini M, Cargnin S, Massarotti A, Pirali T, Genazzani AA (September 2020). "Essential Medicinal Chemistry of Essential Medicines". Journal of Medicinal Chemistry. 63 (18): 10170–10187. doi:10.1021/acs.jmedchem.0c00415. PMC 8007110. PMID 32352778.
• Stuart MC, Kouimtzi M, Hill SR, eds. (2009). WHO Model Formulary 2008. World Health Organization. hdl:10665/44053. ISBN 978-92-4-154765-9.
• 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: World Health Organization. 2015. hdl:10665/189763. ISBN 978-92-4-069494-1. ISSN 0512-3054. WHO technical report series; no. 994.
• 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: World Health Organization. 2017. hdl:10665/259481. ISBN 978-92-4-121015-7. ISSN 0512-3054. WHO technical report series; no. 1006.
• 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. 2019. hdl:10665/330668. ISBN 978-92-4-121030-0. ISSN 0512-3054. WHO technical report series;1021.
• Organization WH (2019). "Additions and deletions of medicines on the WHO model lists of essential medicines: 1977–2017". World Health Organization. hdl:10665/278038. WHO/MVP/EMP/IAU/2019.01.

External links

• eEML - Electronic Essential Medicines List