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
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)
- Acetylsalicylic acid (aspirin)
- Ibuprofen[note 3]
- Paracetamol[note 4] (acetaminophen)
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
- Acetylcysteine
- Atropine
- Calcium gluconate
- Methylthioninium chloride (methylene blue)
- Naloxone
- Penicillamine
- Prussian blue
- Sodium nitrite
- Sodium thiosulfate
Complementary:
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:
- Ethosuximideα
- Levetiracetamα
- Valproic acid (sodium valproate)α[note 17]
Medicines for multiple sclerosis
Complementary:
Medicines for parkinsonism
Anti-infective medicines
Anthelminthics
Intestinal anthelminthics
Antifilarials
Antischistosomals and other antinematode medicines
Complementary:
Cysticidal medicines
Complementary:
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:
Reserve group antibiotics
Reserve antibiotics are last-resort antibiotics. The EML antibiotic book was published in 2022.[29][30][31]
Complementary:
- Cefiderocolα
- Ceftazidime/avibactam (ceftazidime + avibactam)α
- Ceftolozane/tazobactam (ceftolozane + tazobactam)α
- Colistinα
- Fosfomycinα
- Linezolidα[note 35]
- Meropenem/vaborbactam (meropenem + vaborbactam)α
- Plazomicinα
- Polymyxin Bα
Antileprosy medicines
Antituberculosis medicines
- 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:
- Amikacinα
- Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)α[note 37]
- Bedaquilineα
- Clofazimineα
- Cycloserineα[note 38]
- Delamanidα
- Ethionamideα[note 39]
- Levofloxacinα
- Linezolidα
- Meropenemα[note 40]
- Moxifloxacinα
- P-aminosalicylic acid (p-aminosalicylate sodium)α
- Pretomanidα
- Streptomycinα
Antifungal medicines
- Amphotericin B
- Clotrimazole
- Fluconazole
- Flucytosine
- Griseofulvin
- Itraconazole[note 41]
- Nystatin
- Voriconazole[note 42]
Complementary:
Antiviral medicines
Antiherpes medicines
Antiretrovirals
Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
- Atazanavir/ritonavir (atazanavir + ritonavir)
- Darunavir[note 47]
- Lopinavir/ritonavir (lopinavir + ritonavir)
- Ritonavir
Integrase inhibitors
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)
- Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim (isoniazid + pyridoxine + sulfamethoxazole + trimethoprim)
Other antivirals
Complementary:
Antihepatitis medicines
Medicines for hepatitis B
Nucleoside/Nucleotide reverse transcriptase inhibitors
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
Other antivirals for hepatitis C
Antiprotozoal medicines
Antiamoebic and antigiardiasis medicines
Antileishmaniasis medicines
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
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
Medicines for Ebola virus disease
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
Immunomodulators and antineoplastics
Immunomodulators for non-malignant disease
Complementary:
Antineoplastics and supportive medicines
Cytotoxic medicines
Complementary:
- Arsenic trioxideα
- Asparaginaseα[note 18]
- Bendamustineα
- Bleomycinα
- Calcium folinate (leucovorin calcium)α
- Capecitabineα
- Carboplatinα
- Chlorambucilα
- Cisplatinα
- Cyclophosphamideα
- Cytarabineα
- Dacarbazineα
- Dactinomycinα
- Daunorubicinα
- Docetaxelα
- Doxorubicinα
- Doxorubicin (as pegylated liposomal)α
- Etoposideα
- Fludarabineα
- Fluorouracilα
- Gemcitabineα
- Hydroxycarbamide (hydroxyurea)α
- Ifosfamideα
- Irinotecanα
- Melphalanα
- Mercaptopurineα
- Methotrexateα
- Oxaliplatinα
- Paclitaxelα
- Pegaspargaseα[note 18]
- Procarbazineα
- Realgar Indigo naturalis formulationα
- Tioguanineα
- Vinblastineα
- Vincristineα
- Vinorelbineα
Targeted therapies
Complementary:
- All-trans retinoic acid (tretinoin) (ATRA)α
- Bortezomibα
- Dasatinibα
- Erlotinibα[note 85]
- Everolimusα
- Ibrutinibα
- Imatinibα
- Nilotinibα
- Rituximabα[note 18]
- Trastuzumabα[note 18]
Immunomodulators
Complementary:
Hormones and antihormones
Complementary:
- Abirateroneα[note 87]
- Anastrozoleα[note 88]
- Bicalutamideα[note 89]
- Dexamethasoneα
- Hydrocortisoneα
- Leuprorelinα[note 90]
- Methylprednisoloneα
- Prednisoloneα[note 91]
- Tamoxifenα
Supportive medicines
Complementary:
Therapeutic foods
Medicines affecting the blood
Antianaemia medicines
Complementary:
Medicines affecting coagulation
- Dabigatran[note 95]
- Enoxaparin[note 96]
- Heparin sodium
- Phytomenadione
- Protamine sulfate
- Tranexamic acid
- Warfarin
Complementary:
Other medicines for haemoglobinopathies
Complementary:
- Deferoxamineα
- Hydroxycarbamide (hydroxyurea)α
Blood products of human origin and plasma substitutes
Blood and blood components
Plasma-derived medicines
Human immunoglobulins
- Rho(D) immune globulin (anti-D immunoglobulin)
- Anti-rabies immunoglobulin
- Anti-tetanus immunoglobulin
Complementary:
Blood coagulation factors
Complementary:
Plasma substitutes
Cardiovascular medicines
Antianginal medicines
Antiarrhythmic medicines
Complementary:
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:
Medicines used in heart failure
- Bisoprolol[note 101]
- Digoxin
- Enalapril[note 113]
- Furosemide[note 114]
- Hydrochlorothiazide[note 106]
- Losartan[note 109]
- Spironolactone
Complementary:
Antithrombotic medicines
Anti-platelet medicines
- Acetylsalicylic acid (aspirin)
- Clopidogrel
Thrombolytic medicines
Complementary:
Lipid-lowering agents
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
Anti-infective medicines
Anti-inflammatory and antipruritic medicines
Medicines affecting skin differentiation and proliferation
- Benzoyl peroxide
- Calcipotriol[note 126]
- Coal tar
- Fluorouracil
- Podophyllum resin[note 127]
- Salicylic acid
- Urea
Complementary:
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 salts + zinc sulfate (Co-packaged)
Oral rehydration
Medicines for diarrhoea
Medicines for endocrine disorders
Adrenal hormones and synthetic substitutes
Androgens
Complementary:
Estrogens
No listings in this section.
Progestogens
Medicines for diabetes
Insulins
- Insulin injection (soluble)[note 18]
- Intermediate-acting insulin[note 18]
- Long-acting insulin analogues[note 141]
Oral hypoglycaemic agents
Complementary:
Medicines for hypoglycaemia
Complementary:
Thyroid hormones and antithyroid medicines
Complementary:
Medicines for disorders of the pituitary hormone system
Complementary:
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
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
Muscle relaxants (peripherally-acting) and cholinesterase inhibitors
Complementary:
Ophthalmological preparations
Anti-infective agents
- Aciclovir
- Azithromycin
- Erythromycin[note 153]
- Gentamicin[note 154]
- Natamycin
- Ofloxacin[note 155]
- Tetracycline[note 156]
Anti-inflammatory agents
Local anesthetics
Miotics and antiglaucoma medicines
Mydriatics
Complementary:
- Epinephrine (adrenaline)α
Anti-vascular endothelial growth factor (VEGF) preparations
Complementary:
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
Barrier methods
Implantable contraceptives
Intravaginal contraceptives
Ovulation inducers
Complementary:
Uterotonics
- Carbetocin
- Ergometrine[note 163]
- Mifepristone + misoprostol (Co-packaged)[note 164]
- Misoprostol[note 165]
- Oxytocin
Antioxytocics (tocolytics)
Other medicines administered to the mother
Medicines administered to the neonate
Complementary:
Peritoneal dialysis solution
Complementary:
- Intraperitoneal dialysis solution (of appropriate composition)α
Medicines for mental and behavioural disorders
Medicines used in psychotic disorders
Complementary:
Medicines used in mood disorders
Medicines used in depressive disorders
Medicines used in bipolar disorders
- Carbamazepine
- Lithium carbonate
- Quetiapine[note 173]
- Valproic acid (sodium valproate)[note 17]
Medicines for anxiety disorders
Medicines used for obsessive compulsive disorders
Medicines for disorders due to psychoactive substance use
Medicines for alcohol use disorders
Medicines for nicotine use disorders
Complementary:
Medicines acting on the respiratory tract
Antiasthmatic medicines and medicines for chronic obstructive pulmonary disease
Solutions correcting water, electrolyte and acid-base disturbances
Oral
Parenteral
- Glucose
- Glucose with sodium chloride
- Potassium chloride
- Sodium chloride
- Sodium hydrogen carbonate
- Sodium lactate, compound solution (Ringer's lactate solution)
Miscellaneous
Vitamins and minerals
- Ascorbic acid
- Calcium
- Colecalciferol[note 181]
- Ergocalciferol[note 182]
- Iodine
- Multiple micronutrient powder
- Nicotinamide
- Pyridoxine
- Retinol
- Riboflavin
- Thiamine
Complementary:
Ear, nose and throat medicines
Medicines for diseases of joints
Medicines used to treat gout
Disease-modifying anti-rheumatic drugs (DMARDs)
Complementary:
Medicines for juvenile joint diseases
Complementary:
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]
References
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.