Essential drugs : WHO Model List (revised in December 1997)

Essential Drugs WHO Drug information Vol. 12, No. 1, 1998 WHO Model List (revised in December 1997) Section 1 : Anaesthetics 1. 1 GENERAL ANAESTHET/CS AND OXYGEN ether, anaesthetic (1 c) (2) halothane (2) inhalation inhalation ketamine (2) injection, 50 mg (as hydro- chloride)/ml in 10-ml vial nitrous oxide (2) inhalation oxygen *thiopental (2) inhalation (medicinal gas) powder for injection, 0.5 g, 1.0 g (sodium salt) in ampoule 1.2 LOCAL ANAESTHET/CS *bupivacaine (2, 9) injection, 0.25%, 0.5% (hydrochloride) in vial injection for spinal anaesthesia, 0.5% (hydrochloride) in 4-ml ampoule to be mixed with 7.5% glucose solution *Iidocaine injection, 1%, 2% (hydrochloride) in vial injection, 1%, 2% (hydrochloride) + epinephrine 1:200 000 in vial injection for spinal anaesthesia, 5% (hydrochloride) in 2-ml ampoule to be mixed with 7.5% glucose solution topical forms, 2 — 4% (hydrochloride) dental cartridge, 2% (hydrochloride) + epinephrine 1:80 000 Complementary drug ephedrine (C) (To prevent hypotension in spinal anaesthesia during delivery) injection, 30 mg (hydrochloride)/ml in 1-ml ampoule * Example of a therapeutic group. Various drugs can serve as alternatives. Explanatory Notes When the strength of a drug is specified in terms of a selected salt or ester, this is mentioned in brackets; when it refers to the active moiety, the name of the salt or ester in brackets is preceded by the word "as". Many drugs included in the list are preceded by an asterisk (*) to indicate that they represent an example of atherapeutic group and that various drugs could serve as alternatives. It is imperative that this is understood when drugs are selected at national level, since choice is then influenced by the comparative cost and availability of equivalent products. Examples of acceptable substitutions include: * Hydrochlorothiazide: any other thiazide-type diuretic currently in broad clinical use. * Hydralazine: any other peripheral vasodilator having an antihypertesnive effect. * Senna: any stimulant laxative (either synthetic or of plant origin). * Sulfadiazine: any other short-acting systemically-active sulfonamide unlikely to cause crystalluria. Numbers, in parentheses, following the drug names indicate: (1 ) Drugs subject to international control under (a) the Single Convention on Narcotic Drugs (1961); (b) the Convention on Psychotropic Substances (1971); and (c) the Convention on illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988); (2) Specific expertise, diagnostic precision, individualization of dosage or special equipment required for proper use; (3) Greater potency or efficacy; (4) In renal insufficiency, contraindicated or dosage adjustments necessary; (5) To improve compliance; 6) Special pharmacokinetic properties; 7) Adverse effects diminish benefit/risk ratio; 8) Limited indications or narrow spectrum of activity; 9) For epidural anaesthesia; (10) Sustained release preparations are available. The fact of proper sustained release of the dosage form should be documented; (1 1 ) Therapeutic drug monitoring, i.e. plasma concentration, can improve safety and efficacy. A A A A Letters in parentheses following the drug names indicate the reasons for the inclusion of complementary drugs: (A) When drugs in the main list cannot be made available; (B) When drugs in the main listare known to be ineffective or inappropriate for a given individual; (C) For use in rare disorders or in exceptional circumstances. (D) Reserve antimicrobials to be used only when there is significant resistance to other drugs on the list. Drugs are listed in alphabetical order. 22 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs 1.3 PREOPERATIVE MEDICATION 8: SEDATION FOR SHORT-TERM PROCEDURES atropine injection, 1 mg (sulfate) in 1-ml ampoule chloral hydrate syrup, 200 mg/5 ml *diazepam (1b) injection, 5 mg/ml in 2-ml ampoule tablet, 5 mg *morphine (1a) injection, 10 mg (sulfate or hydrochloride) in 1-ml ampoule *promethazine elixir or syrup, 5 mg (hydrochloride)/5 ml Section 2: Analgesics, Antipyretics, Nonsteroidal Anti-Inflammatory Drugs (NSAl), Drugs Used to Treat Gout and Disease-Modifying Agents in Rheumatic Disorders (DMARDs) 2. 1 NON-OP/OID ANALGESICS & NSAIDS tablet, 100 — 500 mg suppository, 50 — 150 mg acetylsalicylic acid *ibuprofen tablet, 200 mg, 400 mg paracetamol tablet, 100 — 500 mg suppository, 100 mg syrup, 125 mg/5 ml 2.2 OPIO/D ANALGESICS *codeine (1a) tablet, 30 mg (phosphate) *morphine (1a) injection, 10 mg (sulfate or hydrochloride) in 1—ml ampoule oral solution, 10 mg (hydrochloride or sulfate))/5 ml tablet, 10 mg (sulfate) Complementary drug *pethidine (A) (1a, 4) injection, 50 mg (hydrochloride) in 1-ml ampoule tablet, 50 mg, 100 mg (hydrochloride) 2.3 DRUGS USED TO TREAT GOUT allopurinol (4) tablet. 100 mg colchicine (7) tablet, 500 pg 2.4 DISEASE MODIFYING AGENTS IN RHEUMATIC DISORDERS tablet, 100 mg, 150 mg (as phosphate or sulfate) chloroquine (2) methotrexate (2) tablet, 2.5 mg (as sodium salt) penicillamine (2 capsule or tablet, 250 mg tablet, 500 mg tablet, 50 mg I sulfasalazine (2) azathioprine (2) cyclophosphamide (2) tablet, 25 mg Section 3: Antiallergics and Drugs Used in Anaphylaxis 'chlorphenamine tablet, 4 mg (hydrogen maleate) injection, 10 mg (hydrogen maleate) in 1-ml ampoule tablet, 500 pg, 4 mg injection, 4 mg dexamethasone phosphate (as disodium) in 1-ml ampoule ‘dexamethasone epinephrine injection, 1 mg (as hydro- chloride or hydrogen tartrate) in 1-ml ampoule hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial *prednisolone tablet, 5 mg Section 4: Antidotes and Other Substances Used in Poisonings 4.1 NON-SPECIFIC ‘charcoal, activated powder ipecacuanha syrup, containing 0.14% ipecacuanha alkaloids calculated as emetine 4.2 SPECIFIC atropine injection, 1 mg (sulfate) in 1—ml ampoule calcium gluconate (2, 8) injection, 100 mg/ml in 10-ml ampoule deferoxamine powder for injection, 500 mg (mesilate) in vial dimercaprol (2) injection in oil, 50 mg/ml in 2—ml ampoule 'cL-methionine tablet, 250 mg * Example of a therapeutic group. Various drugs can serve as alternatives. 23 Essential Drugs WHO Drug Information Vol. 12, No. 1, 1998 methylthioninium chloride (methylene blue) injection, 10 mg/ml in 10-ml ampoule naloxone injection, 400 pg (hydrochloride) in 1-ml ampoule penicillamine (2) capsule or tablet, 250 mg potassium ferric hexacyano- ferrate(||) (Prussian blue) powder for oral administration sodium calcium edetate (2) injection, 200 mg/ml in 5-ml ampoule sodium nitrite injection, 30 mg/ml in10—ml ampoule sodium thiosulfate injection, 250 mg/ml in 50-ml ampoule Section 5: Anticonvulsants/ Antiepileptics carbamazepine (10, 11) scored tablet, 100 mg, 200 mg *diazepam (1b) injection, 5 mg/ml in 2-ml ampoule (intravenous or rectal) ethosuximide capsule, 250 mg syrup, 250 mg/5 ml tablet, 15 — 100 mg elixir, 15 mg/5 ml phenobarbital (1b, 11) phenytoin (7, 11) capsule or tablet, 25 mg, 50 mg, 100 mg (sodium salt) injection, 50 mg (sodium salt)/m| in 5-ml vial enteric coated tablet, 200 mg, 500 mg (sodium salt) valproic acid (7, 11) Complementary drugs *clonazepam (B) (1b) scored tablets, 500 pg magnesium sulfate (C) injection, 500 mg/ml in 2-ml ampoule, 5 g in 10-ml ampoule Section 6: Anti-infective Drugs 6.1 ANTHELMINTHICS 6.1.1 INTESTlNAL ANTHELMINTHICS chewable tablet, 400 mg tablet, 50 mg, 150 mg (as hydrochloride) albendazole levamisole *mebendazole chewable tablet, 100 mg, 500 mg niclosamide chewable tablet, 500 mg praziquantel tablet, 150 mg, 600 mg pyrantel chewable tablet, 250 mg (as embonate) oral suspension, 50 mg (as embonate)/ml 6.1 .2‘ANTIFILARIALS diethylcarbamazine tablet, 50 mg, 100 mg (dihydrogen citrate) ivermectin scored tablet, 3 mg, 6 mg Complementary drug suramin sodium (B) (2, 7) powder for injection, 1 g in vial 6.1.3 ANTISCHISTOSOMALS AND OTHER ANTITREMATODE DRUGS praziquantel tablet, 600 mg triclabendazole tablet, 250 mg Complementary drug oxamniquine (C) (8) capsule, 250 mg syrup, 250 mg/5 ml 6.2 ANTIBACTERIALS 6.2.1 BETA LACTAM DRUGS capsule or tablet, 250 mg, 500 mg (anhydrous) powder for oral suspension, 125 mg (anhydrous)/5 ml *amoxicillin ampicillin powder for injection, 500 mg, 1 g (as sodium salt) in vial benzathine benzylpenicillin powder for injection, 1.44 g benzylpenicillin (= 2.4 million lU) in 5-ml vial benzylpenicillin powder for injection, 600 mg (=1 million IU), 3 g (= 5 million lU) (sodium or potassium salt) in vial *cloxacillin capsule, 500 mg, 1 g (as sodium salt) powder for oral solution, 125 mg (as sodium salt)/5 ml powder for injection, 500 mg (as sodium salt) in vial tablet, 250 mg (as potassium salt) powder for oral suspension, 250 mg (as potassium salt)/5 ml phenoxymethylpenicillin * Example of a therapeutic group. Various drugs can serve as alternatives. 24 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs procaine benzylpenicillin powder for injection, 1 g (:1 million lU), 3 g (= 3 million IU) Reserve antibacterials *amoxicillin + *clavulanic acid (D) tablet, 500 mg + 125 mg, ceftazidime (D) powder for injection, 250 mg (as pentahydrate) in vial *cettriaxone (D) powder for injection, 250 mg (as sodium salt) in vial imipenem + cilastatin (D) powder for injection, 250 mg (as monohydrate) + 250 mg, (as sodium salt) 500 mg (as monohydrate) + 500 mg in vial (as sodium salt) 6.2.2 OTHER ANTIBACTERIALS *chloramphenicol (7) capsule, 250 mg oral suspension, 150 mg (as palmitate)/5 ml powderfor injection, 1 g (sodium succinate) in vial tablet, 250 mg (as hydrochloride) *ciprofloxacin *doxycycline (5, 6) capsule or tabiet, 100 mg (hyclate) *erythromycin capsule or tablet, 250 mg (as stearate or ethyl succinate) powder for oral suspension, 125 mg (as stearate or ethyl succinate) powder for injection, 500 mg (as lactobionate) in vial *gentamicin (2, 4, 7, 11) injection, 10 mg, 40 mg (as sultate)/ml in 2-ml vial tablet, 200 — 500 mg injection, 500 mg in 100-mlvial *metronidazole suppository, 500 mg, 1 g oral suspension, 200 mg (as benzoate)/5 ml nalidixic acid (8) tablet, 250 mg, 500 mg nitrofurantoin (4, 8) tablet, 100 mg spectinomycin (8) powder for injection, 2 g (as hydrochloride) in vial tablet, 500 mg injection, 250 mg (sodium salt) in 4-ml ampoule *sulfadiazine (4) *sultamethoxazole + trimethoprim (4) tablet, 100 mg + 20 mg, 400 mg + 80 mg oral suspension, 200 mg + 40 mg/5 ml injection, 80 mg + 16 mg/ml in 5-ml and 10-ml ampoule tablet, 100 mg, 200 mg injection, 20 mg/ml in 5-ml ampoule trimethoprim (8) Complementary drugs chloramphenicol (C) oily suspension for injection, 0.5 g (as sodium succinate)/ml in 2-ml ampoule clindamycin (B) (8) capsule, 150 mg injection, 150 mg (as phosphate)/ml Reserve antibacterial vancomycin (D) powder for injection 250 mg (as hydrochloride) in vial 6.2.3 ANTILEPROSY DRUGS clotazimine capsule, 50 mg, 100 mg dapsone tablet, 25 mg, 50 mg, 100 mg ritampicin capsule or tablet, 150 mg, 300 mg 6.2.4 ANTITUBERCULOSIS DRUGS ethambutol (4) tablet, 100 — 400 mg (hydrochloride) tablet, ‘lOO — 300 mg tablet, 150 mg + 400 mg (hydrochloride) tablet, 400 mg isoniazid isoniazid + ethambutol (5) pyrazlnamide rifampicin capsule or tablet, 150 mg, 300 mg rifampicin + tablet,150 mg + 75 mg, isoniazid (5) 300 mg +150 mg, 150 mg + 150 mg (for intermittent use 3 times weekly) rifampicin + isoniazid + pyrazinamide tablet, 150 mg + 75 mg + 400 mg, 150 mg +150 mg + 500 mg {for intermittent use 3 times weekly) streptomycin (4) powder for injection, 1 g (as sulfate) in vial Complementary drug thioacetazone + isoniazid (A) (5, 7) tablet, 50 mg +100 mg, 150 mg + 800 mg * Example of a therapeutic group. Various drugs can serve as alternatives. 25 Essential Drugs WHO Drug information Vol. 12, No. 1, 1998 6.3 ANT/FUNGAL DRUGS amphotericin B (4) powder for injection, 50 mg in vial griseofulvin (8) capsule or tablet, 125 mg, 250 mg tablet, 200 mg oral suspension, 100 mg/5 ml *ketoconazole (2) nystatin tablet, 100 000, 500 000 IU lozenge, 100 000 IU pessary, 100 000 IU Complementary drugs flucytosine (B) (4, 8) capsule, 250 mg infusion, 2.5 gin 250 ml potassium iodide (A) saturated solution 6.4 ANTIVIRALS 6.4.1 ANTIHERPES aciclovir (8) tablet, 200 mg powder for injection, 250 mg (as sodium salt) 6.4.2 ANTIRETROVIRALS zidovudine (8) capsule, 100 mg, 250 mg injection, 10 mg/ml in 20-ml vial oral solution, 50 mg/5 ml Drugs for treatment of HIV/AIDS include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTls) and protease inhibitors (Pls). The prototype drug, zidovudine, has been shown to reduce orprevent mother-to-child transmission. This is the only indication for which it is included here. Single drug use with zidovudine, except in preg- nancy, is now regarded as obsolete because of the development of resistance. Triple therapy is beyond the budgets of most national drug programmes and therefore HIV/AIDS treatment policies must be decided at country or institutional level. 6.5 ANTIPROTOZOAL DRUGS 6.5.1 ANTIAMOEBIC AND ANTIGIARDIASIS DRUGS * diloxanide tablet, 500 mg (furoate) tablet, 200 — 500 mg injection, 500 mg in 100-ml vial *metronidazole oral suspension, 200 mg (as benzoate)/5 ml 6.5.2 ANTILEISHMANIASIS DRUGS *meglumine antimonate injection, 30%, equivalent to approx. 8.5% antimony, in 5-ml ampoule pentamidine (5) powder for injection, 200 mg, 300 mg (isetionate) in vial Complementary drug amphotericin B (4) (B) powder for injection, 50 mg in vial 6.5.3 ANTIMALARIAL DRUGS (a) FOR CURATIVE TREATMENT tablet, 100 mg, 150 mg (as phosphate or sulfate) *chloroquine syrup, 50 mg (as phosphate or sulfate)/5 ml injection, 40 mg (as hydro— chloride, phosphate or sulfate)/ml in 5—ml ampoule primaquine tablet, 7.5 mg, 15 mg (as diphosphate) *quinine tablet, 300 mg (bisulfate or sulfate) injection, 300 mg (as dihydrochloride)/ml in 2-ml ampoule Complementary drugs capsule or tablet, 100 mg (hyclate) *doxycycline (B) {for use only with quinine) tablet, 250 mg (as hydrochloride) tablet, 500 mg + 25 mg mefloquine (B) *sulfadoxine + pyrimethamine (B) Reserve antimalarial artemether (D) injection, 80 mg/ml in 1-ml ampoule (b) FOR PROPHYLAXIS chloroquine tablet, 150 mg (as phosphate or sulfate) syrup, 50 mg (as phosphate or sulfate)/5 ml mefloquine tablet, 250 mg (as hydrochloride) proguanil tablet, 100 mg (hydrochloride) (for use only in combination with chloroquine) 6.5.4 ANTIPNEUMOCYSTOSIS AND ANTITOXOPLASMOSIS DRUGS pyrimethamine tablet, 25 mg * Example of a therapeutic group. Various drugs can serve as alternatives. 26 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs sulfamethoxazole + trimethoprim injection, 80 mg + 16 mg/ml in 5-ml ampoule tablet, 200 mg, 300 mg (isetionate) pentamidine (2) 6.5.5 ANTITRYPANOSOMAL DRUGS (a) AFRICAN TRYPANOSOMIASIS melarsoprol (2) injection, 3.6% solution powder for injection, 200 mg, 300 mg, (isetionate) in vial pentamidine (2) suramin sodium powder for injection, 1 g in vial Complementary drug eflornithine (C) injection, 200 mg (hydro- chloride)/ml in 100-ml bottles (b) AMERICAN TRYPANOSOMIASIS benznidazole (7) tablet, 100 mg nifurtimox (2, 8) tablet, 30 mg, 120 mg, 250 mg 6.6 INSECT REPELLENTS diethyltoluamide topical solution, 50%, 75% Section 7: Antimigraine Drugs 7.1 FOR TREATMENT OFACUTE ATTACK acetylsalicylic acid tablet, 300 — 500 mg ergotamine (7) tablet, 1 mg (tartrate) paracetamol tablet, 300 — 500 mg 7.2 FOR PROPHYLAXIS *propranolol tablet, 20 mg, 40 mg (hydrochloride) Section 8: Antineoplastics, Immunosuppressives and Drugs Used in Palliative Care 8.1 IMMUNOSUPPRESSIVE DRUGS *azathioprine (2) tablet, 50 mg powder for injection, 100 mg (as sodium salt) in vial ciclosporin (2) (for organ transplantation) capsule, 25 mg concentrate for injection 50 mg/ml in 1-ml ampoule 8.2 CYTOTOX/C DRUGS asparaginase (2) powder for injection 10 000 IU in vial bleomycin (2) powderfor injection, 15 mg (as sulfate) in vial calcium tolinate (2) tablet, 15 mg injection, 3 mg/ml in 10—ml ampoule chlormethine (2) powder for injection 10 mg (hydrochloride) in vial cisplatin (2) powder for injection, 10 mg, 50 mg in vial cyclophosphamide (2) tablet, 25 mg powder for injection, 500 mg in vial cytarabine (2) powder for injection, 100 mg in vial dacarbazine (2) powder for injection, 100 mg in vial dactinomycin (2) powder for injection 500 pg in vial *doxorubicin (2) powderfor injection, 10 mg, 50 mg (hydrochloride) in vial etoposide (2) capsule, 100 mg injection, 20 mg/ml in 5-ml ampoule fluorouracil (2) injection, 50 mg/ml in 5-ml ampoule levamisole (2) tablet, 50 mg (as hydrochloride) mercaptopurine (2) tablet, 50 mg methotrexate (2) tablet, 2.5 mg (as sodium salt) powder for injection, 50 mg (as sodium salt) in vial procarbazine capsule, 50 mg (as hydrochloride) vinblastine (2) powder for injection, 10 mg (sulfate) in vial vincristine (2) powder for injection, 1 mg, 5 mg (sulfate) in vial 8.3 HORMONES AND ANT/HORMONES *prednisolone tablet, 5 mg powder for injection, 20 mg, 25 mg, (as sodium phosphate or sodium succinate) in vial tamoxifen tablet, 10 mg, 20 mg (as citrate) * Example of a therapeutic group. Various drugs can serve as alternatives. 27 Essential Drugs WHO Drug Information Vol. 12, No. 1, 1998 8.4 DRUGS USED IN PALLIATIVE CARE It is recommended that all the drugs mentioned in the WHO publication Cancer Pain Relief with a Guide to OpioidAvai/ability, 2nd. edition, be considered essential. The drugs are included in the relevant section of the model list according to their therapeutic use, e.g. analge- srcs. Section 9: Antiparkinsonism Drugs *biperiden tablet, 2 mg (hydrochloride) injection, 5 mg (lactate) in 1-ml ampoule levodopa + tablet, 100 mg + 10 mg, *carbidopa (5, 6) 250 mg + 25 mg Section 10: Drugs affecting the Blood 10.1 ANTIANAEMIA DRUGS ferrous salt tablet, equivalent to 60 mg iron oral solution, equivalent to 25 mg iron (as sulfate)/ml ferrous salt + folic acid (nutritional supplement for use during pregnancy) folic acid (2) tablet,equivalent to 60 mg iron + 400 pg tablet, 1 mg, 5 mg injection, 1 mg (as sodium salt) in 1-ml ampoule injection, 1 mg in 1-ml ampoule hydroxocobalamin (2) Complementary drug *iron dextran (B) (5) injection, equivalent to 50 mg iron (as complex of iron(|ll) hydroxide with dextrans)/ ml in 2-ml ampoule 10.2 DRUGS AFFECTING COAGULATION desmopressin (8) injection, 4ug (acetate)/ml in 1-ml ampoule nasal spray 10 pg (acetate)/ metered dose * Example of a therapeutic group. Various drugs can serve as alternatives. 1All plasma fractions should comply with the Requirements for the collection, processing and quality control of blood, blood components, and plasma derivatives (revised 1992). WHO Technical Report Series, No. 840, 1994, Annex 2. heparin sodium injection, 1000 lU/ml, 5000 IU/ml, 20 000 IU/ml in 1-ml ampoule phytomenadione injection, 10 mg/ml in 5-ml ampoule tablet, 10 mg protamine sulfate injection, 10 mg/ml in 5-ml ampoule *warfarin (2, 6) tablet, 1, 2 and 5 mg (sodium salt) Section 11: Blood Products and Plasma Substitutes 11.1 PLASMA SUBSTITUTES *dextran 7O injectable solution, 6% *polygeline injectable solution, 3.5% 11.2 PLASMA FRACTIONS FOR SPECIFIC USE 7 *albumin, human (2, 8) injectable solution, 5%, 25% Complementary drugs *factor VIII concentrate (C) (2, 8) (dried) *factor lX complex (coagulation (dried) factors ||, Vll, IX, X) concentrate (C) (2, 8) Section 12: Cardiovascular Drugs 12.1 ANT/ANGINAL DRUGS *atenolol tablet, 50 mg, 100 mg glyceryl trinitrate tablet (sublingual), 500 pg *isosorbide dinitrate tablet (sublingual), 5 mg *verapamil (10) tablet, 40 mg, 80 mg (hydrochloride) 12.2 ANTIARRHYTHMIC DRUGS tablet, 50 mg, 100 mg tablet, 62.5 pg, 250 pg oral solution, 50 pg/ml *atenolol digoxin (4, 11) injection, 250 ug/ml in 2-ml ampoule injection, 20 mg (hydrochloride)/ml in 5-ml ampoule tablet, 40 mg, 80 mg (hydrochloride) injection, 2.5 mg (hydrochloride)/ml in 2-ml ampoule lidocaine verapamil (8, 10) 28 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs Complementary drugs isoprenaline (C) injection 20 pg (hydrochloride)/ml epinephrine (C) injection, 1 mg (as hydrochloride)lml tablet, 250 mg, 500 mg (hydrochloride) injection, 100 mg (hydrochloride)lml in 10-ml ampoule *procainamide (B) *quinidine (A) (7) tablet, 200 mg (sulfate) 12.3 ANTIHYPERTENSIVE DRUGS *atenolol tablet, 50 mg, 100 mg *captopril scored tablet, 25 mg *hydralazine tablet, 25 mg, 50 mg (hydrochloride) powder for injection, 20 mg (hydrochloride) in ampoule *hydrochlorothiazide scored tablet, 25 mg methyldopa (7) *nifedipine (10) tablet, 250 mg modified release formulations tablet, 10 mg tablet, 100 pg, 250 pg injection, 1 mg in 1-ml ampoule *reserpine Complementary drugs doxazosin (B) tablet, 1 mg, 2 mg, 4 mg (mesilate) *sodium nitroprusside (C) (2, 8) powder for infusion, 50 mg in ampoule 12.4 DRUGS USED IN HEART FAILURE *captopril digoxin (4, 11) scored tablet, 25 mg tablet, 625 pg, 250 pg oral solution, 50 pg/ml injection, 250 pg/ml in 2-ml ampoule dopamine injection, 40 mg (hydrochloride)/ml in 5—ml vial *hydrochlorothiazide tablet 25 mg, 50 mg 12.5 ANTITHROMBOT/C DRUGS acetylsalicylic acid tablet, 100 mg Complementary drug streptokinase (C) powder for injection, 100 000 IU, 750 000 lU in Vial 12.6 LlPlD-LOWERING AGENTS The Committee recognizes the value of lipid-lowering ‘ drugs in treatingpatients with hyper/ipidaemia. However, ’ there are many other risk factors for atherosclerosis and ‘ its complications including tobacco smoking and inad- equate]ycontrolledhypertension. Mosthyper—lipidaemias can be controlled by diet. HMG CoA reductase inhibitors, often referred to as "sta tins “ are potent andeffective lipid-lowering drugs with a good tolerabilityprofile. Several of them have nowbeen shown to reduce fatal andnon-fatalmyocardial infarction, stroke, need for coronary by-pass surgery and all-cause mortality. All remain very costlybutforprimaryprevention in some very high riskpa tients andsecondaryprevention they may be cost effective. Since no drug stands out for greaterefficacyor lower cost, none is included in the List; each country should make its own decisions for use in highest risk patients. Section 13: Dermatological Drugs (topical) 13.1 ANTIFUNGAL DRUGS benzoic acid + salicylic acid ointment or cream, 6% + 3% *miconazole ointment or cream, 2% (nitrate) sodium thiosultate solution, 15% Complementary drug selenium sulfide (C) detergent-based suspension, 2% 13.2 ANTI-lNFECT/VE DRUGS *methylrosanilinium chloride (gentian violet) aqueous solution, 0.5% tincture, 0.5% neomycin + *bacitracin (7) ointment, 5 mg (sulfate) + 500 lU bacitracin zinc/g potassium permanganate aqueous solution, 1:10 000 silver sulfadiazine cream, 1%, in 500-g container 13.3 ANTI—INFLAMMATORYAND ANT/PRUR/T/C DRUGS *betamethasone (3) ointment or cream, 0.1% (as valerate) *calamine lotion lotion ’hydrocortisone ointment or cream, 1% (acetate) * Example of a therapeutic group. Various drugs can serve as alternatives. 29 Essential Drugs WHO Drug Information Vol. 12, N0. 1, 1998 13.4 ASTRINGENT DRUGS aluminium diacetate solution, 13% for dilution 13.5 DRUGS AFFECTING SKIN DIFFERENTIATION AND PROLIFERATION benzoyl peroxide lotion or cream, 5% coal tar solution, 5% dithranol ointment, 0.1 — 2% fluorouracil ointment, 5% *podophyllum resin (7) solution, 10 — 25% salicylic acid solution, topical 5% urea ointment or cream, 10% 13.6 SCABlC/DES AND PEDICUL/CIDES *benzyl benzoate lotion, 25% permethrin cream, 5%, lotion, 1% 13. 7 ULTRA VIOLET BLOCKING AGENTS Complementary drugs topical sun protection agent with activity against UVA and UVB (C) cream, lotion or gel Section 14: Diagnostic Agents 14.1 OPHTHALMIC DRUGS fluorescein eye drops, 1% (sodium salt) *tropicamide eye drops, 0.5% 14.2 RADIOCONTRASTMEDIA injection, 140 — 420 mg iodine (as sodium or meglumine amidotrizoate)/m| in 20-ml ampoule *amidotrizoate barium sulfate aqueous suspension tablet, 500 mg oily suspension, 500-600 mg/ml in 20-ml ampoule *iopanoic acid *propyliodone (This suspension is for administration only into the bronchial tree.) Complementary drug *meglumine iotroxate (C) solution, 5 — 8 g iodine in 100—250 ml Section 15: Disinfectants and Antiseptics 15.1 ANTISEPTICS *chlorhexidine solution, 5% (digluconate) for dilution *povidone—iodine solution, 10% 15.2 DISINFECTANTS *chlorine base compound powder (0.1% available chlorine) for solution *chloroxylenol solution, 4.8% glutaral solution, 2% Section 16: Diuretics *amiloride (4, 7, 8) tablet, 5 mg (hydrochloride) *furosemide tablet, 40 mg injection, 10 mg/ml in 2-ml ampoule *hydrochlorothiazide tablet, 25 mg, 50 mg spironolactone (8) tablet, 25 mg Complementary drugs *mannitol (C) injectable solution, 10%, 20% Section 17: Gastrointestinal Drugs 17.1 ANTAC/DS AND OTHER ANTIULCER DRUGS aluminium hydroxide tablet, 500 mg oral suspension, 320 mg/5 ml tablet, 200 mg injection, 200 mg in 2-ml ampoule *cimetidine oral suspension, equivalent to 550 mg magnesium oxide/10 ml magnesium hydroxide 17.2 ANTIEMETIC DRUGS metoclopramide tablet, 10 mg (hydrochloride) injection, 5 mg (hydrochloride)/m| in 2-ml ampoule * Example of a therapeutic group. Various drugs can serve as alternatives. 3O WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs *promethazine tablet, 10 mg, 25 mg (hydrochloride) elixir or syrup, 5 mg (hydrochloride)/5 ml injection, 25 mg (hydrochloride)/m| in 2-ml ampoule 17.3 ANTIHAEMORRHOIDAL DRUGS *local anaesthetic, astringent and anti-inflammatory drug ointment or suppository 17.4 ANTI-INFLAMMATORY DRUGS hydrocortisone suppository, 25 mg (acetate), retention enema tablet, 500 mg suppository, 500 mg *sulfasalazine (2) retention enema 17.5 ANTISPASMODIC DRUGS tablet, 0.6 mg (sulfate) injection, 1 mg (sulfate) in 1-ml ampoule *atropine 17.6 LAXATIVES *senna tablet, 7.5 mg (sennosides) (or traditional dosage forms) 17.7 DIARRHOEA, DRUGS USED IN 17.7.1 ORAL REHYDRATION oral rehydration salts (for glucose- electrolyte solution) powder, 27.9 g/l Components to reconstitute 1 litre of g/I glucose-electrolyte solution: sodium chloride 3.5 trisodium citrate dihydrate 2 2.9 potassium chloride 1.5 glucose, anhydrous 20.0 17.7.2 ANTIDIARRHOEAL (SYMPTOMATIC) DRUGS *codeine (1a) tablet, 30 mg (phosphate) Section 18: Hormones, other Endo- crine Drugs and Contraceptives 18.1 ADRENAL HORMONES AND SYNTHETIC SUBSTITUTES *dexamethasone tablet, 500 pg, 4 mg injection, 4 mg dexamethasone phosphate (as disodium) in 1-ml ampoule hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial *prednisolone tablet, 1 mg, 5 mg Complementary drug fludrocortisone (C) tablet, 100 pg (acetate) 18.2 ANDROGENS Comp/ementary drug testosterone (C) (2) injection, 200 mg (enantate) in 1-ml ampoule 18.3 CONTRACEPTIVES 18.3.1 HORMONAL CONTRACEPTIVES *ethinylestradiol + tablet, 30 pg + 150 pg, *levonorgestrel *ethinylestradiol + *norethisterone tablet, 35 pg + 1.0 mg Complementary drugs *ethinylestradiol + ‘levonorgestrel (C) 50 pg + 250 pg (pack of four) *levonorgestrel (B) tablet 30 pg depot injection 150 mg/ml in 1-ml, medroxy- progesterone acetate (B) (7, 8) norethisterone enantate (B) (7, 8) oily solution, 200 mg/ml in 1-ml ampoule 18.3.2 INTRAUTERINE DEVICES copper-containing device 18.3.3 BARRIER METHODS condoms with or without spermicide (nonoxinol) diaphragms with spermicide (nonoxinol) * Example of a therapeutic group. Various drugs can serve as alternatives. 2Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5 g/litre. However, as the stability of this latter formulation is very poor under tropical conditions. it is only recommended when manufactured for immediate use. 31 Essential Drugs WHO Drug Information Vol. 12, No. 1, 1998 18.4 ESTROGENS *ethinylestradiol tablet, 10 ug, 50 pg 18.5 INSUL/NS AND OTHER ANT/DIABETIC AGENTS insulin injection (soluble) injection, 40 lU/ml in 10-ml vial, 100 lU/ml in 10—ml vial intermediate-acting insulin injection, 40 lU/ml in 10-ml vial, 100 lU/ml in 10—ml vial (as compound insulin zinc suspension or isophane insulin) *glibenclamide tablet, 2.5 mg, 5 mg metformin tablet, 500 mg 18. 6 OVULAT/ON INDUCERS *clomifene (2, 8) tablet, 50 mg (citrate) 18.7 PROGESTOGENS norethisterone tablet, 5 mg Complementary drug medroxyprogesterone acetate (B) tablet, 5 mg 18.8 THYROID HORMONES AND ANTITHYRO/D DRUGS levothyroxine tablet, 50 pg, 100 pg (sodium salt) tablet, 60 mg tablet, 50 mg potassium iodide *propylthiouracil Section 19: lmmunologicals 19.1 DIAGNOSTIC AGENTS tuberculin,‘3 purified protein derivative (PPD) injection 19.2 SERA AND IMMUNOGLOBULINS 4 injection, 250 pg in single-dose vial anti-D immunoglobulin, (human) antiscorpion sera injection *antitetanus immunoglobulin, injection, 500 IU (human) in vial antivenom serum injection injection, 10 000 lU, 20 000 IU in vial diphtheria antitoxin immunoglobulin, human normal (2) injection (intramuscular) immunoglobulin, human normal (2, 8) injection (intravenous) *rabies immunoglobulin injection, 150 lU/ml 19.3 VACCINES 5 19.3.1 FOR UNIVERSAL IMMUNIZATION BCG vaccine (dried) injection diphtheria—pertussis-tetanus injection vacctne diphtheria-tetanus vaccine injection hepatitis B vaccine injection measles-mumps-rubella vaccine injection measles vaccine injection poliomyelitis vaccine (inactivated) injection poliomyelitis vaccine oral solution (live attenuated) tetanus vaccine injection tetanus-diphtheria (Td) injection 19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS influenza vaccine injection meningococcal vaccine injection rabies vaccine injection (in cell culture) rubella vaccine injection typhoid vaccine injection yellow fever vaccine injection * Example of a therapeutic group. Various dmgs can serve as alternatives. 3 All tuberculins should comply with the WHO requirements for tuberculins (Revised 1985). WHO Technical Report Series, No. 745, 1987. Annex 1. 4All plasma fractions should comply with the WHO requirements forthe collection, processing and quality control of blood, blood components and plasma derivatives (Revised 1992). WHO Technical Report Series, No. 840, 1994, Annex 2. 5 All vaccines should comply with the WHO requirements for biological substances. 32 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs Section 20: Muscle Relaxants (peripherally act- ing) and Cholinesterase Inhibitors *alcuronium chloride (2) injection, 5 mg/ml in 2-ml ampoule *neostigmine tablet, 15 mg (bromide) injection, 500 pg, 2.5 mg (metilsulfate) in 1-ml ampoule pyridostigmine bromide (2, 8) tablet, 60 mg injection, 1 mg in 1-ml ampoule suxamethonium chloride (2) injection, 50 mg/ml in 2-ml ampoule powder for injection Complementary drug vecuronium bromide (C) powder for injection, 10 mg in vial Section 21: Ophthalmological Preparations 21. 1 ANTI-lNFECT/VE AGENTS *gentamicin solution (eye drops), 0.3% (as sulfate) *idoxuridine solution (eye drops), 0.1% eye ointment, 0.2% silver nitrate solution (eye drops), 1% *tetracycline eye ointment, 1% (hydrochloride) 21.2 ANTI-INFLAMMATOFlYAGENTS *prednisolone eye drops, 0.5% (sodium phosphate) 21.3 LOCAL ANAESTHET/CS solution (eye drops), 0.5% (hydrochloride) *tetracaine 21.4 M/OTICS AND ANTIGLAUCOMA DRUGS acetazolamide tablet, 250 mg *pilocarpine solution (eye drops), 2%, 4% (hydrochloride or nitrate) *timolol solution (eye drops), 0.25%, 0.5% (as maleate) 21,5 MYDRIATICS atropine solution (eye drops), 0.1%, 0.5%, 1% (sulfate) Complementary drug epinephrine (A) solution (eye drops), 2% (as hydrochloride) Section 22: Oxytocics and Antioxytocics 22.1 OXYTOCICS *ergometrine tablet, 200 pg (hydrogen maleate) injection, 200 pg (hydrogen maleate) in 1-ml ampoule oxytocin injection, 10 lU in 1-ml ampoule 22.2 ANTIOXYTOCICS *salbutamol (2) tablet, 4 mg (as sulfate) injection, 50 pg (as sulfate)/ml in 5-ml ampoule Section 23: Peritoneal Dialysis Solution intraperitoneal dialysis solution (of appropriate composition) parenteral solution Section 24: Psychotherapeutic Drugs 24.1 DRUGS USED IN PSYCHOTIC DISORDERS tablet, 100 mg (hydrochloride) syrup, 25 mg (hydrochloride)/5 ml *chlorpromazine injection, 25 mg (hydrochloride)/ml in 2-ml ampoule *tluphenazine (5) injection, 25 mg (decanoate or enantate) in 1-ml ampoule *haloperidol tablet, 2 mg, 5 mg injection, 5 mg in 1-ml ampoule * Example of a therapeutic group. Various drugs can serve as alternatives. 33 Essential Drugs WHO Drug Information Vol. 12, No. 1, 1998 24.2 DRUGS USED IN MOOD DISORDERS 24.2.1 DRUGS USED IN DEPRESSIVE DISORDERS *amitriptyline 24.2.2 DRUGS USED IN BIPOLAR DISORDERS carbamazepine (10, 11) scored tablet, 100 mg, 200 mg tablet, 25 mg (hydrochloride) lithium carbonate (2, 4) capsule or tablet, 300 mg enteric coated tablet, 200 mg, 500 mg (sodium salt) 24.3 DRUGS USED FOR GENERALIZED ANXIETY AND SLEEP DISORDERS *diazepam (1b) 24.4 DRUGS USED FOR OBSESSIVE COMPUL- SIVE DISORDERS AND PAN/C ATTACKS capsules, 10 mg, 25 mg (hydrochloride) valproic acid (7, 11) scored tablet, 2 mg, 5 mg clomipramine Section 25: Drugs Acting on the Respiratory Tract 25. 1 ANT/ASTHMATIC DRUGS *aminophylline (2) injection, 25 mg/ml in 10-ml ampoule *beclometasone inhalation (aerosol), 50 pg, 250 ug, (dipropionate) per dose injection, 1 mg (as hydrochloride or hydrogen tartrate) in 1-ml ampoule *epinephrine ipratropium bromide inhalation, 20 jig/metered dose *salbutamol tablet, 2 mg, 4 mg (as sulfate) inhalation (aerosol), 100 pg (as sulfate) per dose syrup, 2 mg (as sulfate)/5 ml injection, 50 ug (as sulfate)/ml in 5-ml ampoule respirator solution for use in nebulizers, 5 mg (as sulfate)/ml theophylline (10, 11) Complementary drug tablet, 100 mg, 200 mg inhalation (aerosol), 20 mg (sodium salt) per dose *cromoglicic acid (B) 25.2 ANTITUSSIVES *dextromethorphan oral solution, 3.5 mg/5 ml Section 26: Solutions correcting Water, Electro- lyte and Acid-base Disturbances 26.1 ORAL oral rehydration salts (for glucose- electrolyte solution) see section 17.7.1 potassium chloride powder for solution 26.2 PARENTERAL * compound solution of sodium lactate injectable solution glucose injectable solution, 5% isotonic, 50% hypertonic glucose with injectable solution, 4% sodium chloride glucose, 0.18% sodium chloride (equivalent to Na+ 30 mmol/l Cl' 30 mmol/l ) 11.2% solution in 20-ml ampoule, (equivalent to Kt 1.5 mmol/ml, CI- 1.5 mmol/ml) potassium chloride (2) sodium chloride injectable solution, 0.9% isotonic (equivalent to Na+ 154 mmol/l, Cl' 154 mmol/l) injectable solution, 1.4% isotonic (equivalent to Nat 167 mmol/l, HCOS'167 mmol/l) 8.4% solution in 10-ml ampoule (equivalent to Na+ 1000 mmol/l, H00; 1000 mmol/l) sodium hydrogen carbonate 26.3 MISCELLANEOUS water for injection 2—ml, 5-ml, 10-ml ampoules Section 27: Vitamins and Minerals ascorbic acid tablet, 50 mg *ergocalciferol capsule or tablet, 1.25 mg (50 000 IU) oral solution, 250 ug/ml (10 000 IU/ml) iodine (8) iodized oil, 1 ml (480 mg iodine), 0.5 ml (240 mg iodine) in ampoule (oral or injectable) * Example of a therapeutic group. Various drugs can serve as alternatives. 34 WHO Drug Information Vol. 12, No. 1, 1998 Essential Drugs solution,0.57 ml, (308 mg iodine) dispenser (as palmitate) m dispenser bottle water-miscible injection, capsule, 200 mg 100 000 lU (as palmitate) (55 mg) in 2-ml ampoule*nicotinamide tablet, 50 mg pyridoxine tablet, 25 mg (hydrochloride) riboflavm tablet, 5 mg *retinol sugar-coated tablet 10 000 lU *sodium fluoride in any appropriate formulation (as palmitate) (5.5 mg) thiamine tablet, 50 mg (hydrochloride) capsule, 200 000 IU (as palmitate) (110 mg) Complementary drug oral oily solution calcium gluconate (C), (2, 8) injection,100 mg/ml 100 000 lU/ml in multidose '” io'm' ampou'e The following changes in the WHO Model List were approved by the WHO Expert Committee on the Use of Essential Drugs which met in December 1997. The report of the meeting will be published in the WHO Technical Report Series. Deletions: hydrogen peroxide; metrifonate. Additions: aciclovirfor use in herpes infections; amoxicillin + clavulanic acid fortreatment of infections resistant to the production of beta lactamase; dextromethorphan fortreatment of cough; ephedrine for treatment of hypotension in spinal anaesthesia during delivery; imipenem + cilastatin fortreatment of Pseudomonas and Acinetobacterspp.; ipratropium bromideforthe treatment of asthma; metformin for the treatment of non-insulin dependent diabetes; triclabendazole fortreatment of liver and lung flukes; zidovudine to reduce or prevent mother-to-child transmission of HIV infection. Replacements:chloroxylenol to replace phenol disinfectant; chlorine (NaDCC) for calcium hypochlorite; glibenclamide for tolbutamide; sulfadiazine for sulfadimidine; topical sunscreen for benzophenones and zinc oxide. * Example of a therapeutic group. Various drugs can serve as alternatives. 35