Essential drugs : WHO Model List (revised December 1999)

WHO Drug Information Vol. 13, No. 4, 1999 Essential Drugs WHO Model List (revised December 1999) Section 1: Anaesthetics 1.1 GENERAL ANAESTHET/CS AND OXYGEN ether, anaesthetic (1c) (2) halothane (2) inhalation inhalation ketamine (2) injection, 50 mg (as hydro- chloride)/ml in 10-ml vial nitrous oxide (2) inhalation oxygen uthiopental (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 Dlidocaine 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) injection, 30 mg (For use in spinal anaesthesia (hydrochloride)/m| in during delivery to prevent hypotension) 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 a box (2) to indicate that they represent an example of a therapeutic group and that various drugs could serve as alternatives. it is imperative thatthis 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: ‘1 Hydrochlorothiazide: any other thiazide-type diuretic cur- rently in broad clinical use. ° Hydralazine: any other peripheral vasodilator having an antihypertensive 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 drug names indicate: (1) Drugs subject to international control under: (a) the Single Convention on Narcotic Drugs (1961); (b) the Con- vention on Psychotropic Substances (1971); or (c) the United Nations Convention against 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 adjust- ments 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. A pro- posal to include such a product in a national list of essential drugs should be supported by adequate documentation. (11) Monitoring oftherapeutic concentrations in plasma can improve safety and efficacy. 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) Foruse 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. 249 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 1.3 PREOPERATIVE MEDICATION & SEDATION FOR SHORT-TERM PROCEDURES atropine injection, 1 mg (sulfate) in 1-ml ampoule syrup, 200 mg/5 ml injection, 5 mg/ml in 2-ml ampoule tablet, 5 mg injection, 10 mg (sulfate or hydrochloride) in 1-ml ampoule elixir or syrup, 5 mg (hydrochloride)/5 ml chloral hydrate udiazepam (1b) “morphine (1 a) npromethazine Section 2: Analgesics, Antipyretics, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Drugs Used to Treat Gout and Disease-Modifying Agents used in Rheumatic Disorders (DMARDs) 2.1 NON-OPIOID ANALGESICS & NSAl 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 OPIOID ANALGESICS “codeine (1a) tablet, 30 mg (phosphate) injection, 10 mg (sulfate or hydrochloride) in 1-ml ampoule “morphine (1a) oral solution, 10 mg (hydrochloride or sulfate))l5 ml tablet, 10 mg (sulfate) Complementary drug “pethidine (A) (1 a, 4) injection, 50 mg (hydrochloride) in 1-ml ampoule tablet, 50 mg, 100 mg (hydrochloride) 2.3 DRUGS USED TO TFlEAT GOUT tablet, 100 mg tablet, 500 pg allopurinol (4) colchicine (7) 2.4 DISEASE-MODIFYING AGENTS USED IN RHEUMATIC DISORDERS azathioprine (2) tablet, 50 mg tablet, 100 mg, 150 mg (as phosphate or sulfate) tablet, 25 mg chloroquine (2) cyclophosphamide (2) methotrexate (2) tablet, 2.5 mg (as sodium salt) penicillamine (2) capsule or tablet, 250 mg sulfasalazine (2) tablet, 500 mg Section 3: Antiallergics and Drugs Used in Anaphylaxis L‘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 salt) in 1-ml ampoule “dexamethasone epinephrine injection, 1 mg (as hydro- chloride or hydrogen tartrate) in 1-ml ampoule powder for injection, 100 mg (as sodium succinate) in vial hydrocortisone “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 acetylcysteine injection, 200 mg/ml in 10-ml vial atropine injection, 1 mg (sulfate) in 1-ml ampoule calcium gluconate (2, 8) injection, 100 mg/ml in 10-ml ampoule powder for injection, 500 mg (mesilate) in vial deferoxamine ” Example of a therapeutic group. Various drugs can serve as alternatives. 250 WHO Drug information Vol. 13, No. 4, 1999 Essential Drugs dimercaprol (2) injection in oil, 50 mg/ml in 2-ml ampoule tablet, 250 mg injection, 10 mg/ml in 10-ml ampoule c’DL-methionine methylthioninium chloride (methylene blue) naloxone injection, 400 pg (hydrochloride) in 1-ml ampoule penicillamine (2) capsule or tablet, 250 mg potassium ferric hexacyano- ferrate(ll) ~2H20 (Prussian blue) powder for oral administration sodium calcium edetate (2) injection, 200 mg/ml in 5-ml ampoule sodium nitrite injection, 30 mg/ml in 10-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 (1 b) injection, 5 mg/ml in 2-ml ampoule (intravenous or rectal) ethosuximide capsule, 250 mg syrup, 250 mg/5 ml magnesium sulfate injection, 500 mg/ml in 2-ml ampoule and 10-ml ampoule tablet, 15—100 mg elixir, 15 mg/5 ml phenobarbital (1 b, 11) phenytoin (7, 11) capsule ortablet, 25 mg, 50 mg, 100 mg (sodium salt) injection, 50 mg (sodium salt)/ml in 5-ml vial valproic acid (7, 11) enteric coated tablet, 200 mg, 500 mg (sodium salt) Complementary drug “clonazepam (B) (1b) scored tablet, 500 pg Section 6: Anti-infective Drugs 6.1 ANTHELMINTHICS 6.1.1 INTESTINAL ANTHELMINTHICS albendazole chewable tablet, 400 mg tablet, 50 mg, 150 mg (as hydrochloride) levamisole “mebendazole chewable tablet, 100 mg, 500 mg niclosamide chewable tablet, 500 mg tablet, 150 mg, 600 mg chewable tablet, 250 mg (as embonate) oral suspension, 50 mg (as embonate)/m| praziquantel pyrantel 6.1.2 ANTIFILARIALS diethylcarbamazine tablet, 50 mg, 100 mg (dihydrogen citrate) ivermectin scored tablet, 3 mg, 6 mg Complementary drug suramin sodium (8) (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 aamoxicillin capsule or tablet, 250 mg, 500 mg (anhydrous) powder for oral suspension, 125 mg (anhydrous)/5 ml ampicillin powder for injection, 500 mg, 1 g (as sodium salt) in vial benzathine powder for injection, benzylpenicillin 1.44 g benzylpenicillin (= 2.4 million lU) in 5-ml vial benzylpenicillin powder for injection, 600 mg (:1 million lU), 3 g (= 5 million lU) (sodium or potassium salt) in vial ° Example of a therapeutic group. Various drugs can serve as alternatives. 251 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 ucloxacillin 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) phenoxymethylpenicillin powder for oral suspension, 250 mg (as potassium salt)/5 ml procaine benzylpenicillin powder for injection, 1 9 (=1 million IU), 3 g (= 3 million IU) in vial Restricted indications uamoxicillin + uclavulanic acid (D) tablet, 500 mg + 125 mg ceftazidime (D) powder for injection, 250 mg (as pentahydrate) in vial ”ceftriaxone (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 powder for injection, 1 g (sodium succinate) in vial tablet, 250 mg (as hydrochloride) nciprofloxacin capsule or tablet, 100 mg (hydrochloride) udoxycycline (5, 6) uerythromycin 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 ugentamicin (2, 4, 7, 11) injection, 10 mg, 40 mg (as sulfate)/m| in 2-ml vial “metronidazole tablet, 200—500 mg injection, 500 mg in 100-ml vial suppository, 500 mg, 1 g oral suspension, 200 mg (as benzoate)/5 ml tablet, 250 mg, 500 mg tablet, 100 mg nalidixic acid (3) nitrofurantoin (4, 8) 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) “sulfamethoxazole + 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 Restricted indications vancomycin (D) powder for injection 250 mg (as hydrochloride) in vial 6.2.3 ANTILEPROSY DRUGS clofazimine capsule, 50 mg, 100 mg dapsone tablet, 25 mg, 50 mg, 100 mg rifampicin capsule or tablet, 150 mg, 300 mg 6.2.4 ANTITUBERCULOSIS DRUGS ethambutol (4) tablet, 100—400 mg (hydrochloride) tablet, 100—300 mg tablet, 150 mg + 400 mg isoniazid isoniazid + ethambutol (5) ° Example of a therapeutic group. Various drugs can serve as alternatives. 252 WHO Drug Information Vol. 13, No. 4, 1999 Essential Drugs pyrazinamide tablet, 400 mg rifampicin capsule or tablet, 150 mg, 300 mg rifampicin + tablet, 60 mg + 30 mg, 150 mg + 75 mg, isoniazid (5) 300 mg + 150 mg tablet, 60 mg + 60 mg, 150 mg + 150 mg (for intermittent use 3 times weekly) tablet, 60 mg + 30 mg +150 mg, 150 mg + 75 mg + 400 mg tablet, 150 mg + 150 mg + 500 mg (for intermittent use 3 times weekly) rifampicin + isoniazid + pyrazinamide (5) rifampicin + isoniazid + pyrazinamide + ethambutol tablet, 150 mg + 75 mg + 400 mg + 275 mg 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 + 300 mg 6.42 ANTIRETROVIRAL DRUGS Adequate resources and specialist oversight are a pre- requisite lor the introduction of this class of drugs. tablet, 200 mg oral solution, 50 mg/5 ml nevirapine (8) 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 (NNRTIs) and protease inhibitors (Pls). Zidovudine and nevirapine have been shown to reduce or prevent mother-to-child transmission of HIV infection. This is the only indication for which they are included here. Single drug use with zidovudine, except in pregnancy, is now regarded as obsolete be- cause ot the development of resistance. Triple therapy is beyond the budgets of most national drug programmes and therefore HlV/AlDS treatment policies must be de- cided at country or institutional level. Additional reserve antituberculosis drugs for the treat- ment of drug-resistant tuberculosis should be used in specialized centres only with WHO-recommended TB control strategy, DOTS, and treatment programmes. 6.3 ANTIFUNGAL DRUGS amphotericin B (4) powder for injection, 50 mg in vial “fluconazole capsule, 50 mg injection, 2 mg/ml in vial oral suspension, 50 mg/5-ml griseofulvin (7) capsule or tablet, 125 mg, 250 mg tablet, 100 000, 500 000 lU lozenge, 100 000 lU pessary, 100 000 IU nystatin Complementary drugs flucytosine (B) (4, 8) capsule, 250 mg infusion, 2.5 g in 250 ml potassium iodide (A) saturated solution 6.4 ANT/VIRAL DRUGS 6.4.1 ANTIHERPES DRUGS aciclovir (8) tablet, 200 mg powder for injection, 250 mg (as sodium salt) in vial 6.5 ANTIPROTOZOAL DRUGS 6.5.1 ANTIAMOEBIC AND ANTlGlARDIASIS DRUGS ° diloxanide tablet, 500 mg (furoate) tablet, 200—500 mg injection, 500 mg in 100-ml vial oral suspension, 200 mg (as benzoate)/5 ml “metronidazole 6.5.2 ANTlLElSHMANlASIS DRUGS “meglumine antimoniate 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 (B) (4) 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) syrup, 50 mg (as phosphate or sulfate)/5 ml achloroquine injection, 40 mg (as hydro— chloride, phosphate or sultate)/m| in 5-ml ampoule ° Example of a therapeutic group. Various drugs can serve as alternatives. 253 Essential Drugs WHO Drug information Vol. 13, No. 4, 1999 primaquine tablet, 7.5 mg, 15 mg (as diphosphate) 0quinine tablet, 300 mg (as bisulfate or sulfate) injection, 300 mg (as dihydrochloride)/ml in 2—ml ampoule Complementary drugs “doxycycline (B) (for use only in combination with quinine) capsule or tablet, 100 mg (hydrochloride) tablet, 250 mg (as hydrochloride) tablet, 500 mg + 25 mg mefloquine (B) "sulfadoxine + pyrimethamine (B) Restricted indications artemether (D) injection, 80 mg/ml in 1-ml ampoule artesunate (D) tablet, 50 mg (b) FOR PROPHYLAXIS chloroquine tablet, 150 mg (as phosphate or sulfate) syrup, 50 mg (as phosphate or sulfate)/5 ml doxycycline capsule or tablet, 100 mg (hydrochloride) tablet, 250 mg (as hydrochloride) tablet, 100 mg (hydrochloride) metloquine proguanil (for use only in combination with chloroquine) 6.5.4 ANTIPNEUMOCYSTOSIS AND ANTITOXOPLASMOSIS DRUGS tablet, 200 mg, 300 mg tablet, 25 mg pentamidine (2) pyrimethamine sulfamethoxazole + trimethoprim injection, 80 mg + 16 mg/ml in 5-ml and 10-ml ampoule 6.5.5 ANTITRYPANOSOMAL DRUGS (a) AFRICAN TRYPANOSOMIASIS melarsoprol (2) injection, 3.6% solution powder tor injection, 200 mg, 300 mg (isetionate) in vial powder for injection, 1 gin vial pentamidine (2) suramin sodium Complementary drug eflornithine (0) injection, 200 mg (hydro- chloride)/ml in 100-ml bottles (b) AMERICAN TRYPANOSOMIASIS benznidazole (7) nifurtimox (2, 8) tablet, 100 mg tablet, 30 mg, 120 mg, 250 mg 6.6 INSECT REPELLENTS diethyltoluamide topical solution, 50%, 75% Section 7: Antimigraine Drugs 7.1 FOR TREATMENT OFACUTEATTACK tablet, 300—500 mg tablet, 1 mg (tartrate) acetylsalicylic acid ergotamine (1c) (7) paracetamol tablet, 300-500 mg 7.2 FOR PROPHYLAXIS c‘propranolol tablet, 20 mg, 40 mg (hydrochloride) Section 8: Antineoplastic and lmmunosuppressive Drugs and Drugs Used in Palliative Care 8.1 IMMUNOSUPPRESSIVE DRUGS Adequate resources and specialist oversight are a pre- requisite for the introduction of this class of 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 CYTOTOXIC DRUGS Adequate resources and specialist oversight are a pre- requisite for the introduction of this class of drugs. asparaginase (2) powder for injection, 10 000 IU in vial bleomycin (2) powder for injection, 15 mg (as sulfate) in vial calcium folinate (2) tablet, 15 mg injection, 3 mg/ml in 10-ml ampoule chlorambucil (2) tablet, 2 mg chlormethine (2) powder for injection, 10 mg (hydrochloride) in vial “ Example of a therapeutic group. Various drugs can serve as alternatives. 254 WHO Drug Information Vol. 13, No. 4, 1999 Essential Drugs 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 daunorubicin (2) powder for injection, 50 mg (as hydrochloride) in vial dactinomycin (2) powder for injection 500 pg in vial “doxorubicin (2) powder for 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 ANTIHORMONES “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) 8.4 DRUGS USED IN PALLIATIVE CARE TheWHO Expert Committee on Essential Drugs recom- mended that all the drugs mentioned in the WHO publi- cation Cancer Pain Relief: with a Guide to OpioidAvaiI- ability, 2nd edition, be considered essential. The drugs are included in the relevant sections of the model list according to their therapeutic use, e.g. analgesics. 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 folic acid tablet, 1 mg, 5 mg injection, 1 mg (as sodium salt) in 1-ml ampoule hydroxocobalamin (2) injection, 1 mg in 1—ml ampoule Complementary drug ”iron dextran (B) (5) injection, equivalent to 50 mg iron/ ml in 2-ml ampoule 10.2 DRUGS AFFECTING COAGULATION desmopressin (8) injection, 4 pg (acetate)/m| in 1-ml ampoule nasal spray, 10 pg (acetate)/ metered dose injection, 1000 IU/ml, 5000 lU/ml, 20 000 IU/ml in 1-ml ampoule heparin sodium phytomenadione injection, 10 mg/ml in 5-ml ampoule tablet, 10 mg protamine sulfate injection, 10 mg/ml in 5-ml ampoule Dwarfarin (2, 8) tablet, 1 mg, 2 mg and 5 mg (sodium salt) " Example of a therapeutic group. Van'ous drugs can serve as alternatives. 255 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 Section 11: Blood Products and Plasma Substitutes 11.1 PLASMA SUBSTITUTES udextran 70 injectable solution, 6% "polygeline injectable solution, 3.5% 11.2 PLASMA FRACTIONS FOR SPECIFIC USE 7 Complementary drugs “factor VIII concentrate (C) (2, 8) “factor IX complex (coagulation factors ll, Vll, IX, X) concentrate (C) (2, 8) dried dried Section 12: Cardiovascular Drugs 12.1 ANTIANGINAL DRUGS “atenolol tablet, 50 mg, 100 mg glyceryl trinitrate tablet (sublingual), 500 pg “isosorbide dinitrate tablet (sublingual), 5 mg tablet, 40 mg, 80 mg (hydrochloride) “verapamil (1 O) 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 pg/ml in 2-ml ampoule lidocaine injection, 20 mg (hydrochloride)/ml in 5-ml ampoule verapamil (8, 10) tablet, 40 mg, 80 mg (hydrochloride) injection, 2.5 mg (hydrochloride)/ml in 2-ml ampoule Complementary drugs injection, 1 mg (as hydrochloride)/ml epinephrine (C) injection, 20 pg (hydrochloride)/ml isoprenaline (C) “procainamide (B) tablet, 250 mg, 500 mg (hydrochloride) injection, 100 mg (hydrochloride)lml in 10-ml ampoule uquinidine (A) (7) tablet, 200 mg (sulfate) 12.3 ANTIHYPERTENSIVE DRUGS “atenolol tablet, 50 mg, 100 mg ucaptopril 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) tablet, 250 mg “nifedipine (10) sustained-release formulations tablet, 10 mg “reserpine tablet, 100 pg, 250 pg injection, 1 mg in 1-ml ampoule Complementary drugs prazosin tablet, 500 pg, 1 mg (mesilate) powder for infusion, 50 mg in ampoule "sodium nitroprusside (C) (2. 8) 12.4 DRUGS USED IN HEART FAILURE scored tablet, 25 mg tablet, 62.5 pg, 250 pg oral solution, 50 pg/ml injection, 250 pglml in 2-ml ampoule ucaptopril digoxin (4, 11) injection, 40 mg (hydrochloride)/ml in 5-ml vial dopamine “hydrochlorothiazide 12.5 ANTITHROMBOTIC DRUGS acetylsalicylic acid tablet, 25 mg, 50 mg tablet, 100 mg Complementary drug streptokinase (C) powder for injection, 100 000 IU, 750 000 IU in vial “ Example of a therapeutic group. Various drugs can serve as alternatives. 1 All plasma fractions should comply with the 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. 256 WHO Drug lnfonnation Vol. 13, No. 4, 1999 Essential Drugs 12.6 LlPID-LOWERING AGENTS The WHO Expert Committee on Essential Drugs recog— nizes the value of lipid-lowering dmgs in treatingpatients with hyperlipidaemia. Beta—hydroxy-beta-methylglutaryl— coenzyme A (HMG CoA) reductase inhibitors, often re- ferred to as "statins", are potent and effective lipid- lowering drugs with a good tolerabi/ity profile. Several of these drugs have been shown to reduce the incidence of fatal andnon-fatalmyocardial infarction, stroke andmor- tality (all causes), as well as the need for coronary by- pass surgery. All remain very costly but may be cost- effective for secondaryprevention ofcardiovascular dis- ease as well as forprimaryprevention in some veryhigh- riskpatients. Since no single drug has been shown to be significantlymore effective or less expensive than others in the group, none is included in the model list; the choice of drug for use in patients at highest risk should be decided at national level. Section 13: Dermatological Drugs (topical) 13.1 ANTIFUNGAL DRUGS benzoic acid + salicylic acid ointment or cream, 6% + 3% umiconazole ointment or cream, 2% (nitrate) sodium thiosulfate solution, 15% Complementary drug selenium sulfide (C) detergent-based suspension, 2% 13.2 ANTI-INFECTIVE DRUGS nmethylrosanilinium chloride (gentian violet) aqueous solution, 0.5% tincture, 0.5% neomycin + “bacitracin (7) ointment, 5 mg neomycin sulfate + 500 IU bacitracin zinc/g potassium permanganate aqueous solution, 1:10 000 silver sulfadiazine cream, 1%, in 500-g container 13.3 ANTI-INFLAMMATORYAND ANTIPRURITIC DRUGS C‘betamethasone (3) ointment or cream, 0.1% (as valerate) “calamine lotion lotion ”hydrocortisone ointment or cream, 1% (acetate) 13.4 ASTRINGENT DRUGS aluminium diacetate solution, 13% for dilution 13.5 DRUGS AFFECTING SKIN DIFFERENTIATIONAND PROLIFERATION benzoyl peroxide lotion or cream, 5% coal tar solution, 5% dithranol ointment, 0.1—2% tluorouracil ointment, 5% upodophyllum resin (7) solution, 10—25% salicylic acid solution 5% urea ointment or cream, 10% 13.6 SCAB/CIDES AND PEDICUL/C/DES “benzyl benzoate lotion, 25% permethrin cream, 5% lotion, 1% 13. 7 ULTRAVIOLET-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 RAD/OCONTRASTMEDIA injection, 140—420 mg iodine (as sodium or meglumine salt)/m| in 20-ml ampoule “amidotrizoate barium sulfate aqueous suspension aiohexol injection, 140-350 mg iodine/ml in 5-ml, 10-ml and 20-ml ampoule tablet, 500 mg oily suspension, 500—600 mg/ml in 20-ml ampoule “iopanoic acid apropyliodone (For administration only into the bronchial tree). Complementary drug =meg|umine iotroxate (C) solution, 5 — 8 g iodine in 100—250 ml “ Example of a therapeutic group. Various drugs can serve as alternatives. 257 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 Section 15: Disinfectants and Antiseptics 15.1 ANTISEPTICS “chlorhexidine solution, 5% (digluconate) for dilution “ethanol solution, 70% (denatured) “polyvidone 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 uhydrochlorothiazide tablet, 25 mg, 50 mg spironolactone (8) tablet, 25 mg Complementary drug “mannitol (C) injectable solution, 10%, 20% Section 17: Gastrointestinal Drugs 17.1 ANTACIDS 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/1O ml magnesium hydroxide 17.2 ANTIEMETIC DRUGS metoclopramide tablet, 10 mg (hydrochloride) injection, 5 mg (hydrochloride)/ml in 2-ml ampoule tablet, 10 mg, 25 mg (hydrochloride) elixir or syrup, 5 mg (hydrochloride)/5 ml injection, 25 mg (hydrochloride)/m| in 2-ml ampoule “promethazine 17.3 ANTIHAEMORRHOIDAL DRUGS c‘local anaesthetic, astringent and anti-inflammatory drug 17.4 ANTI-INFLAMMATORY DRUGS suppository, 25 mg (acetate) ointment or suppository hydrocortisone ° 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 DRUGS USED IN DIARRHOEA 17.7.1 ORAL REHYDRATION oral rehydration salts (for glucose— electrolyte solution) powder, 27.9 g/l Components g/I sodium chloride 3.5 trisodium citrate dihydrate 2 2.9 potassium chloride 1.5 glucose 20.0 ° 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/l. However, as the stability of this latter formulation is very poor under tropical conditions, it is only recommended when manufactured for immediate use. 258 WHO Drug information Vol. 13, No. 4, 1999 Essential Drugs 17.7.2 ANTIDIARRHOEAL (SYMPTOMATlC) DRUGS ucodeine (1a) tablet, 30 mg (phosphate) Section 18: Hormones, other Endo- crine Drugs and Contraceptives 18.1 ADRENAL HORMONES AND SYNTHETIC SUBSTITUTES udexamethasone tablet, 500 pg, 4 mg injection, 4 mg dexamethasone phosphate (as disodium salt) in 1-ml ampoule hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial uprednisolone tablet, 1 mg, 5 mg Complementary drug fludrocortisone (C) tablet, 100 pg (acetate) 18.2 ANDROGENS Complementary drug testosterone (C) (2) injection, 200 mg (enantate) in 1-ml ampoule 18.3 CONTRACEPTIVES 18.3.1 HORMONAL CONTRACEPTIVES uethinylestradiol + “Ievonorgestrel tablet, 30 pg + 150 pg, “ethinylestradiol + “levonorgestrel tablet, 50 pg + 250 pg (pack of tour) “ethinylestradiol + “norethisterone tablet, 35 pg «1» 1.0 mg Ievonorgestrel tablet, 0.75 mg (pack of two) Complementary drugs “Ievonorgestrel (B) tablet, 30 pg medroxyprogesterone acetate (B) (7, 8) depot injection, 150 mg in 1-ml vial norethisterone enantate (B) (7, 8) oily solution, 200 mg/ml in 1-ml ampoule 18.3.2 INTRAUTERlNE DEVICES copper-containing device 18.3.3 BARRIER METHODS condoms with or without spermicide (nonoxinol) diaphragms with spermicide (nonoxinol) 18.4 ESTROGENS “ethinylestradiol tablet, 10 pg, 50 pg 18.5 lNSULlNS AND OTHER ANT/DIABETIC AGENTS “glibenclamide tablet, 2.5 mg, 5 mg 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) metformin tablet, 500 m (hydrochloride) 18.6 OVULAT/ON INDUCERS ”clomifene (2, 8) tablet, 50 mg (citrate) 18. 7 PROGESTOGENS norethisterone tablet, 5 mg Complementary dnJg medroxyprogesterone acetate (B) tablet, 5 mg 18.8 THYRO/D HORMONES AND ANTITHYROID DRUGS levothyroxine tablet, 50 pg, 100 pg (sodium salt) potassium iodide tablet, 60 mg‘ r’propylthiouracil tablet, 50 mg Section 19: lmmunologicals 19.1 DIAGNOSTIC AGENTS tuberculin,3 purified protein derivative (PPD) injection ° Example of a therapeutic group. Various drugs can serve as altematlves. 3 All tuberculins should comply with the Requirements for Tuberculins (Revised 1985). WHO Technical Report Series, No. 745, 1987, Annex 1. 259 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 19.2 SEPIA AND IMMUNOGLOBULINS “ anti-D immunogiobulin injection, 250 pg in (human) single-dose vial “antitetanus immunogiobulin injection, 500 IU (human) in vial antivenom serum injection diphtheria antitoxin injection, 10 000 IU, 20 000 IU in vial immunogiobulin, human normal (2) injection (intramuscular) immunogiobulin, human normal (2, 8) injection (intravenous) ”rabies immunogiobulin injection, 150 lU/ml 19.3 VACCINES 5 19.3.1 FOR UNIVERSAL IMMUNIZATION BCG diphtheria pertussis tetanus hepatitis B measles poliomyelitis 19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS influenza meningitis mumps rabies rubella typhoid yellow fever Section 20: Muscle Relaxants (peripherally act- ing) and Cholinesterase Inhibitors “alcuronium chloride (2) injection, 5 mg/ml in 2-ml ampoule c’neostigmine tablet,'15 mg (bromide) injection, 500 pg, 2.5 mg (metilsulfate) in 1-ml ampoule tablet, 60 mg injection, 1 mg in 1-ml ampoule pyridostigmine bromide (2, 8) 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-INFECTIVE AGENTS ugentamicin solution (eye drops), 0.3% (as sulfate) uidoxuridine solution (eye drops), 0.1% eye ointment, 0.2% silver nitrate solution (eye drops), 1% t’tetracycline eye ointment, 1% (hydrochloride) 21.2 ANTI-INFLAMMATORYAGENTS “prednisolone solution (eye drops), 0.5% (sodium phosphate) 21.3 LOCAL ANAESTHETICS utetracaine solution (eye drops), 0.5% (hydrochloride) 21.4 MIOT/CS AND ANTIGLAUCOMA DRUGS acetazolamide tablet, 250 mg " Example of a therapeutic group. Various drugs can serve as alternatives. “All 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. 5 All vaccines should comply with current WHO recommendations for biological substances. 260 WHO Drug Information Vol. 13, No. 4, 1999 Essential Drugs “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 uergometrine (1c) tablet, 200 pg (hydrogen maleate) injection, 200 pg (hydrogen maleate) in 1—ml ampoule oxytocin injection, 10 IU in 1-ml ampoule 22.2 ANTIOXYTOCICS c’salbutamol (2) tablet, 4 mg (as sulfate) injection, 50 pg (as sultate)/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 PSYCHOT/C DISORDERS uchlorpromazine tablet, 100 mg (hydrochloride) syrup, 25 mg (hydrochloride)/5 ml injection, 25 mg (hydrochloride)/ml in 2-ml ampoule ”fluphenazine (5) injection, 25 mg (decanoate or enantate) in 1-ml ampoule ”haloperidol tablet, 2 mg, 5 mg injection, 5 mg in 1~ml ampoule 24.2 DRUGS USED IN MOOD DISORDERS 24.2.1 DRUGS USED IN DEPRESSIVE DISORDERS uamitriptyline tablet, 25 mg (hydrochloride) 24.2.2 DRUGS USED IN BIPOLAR DISORDERS carbamazepine (10, 11) scored tablet, 100 mg, 200 mg lithium carbonate (2, 4) capsule or tablet, 300 mg valproic acid (7, 11) enteric coated tablet, 200 mg, 500 mg (sodium salt) 24.3 DRUGS USED IN GENERAL/ZED ANXIETYAND SLEEP DISORDERS “diazepam (1b) scored tablet, 2 mg, 5 mg 24.4 DRUGS USED IN OBSESSIVE COMPULSIVE DISORDERS AND PAN/C AITACKS clomipramine capsules, 10 mg, 25 mg (hydrochloride) Section 25: Drugs Acting on the Respiratory Tract 25. 1 ANT/ASTHMATIC DRUGS “aminophylline (2) injection, 25 mg/ml in 10-ml ampoule l‘becIometasone inhalation (aerosol), 50 pg, 250 pg, (dipropionate) per dose uepinephrine injection, 1 mg (as hydrochloride or hydrogen tartrate) in 1-ml ampoule ipratropium bromide inhalation (aerosol), 2O pg/dose Dsalbutamol tablet, 2 mg, 4 mg (as sulfate) inhalation (aerosol), 100 pg (as sulfate) per dose syrup, 2 mg (as sulfate)/5 ml injection, 50 pg (as sulfate)/ml in 5-ml ampoule respirator solution for use in nebulizers, 5 mg (as sulfate)/m| theophylline (10, 11) Complementary drug tablet, 100 mg, 200 mg, 300 mg acromoglicic acid (B) inhalation (aerosol), 20 mg (sodium salt) per dose ° Example of a therapeutic group. Various drugs can serve as alternatives. 261 Essential Drugs WHO Drug Information Vol. 13, No. 4, 1999 25.2 ANTITUSSIVES L‘dextromethorphan oral solution, 3.5 mg (bromide)/5 ml Section 26: Solutions correcting Water, Electro- lyte and Acid—base Disturbances 26. 1 ORAL oral rehydration salts (for glucose-— electrolyte solution) for composition see section 17.7.1 potassium chloride powder for solution 26.2 PARENTERAL glucose injectable solution, 5% isotonic, 10% 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 K+ 1.5 mmol/ml, Cl' 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 Na+ 167 mmol/l, H00; 167 mmol/l) 8.4% solution in 10-ml ampoule (equivalent to Na* 1000 mmol/l, H00; 1000 mmol/l) sodium hydrogen carbonate ° compound solution of sodium lactate injectable solution 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 lU/ml) iodine (8) iodized oil, 1 ml (480 mg iodine), 0.5 ml (240 mg iodine) in ampoule (oral or injectable) solution, 0.57 ml, (308 mg iodine) in dispenser bottle capsule, 200 mg tablet, 50 mg tablet, 25 mg (hydrochloride) "nicotinamide pyridoxine “retinol sugar-coated tablet, 10 000 IU (as palmitate) (5.5 mg) capsule, 200 000 IU (as palmitate) (110 mg) oral oily solution, 100 000 lU/ml in multidose dispenser (as palmitate) water-miscible injection, 100 000 IU (as palmitate) (55 mg) in 2-ml ampoule riboflavin tablet, 5 mg l“sodium fluoride in any appropriate formulation thiamine tablet, 50 mg (hydrochloride) Complementary drug calcium gluconate (C) (2, 8) injection,100 mg/ml in 10—ml ampoule " Example of a therapeutic group. Various drugs can serve as alternatives. Deletions:, albumin (human); antiscorpion sera. chlorambucil; daunorubicin; ethanol; iohexol. 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 1999. The report of the meeting will be published in the WHO Technical Report Series. Additions: acetylcysteine; rifampicin + isoniazid + pyrazinamide + ethambutol; nevirapine; artesunate; Replacements: fluconazole to replace ketoconazole; prazosin to replace doxazosin. 262