13-4 model

WHO Drug Information Vol. 13, No. 4, 1999 Essential Drugs
WHO Model List (revised December 1999)
Section 1: Anaesthetics
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
Explanatory Notes
United Nations Convention against Illicit Traffic in Narcotic When the strength of a drug is specified in terms of a Drugs and Psychotropic Substances (1988).
selected salt or ester, this is mentioned in brackets; when it (2) Specific expertise, diagnostic precision, individualization refers to the active moiety, the name of the salt or ester in of dosage or special equipment required for proper use.
brackets is preceded by the word "as".
(3) Greater potency or efficacy.
(4) In renal insufficiency, contraindicated or dosage adjust- Many drugs included in the list are preceded by a box (¤) to indicate that they represent an example of a therapeutic group and that various drugs could serve as alternatives. It (6) Special pharmacokinetic properties.
is imperative that this is understood when drugs are selected (7) Adverse effects diminish benefit/risk ratio.
at national level, since choice is then influenced by the (8) Limited indications or narrow spectrum of activity.
comparative cost and availability of equivalent products.
Examples of acceptable substitutions include: (10) Sustained-release preparations are available. A pro- ¤ Hydrochlorothiazide: any other thiazide-type diuretic cur- posal to include such a product in a national list of essential drugs should be supported by adequate documentation.
¤ Hydralazine: any other peripheral vasodilator having an (11) Monitoring of therapeutic concentrations in plasma can ¤ Senna: any stimulant laxative (either synthetic or of plant Letters in parentheses following the drug names indicate the reasons for the inclusion of complementary drugs: ¤ Sulfadiazine: any other short-acting, systemically active (A) When drugs in the main list cannot be made available.
sulfonamide unlikely to cause crystalluria.
(B) When drugs in the main list are known to be ineffective or inappropriate for a given individual.
Numbers in parentheses following drug names indicate: (C) For use in rare disorders or in exceptional circumstances.
(1) Drugs subject to international control under: (a) the (D) Reserve antimicrobials to be used only when there is Single Convention on Narcotic Drugs (1961); (b) the Con- significant resistance to other drugs on the list.
vention on Psychotropic Substances (1971); or (c) the Drugs are listed in alphabetical order.
WHO Drug Information Vol. 13, No. 4, 1999 1.3 PREOPERATIVE MEDICATION & SEDATION Section 3: Antiallergics and
Section 2: Analgesics, Antipyretics,
Drugs Used in Anaphylaxis
Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs), Drugs Used to
Treat Gout and Disease-Modifying
Agents used in Rheumatic
Disorders (DMARDs)
Section 4: Antidotes and Other
Substances Used in Poisonings
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 Section 6: Anti-infective Drugs
Section 5: Anticonvulsants/
Antiepileptics
carbamazepine (10, 11) scored tablet, 100 mg, 200 mg 6.1.3 ANTISCHISTOSOMALS AND OTHER ANTITREMATODE DRUGS ¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 ¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 6.4.2 ANTIRETROVIRAL DRUGSAdequate resources and specialist oversight are a pre- requisite for the introduction of this class of drugs.
Drugs for treatment of HIV/AIDS include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). 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 of the development of resistance. Triple therapy is beyond the budgets of most national drug programmes and therefore HIV/AIDS 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 inspecialized centres only with WHO-recommended TB control strategy, DOTS, and treatment programmes.
6.5.2 ANTILEISHMANIASIS DRUGS¤meglumine antimoniate ¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 injection, 300 mg (as dihydrochloride)/ml Section 7: Antimigraine Drugs
Section 8: Antineoplastic and
Immunosuppressive Drugs and
Drugs Used in Palliative Care
Adequate resources and specialist oversight are a pre- requisite for the introduction of this class of drugs.
8.2 CYTOTOXIC DRUGSAdequate resources and specialist oversight are a pre- requisite for the introduction of this class of drugs.
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 Section 9: Antiparkinsonism Drugs
Section 10: Drugs affecting the
The WHO Expert Committee on Essential Drugs recom- mended that all the drugs mentioned in the WHO publi-cation Cancer Pain Relief: with a Guide to Opioid Avail-ability, 2nd edition, be considered essential. The drugsare included in the relevant sections of the model listaccording to their therapeutic use, e.g. analgesics.
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 Section 11: Blood Products and
Plasma Substitutes
factors II, VII, IX, X) concentrate (C) (2, 8) Section 12: Cardiovascular Drugs
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
1 All plasma fractions should comply with the Requirements for the Collection, Processing and Quality Control of Blood, BloodComponents and Plasma Derivatives (Revised 1992). WHO Technical Report Series, No. 840, 1994, Annex 2.
WHO Drug Information Vol. 13, No. 4, 1999 The WHO Expert Committee on Essential Drugs recog- nizes the value of lipid-lowering drugs in treating patientswith 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 tolerability profile. Several of these drugs have been shown to reduce the incidence of fatal and non-fatal myocardial infarction, stroke and mor-tality (all causes), as well as the need for coronary by- pass surgery. All remain very costly but may be cost- effective for secondary prevention of cardiovascular dis- ease as well as for primary prevention in some very high- risk patients. Since no single drug has been shown to be significantly more effective or less expensive than othersin the group, none is included in the model list; the choice of drug for use in patients at highest risk should bedecided at national level.
Section 13:
Dermatological Drugs (topical)
activity against UVA and UVB (C) cream, lotion or gel Section 14: Diagnostic Agents
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 Section 15:
Disinfectants and Antiseptics
Section 16: Diuretics
Section 17: Gastrointestinal Drugs
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
2 Trisodium citrate dihydrate may be replaced by sodium bicarbonate (sodium hydrogen carbonate) 2.5 g/l. However, as thestability of this latter formulation is very poor under tropical conditions, it is only recommended when manufactured forimmediate use.
WHO Drug Information Vol. 13, No. 4, 1999 Section 18: Hormones, other Endo-
crine Drugs and Contraceptives
Section 19: Immunologicals
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
3 All tuberculins should comply with the Requirements for Tuberculins (Revised 1985). WHO Technical Report Series, No.
WHO Drug Information Vol. 13, No. 4, 1999 Section 20:
Muscle Relaxants (peripherally act-
ing) and Cholinesterase Inhibitors
Section 21:
Ophthalmological Preparations
19.3.2 FOR SPECIFIC GROUPS OF INDIVIDUALS ¤ Example of a therapeutic group. Various drugs can serve as alternatives.
4 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.
WHO Drug Information Vol. 13, No. 4, 1999 carbamazepine (10, 11) scored tablet, 100 mg, 200 mg Section 22:
24.3 DRUGS USED IN GENERALIZED ANXIETY AND SLEEP DISORDERS Oxytocics and Antioxytocics
Section 25: Drugs Acting on
the Respiratory Tract
Section 23: Peritoneal
Dialysis Solution
Section 24:
Psychotherapeutic Drugs
respirator solution for use in nebulizers, ¤ Example of a therapeutic group. Various drugs can serve as alternatives.
WHO Drug Information Vol. 13, No. 4, 1999 Section 27: Vitamins and Minerals
Section 26:
Solutions correcting Water, Electro-
lyte and Acid–base Disturbances
¤ Example of a therapeutic group. Various drugs can serve as alternatives.
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.
Deletions: , albumin (human); antiscorpion sera.
Additions: acetylcysteine; rifampicin + isoniazid + pyrazinamide + ethambutol; nevirapine; artesunate;
chlorambucil; daunorubicin; ethanol; iohexol.
Replacements: fluconazole to replace ketoconazole; prazosin to replace doxazosin.

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