WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Rationale+
1. ANAESTHETICS
Evidence++ and comments
No entries in CE6
1.1 General anaesthetics and oxygen
ether, anaesthetic
(1c, 2)
Inhalation
Safe inhalation anaesthetic -widely
available
Fire risk
halothane
(2)
inhalation
Potent non irritant inhalation
anaesthetic
Can cause hepatotoxicity
ketamine
(2)
injection, 50 mg (as hydrochloride)/ml in 10ml vial
EDL4 Added as an intravenous
anaesthetic. Useful in emergency and
field setting
Cochrane Library: One review with no
clear evidence but RCTs exist
nitrous oxide
(2)
inhalation
inhalation anaesthetic and analgesic
Cochrane Library: No reviews but
RCTs exist
inhalation (medicinal gas)
EDL2
powder for injection, 0.5 g, 1.0 g (sodium
salt) in ampoule
Induction agent for general anaesthesia
oxygen
*thiopental
(2)
1.2 Local anaesthetics
*bupivacaine
*lidocaine
Cochrane Library: No reviews but
RCTs exist
No entries in CE6
(2, 9)
injection, 0.25%, 0.5% (hydrochloride) in
vial; injection for spinal anaesthesia, 0.5% in
4-ml ampoule to be mixed with 7.5% glucose
solution
Local anaesthetic blocks and spinal
anaesthesia. Longer acting than
Lidocaine
Cochrane Library: No reviews but
RCTs exist
injection, 1%, 2% (hydrochloride) in vial;
injection for spinal anaesthesia, 5% in 2-ml
ampoule to be mixed with 7.5% glucose
solution; topical forms, 2-4%
Local anaesthetic blocks, dental work
and spinal anaesthesia
Cochrane Library: No reviews but
RCTs exist
Section1 Page 1 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*lidocaine + epinephrine
(adrenaline)
injection 1%, 2% (hydrochloride)+
epinephrine 1:200 000 in vial; dental
cartridge 2% + epinephrine 1:80 000
Prolonged effect lidocaine. Mainly
dental use
injection, 30 mg/ml in 1-ml ampoule (To
prevent hypotension in spinal anaesthesia
during delivery)
EDL10 Prevention of hypotension in
spinal anaesthesia during delivery
Must not be used in digits.
Complementary drug
ephedrine
(C)
1.3 Preoperative medication and sedation for short-term procedures
No entries in CE6
atropine
injection, 1 mg (sulfate) in 1-ml ampoule
Premedication to reduce bronchial and
salivary secretions
Cochrane Library: No reviews but
RCTs exist
chloral hydrate
syrup, 200 mg/5-ml
EDL5 for paediatric premedication
? justifiable
*diazepam
(1b)
injection, 5 mg/ml in 2-ml ampoule; tablet, 5
mg
Sedative with amnesic effect.
*morphine
(1a)
injection, 10 mg (sulfate or hydrochloride) in
1-ml ampoule
Analgesic and sedative
elixir or syrup, 5 mg (hydrochloride)/5-ml
Sedative useful in children
*promethazine
2. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs), DRUGS USED TO TREAT GOUT AND DISEASE
MODIFYING AGENTS IN RHEUMATOID DISORDERS (DMARDs)
2.1 Non-opioids and NSAIDs
acetylsalicylic acid
tablet, 100-500 mg; suppository, 50-150 mg
Analgesic- mild to moderate pain and
antipyretic
Not to be used in children under 12yrs
linked to Reyes syndrome
*ibuprofen
tablet, 200 mg, 400 mg
Analgesic- mild to moderate pain and
antipyretic
Cochrane Library: 1 large SR showing
benefit in acute pain
CE6 benefit in RA
Section1 Page 2 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
paracetamol
tablet, 100-500 mg; suppository, 100 mg;
syrup, 125 mg/5-ml
Analgesic- mild to moderate pain and
antipyretic
Cochrane Library: 1 large SR showing
benefit in acute pain
CE6 benefit in RA
2.2 Opioid analgesics
*codeine
(1a)
tablet, 30 mg (phosphate)
Potent opioid analgesic
Little evidence for effect as single
agent
Cochrane Library: 1 large SR showing
benefit in combination with
paracetamol
*morphine
(1a)
injection, 10 mg in 1-ml ampoule (sulfate or
hydrochloride); oral solution, 10 mg (sulfate
or hydrochloride)/5 ml; tablet, 10 mg (sulfate)
Potent opioid analgesic used post
operatively and for severe pain.
Cochrane Library: No reviews but
RCTs exist
(A) (1a, 4)
injection, 50 mg (hydrochloride) in 1-ml
ampoule; tablet, 50 mg, 100 mg
Potent opioid analgesic. Morphine
preferred as pethidine produces toxic
metabolite
Cochrane Library: 1 SR in labour no
clear results
Complementary drug
*pethidine
2.3 Drugs used to treat gout
No entries in CE6
allopurinol
(4)
Tablet, 100 mg
First line treatment for gout -reduces
uric acid levels.
Cochrane Library: No reviews but
RCTs exist
colchicine
(7)
tablet, 500 micrograms
For acute attacks of gout
Dose control essential
Cochrane Library: No reviews but
RCTs exist
2.4 Disease modifying agents used in rheumatoid disorders (DMARDs) Currently no evidence to show that one is more effective that another
azathioprine
(2)
tablet, 50 mg
EDL10 Immunosuppressant
Blood monitoring required
CE6 One SR shows effect
Section1 Page 3 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
chloroquine
(2)
tablet, 100 mg, 150 mg (as phosphate or
sulfate)
EDL10 Suppresses disease process
Ophthalmic screening for retinopathy is
necessary
CE6 One SR shows effect
cyclophosphamide
(2)
tablet, 25 mg
EDL10 Immunosuppressant
Blood monitoring required
CE6 One SR shows effect
methotrexate
(2)
tablet, 2.5 mg (as sodium salt)
EDL10 Immunosuppressant
Blood monitoring required
CE6: No SR but may be more effective
than azathioprine.
penicillamine
(2)
capsule or tablet, 250 mg
EDL10 Suppresses disease process
Blood monitoring required
CE6 One SR shows effect
sulfasalazine
(2)
tablet, 500 mg
EDL10 Suppresses disease process
Blood monitoring required
CE6 One SR shows effect
3. ANTIALLERGICS AND DRUGS USED IN ANAPHYLAXIS
No entries in CE6
*chlorphenamine
tablet, 4 mg (hydrogen maleate); injection, 10
mg (hydrogen maleate) in 1-ml ampoule
Sedating antihistamine
Cochrane Library: No reviews but
RCTs exist
*dexamethasone
tablet, 500 micrograms, 4 mg; injection, 4 mg
dexamethasone phosphate (as disodium salt)
in 1-ml ampoule
EDL4 Corticosteroid
Cochrane Library: Number of SRs
across a range of conditions
epinephrine (adrenaline)
injection, 1 mg (as hydrochloride or hydrogen
tartrate) in 1-ml ampoule
EDL2 For shock or anaphylaxis
Cochrane Library: No reviews but
RCTs exist
hydrocortisone
powder for injection, 100 mg (as sodium
succinate) in vial
EDL5 Corticosteroid. Added as an
adjunct to epinephrine in anaphylactic
shock
Cochrane Library: Number of SRs
across a range of conditions
*prednisolone
tablet, 5 mg
Corticosteroid
Cochrane Library: Number of SRs
across a range of conditions
Section1 Page 4 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
4. ANTIDOTES AND OTHER SUBSTANCES USED IN POISONING
4.1 Non-specific
*charcoal, activated
powder
Binds poisons in the stomach to reduce
toxic effect
CE6 No evidence found (no SR or
RCTs)
ipecacuanha
syrup, containing 0.14% ipecacuanha
alkaloids calculated as emetine
EDL2 Added as an emetic
Cochrane Library: One SR underway
acetylcysteine (N-)
injection, 200 mg/ml in 10-ml ampoule
EDL11 Specific antidote for
paracetamol poisoning
atropine
injection, 1 mg (sulfate) in 1-ml ampoule
To treat effects of organophosphorus
poisoning
injection, 100 mg in 10-ml ampoule
EDL10 For the specific treatment of
magnesium toxicity
powder for injection, 500 mg (mesilate) in
vial
EDL2 For iron poisoning and chronic
iron overload e.g. haemolytic anaemia
Cochrane Library: No reviews but
RCTs exist
injection in oil, 50 mg/ml in 2-ml ampoule
For heavy metal poisoning but not iron,
cadmium or selenium
Cochrane Library: 2 RCTs
*dl-methionine
tablet, 250 mg
EDL5 Specific antidote for paracetamol
poisoning
CE6 No evidence found (no SR and
one small RCT)
methylthioninium chloride
(methylene blue)
injection, 10 mg/ml in 10-ml ampoule
EDL2 For methaemaglobinaemia
naloxone
injection, 400 micrograms (hydrochloride) in
1-ml ampoule
To reverse opioid toxicity
capsule or tablet, 250 mg
For lead poisoning
CE6 No evidence found (no SR or
RCTs)
4.2 Specific
calcium gluconate
(2, 8)
deferoxamine
dimercaprol
penicillamine
(2)
(2)
Section1 Page 5 of 22
CE6 One small RCT suggesting
reduced mortality
Cochrane Library: No SR but RCTs
exist
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
potassium ferric hexacyanoferrate(II) ·2H20 (Prussian
blue)
powder for oral administration
EDL6 For thallium poisoning
injection, 200 mg/ml in 5-ml ampoule
For heavy metal poisoning esp. lead
sodium nitrite
injection, 30 mg/ml in 10-ml ampoule
EDL2 for cyanide poisoning
Cochrane Library: No SR or RCT
sodium thiosulfate
injection, 250 mg/ml in 50-ml ampoule
For cyanide poisoning
Cochrane Library: 1 RCT
sodium calcium edetate
(2)
5. ANTICONVULSANTS/ANTIEPILEPTICS
CE6 No placebo controlled trials in this area.
carbamazepine
(10,11)
scored tablet, 100 mg, 200 mg
For control of epilepsy ( and trigeminal
neuralgia)
Cochrane Library: One SR but results
confounded by classification of
epilepsy
*diazepam
(1b)
injection, 5 mg/ml in 2-ml ampoule
(intravenous or rectal)
Used in status epilepticus
Cochrane Library: No SR but RCTs
exist
ethosuximide
capsule, 250 mg; syrup, 250 mg/5-ml
For control of epilepsy especially
absence seizures
Cochrane Library: No SR but RCTs
exist
magnesium sulfate
injection, 500 mg/ml in 2-ml ampoule
EDL9 For the treatment of eclampsia
Cochrane Library: One SR showing
more effective than diazepam
phenobarbital
(1b, 11)
tablet, 15-100 mg; elixir, 15 mg/5-ml
For control of epilepsy
CE6 Less tolerated than other drugs
phenytoin
(7, 11)
capsule or tablet, 25 mg, 50 mg, 100 mg
(sodium salt); injection, 50 mg/ml in 5-ml
vial
For control of epilepsy
Cochrane Library: One SR showing
similar benefit to valproate
valproic acid
(7, 11)
enteric coated tablet, 200 mg, 500 mg
(sodium salt)
EDL2 complementary antiepileptic
drugs. For control of epilepsy
Cochrane Library: One SR but results
confounded by classification of
epilepsy
(B) (1b)
scored tablets 500 micrograms
EDL9 alternative drug for the treatment
of myoclonic epilepsy
Complementary drug
*clonazepam
Section1 Page 6 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
6. ANTI-INFECTIVE DRUGS See WHO model prescribing information on Drugs in parasitic diseases for a number of sections in this group
6.1 Anthelminthics
6.1.1 Intestinal anthelminthics
No entries in CE6
albendazole
chewable tablet, 400 mg
EDL6 Specific treatment for
echinococcosis and cysticerosis
Cochrane Library: One SR on brain
cysticerosis no clear evidence of
benefit. RCTs exist
levamisole
tablet, 50 mg; 150 mg (as hydrochloride)
For roundworm infections
Cochrane Library: No SR but RCTs
exist
*mebendazole
chewable tablet, 100 mg, 500 mg
For threadworm, roundworm,
whipworm and hookworm
Cochrane Library: No SR but RCTs
exist
niclosamide
chewable tablet, 500 mg
For tapeworm
Cochrane Library: No SR but one RCT
praziquantel
tablet, 150 mg, 600 mg
EDL3 for flukes, bilharzia and
tapeworms
Cochrane Library: One SR on brain
cysticerosis no clear evidence of
benefit. RCTs exist
pyrantel
chewable tablet 250 mg (as embonate); oral
suspension, 50 mg (as embonate)/ml
EDL3 Added as chewable tablet and
oral suspension. For threadworm,
roundworm, and hookworm
Cochrane Library: No SR but RCTs
exist
tablet, 50 mg, 100 mg ( dihydrogen citrate)
For filariasis, toxocariasis and
onchocerciasis
Hypersensitivity reactions common
scored tablet, 3 mg, 6 mg
EDL5 Added for its unique therapeutic
potential in onchocerciasis
Cochrane Library: One SR showing no
benefit in preventing visual acuity loss
powder for injection, 1 g in vial
For onchocerciasis
Cochrane Library: No SR but RCTs
exist
6.1.2 Antifilarials
diethylcarbamazine
ivermectin
Cochrane Library: No SR but RCTs
exist
Complementary drug
suramin sodium
(B) (2, 7)
Section1 Page 7 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
6.1.3 Antischistosomals and anti-trematode drugs
praziquantel
tablet, 600 mg
EDL3 Replaced Niridazole, antimony
Na tartrate and Na stibocaptate
Cochrane Library: Two SRs showing
more effective than metrifonate (S
heamatobium) and equally effective as
oxamniquine (S mansoni)
triclabendazole
tablet, 250 mg
EDL10 For fascioliasis and
paragonimiasis and schistomiasis
Cochrane Library: No SR but RCTs
exist
(C) (8)
capsule, 250 mg; syrup, 250 mg/5-ml
For schistomiasis
Cochrane Library: One SR equally
effective as praziquantel (S mansoni)
(4)
capsule or tablet, 250 mg, 500 mg
(anhydrous); powder for oral suspension, 125
mg (anhydrous)/5 ml
EDL6 Replaces oral ampicillin because
better absorbed + fewer side effects
Cochrane Library: Number of SRs
across a range of conditions
Broad spectrum penicillin
CE6 No evidence of benefit in acute
otitis media
powder for injection, 500 mg, 1 g (as sodium
salt) in vial
Broad spectrum penicillin
Cochrane Library: Number of SRs
across a range of conditions
Complementary drug
oxamniquine
6.2 Antibacterials
6.2.1 Beta lactam drugs
*amoxicillin
ampicillin
CE6 No evidence of benefit in acute
otitis media
benzathine benzylpenicillin
powder for injection, 1.44 g benzylpenicillin
(=2.4 million IU) in 5-ml vial
Long acting injectable penicillin
Cochrane Library: A DARE review and
several RCTs
benzylpenicillin
powder for injection, 600 mg (= 1 million
IU), 3 g (= 5 million IU) (sodium or
potassium salt) in vial
Injectable penicillin
Cochrane Library: Number of SRs
across a range of conditions
Section1 Page 8 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*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
Penicillin antibiotic for penicillin
resistant Staphylococci
Discuss Flucloxacillin
phenoxymethylpenicillin
tablet, 250 mg (as potassium salt); powder for
oral suspension, 250 mg (as potassium salt)/5
ml
Oral penicillin for mild or moderate
infections
Cochrane Library: Number of SRs
across a range of conditions
procaine benzylpenicillin
powder for injection, 1 g (=1 million IU), 3 g
(=3 million IU)
Long acting injectable penicillin
Cochrane Library: Number of SRs
across a range of conditions
Cochrane Library: Number of SRs
across a range of conditions
Restricted Indications
*amoxicillin + *clavulanic
acid
(D)
tablet, 500 mg + 125 mg
EDL10 For B lactase producing
organisms
Cochrane Library: Number of SRs
across a range of conditions
ceftazidime
(D)
powder for injection, 250 mg (as
pentahydrate) in vial
EDL9 Multirestant organisms
(pseudomonas) including to
aminoglycosides. Injectable
cephalosporin.
Cochrane Library: Number of SRs
across a range of conditions
*ceftriaxone
(D)
powder for injection, 250 mg (as sodium salt)
in vial
EDL9 For use only if no alternatives
are effective. Long acting injectable
cephalosporin.
Cochrane Library: Number of SRs
across a range of conditions
imipenem + cilastatin
(D)
powder for injection 250 mg (as
monohydrate) + 250 mg (as sodium salt), 500
mg (as monohydrate) + 500 mg (as sodium
salt) in vial
EDL10 For multiresistant pseudomonas
spp and actinetobacter spp. Broad
spectrum injectable antibiotic
Cochrane Library: Number of SRs
across a range of conditions
(7)
capsule, 250 mg; oral suspension, 150 mg (as
palmitate)/5 ml; powder for injection, 1 g
(sodium succinate) in vial
Broad spectrum potent antibiotic
Serious haematological side effects.
6.2.2 Other antibacterials
*chloramphenicol
Section1 Page 9 of 22
Cochrane Library: Number of SRs
across a range of conditions
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*ciprofloxacin
*doxycycline
(5, 6)
*erythromycin
*gentamicin
(2, 4, 7,
11)
tablet 250 mg (as hydrochloride)
EDL7 For infections resistant to drugs
on the main list
Cochrane Library: Number of SRs
across a range of conditions
capsule or tablet, 100 mg (hydrochloride)
Long acting tetracycline
Cochrane Library: Number of SRs
across a range of conditions
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
Broad spectrum antibiotic as an
alternative to penicillin.
Cochrane Library: Number of SRs
across a range of conditions
injection, 10 mg, 40 mg (as sulfate)/ml in 2ml vial
Aminoglycoside
Serum concentration monitoring
advised
Cochrane Library: Number of SRs
across a range of conditions
*metronidazole
tablet, 200-500 mg; injection, 500 mg in 100ml vial; suppository, 500 mg, 1 g; oral
suspension, 200 mg (as benzoate)/5 ml
EDL2 Of value against anaerobic
organisms
Cochrane Library: Number of SRs
across a range of conditions
nalidixic acid
(8)
tablet 250 mg, 500 mg
EDL8 For treatment of resistant
shigellosis and urinary tract infections
Cochrane Library: One DARE review
showing reduced bacteriuria in
paralysed persons
nitrofurantoin
(4, 8)
tablet, 100 mg
EDL2 An effective and inexpensive
drug for urinary tract infections
Cochrane Library: One DARE review
showing reduced bacteriuria in
paralysed persons
spectinomycin
(8)
powder for injection, 2 g (as hydrochloride)
in vial
Used for gonorrhoea
Cochrane Library: One SR showing as
effective as penicillin
*sulfadiazine
(4)
tablet, 500 mg
EDL10 More effective for Rx of
toxoplasmosis than sulfadimidine
Cochrane Library: Two SRs. One
shows a lack of clear evidence for
reduction of mother to child
transmission. The other shows lack of
evidence for effect in
T.retinochoroiditis
Section1 Page 10 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*sulfadiazine
(4)
injection, 250 mg (sodium salt) in 4-ml
ampoule
EDL10 Sulphonamide. Used to
prevent recurrence of rheumatic fever
and used for toxplasmosis(unlicensed)
*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
ampoules
Restricted to use in Pneumocystis in
some countries
Discuss ?
trimethoprim
(8)
tablet, 100 mg, 200 mg; injection 20 mg/ml in
5-ml ampoule
EDL5 For use in urinary tract
infections
Cochrane Library: Number of SRs
across a range of conditions
(C)
oily suspension for injection 0.5 g (as sodium
succinate)/ml in 2-ml ampoule
Broad spectrum potent antibiotic
Serious haematological side effects.
CE6 Good SR evidence for benefit
Complementary drugs
chloramphenicol
Cochrane Library: Number of SRs
across a range of conditions
clindamycin
(B) (8)
capsule, 150 mg; injection, 150 mg (as
phosphate)/ml
EDL7 Patients allergic to penicillin &
infections resistant to main list drugs
Cochrane Library: Number of SRs
across a range of conditions
vancomycin
(D)
powder for injection, 250 mg (as
hydrochloride) in vial
EDL9 For use only if no alternatives
are effective
Cochrane Library: No reviews but
RCTs exist
clofazimine
capsule, 50 mg, 100 mg
WHO recommendation for leprosy
Cochrane Library: No reviews but
RCTs exist
dapsone
tablet, 25 mg, 50 mg, 100 mg
WHO recommendation for leprosy
Cochrane Library: No reviews but
RCTs exist
rifampicin
capsule or tablet, 150 mg, 300 mg
WHO recommendation for leprosy
Cochrane Library: No reviews but
RCTs exist
6.2.3 Antileprosy drugs
6.2.4 Antituberculosis drugs
Section1 Page 11 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
ethambutol
(4)
tablet, 100 mg-400 mg (hydrochloride)
For Tuberculosis in combination with
other drugs
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
tablet, 100 -300 mg
For Tuberculosis in combination with
other drugs
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
tablet, 150 mg + 400 mg
EDL9 For improved compliance
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
pyrazinamide
tablet, 400 mg
For Tuberculosis in combination with
other drugs
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
rifampicin
capsule or tablet, 150 mg, 300 mg
For Tuberculosis in combination with
other drugs
CE6: RCTs suggest use in first two
months speeds up sputum clearance
isoniazid
isoniazid + ethambutol
(5)
rifampicin + isoniazid
(5)
tablet, 60 mg + 30 mg; 150 mg + 75 mg; 300
mg + 150 mg; 150 mg + 150 mg (For
intermittent use three times weekly.)
EDL6 Combination to improve
compliance
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
rifampicin + isoniazid +
pyrazinamide
(5)
tablet, 60 mg + 30 mg + 150 mg; 150 mg +
75 mg + 400 mg; 150 mg + 150 mg + 500 mg
(For intermittent use three times weekly.)
EDL9 For improved compliance
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
tablet, 150 mg + 75 mg +400 mg + 275 mg
EDL11 For improved compliance
CE6 No comparisons of regimes but 6
months as effective as longer (8-9
months)
(4)
powder for injection, 1 g (as sulfate) in vial
For Tuberculosis in combination with
other drugs
Cochrane Library: No reviews but
RCTs exist
(A) (5, 7)
tablet, 50 mg + 100 mg; 150 mg + 300 mg
EDL3 For improved compliance
Cochrane Library: No reviews but
RCTs exist
rifampicin + isoniazid +
pyrazinamide + ethambutol
streptomycin
Complementary drug
thioacetazone + isoniazid
Section1 Page 12 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Restricted Indications
Additional reserve second-line drugs for the treatment of multidrug-resistant tuberculosis (MDR-TB) should be used in specialized centres adhering to WHO standards for TB
control. (D)
6.3 Antifungal drugs
amphotericin B
(4)
powder for injection, 50 mg in vial
For systemic fungal infections
Cochrane Library: Several SRs exist
Variety of toxic reactions possible
*fluconazole
griseofulvin
(7)
nystatin
capsule 50 mg; injection 2 mg/ml in vial; oral
suspension 50 mg/5-ml
EDL11 Replaces ketoconazole. Broad
spectrum antifungal.
CE6: RCTs show more effective for
oral candidiasis than topical agents
capsule or tablet, 125 mg, 250 mg
For fungal infections of skin, scalp and
nails
Cochrane Library: One DARE review
in tinea capitis showing as effective as
ketoconazole and cheaper
tablet, 100,000, 500,000 IU; lozenge 100,000
IU; pessary, 100,000 IU
For local action only- not absorbed
systemically
Cochrane Library: Several SRs exist.
Little evidence for effect
Complementary drugs
flucytosine
(B) (4, 8)
capsule, 250 mg; infusion, 2.5 g in 250 ml
For systemic yeast and fungal
infections
Cochrane Library: No reviews but
RCTs exist
potassium iodide
(A)
saturated solution
Antiseptic and disinfectant. Used in
cutaneous sporotrichosis
Cochrane Library: One RCT and a
narrative review
(8)
tablet, 200 mg; powder for injection 250 mg
(as sodium salt) in vial
EDL10 Disseminated H simplex & H
zoster & herpes viral encephalitis
Cochrane Library: No reviews but
RCTs exist
6.4 Antivirals
6.4.1 Antiherpes
Aciclovir
CE6: Effective at reducing pain in post
herpetic neuralgia
6.4.2 Antiretrovirals Adequate resources and specialist oversight are a prerequisite for the introduction of this class of drugs.
Section1 Page 13 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
Nevirapine
(8)
tablet 200 mg; oral solution 50 mg/5-mL
EDL11 HIV-mother-child transmission
prevention
CE6 One RCT shows effective
Zidovudine
(8)
capsules 100 mg, 250 mg; injection, 10
mg/ml in 20-ml vial; oral solution 50 mg/5-ml
EDL10 HIV-mother-child transmission
prevention
CE6 One SR shows effective
Drugs for treatment of HIV/AIDS include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors
(PIs). The drugs zidovudine and nevirapine have been shown to reduce or prevent mother-to-child transmission. THIS IS THE ONLY INDICATION FOR WHICH IT IS
INCLUDED HERE. Single drug use with zidovudine, except in pregnancy, 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)
Amoebiasis in the gastrointestinal
contents.
Cochrane Library: No reviews but
RCTs exist
*metronidazole
tablet, 200-500 mg; injection, 500 mg in 100ml vial; oral suspension 200 mg (as
benzoate)/5 ml
Amoebiasis and giardiasis
Cochrane Library: One SR shows
effective in giardiasis
injection, 30%, equivalent to approximately
8.5% antimony, in 5-ml ampoule
EDL5 Alternative 1st line treatment for
Leishmaniasis
Cochrane Library: No reviews but
RCTs exist
(5)
powder for injection, 200 mg, 300 mg
(isetionate) in vial
Leishmaniasis
Cochrane Library: No reviews but
RCTs exist
(B) (4)
powder for injection, 50 mg in vial
Leishmaniasis when unresponsive to
meglumine
Cochrane Library: No reviews but
RCTs exist
6.5.2 Antileishmaniasis drugs
*meglumine antimoniate
Pentamidine
Complementary drug
amphotericin B
6.5.3 Antimalarial drugs
6.5.3.1 For curative treatment
Section1 Page 14 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*chloroquine
tablet 100 mg, 150 mg (as phosphate or
sulfate); syrup, 50 mg (as phosphate or
sulfate)/5 ml; injection 40 mg (as
hydrochloride, phosphate or sulfate)/ml in 5ml ampoule
For acute attacks
National policy needed as increasing
resistance. Is this drug still relevant for
treatment ?
primaquine
tablet, 7.5 mg, 15 mg (as diphosphate)
To eliminate intra-hepatic forms and
gametocytes.
Cochrane Library: No reviews but
RCTs exist
*quinine
tablet, 300 mg (as bisulfate or sulfate);
injection, 300 mg (as dihydrochloride)/ml in
2-ml ampoule
For acute attacks
Cochrane Library: No reviews but
RCTs exist
Complementary drugs
*doxycycline
(B)
capsule or tablet, 100 mg (hydrochloride)
(For use only in combination with
chloroquine.)
mefloquine
(B)
tablet, 250 mg (hydrochloride)
EDL5 For treatment of multi-drugresistant falciparum malaria
*sulfadoxine +
pyrimethamine
(B)
tablet, 500 mg + 25 mg
EDL2 Replaced sulfadoxine
(D)
injection, 80 mg/ml in 1-ml ampoule
EDL9 For use only in areas with
quinine resistance. Artimisinin
derivative
Cochrane Library: One SR shows
effective
(D)
tablet, 50 mg
EDL11 For mal. resistant to older
drugs, variable bioavailability=sp.
att.quality. Artimisinin derivative
Cochrane Library: One SR shows
effective
tablet, 150 mg (as phosphate or sulfate);
malaria prophylaxis
Local resistance patterns important
Restricted Indications
artemether
Restricted Indications
artesunate
6.5.3.2 For prophylaxis
chloroquine
Section1 Page 15 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
syrup, 50 mg (as phosphate or sulfate)/5 ml
CE6 little evidence of effectiveness
doxycycline
capsule or tablet, 100 mg ( hydrochloride)
malaria prophylaxis
CE6 One RCT shows effective but up
to 40% experienced side effects
mefloquine
tablet, 250 mg (as hydrochloride)
malaria prophylaxis
CE6 One SR shows effective in
preventing malaria
proguanil
tablet, 100 mg (hydrochloride) (For use only
in combination with chloroquine.)
EDL5 Added for malaria prophylaxis
CE6 no evidence to show that
primaquine plus chloroquine is more
effective that chloroquine
alone.(2RCTs)
EDL10 New section
Confirm entry in EDL11 as ?no oral
form only injection and nebulised
solution
6.5.4 Anti-pneumocystosis and anti-toxoplasmosis drugs
pentamidine
(2)
tablet 200 mg, 300 mg
CE6 SR shows sulfamethoxazole +
trimethoprim more effective than
pentamidine at reducing incidence of
pneumocystis or toxoplasmosis
pyrimethamine
tablet, 25 mg
EDL10 Re-introduced
sulfamethoxazole +
trimethoprim
injection 80 mg + 16 mg in 5-ml ampoule
EDL10 New section
CE6 SR shows sulfamethoxazole +
trimethoprim more effective than
pentamidine at reducing incidence of
pneumocystis or toxoplasmosis
Cochrane Library: One RCT
6.5.5. Antitrypanosomal drugs
6.5.5 (a) African trypanosomiasis
melarsoprol
(2)
injection, 3.6% solution
Alternative exists (follow up treatment)
pentamidine
(5)
powder for injection, 200 mg, 300 mg
(isetionate) in vial
Antiprotozoal drug for adults and
children
Section1 Page 16 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
suramin sodium
powder for injection, 1 g in vial
Antiprotozoal drug for adults and
children
Injection, 200 mg ( hydrochloride)/ml in 100ml bottles
EDL7 For late stage African tryp. due
to Trypanosoma brucei gambiense
Cochrane Library: No reviews but
RCTs exist
Complementary drug
eflornithine
(C)
6.5.5 (b) American trypanosomiasis
benznidazole
(7)
tablet, 100 mg
EDL5 Only drug (with nifurtimox)
useful for American trypanosomiasis
Cochrane Library: No reviews but
RCTs exist
nifurtimox
(2, 8)
tablet, 30 mg; 120 mg; 250 mg
Antiprotozoal drug for adults and
children
Cochrane Library: No reviews but
RCTs exist
topical solution, 50%, 75%
Topical insect repellent effective for a
few hours
CE6 One RCT shows that DEET
reduces number of bites. Case reports
show serious ADRs in children
tablet, 300 -500 mg
For mild to moderate pain
Useful when used with metoclopramide
6.6 Insect repellents
diethyltoluamide
7. ANTIMIGRAINE DRUGS
7.1 For treatment of acute attack
acetylsalicylic acid
CE6 evidence of effect alone or with
metoclopramide.
ergotamine
(7)
tablet, 1 mg (tartrate)
For acute migraine attack
Dose control during attack and
frequency of use important
CE6 limited evidence of effect
paracetamol
tablet, 300-500 mg
For mild to moderate pain
7.2 For prophylaxis
Section1 Page 17 of 22
Cochrane Library: No reviews but
RCTs exist
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
*propranolol
tablet, 20 mg, 40 mg (hydrochloride)
EDL6 Migraine, prophylaxis
Cochrane Library: No reviews but
RCTs exist. One review underway.
8. ANTINEOPLASTIC, IMMUNOSUPPRESSIVES AND DRUGS USED IN PALLIATIVE CARE
8.1 Immunosuppressive drugs
Adequate resources and specialist oversight are a prerequisite for this class of drugs.
*azathioprine
(2)
tablet, 50 mg; powder for injection, 100 mg
(as sodium salt) in vial
For use in organ transplant programmes
in combination with other products
Cochrane Library: No reviews but a
number of RCTs exist
*ciclosporin
(2)
capsule, 25 mg; concentrate for injection 50
mg/ml in 1-ml ampoule (For organ
transplantation.)
EDL7 For use in organ transplant
programmes. Tacrolimus is alternative
Cochrane Library: No reviews but
RCTs exist
CE6 effective for psoriasis but toxicity
high
8.2 Cytotoxic drugs Adequate resources and specialist oversight are a prerequisite for this class of drugs.
This section needs a more detailed search for evidence
asparaginase
(2)
powder for injection, 10,000 IU in vial
EDL8 For the treatment of various
cancers
Cochrane Library: No reviews but
RCTs exist
bleomycin
(2)
powder for injection, 15 mg (as sulfate) in
vial
EDL2 Specific expertise, diagnostic
precision or special equipment
Cochrane Library: No reviews but
RCTs exist
calcium folinate
(2)
tablet, 15 mg; injection, 3 mg/ml in 10-ml
ampoule
EDL2 For use with methotrexate
Cochrane Library: No reviews but
RCTs exist
chlorambucil
(2)
tablet 2 mg
EDL11 Recommended by Int. Agency
for Research on Cancer (IARC)
Cochrane Library: No reviews but
RCTs exist
chlormethine
(2)
powder for injection, 10 mg (hydrochloride)
in vial
EDL11 Out: No advantage over other
antineoplastics-In: For various cancers
Cochrane Library: No reviews but
RCTs exist
cisplatin
(2)
powder for injection, 10 mg, 50 mg in vial
For the treatment of various cancers
Cochrane Library: several reviews exist
CE6 Cisplatin as part of a
chemotherapy regime improves
survival in non small cell lung cancer
Section1 Page 18 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
cyclophosphamide
(2)
tablet, 25 mg; powder for injection, 500 mg in
vial
For the treatment of various cancers
Cochrane Library: One review in non
small cell lung cancer
cytarabine
(2)
powder for injection, 100 mg in vial
EDL2 Antimetabolite for acute
leukaemia
Cochrane Library: No reviews but
RCTs exist. One DARE report
dacarbazine
(2)
powder for injection, 100 mg in vial
EDL6 For specific Rx of malignant
melanoma and Hodgkin's disease
Cochrane Library: One review in
melanoma but no clear outcome.
dactinomycin
(2)
powder for injection, 500 micrograms in vial
For the treatment of various cancers
mainly in children
Cochrane Library: One review in
advanced ovarian cancer
daunorubicin
(2)
powder for injection, 50 mg (as
hydrochloride) in vial
EDL11 Recommended by Int. Agency
for Research on Cancer (IARC)
Cochrane Library: No reviews but
RCTs exist
*doxorubicin
(2)
powder for injection, 10 mg, 50 mg (as
hydrochloride) in vial
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
etoposide
(2)
capsule, 100 mg; injection, 20 mg/ml in 5-ml
ampoule
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
fluorouracil
(2)
injection, 50 mg/ml in 5-ml ampoule
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
CE6 improves survival in colorectal
cancer
levamisole
(2)
tablet, 50 mg (as hydrochloride)
EDL8 For the treatment of various
cancers
Cochrane Library: No reviews but
RCTs exist. One DARE report
CE6 no benefit in preventing reoccurrence in colorectal cancer
mercaptopurine
(2)
tablet, 50 mg
For acute leukaemia
Section1 Page 19 of 22
Cochrane Library: No reviews but
RCTs exist
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
methotrexate
(2)
tablet, 2.5 mg; powder for injection, 50 mg
(as sodium salt) in vial
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
CE6 neoadjuvant chemotherapy with
methotrexate leads to lower
mastectomy rates.
procarbazine
vinblastine
(2)
capsule, 50 mg (as hydrochloride)
EDL2 Used to treat Hodgkins disease
in combination with other drugs
Cochrane Library: No reviews but
RCTs exist and several DARE reports
powder for injection, 10 mg (sulfate) in vial
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
CE6 Vinblastine regimes with
radiotherapy improve survival
compared to radiotherapy alone in
Stage 3 non small cell lung cancer
vincristine
(2)
powder for injection, 1 mg, 5 mg (sulfate) in
vial
For the treatment of various cancers
Cochrane Library: Number of reviews
for different conditions
*prednisolone
tablet, 5 mg; powder for injection, 20 mg in
vial, 25 mg (as sodium phosphate or sodium
succinate) in vial
EDL4 Corticosteroid &
Immunosuppressant
Cochrane Library: Number of reviews
for different conditions
tamoxifen
tablet, 10 mg, 20 mg (as citrate)
EDL4 Oestrogen receptor antagonist
for use in breast cancer
Cochrane Library: Number of reviews
for different conditions
8.3 Hormones and antihormones
CE6 Useful in first line treatment of
oestrogen receptor positive metastatic
breast cancer
8.4 Drugs used in palliative care
The WHO Expert Committee on the Use of Essential Drugs recommended that all the drugs mentioned in the WHO publication Cancer Pain Relief: with a Guide to Opioid
Availability, second edition, be considered essential. The drugs are included in the relevant sections of the Model List, according to their therapeutic use, e.g. analgesics.
Section1 Page 20 of 22
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
9. ANTIPARKINSONISM DRUGS
*biperiden
levodopa + *carbidopa
(5, 6)
tablet, 2 mg (hydrochloride); injection, 5 mg
(lactate) in 1-ml ampoule
EDL3 Replaced trihexyphenidyl
tablet, 100 mg + 10 mg; 250 mg + 25 mg
Combination treatment for
parkinsonism
Cochrane Library: Number of reviews
Reduces tremor
Cochrane Library: No reviews but
RCTs exist
CE6 no good evidence that any drug
delays progression of Parkinson's
10. DRUGS AFFECTING THE BLOOD
10.1 Anti-anaemia drugs
ferrous salt
tablet, 60 mg iron; oral solution, 25 mg iron
(as sulfate)/1 ml
Oral iron for iron deficiency or as
nutritional supplement
Cochrane Library: One review for
pregnancy
ferrous salt + folic acid
tablet equivalent to 60 mg iron + 400
micrograms folic acid (Nutritional
supplement for use during pregnancy.)
EDL3 Oral iron for iron deficiency or
as nutritional supplement
For prevention of neural tube defects as
well as nutritional supplement
Cochrane Library: One review for
pregnancy
folic acid
(2)
injection, 1 mg (as sodium salt) in 1-ml
ampoule
Nutritional supplement in anaemia
Cochrane Library: Number of reviews
hydroxocobalamin
(2)
injection, 1 mg in 1-ml ampoule
EDL2 Replaces cynocobalamin
Cochrane Library: No reviews but
RCTs exist
(B) (5)
injection, equivalent to 50 mg iron/ml in 2-ml
ampoule
Injectable iron
Cochrane Library: No reviews but
RCTs exist
Complementary drug
*iron dextran
Allergic reactions possible. CPR
facilities should be on hand
10.2 Drugs affecting coagulation
desmopressin
(8)
injection, 4 micrograms (acetate)/ml in 1-ml
EDL7 Reduce need for blood
Section1 Page 21 of 22
Cochrane Library: No reviews but
WHO Model List of Essential Drugs (EDL) with rational and evidence where available
11th edition (Nov. 1999)
By Therapeutic Group
ampoule; nasal spray 10 micrograms/metered
dose
products(haemphilia A &Von
Willebrand's disease)
RCTs exist
injection, 1000 IU/ml, 5000 IU/ml, 20,000 IU
(acetate)/ml in 1-ml ampoule
Short acting injectable anticoagulant
Cochrane Library: Number of reviews
phytomenadione
injection, 10 mg/ml in 5-ml ampoule; tablet,
10 mg
To correct excessive bleeding due to
anticoagulants.
Cochrane Library: One review in
neonates and RCTs
protamine sulfate
injection, 10 mg/ml in 5-ml ampoule
Used to treat heparin overdose
Cochrane Library: No reviews but
RCTs exist
tablet, 1 mg, 2 mg and 5 mg (sodium salt)
Oral anticoagulant
Cochrane Library: Number of reviews
heparin sodium
*warfarin
(2, 6)
CE6 One small RCT showed warfarin
and heparin reduced mortality
compared to no anticoagulants in
Pulmonary embolism
See heparin above
Section1 Page 22 of 22