WHO Model List of Essential Medicines

The WHO Model List of Essential Medicines (aka Essential Medicines List or EML[1]), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.[2] The list is frequently used by countries to help develop their own local lists of essential medicines.[2] As of 2016, more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list.[1] This includes both developed and developing countries.[2][3]

For the list for children, see WHO Model List of Essential Medicines for Children.

The list is divided into core items and complementary items.[4] The core items are deemed to be the most cost-effective options for key health problems and are usable with little additional health care resources.[4] The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost–benefit ratio.[4] About 25% of items are in the complementary list.[5] Some medications are listed as both core and complementary.[6] While most medications on the list are available as generic products, being under patent does not preclude inclusion.[7]

The first list was published in 1977 and included 208 medications.[8][2][9] The WHO updates the list every two years.[10] There are 306 medications in the 14th list in 2005,[11] 410 in the 19th list in 2015,[10] 433 in the 20th list in 2017,[12][13] 460 in the 21st list in 2019,[14][15][16] and 479 in the 22nd list in 2021.[17][18] Various national lists contain between 334 and 580 medications.[5][19] 23rd The Essential Medicines List (EML) was updated in July 2023. This list contains 1200 recommendations for 591 drugs and 103 therapeutic equivalents.[20]

A separate list for children up to 12 years of age, known as the WHO Model List of Essential Medicines for Children (EMLc), was created in 2007 and is in its 9th edition.[10][21][22][23] It was created to make sure that the needs of children were systematically considered such as availability of proper formulations.[24][25] Everything in the children's list is also included in the main list.[26] The list and notes are based on the 19th to 23rd edition of the main list.[4][12][14][17][27] An α indicates a medicine is on the complementary list.[4][14][17] Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists.[17][18] The 9th Essential Medicines List for Children was updated in July 2023.[23][28]

Anaesthetics, preoperative medicines and medical gases

Inhalational medicines

Injectable medicines

Local anaesthetics

Complementary:

Preoperative medication and sedation for short-term procedures

Medical gases

Medicines for pain and palliative care

Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs)
A line drawing of a hexagon with two attachments
A skeletal model of the chemical structure of aspirin

Opioid analgesics

Complementary:

Medicines for other common symptoms in palliative care

Antiallergics and medicines used in anaphylaxis

Antidotes and other substances used in poisonings

Non-specific

Specific

Complementary:

Medicines for diseases of the nervous system

Antiseizure medicines

Complementary:

Medicines for multiple sclerosis

Complementary:

Medicines for parkinsonism

Anti-infective medicines

Intestinal anthelminthics
A hexagon joined to a polygon with two attachments to this double ringed structure
A skeletal model of the chemical structure of albendazole

Antifilarials

Antischistosomals and other antinematode medicines

Complementary:

Cysticidal medicines

Complementary:

Access group antibiotics

Watch group antibiotics

Complementary:

Reserve group antibiotics

Reserve antibiotics are last-resort antibiotics. The EML antibiotic book was published in 2022.[29][30][31]

Complementary:

Antileprosy medicines

Antituberculosis medicines
A small pile of white crystals
Pure crystals of ethambutol

Complementary:

Antifungal medicines

Complementary:

Antiherpes medicines
Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Two dark blue capsules with writing on them
Two capsules of atazanavir
Integrase inhibitors
Fixed-dose combinations of antiretroviral medicines
Other antivirals

Complementary:

Nucleoside/Nucleotide reverse transcriptase inhibitors
Pangenotypic direct-acting antiviral combinations
Non-pangenotypic direct-acting antiviral combinations
Other antivirals for hepatitis C

Antiamoebic and antigiardiasis medicines

Antileishmaniasis medicines
For curative treatment
For chemoprevention

Antipneumocystosis and antitoxoplasmosis medicines

Complementary:

African trypanosomiasis
Medicines for the treatment of 1st stage African trypanosomiasis
Medicines for the treatment of 2nd stage African trypanosomiasis

Complementary:

American trypanosomiasis

Medicines for ectoparasitic infections

Medicines for Ebola virus disease

Medicines for COVID-19

No listings in this section.

Antimigraine medicines

For treatment of acute attack

For prophylaxis

Immunomodulators and antineoplastics

Immunomodulators for non-malignant disease

Complementary:

Cytotoxic medicines

Complementary:

Targeted therapies

Complementary:

Immunomodulators

Complementary:

Hormones and antihormones

Complementary:

Supportive medicines

Complementary:

Therapeutic foods

Medicines affecting the blood

Antianaemia medicines

Complementary:

Medicines affecting coagulation

Complementary:

Other medicines for haemoglobinopathies

Complementary:

Blood products of human origin and plasma substitutes

Blood and blood components
A straw colored liquid inside a clear plastic bag
Bag containing one unit of fresh frozen plasma

Human immunoglobulins

Complementary:

Blood coagulation factors

Complementary:

Plasma substitutes

Cardiovascular medicines

Antianginal medicines

Antiarrhythmic medicines

Complementary:

Antihypertensive medicines

Complementary:

Medicines used in heart failure

Complementary:

Anti-platelet medicines

Thrombolytic medicines

Complementary:

Lipid-lowering agents

Fixed-dose combinations for prevention of atherosclerotic cardiovascular disease

Dermatological medicines (topical)

Antifungal medicines

Anti-infective medicines

Anti-inflammatory and antipruritic medicines

Medicines affecting skin differentiation and proliferation

Complementary:

Scabicides and pediculicides

Diagnostic agents

Ophthalmic medicines

Radiocontrast media

Complementary:

Antiseptics and disinfectants

Antiseptics

Disinfectants

Diuretics

Complementary:

Gastrointestinal medicines

Complementary:

Antiulcer medicines

Antiemetic medicines

Complementary:

Anti-inflammatory medicines

Complementary:

Laxatives

Medicines used in diarrhoea

Oral rehydration

Medicines for diarrhoea

Medicines for endocrine disorders

Adrenal hormones and synthetic substitutes

Androgens

Complementary:

Estrogens

No listings in this section.

Progestogens

Insulins

Oral hypoglycaemic agents

Complementary:

Medicines for hypoglycaemia

Complementary:

Thyroid hormones and antithyroid medicines

Complementary:

Medicines for disorders of the pituitary hormone system

Complementary:

Immunologicals

Diagnostic agents

Sera, immunoglobulins and monoclonal antibodies

Vaccines
A small vial with writing on it being removed from a cardboard package
A vial of oral cholera vaccine

Recommendations for all

Recommendations for certain regions

Recommendations for some high-risk populations

Recommendations for immunization programmes with certain characteristics

Muscle relaxants (peripherally-acting) and cholinesterase inhibitors

Complementary:

Ophthalmological preparations

Anti-infective agents

Anti-inflammatory agents

Local anesthetics

Miotics and antiglaucoma medicines

Mydriatics

Complementary:

Anti-vascular endothelial growth factor (VEGF) preparations

Complementary:

Medicines for reproductive health and perinatal care

Oral hormonal contraceptives

Injectable hormonal contraceptives

Intrauterine devices

Barrier methods

Implantable contraceptives

Intravaginal contraceptives

Ovulation inducers

Complementary:

Uterotonics

Antioxytocics (tocolytics)

Other medicines administered to the mother

Medicines administered to the neonate

Complementary:

Peritoneal dialysis solution

Complementary:

Medicines for mental and behavioural disorders

Medicines used in psychotic disorders

Complementary:

Medicines used in depressive disorders

Medicines used in bipolar disorders

Medicines for anxiety disorders

Medicines used for obsessive compulsive disorders

Medicines for alcohol use disorders

Medicines for nicotine use disorders

Complementary:

Medicines acting on the respiratory tract

Antiasthmatic medicines and medicines for chronic obstructive pulmonary disease

Solutions correcting water, electrolyte and acid-base disturbances

Oral

Parenteral

Miscellaneous

Vitamins and minerals

Complementary:

Ear, nose and throat medicines

Medicines for diseases of joints

Medicines used to treat gout

Disease-modifying anti-rheumatic drugs (DMARDs)

Complementary:

Medicines for juvenile joint diseases

Complementary:

Dental medicines and preparations

Notes

An α indicates the medicine is on the complementary list for which specialized diagnostic or monitoring or training is needed. An item may also be listed as complementary on the basis of higher costs or a less attractive cost-benefit ratio.[4][14]

  1. (For use in spinal anaesthesia during delivery, to prevent hypotension).
  2. No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
  3. Not in children less than three months.
  4. Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect.
  5. For the management of cancer pain
  6. Hydromorphone and oxycodone are alternatives
  7. For the management of cancer pain.
  8. Dolasetron, granisetron, palonosetron, and tropisetron are alternatives
  9. Cetirizine and fexofenadine are alternatives
  10. There may be a role for sedating antihistamines for limited indications (EMLc).
  11. Prednisone is an alternative
  12. For use as adjunctive therapy for treatment-resistant partial or generalized seizures.
  13. Diazepam and midazolam are alternatives
  14. For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders.
  15. For buccal administration when solution for oromucosal administration is not available.
  16. The presence of both 25 mg/5 mL and 30 mg/5 mL strengths on the same market would cause confusion in prescribing and dispensing and should be avoided.
  17. Avoid use in pregnancy and in women and girls of child-bearing potential, unless alternative treatments are ineffective or not tolerated because of the high risk of birth defects and developmental disorders in children exposed to valproate in the womb.
  18. Including quality-assured biosimilars
  19. Trihexyphenidyl is an alternative
  20. benserazide is an alternative for carbidopa
  21. Oxamniquine is listed for use when praziquantel treatment fails.
  22. > 1 month.
  23. Only for the presumptive treatment of epidemic meningitis in children older than two years and in adults.
  24. Alternatives are 4th level ATC chemical subgroup (J01CF Beta-lactamase resistant penicillins)
  25. cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
  26. Use in children <8 years only for life-threatening infections when no alternative exists.
  27. Procaine benzylpenicillin is not recommended as first-line treatment for neonatal sepsis except in settings with high neonatal mortality, when given by trained health workers in cases where hospital care is not achievable.
  28. Third-generation cephalosporin of choice for use in hospitalized neonates.
  29. Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  30. > 41 weeks corrected gestational age.
  31. Erythromycin is an alternative as second choice treatment for pharyngitis in children (EMLc only)
  32. For use in combination regimens for eradication of H. pylori in adults.
  33. Vancomycin powder for injection may also be used for oral administration
  34. Imipenem/cilastatin is an alternative for complicated intraabdominal infections and high-risk febrile neutropenia only, except for acute bacterial meningitis in neonates, where meropenem is preferred
  35. Tedizolid phosphate is an alternative
  36. For use only in patients with HIV receiving protease inhibitors.
  37. For use only in combination with meropenem or imipenem/cilastatin.
  38. Terizidone is an alternative
  39. Prothionamide is an alternative
  40. Imipenem/cilastatin is an alternative
  41. For treatment of chronic pulmonary aspergillosis, histoplasmosis, sporotrichosis, paracoccidioidomycosis, mycoses caused by Talaromyces marneffei and chromoblastomycosis; and prophylaxis of histoplasmosis and infections caused by Talaromyces marneffei in AIDS patients.
  42. For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis.
  43. Anidulafungin and caspofungin are alternatives
  44. Valaciclovir is an alternative
  45. also indicated for pre-exposure prophylaxis.
  46. > 6 weeks
  47. > 3 years
  48. For use in pregnant women and in second-line regimens in accordance with WHO treatment guidelines.
  49. lamivudine is an alternative for emtricitabine
  50. combination also indicated for pre-exposure prophylaxis
  51. For the treatment of viral haemorrhagic fevers
  52. For the treatment of cytomegalovirus retinitis (CMVr).
  53. For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
  54. For the treatment of cytomegalovirus retinitis (CMVr).
  55. Pangenotypic when used in combination with sofosbuvir
  56. Pangenotypic when used in combination with sofosbuvir
  57. Pangenotypic when used in combination with daclatasvir or ravidasvir
  58. For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
  59. > 25 kg.
  60. Tinidazole is an alternative
  61. Liposomal amphotericin B has a better safety profile than the sodium deoxycholate formulation and should be prioritized for selection and use depending on local availability and cost.
  62. To be used in combination with artesunate 50 mg.
  63. For use in the management of severe malaria.
  64. Not recommended in the first trimester of pregnancy or in children below 5 kg.
  65. To be used in combination with either amodiaquine, mefloquine, or sulfadoxine + pyrimethamine.
  66. Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate are alternatives
  67. > 5 kg
  68. For use only for the treatment of Plasmodium vivax infection.
  69. > 5 kg
  70. For use only in combination with quinine.
  71. Only for use to achieve radical cure of Plasmodium vivax and Plasmodium ovale infections, given for 14 days.
  72. For use only in the management of severe malaria, and should be used in combination with doxycycline.
  73. Only in combination with artesunate 50 mg.
  74. For use only in Central American regions, for Plasmodium vivax infections.
  75. > 8 years.
  76. > 5 kg or > 3 months.
  77. For use only in combination with chloroquine.
  78. For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection.
  79. To be used for the treatment of Trypanosoma brucei gambiense infection.
  80. To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection.
  81. To be used for the treatment of Trypanosoma brucei gambiense infection
  82. Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection.
  83. The presence of both 120 mg/5 mL and 125 mg/5mL strengths on the same market would cause confusion in prescribing and dispensing and should be avoided.
  84. Certolizumab pegol, etanercept, golimumab and infliximab are alternatives, including quality-assured biosimilars
  85. Afatinib and gefitinib are alternatives
  86. Pembrolizumab is an alternative, including quality-assured biosimilars
  87. Enzalutamide is an alternative
  88. Alternatives are 4th level ATC chemical subgroup (L02BG Aromatase inhibitors)
  89. Flutamide and nilutamide are alternatives
  90. Goserelin and triptorelin are alternatives
  91. Prednisone is an alternative
  92. Biscuit or paste of nutritional composition as determined by the UN joint statement on the community-based management of severe acute malnutrition and Codex alimentarius guidelines.
  93. periconceptual use for prevention of first occurrence of neural tube defects
  94. Epoetin alfa, beta and theta; darbepoetin alfa; methoxy polyethylene glycol-epoetin beta; and their quality-assured biosimilars are alternatives
  95. Apixaban, edoxaban, and rivaroxaban are alternatives
  96. Alternatives are dalteparin and nadroparin, including their quality-assured biosimilars.
  97. Deferiprone is an alternative
  98. cryoprecipitate (not pathogen-reduced) is an alternative
  99. coagulation factor IX complex is an alternative
  100. Polygeline, injectable solution, 3.5% is considered an alternative
  101. Carvedilol and metoprolol are alternatives
  102. Alternatives are 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives)
  103. Includes atenolol, carvedilol, and metoprolol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients > 60 years.
  104. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  105. Hydralazine is listed for use only in the acute management of severe pregnancy-induced hypertension. Its use in the treatment of essential hypertension is not recommended in view of the evidence of greater efficacy and safety of other medicines.
  106. Chlorothiazide, chlorthalidone, and indapamide are alternatives
  107. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
  108. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  109. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain)
  110. Methyldopa is listed for use only in the management of pregnancy-induced hypertension. Its use in the treatment of essential hypertension is not recommended in view of the evidence of greater efficacy and safety of other medicines.
  111. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
  112. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  113. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  114. Bumetanide and torasemide are alternatives
  115. For use in high‐risk patients. Atorvastatin, fluvastatin, lovastatin, and pravastatin are alternatives
  116. fluvastatin, lovastatin, pravastatin, and simvastatin are alternatives for atorvastatin
  117. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for ramipril
  118. atorvastatin, fluvastatin, lovastatin, and pravastatin are alternatives for simvastatin
  119. bisoprolol, carvedilol, and metoprolol are alternatives for atenolol
  120. chlorthalidone, chlorothiazide, and indapamide are alternatives for hydrochlorothiazide
  121. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for perindopril
  122. 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) are alternatives for amlodipine
  123. Alternatives are 4th level ATC chemical subgroup (D01AC Imidazole and triazole derivatives) excluding combinations
  124. Alternatives are 4th level ATC chemical subgroup (D07AC Corticosteroids, potent (group III))
  125. Alternatives are 4th level ATC chemical subgroup (D07AA Corticosteroids, weak (group I))
  126. Calcitriol and tacalcitol are alternatives
  127. Podophyllotoxin is an alternative
  128. precipitated sulfur topical ointment is an alternative
  129. Atropine and cyclopentolate are alternatives
  130. Propanol is an alternative
  131. Iodine is an alternative
  132. Alternatives are 4th level ATC chemical subgroup (D08AE Phenol and derivatives)
  133. Bumetanide and torasemide are alternatives
  134. Chlorothiazide and chlorthalidone are alternatives
  135. Alternatives are 4th level ATC chemical subgroup (A02BC Proton pump inhibitors) excluding combinations
  136. Alternatives are 4th level ATC chemical subgroup (A02BA H2-receptor antagonists) excluding combinations
  137. Mesalazine is an alternative
  138. Bisacodyl is an alternative
  139. In acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts.
  140. Norethisterone is an alternative
  141. Insulin degludec, insulin detemir, and insulin glargine, including quality-assured biosimilars are alternatives
  142. Canagliflozin and dapagliflozin are alternatives
  143. Glibenclamide not suitable above 60 years. Alternatives are 4th level ATC chemical subgroup (A10BB Sulfonylureas)
  144. Carbimazole is an alternative depending on local availability
  145. For use when alternative first-line treatment is not appropriate or available; and in patients during the first trimester of pregnancy.
  146. For use when alternative first-line treatment is not appropriate or available
  147. bromocriptine is an alternative
  148. Exact type to be defined locally
  149. Recommended for certain regions
  150. Recommended for some high-risk populations
  151. Recommended only for immunization programmes with certain characteristics
  152. atracurium is an alternative
  153. For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae.
  154. Amikacin, kanamycin, netilmicin, and tobramycin are alternatives
  155. Alternatives are 4th level ATC chemical subgroup (S01AE Fluoroquinolones)
  156. Chlortetracycline and oxytetracycline are alternatives
  157. Alternatives are 4th level ATC chemical subgroup (S01HA Local anaesthetics) excluding cocaine and combinations
  158. Carbachol is an alternative
  159. Alternatives are 4th level ATC chemical subgroup (S01ED Beta blocking agents) excluding combinations
  160. Cyclopentolate hydrochloride or homatropine hydrobromide are alternatives only for the EMLc
  161. For use in women actively breastfeeding at least 4 times per day
  162. anastrozole is an alternative
  163. Methylergometrine is an alternative
  164. Where permitted under national law and where culturally acceptable.
  165. Only for use for induction of labour where appropriate facilities are available.
  166. Indometacin is an alternative
  167. Prostaglandin E2 is an alternative
  168. haloperidol decanonate and zuclopenthixol decanonate are alternatives
  169. Chlorpromazine is an alternative for the tablet
  170. Risperidone injection is an alternative
  171. aripiprazole, olanzapine, paliperidone, and quetiapine are alternatives
  172. Citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline are alternatives
  173. aripiprazole, olanzapine, and paliperidone are alternatives
  174. lorazepam is an alternative
  175. For short-term emergency management of acute and severe anxiety symptoms only
  176. buprenorphine is an alternative. The medicines should only be used within an established support programme.
  177. Beclometasone, ciclesonide, flunisolide, fluticasone, and mometasone are alternatives
  178. Beclometasone/formoterol, budesonide/salmeterol, fluticasone/formoterol, fluticasone furoate/vilanterol, and mometasone/formoterol are alternatives
  179. Terbutaline is an alternative
  180. Aclidinium, glycopyrronium, and umeclidinium are alternatives
  181. Ergocalciferol is an alternative
  182. Colecalciferol is an alternative
  183. Ofloxacin is an alternative
  184. For use for rheumatic fever, juvenile arthritis, Kawasaki disease
  185. triamcinolone acetonide is an alternative
  186. of any type for use as dental sealant
  187. of any type for use as dental filling material

References
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