WHO Model List of Essential Medicines explained

The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), 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. The list is frequently used by countries to help develop their own local lists of essential medicines.[1], more than 155 countries have created national lists of essential medicines based on the World Health Organization's model list.[2] This includes both developed and developing countries.[1] [3]

The list is divided into core items and complementary items. 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. 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] [1] [9] The WHO updates the list every two years. There are 306 medications in the 14th list in 2005,[10] 410 in the 19th list in 2015,[11] 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.[19] The Essential Medicines List (EML) was updated in July 2023 to its 23rd edition. 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.[11] [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] [27] Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists. The 9th Essential Medicines List for Children was updated in July 2023.[28]

Note: An α indicates a medicine is on the complementary list.

Anaesthetics, preoperative medicines and medical gases

General anaesthetics and oxygen

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)

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

Anthelminthics

Intestinal anthelminthics

Antifilarials

Antischistosomals and other antinematode medicines

Complementary:

Cysticidal medicines

Complementary:

Antibacterials

Access group antibiotics

Watch group antibiotics

Complementary:

Reserve group antibiotics

Reserve antibiotics are last-resort antibiotics. The EML antibiotic book was published in 2022.[63] [64] [65]

Complementary:

Antileprosy medicines

Antituberculosis medicines

Complementary:

Antifungal medicines

Complementary:

Antiviral medicines

Antiherpes medicines

Antiretrovirals

Nucleoside/nucleotide reverse transcriptase inhibitors
Non-nucleoside reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors
Fixed-dose combinations of antiretroviral medicines
Medicines for prevention of HIV-related opportunistic infections
Other antivirals

Complementary:

Antihepatitis medicines

=Nucleoside/Nucleotide reverse transcriptase inhibitors

=

=Pangenotypic direct-acting antiviral combinations

=

=Non-pangenotypic direct-acting antiviral combinations

=

=Other antivirals for hepatitis C

=

Antiprotozoal medicines

Antiamoebic and antigiardiasis medicines

Antileishmaniasis medicines

Antimalarial medicines

For curative treatment
For chemoprevention

Antipneumocystosis and antitoxoplasmosis medicines

Complementary:

Antitrypanosomal medicines

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:

Antineoplastics and supportive medicines

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

Plasma-derived medicines

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:

Antithrombotic medicines

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

Medicines for diabetes

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

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

Contraceptives

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 mood disorders

Medicines used in depressive disorders

Medicines used in bipolar disorders

Medicines for anxiety disorders

Medicines used for obsessive compulsive disorders

Medicines for disorders due to psychoactive substance use

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]

Further reading

Notes and References

  1. Web site: Essential medicines. https://web.archive.org/web/20081002110638/http://www.who.int/medicines/services/essmedicines_def/en/. 2 October 2008. World Health Organization. 19 January 2017.
  2. Web site: The WHO Essential Medicines List (EML): 30th anniversary . https://web.archive.org/web/20140527003625/http://www.who.int/medicines/events/fs/en/ . 27 May 2014 . World Health Organization . 26 June 2016.
  3. Persaud N, Jiang M, Shaikh R, Bali A, Oronsaye E, Woods H, Drozdzal G, Rajakulasingam Y, Maraj D, Wadhawan S, Umali N, Wang R, McCall M, Aronson JK, Plüddemann A, Moja L, Magrini N, Heneghan C . Comparison of essential medicines lists in 137 countries . Bull. World Health Organ. . 97 . 6 . 394–404C . June 2019 . 31210677 . 6560372 . 10.2471/BLT.18.222448 . 10665/325509 . 0042-9686 . free . free .
  4. Web site: 19th WHO Model List of Essential Medicines . April 2015. World Health Organization. 17 January 2017. Annex 1.
  5. Bansal D, Purohit VK . Accessibility and use of essential medicines in health care: Current progress and challenges in India . Journal of Pharmacology & Pharmacotherapeutics . 4 . 1 . 13–18 . January 2013 . 23662019 . 3643337 . 10.4103/0976-500X.107642 . free .
  6. The selection and use of essential medicines . ((World Health Organization)) . WHO technical report series 920 . 10665/42826 . free . World Health Organization (WHO) . 2003 . 92-4-120920-8 .
  7. Web site: Beall R . Patents and the WHO Model List of Essential Medicines (18th Edition): Clarifying the Debate on IP and Access. World Intellectual Property Organization (WIPO) . 3 May 2017. 2016.
  8. Book: ((World Health Organization)) . The selection of essential drugs: report of a WHO expert committee [meeting held in Geneva from 17 to 21 October 1977] . 1977 . 10665/41272 . World Health Organization . World Health Organization . Geneva . Technical report series; no. 615 . free . 92-4-120615-2 .
  9. Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, Gyansa-Lutterodt M, Jing S, Luiza VL, Mbindyo RM, Möller H, Moucheraud C, Pécoul B, Rägo L, Rashidian A, Ross-Degnan D, Stephens PN, Teerawattananon Y, 't Hoen EF, Wagner AK, Yadav P, Reich MR . Essential medicines for universal health coverage . Lancet . 389 . 10067 . 403–476 . January 2017 . 27832874 . 7159295 . 10.1016/S0140-6736(16)31599-9 . free . doi .
  10. Prakash B, Nadig P, Nayak A . Rational Prescription for a Dermatologist . Indian Journal of Dermatology . 61 . 1 . 32–38 . 2016 . 26955092 . 4763692 . 10.4103/0019-5154.174017 . free .
  11. Web site: WHO Model Lists of Essential Medicines. World Health Organization . The current versions are the 21st WHO Essential Medicines List (EML) and the 7th WHO Essential Medicines List for Children (EMLc) updated in June 2019..
  12. Book: ((World Health Organization)) . WHO model list of essential medicines, 20th list (March 2017, amended August 2017) . 2017 . 10665/273826 . World Health Organization . Geneva . free .
  13. Web site: Essential Medicines List and WHO Model Formulary. https://web.archive.org/web/20080803023013/http://www.who.int/selection_medicines/list/en/. 3 August 2008. World Health Organization. 5 May 2018.
  14. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  15. Book: ((World Health Organization)) . 2019 . Executive summary: the selection and use of essential medicines 2019: report of the 22nd WHO Expert Committee on the selection and use of essential medicines . Geneva . World Health Organization . 10665/325773 . WHO/MVP/EMP/IAU/2019.05. License: CC BY-NC-SA 3.0 IGO . free .
  16. Web site: Strengthening access to essential medicines . World Health Organization . 3 May 2020.
  17. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  18. Book: ((World Health Organization)) . 2021 . Executive summary: the selection and use of essential medicines 2021: report of the 23rd WHO Expert Committee on the selection and use of essential medicines: virtual meeting, 21 June–2 July 2021 . World Health Organization . Geneva . World Health Organization . 10665/345554 . WHO/MHP/HPS/EML/2021.01 . free .
  19. Book: ((World Health Organization)) . 2021 . The selection and use of essential medicines: report of the WHO Expert Committee on Selection and Use of Essential Medicines, 2021 (including the 22nd WHO model list of essential medicines and the 8th WHO model list of essential medicines for children) . World Health Organization . Geneva . World Health Organization . 10665/351172 . WHO technical report series;1035. License: CC BY-NC-SA 3.0 IGO . free . 978-92-4-004114-1 .
  20. Web site: WHO Model Lists of Essential Medicines . 2023-08-08 . World Health Organization .
  21. Book: ((World Health Organization)) . World Health Organization model list of essential medicines for children: 7th list 2019 . 2019 . 10665/325772 . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.07. License: CC BY-NC-SA 3.0 IGO . free .
  22. Book: ((World Health Organization)) . World Health Organization model list of essential medicines for children: 8th list (2021) . 2021 . 10665/345534 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.03 . free .
  23. Book: ((World Health Organization)) . The selection and use of essential medicines 2023: web annex B: World Health Organization model list of essential medicines for children: 9th list (2023) . 2023 . 10665/371091 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2023.03 . free .
  24. Book: Rose K, Anker JN . Guide to Paediatric Drug Development and Clinical Research. 2010. Karger Medical and Scientific Publishers. 978-3-8055-9362-5. 42.
  25. Book: Seyberth HW, Rane A, Schwab M . Pediatric Clinical Pharmacology. 2011. Springer Science & Business Media. 978-3-642-20195-0. 358.
  26. Hoppu K . Essential Medicines for Children . Clinical Pharmacology and Therapeutics . 101 . 6 . 718–720 . June 2017 . 28182281 . 10.1002/cpt.661 . 23873145 .
  27. Book: ((World Health Organization)) . The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) . 2023 . 10665/371090 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2023.02 . free .
  28. Book: ((World Health Organization)) . 2023 . The selection and use of essential medicines 2023: executive summary of the report of the 24th WHO Expert Committee on Selection and Use of Essential Medicines, 24 28 April 2023 . World Health Organization . Geneva . World Health Organization . 10665/371291 . WHO/MHP/HPS/EML/2023.01 . free .
  29. (For use in spinal anaesthesia during delivery, to prevent hypotension).
  30. No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation.
  31. Not in children less than three months.
  32. Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect.
  33. For the management of cancer pain
  34. [Hydromorphone]
  35. For the management of cancer pain.
  36. [Dolasetron]
  37. [Cetirizine]
  38. There may be a role for sedating antihistamines for limited indications (EMLc).
  39. [Prednisone]
  40. For use as adjunctive therapy for treatment-resistant partial or generalized seizures.
  41. [Diazepam]
  42. For use in eclampsia and severe pre‐eclampsia and not for other convulsant disorders.
  43. For buccal administration when solution for oromucosal administration is not available.
  44. 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.
  45. 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.
  46. 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.
  47. [Trihexyphenidyl]
  48. [benserazide]
  49. Oxamniquine is listed for use when praziquantel treatment fails.
  50. > 1 month.
  51. Only for the presumptive treatment of epidemic meningitis in children older than two years and in adults.
  52. Alternatives are 4th level ATC chemical subgroup (J01CF Beta-lactamase resistant penicillins)
  53. cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to better bioavailability.
  54. Use in children <8 years only for life-threatening infections when no alternative exists.
  55. 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.
  56. Third-generation cephalosporin of choice for use in hospitalized neonates.
  57. Do not administer with calcium and avoid in infants with hyperbilirubinemia.
  58. > 41 weeks corrected gestational age.
  59. [Erythromycin]
  60. For use in combination regimens for eradication of H. pylori in adults.
  61. Vancomycin powder for injection may also be used for oral administration
  62. [Imipenem/cilastatin]
  63. Web site: 24 November 2021 . The WHO Essential Medicines List Antibiotic Book . 2022-10-06 . World Health Organization (WHO) .
  64. Book: The WHO AWaRe (Access, Watch, Reserve) antibiotic book . Geneva . World Health Organization (WHO) . 2022 . 29 January 2023 . 978-92-4-006238-2 .
  65. Book: The WHO AWaRe (Access, Watch, Reserve) antibiotic book - Infographics . Geneva . World Health Organization (WHO) . 2022 . 29 January 2023 . WHO/MHP/HPS/EML/2022.02 .
  66. [Tedizolid phosphate]
  67. For use only in patients with HIV receiving protease inhibitors.
  68. For use only in combination with meropenem or imipenem/cilastatin.
  69. [Terizidone]
  70. [Prothionamide]
  71. [Imipenem/cilastatin]
  72. 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.
  73. For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis.
  74. [Anidulafungin]
  75. [Valaciclovir]
  76. also indicated for pre-exposure prophylaxis.
  77. > 6 weeks
  78. > 3 years
  79. For use in pregnant women and in second-line regimens in accordance with WHO treatment guidelines.
  80. [lamivudine]
  81. combination also indicated for pre-exposure prophylaxis
  82. For the treatment of viral haemorrhagic fevers
  83. For the treatment of cytomegalovirus retinitis (CMVr).
  84. For severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients
  85. For the treatment of cytomegalovirus retinitis (CMVr).
  86. Pangenotypic when used in combination with sofosbuvir
  87. Pangenotypic when used in combination with sofosbuvir
  88. Pangenotypic when used in combination with daclatasvir or ravidasvir
  89. For the treatment of hepatitis C, in combination with direct acting anti-viral medicines
  90. > 25 kg.
  91. [Tinidazole]
  92. 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.
  93. To be used in combination with artesunate 50 mg.
  94. For use in the management of severe malaria.
  95. Not recommended in the first trimester of pregnancy or in children below 5 kg.
  96. To be used in combination with either amodiaquine, mefloquine, or sulfadoxine + pyrimethamine.
  97. Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate are alternatives
  98. > 5 kg
  99. For use only for the treatment of Plasmodium vivax infection.
  100. > 5 kg
  101. For use only in combination with quinine.
  102. Only for use to achieve radical cure of Plasmodium vivax and Plasmodium ovale infections, given for 14 days.
  103. For use only in the management of severe malaria, and should be used in combination with doxycycline.
  104. Only in combination with artesunate 50 mg.
  105. For use only in Central American regions, for Plasmodium vivax infections.
  106. > 8 years.
  107. > 5 kg or > 3 months.
  108. For use only in combination with chloroquine.
  109. For the treatment of 1st and 2nd stage human African trypanosomiasis due to Trypanosoma brucei gambiense infection.
  110. To be used for the treatment of Trypanosoma brucei gambiense infection.
  111. To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection.
  112. To be used for the treatment of Trypanosoma brucei gambiense infection
  113. Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection.
  114. 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.
  115. [Certolizumab pegol]
  116. Including quality-assured biosimilars
  117. [Afatinib]
  118. [Pembrolizumab]
  119. [Enzalutamide]
  120. Alternatives are 4th level ATC chemical subgroup (L02BG Aromatase inhibitors)
  121. [Flutamide]
  122. [Goserelin]
  123. [Prednisone]
  124. 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.
  125. periconceptual use for prevention of first occurrence of neural tube defects
  126. [Epoetin alfa]
  127. [Apixaban]
  128. Alternatives are dalteparin and nadroparin, including their quality-assured biosimilars.
  129. [Deferiprone]
  130. cryoprecipitate (not pathogen-reduced) is an alternative
  131. coagulation factor IX complex is an alternative
  132. [Polygeline]
  133. [Carvedilol]
  134. Alternatives are 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives)
  135. Includes atenolol, carvedilol, and metoprolol as alternatives. Atenolol should not be used as a first-line agent in uncomplicated hypertension in patients > 60 years.
  136. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  137. 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.
  138. [Chlorothiazide]
  139. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) (for amlodipine)
  140. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) (for lisinopril) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  141. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain)
  142. 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.
  143. 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)
  144. Alternatives are 4th level ATC chemical subgroup (C09CA Angiotensin II receptor blockers (ARBs), plain) (for telmisartan) and chlorthalidone, chlorothiazide, indapamide (for hydrochlorothiazide)
  145. Alternatives are 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain)
  146. [Bumetanide]
  147. For use in high‐risk patients. Atorvastatin, fluvastatin, lovastatin, and pravastatin are alternatives
  148. [fluvastatin]
  149. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for ramipril
  150. [atorvastatin]
  151. [bisoprolol]
  152. [chlorthalidone]
  153. 4th level ATC chemical subgroup (C09AA ACE inhibitors, plain) are alternatives for perindopril
  154. 4th level ATC chemical subgroup (C08CA Dihydropyridine derivatives) are alternatives for amlodipine
  155. Alternatives are 4th level ATC chemical subgroup (D01AC Imidazole and triazole derivatives) excluding combinations
  156. Alternatives are 4th level ATC chemical subgroup (D07AC Corticosteroids, potent (group III))
  157. Alternatives are 4th level ATC chemical subgroup (D07AA Corticosteroids, weak (group I))
  158. [Calcitriol]
  159. [Podophyllotoxin]
  160. precipitated sulfur topical ointment is an alternative
  161. [Atropine]
  162. [Propanol]
  163. [Iodine]
  164. Alternatives are 4th level ATC chemical subgroup (D08AE Phenol and derivatives)
  165. [Bumetanide]
  166. [Chlorothiazide]
  167. Alternatives are 4th level ATC chemical subgroup (A02BC Proton pump inhibitors) excluding combinations
  168. Alternatives are 4th level ATC chemical subgroup (A02BA H2-receptor antagonists) excluding combinations
  169. [Mesalazine]
  170. [Bisacodyl]
  171. In acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts.
  172. [Norethisterone]
  173. [Insulin degludec]
  174. [Canagliflozin]
  175. Glibenclamide not suitable above 60 years. Alternatives are 4th level ATC chemical subgroup (A10BB Sulfonylureas)
  176. [Carbimazole]
  177. For use when alternative first-line treatment is not appropriate or available; and in patients during the first trimester of pregnancy.
  178. For use when alternative first-line treatment is not appropriate or available
  179. [bromocriptine]
  180. Exact type to be defined locally
  181. Recommended for certain regions
  182. Recommended for some high-risk populations
  183. Recommended only for immunization programmes with certain characteristics
  184. [atracurium]
  185. For infections due to Chlamydia trachomatis or Neisseria gonorrhoeae.
  186. [Amikacin]
  187. Alternatives are 4th level ATC chemical subgroup (S01AE Fluoroquinolones)
  188. [Chlortetracycline]
  189. Alternatives are 4th level ATC chemical subgroup (S01HA Local anaesthetics) excluding cocaine and combinations
  190. [Carbachol]
  191. Alternatives are 4th level ATC chemical subgroup (S01ED Beta blocking agents) excluding combinations
  192. [Cyclopentolate hydrochloride]
  193. For use in women actively breastfeeding at least 4 times per day
  194. [anastrozole]
  195. [Methylergometrine]
  196. Where permitted under national law and where culturally acceptable.
  197. Only for use for induction of labour where appropriate facilities are available.
  198. [Indometacin]
  199. [Prostaglandin E2]
  200. [haloperidol decanonate]
  201. [Chlorpromazine]
  202. [Risperidone]
  203. [aripiprazole]
  204. [Citalopram]
  205. [aripiprazole]
  206. [lorazepam]
  207. For short-term emergency management of acute and severe anxiety symptoms only
  208. [buprenorphine]
  209. [Beclometasone]
  210. [Beclometasone/formoterol]
  211. [Terbutaline]
  212. [Aclidinium]
  213. [Ergocalciferol]
  214. [Colecalciferol]
  215. [Ofloxacin]
  216. For use for rheumatic fever, juvenile arthritis, Kawasaki disease
  217. [triamcinolone acetonide]
  218. of any type for use as dental sealant
  219. of any type for use as dental filling material

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