WHO Model List of Essential Drugs

(March 2002)

 

Review of summary statements on reasons for inclusion of essential drugs and underlying evidence

 

The following three files contain short statements as to why individual drugs are on the WHO Essential Drug List. For those placed on the first Essential Drug List (1977) statements have been constructed. The remaining rationales use comments taken from the Technical Report Series when drugs were substituted or added to the list. 

 

This review has been prepared for EDM/PAR by Phil Wiffen, Regional Pharmaceutical Adviser, SEARO, and Co-ordinating Editor PaPaS Cochrane Group, Oxford, UK.

 

Included in the files is a column showing a preliminary assessment on availability of evidence to support recommendation of an individual drug.

 

Section 1

Anaesthetics

 

to

Section 10

Drugs affecting the blood

Section 11

Blood products and plasma substitutes

 

to

Section 17

Gastrointestinal drugs

Section 18

Hormones, other endocrine drugs & contraceptives

 

to

Section 27 

Vitamins and minerals

 

Explanatory notes  on the list (from Technical Report Series  895)

 

Many drugs are included in the list are preceded by a * to indicate that they represent an example of a therapeutic group and that various drugs could serve as alternatives. It is imperative that this is understood when drugs are selected at a national level, since choice is then influenced by the comparative cost and availability of equivalent products.

 

Numbers in parentheses following the drug names indicate:

 

(1a)

Drugs subject to international control under the Single Convention on Narcotic Drugs, 1961 (38)

(1b)

Drugs subject to international control under the Convention on Psychotropic Substances, 1971 (39)

(1c)

Drugs subject to international control under the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 (40)

(2)

Specific expertise, diagnostic precision, individualization of dosage or special equipment required for proper use

(3)

Greater potency or efficacy

(4)

In renal insufficiency, contraindicated or dosage adjustments necessary

(5)

To improve compliance

(6)

Special pharmacokinetic properties

(7)

Adverse effects diminish benefit/risk ratio

(8)

Limited indications or narrow spectrum of activity

(9)

For epidural anaesthesia

(10)

Sustained-release preparations are available.  A proposal to include such a product in a national list of essential drugs should be supported by adequate documentation

(11)

Monitoring of therapeutic drug concentrations (in plasma) can be used to improve safety and efficacy

 

Letters in parentheses after the drug names indicate the reasons for the inclusion of complementary drugs:

 

(A) When drugs in the main list cannot be made available

(B)

When drugs in the main list are known to be ineffective or inappropriate for a given individual 
(C) For use in rare disorders or in exceptional circumstances

(D)

Reserve antimicrobials to be used only when there is significant resistance to other drugs on the List

 

Explanatory notes on the evidence and comments columns

 

+It can be assumed that drugs were on the original EDL (EDL1) unless there is a later reference to a subsequent EDL list.

 

++ level of evidence used. 

 

CE6 refers to Clinical Evidence Issue 6 December 2001. SR - systematic review, RCT -randomised controlled trial.

 

Cochrane Library:  2002 Issue 1.

 

DARE database of abstracts of reviews from National Health Service (NHS) centre in York England published on their website (http://nhscrd.york.ac.uk/) and the Cochrane Library:

ADR- Adverse drug effect

AE- adverse effects.

 

Comment. The review of evidence is minimal but gives an indication of what is available. Some sections such as section 8 where drugs are used for a number of indications need a thorough work up beyond the scope of this first review. Other areas need to be linked to WHO guidelines which are also being reviewed in the light of available evidence.

 

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