WHO Model List of Essential Medicines 2023 PDF

WHO/MHP/HPS/EML/2023.02 © World Health Organization 2023 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you...

WHO/MHP/HPS/EML/2023.02 © World Health Organization 2023 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. Web Annex A. World Health Organization Model List of Essential Medicines – 23rd List, 2023. In: The selection and use of essential medicines 2023: Executive summary of the report of the 24th WHO Expert Committee on the Selection and Use of Essential Medicines, 24 – 28 April 2023. Geneva: World Health Organization; 2023 (WHO/MHP/HPS/EML/2023.02). Licence: CC BY- NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. 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The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. This publication contains the collective views of an international group of experts and does not necessarily represent the decisions or the policies of WHO. The recommendations contained in this publication are based on the advice of independent experts, who have considered the best available evidence, a risk–benefit analysis and other factors, as appropriate. This publication may include recommendations on the use of medicinal products for an indication, in a dosage form, dose regimen, population or other use parameters that are not included in the approved labelling. Relevant stakeholders should familiarize themselves with applicable national legal and ethical requirements. WHO does not accept any liability for the procurement, distribution and/or administration of any product for any use. WHO Model List of Essential Medicines – 23rd List (2023) Explanatory notes The core list presents a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe and cost–effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment. Where the [c] symbol is placed next to an individual medicine or strength of medicine on the core list it signifies that there is a specific indication for restricting its use to children. The complementary list presents essential medicines for priority diseases, for which specialized diagnostic or monitoring facilities, and/or specialist medical care, and/or specialist training are needed. In case of doubt medicines may also be listed as complementary on the basis of consistent higher costs or less attractive cost-effectiveness in a variety of settings. Where the [c] symbol is placed next to an individual medicine or strength of medicine on the complementary list it signifies that the medicine(s) require(s) specialist diagnostic or monitoring facilities, and/or specialist medical care, and/or specialist training for their use in children. The square box symbol () is intended to indicate therapeutic alternatives to the listed medicine that may be considered for selection in national essential medicines lists. Alternatives may be individual medicines, or multiple medicines within a pharmacological class or chemical subgroup, defined at the 4th level of the Anatomical Therapeutic Chemical (ATC) classification, which have similar clinical effectiveness and safety. The listed medicine should be the example of the class or subgroup for which there is the best evidence for effectiveness and safety. In some cases, this may be the first medicine that is licensed for marketing; in other instances, subsequently licensed compounds may be safer or more effective. Where there is no difference in terms of efficacy and safety data, the listed medicine should be the one that is generally available at the lowest price, based on international drug price information sources. Not all square box listings are applicable to medicine selection for children. A square box is not used to indicate alternative generic brands of the same small molecule medicines, nor alternative biosimilars of biological medicines. However, the selection and use of quality-assured generics and biosimilars of essential medicines at country level is recommended. National lists should not use a similar symbol and should be specific in their final selection, which would depend on local availability and price. The a symbol indicates that there is an age or weight restriction on use of the medicine; details for each medicine can be found in Table 1.1. The presence of an entry on the Essential Medicines List carries no assurance as to pharmaceutical quality. It is the responsibility of the relevant national or regional drug regulatory authority to ensure that each product is of appropriate pharmaceutical quality (including stability) and that, when relevant, different products are interchangeable. For recommendations and advice concerning all aspects of the quality assurance of medicines see the WHO website https://www.who.int/teams/health-product-and-policy-standards/standards-and-specifications/norms-and-standards-for- pharmaceuticals/guidelines/quality-assurance Medicines and dosage forms are listed in alphabetical order within each section and the order of listing does not imply preference for one form over another. Standard treatment guidelines should be consulted for information on appropriate dosage forms. The main terms used for dosage forms in the Essential Medicines List can be found in Table 1.2. Definitions of many of these terms and pharmaceutical quality requirements applicable to the different categories are published in the current edition of The International Pharmacopoeia. https://www.who.int/teams/health-product-and-policy- standards/standards-and-specifications/norms-and-standards-for-pharmaceuticals/pharmacopoeia. WHO Model List of Essential Medicines – 23rd List (2023) 1. ANAESTHETICS, PREOPERATIVE MEDICINES AND MEDICAL GASES 1.1 General anaesthetics and oxygen 1.1.1 Inhalational medicines halothane Inhalation. isoflurane Inhalation. nitrous oxide Inhalation. oxygen Inhalation (medical gas). sevoflurane Inhalation. 1.1.2 Injectable medicines ketamine Injection: 50 mg/mL (as hydrochloride) in 10 mL vial.  propofol Therapeutic alternatives: Injection: 10 mg/mL; 20 mg/mL. - thiopental 1.2 Local anaesthetics Injection: 0.25%; 0.5% (hydrochloride) in vial.  bupivacaine Injection for spinal anaesthesia: 0.5% (hydrochloride) in 4 mL Therapeutic alternatives to be reviewed ampoule to be mixed with 7.5% glucose solution. Injection: 1%; 2% (hydrochloride) in vial.  lidocaine Injection for spinal anaesthesia: 5% (hydrochloride) in 2 mL ampoule to be mixed with 7.5% glucose solution. Therapeutic alternatives to be reviewed Topical forms: 2% to 4% (hydrochloride). Dental cartridge: 2% (hydrochloride) + epinephrine 1:80 000. lidocaine + epinephrine (adrenaline) Injection: 1%; 2% (hydrochloride or sulfate) + epinephrine 1:200 000 in vial. Complementary List Injection: 30 mg/mL (hydrochloride) in 1 mL ampoule. ephedrine (For use in spinal anaesthesia during delivery, to prevent hypotension). 1.3 Preoperative medication and sedation for short-term procedures atropine Injection: 1 mg (sulfate) in 1 mL ampoule. Injection: 1 mg/mL.  midazolam Oral liquid: 2 mg/mL [c]. Therapeutic alternatives to be reviewed Tablet: 7.5 mg; 15 mg. morphine Injection: 10 mg (sulfate or hydrochloride) in 1 mL ampoule. WHO Model List of Essential Medicines – 23rd List (2023) page 1 WHO Model List of Essential Medicines – 23rd List (2023) 1.4 Medical gases Inhalation For use in the management of hypoxaemia. oxygen* *No more than 30% oxygen should be used to initiate resuscitation of neonates less than or equal to 32 weeks of gestation. 2. MEDICINES FOR PAIN AND PALLIATIVE CARE 2.1 Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs) Suppository: 50 mg to 150 mg. acetylsalicylic acid Tablet: 100 mg to 500 mg. Oral liquid: 100 mg/5 mL [c], 200 mg/5 mL. ibuprofen a Tablet: 200 mg; 400 mg; 600 mg. a Not in children less than 3 months. Oral liquid: 120 mg/5 mL or 125 mg/5 mL**, 250 mg/5 mL [c]. **The presence of both 120 mg/5 mL and 125 mg/5 mL strengths on the same market would cause confusion in prescribing and dispensing and should be avoided. Suppository: 100 mg, 250 mg [c]. paracetamol (acetaminophen)* Tablet: 250 mg, 325 mg, 500 mg. Tablet (dispersible): 100 mg, 250 mg [c]. *Not recommended for anti-inflammatory use due to lack of proven benefit to that effect. 2.2 Opioid analgesics codeine Tablet: 30 mg (phosphate). Transdermal patch: 12 micrograms/hr; 25 micrograms/hr; fentanyl* 50 micrograms/hr; 75 micrograms/hr; 100 micrograms/hr. *For the management of cancer pain Granules (slow release; to mix with water): 20 mg to 200 mg (morphine sulfate). Injection: 10 mg (morphine hydrochloride or morphine sulfate) in  morphine 1 mL ampoule. Therapeutic alternatives: Oral liquid: 10 mg/5 mL (morphine hydrochloride or morphine - hydromorphone sulfate). - oxycodone Tablet (slow release): 10 mg to 200mg (morphine hydrochloride or morphine sulfate). Tablet (immediate release): 10 mg (morphine sulfate). Complementary list Tablet: 5 mg; 10 mg (hydrochloride) Oral liquid: 5 mg/5 mL; 10 mg/5 mL (hydrochloride) methadone* Concentrate for oral liquid: 5 mg/mL; 10 mg/mL (hydrochloride) *For the management of cancer pain. WHO Model List of Essential Medicines – 23rd List (2023) page 2 WHO Model List of Essential Medicines – 23rd List (2023) 2.3 Medicines for other common symptoms in palliative care amitriptyline Tablet: 10 mg; 25 mg; 75 mg. Injection: 50 mg/mL. cyclizine [c] Tablet: 50 mg. Injection: 4 mg/mL (as disodium phosphate salt) in 1 mL ampoule. dexamethasone Oral liquid: 2 mg/5 mL. Tablet: 2 mg [c]; 4 mg. Injection: 5 mg/mL. Oral liquid: 2 mg/5 mL. Rectal gel: 5 mg/mL in 0.5 mL, 2 mL, 4 mL rectal delivery system. diazepam Rectal solution: 2 mg/mL in 1.25 mL, 2.5 mL rectal tube; 4 mg/mL in 2.5 mL rectal tube. Tablet: 5 mg; 10 mg. Capsule: 100 mg. docusate sodium Oral liquid: 50 mg/5 mL. fluoxetine Solid oral dosage form: 20 mg (as hydrochloride). Injection: 5 mg in 1 mL ampoule. haloperidol Oral liquid: 2 mg/mL. Solid oral dosage form: 0.5 mg; 2mg; 5 mg. hyoscine butylbromide Injection: 20 mg/mL. Injection: 400 micrograms/mL; 600 micrograms/mL. hyoscine hydrobromide [c] Transdermal patches: 1 mg/72 hours. lactulose [c] Oral liquid: 3.1 to 3.7 g/5 mL. loperamide Solid oral dosage form: 2 mg. Injection: 5 mg/mL (hydrochloride) in 2 mL ampoule. metoclopramide Oral liquid: 5 mg/5 mL. Solid oral form: 10 mg (hydrochloride). Injection: 1 mg/mL; 5 mg/mL. midazolam Oral liquid: 2mg/mL [c]. Solid oral dosage form: 7.5 mg; 15 mg.  ondansetron a Injection: 2 mg base/mL in 2 mL ampoule (as hydrochloride). Therapeutic alternatives: Oral liquid: 4 mg base/5 mL. - dolasetron Solid oral dosage form: Eq 4 mg base; Eq 8 mg base. - granisetron - palonosetron a > 1 month. - tropisetron senna Oral liquid: 7.5 mg/5 mL. WHO Model List of Essential Medicines – 23rd List (2023) page 3 WHO Model List of Essential Medicines – 23rd List (2023) 3. ANTIALLERGICS AND MEDICINES USED IN ANAPHYLAXIS dexamethasone Injection: 4 mg/mL (as disodium phosphate salt) in 1 mL ampoule. Injection: 1 mg/mL (as hydrochloride or hydrogen tartrate) in 1 mL epinephrine (adrenaline) ampoule. hydrocortisone Powder for injection: 100 mg (as sodium succinate) in vial.  loratadine* Oral liquid: 1 mg/mL. Therapeutic alternatives: Tablet: 10 mg. - cetirizine *There may be a role for sedating antihistamines for limited - fexofenadine indications (EMLc).  prednisolone Oral liquid: 5 mg/mL [c]. Therapeutic alternatives: Tablet: 5 mg; 25 mg. - prednisone 4. ANTIDOTES AND OTHER SUBSTANCES USED IN POISONINGS 4.1 Non-specific charcoal, activated Powder. 4.2 Specific Injection: 200 mg/mL in 10 mL ampoule. acetylcysteine Oral liquid: 10% [c]; 20% [c]. atropine Injection: 1 mg (sulfate) in 1 mL ampoule. calcium gluconate Injection: 100 mg/mL in 10 mL ampoule. methylthioninium chloride Injection: 10 mg/mL in 10 mL ampoule. (methylene blue) naloxone Injection: 400 micrograms (hydrochloride) in 1 mL ampoule. penicillamine Solid oral dosage form: 250 mg. potassium ferric hexacyano-ferrate(II) -2H2O Powder for oral administration. (Prussian blue) sodium nitrite Injection: 30 mg/mL in 10 mL ampoule. sodium thiosulfate Injection: 250 mg/mL in 50 mL ampoule. Complementary List deferoxamine Powder for injection: 500 mg (mesilate) in vial. dimercaprol Injection in oil: 50 mg/mL in 2 mL ampoule. Injection: 5 mg/mL (sulfate) in 20 mL ampoule or 1 g/mL (base) in fomepizole 1.5 mL ampoule. sodium calcium edetate Injection: 200 mg/mL in 5 mL ampoule. succimer Solid oral dosage form: 100 mg. WHO Model List of Essential Medicines – 23rd List (2023) page 4 WHO Model List of Essential Medicines – 23rd List (2023) 5. MEDICINES FOR DISEASES OF THE NERVOUS SYSTEM 5.1 Antiseizure medicines Oral liquid: 100 mg/5 mL. carbamazepine Tablet (chewable): 100 mg; 200 mg. Tablet (scored): 100 mg; 200 mg; 400 mg. Rectal gel: 5 mg/mL in 0.5 mL, 2 mL, 4 mL rectal delivery system. diazepam Rectal solution: 2 mg/mL in 1.25 mL, 2.5 mL rectal tube; 4 mg/mL in 2.5 mL rectal tube. Tablet: 25 mg; 50 mg; 100 mg; 200 mg. Tablet (chewable, dispersible): 2 mg; 5 mg; 25 mg; 50 mg; lamotrigine* 100 mg; 200 mg. *For use as adjunctive therapy for treatment-resistant partial or generalized seizures. Oral solution: 100 mg/mL levetiracetam Tablet: 250 mg; 500 mg; 750 mg; 1000 mg.  lorazepam Therapeutic alternatives: Injection: 2 mg/mL in 1 mL ampoule; 4 mg/mL in 1 mL ampoule. - diazepam (injection) - midazolam (injection) Injection: 0.5 g/mL in 2 mL ampoule (equivalent to 1 g in 2 mL; 50% weight/volume); 0.5 g/mL in 10 mL ampoule (equivalent to 5 g magnesium sulfate* in 10 mL; 50% weight/volume). *For use in eclampsia and severe pre-eclampsia and not for other convulsant disorders. Solution for oromucosal administration: 5 mg/mL in 0.5 mL, 1 mL, 1.5 mL, 2 mL pre-filled syringe; 10 mg/mL in 0.25 mL, 0.5 mL, 0.75 mL, 1 mL pre-filled syringe. midazolam Injection*: 1 mg/mL in 5 mL vial; 5 mg/mL in 1 mL or 3 mL vial. *For buccal administration when solution for oromucosal administration is not available. Injection: 30 mg/mL or 60 mg/mL [c], 200 mg/mL (sodium). phenobarbital Oral liquid: 15 mg/5 mL. Tablet: 15 mg to 100 mg. Injection: 50 mg/mL (phenytoin sodium). Oral liquid: 30 mg/5 mL (phenytoin). phenytoin Solid oral dosage form: 25 mg; 50 mg; 100 mg (phenytoin sodium). Tablet (chewable): 50 mg (phenytoin). valproic acid (sodium valproate)* Oral liquid: 200 mg/5 mL. *Avoid use in pregnancy and in women and girls of child-bearing potential, unless alternative treatments Tablet (crushable): 100 mg. are ineffective or not tolerated because of the high risk of birth defects and developmental disorders in Tablet (enteric-coated): 200 mg; 500 mg. children exposed to valproate in the womb. WHO Model List of Essential Medicines – 23rd List (2023) page 5 WHO Model List of Essential Medicines – 23rd List (2023) Complementary List Capsule: 250 mg. ethosuximide Oral liquid: 250 mg/5 mL. Concentrate solution for infusion: 500 mg/5mL in 5 mL vial. levetiracetam Solution for infusion: 5 mg/mL; 10 mg/mL; 15 mg/mL in 100 mL bag. valproic acid (sodium valproate)* *Avoid use in pregnancy and in women and girls of child-bearing potential, unless alternative treatments are ineffective or not Injection: 100 mg/mL in 3 mL, 4 mL, 10 mL ampoule. tolerated because of the high risk of birth defects and developmental disorders in children exposed to valproate in the womb. 5.2 Medicines for multiple sclerosis Complementary List cladribine Tablet: 10 mg. Injection (subcutaneous): 20 mg/mL; 40 mg/mL in pre-filled glatiramer acetate syringe. rituximab* Injection (intravenous): 500 mg/50 mL in 50 mL vial. *including quality-assured biosimilars 5.3 Medicines for parkinsonism  biperiden Injection: 5 mg (lactate) in 1 mL ampoule. Therapeutic alternatives: Tablet: 2 mg (hydrochloride). − trihexyphenidyl levodopa +  carbidopa Therapeutic alternatives: Tablet: 100 mg + 10 mg; 100 mg + 25 mg; 250 mg + 25 mg. − benserazide (for carbidopa) WHO Model List of Essential Medicines – 23rd List (2023) page 6 WHO Model List of Essential Medicines – 23rd List (2023) 6. ANTI-INFECTIVE MEDICINES 6.1 Anthelminthics 6.1.1 Intestinal anthelminthics albendazole Tablet (chewable, scored): 400 mg. ivermectin Tablet: 3 mg. levamisole Tablet: 50 mg; 150 mg (as hydrochloride). mebendazole Tablet (chewable): 100 mg; 500 mg. niclosamide Tablet (chewable): 500 mg. Tablet: 150 mg, 500 mg praziquantel Tablet (scored): 600 mg. pyrantel Tablet (chewable): 250 mg (as embonate or pamoate). 6.1.2 Antifilarials albendazole Tablet (chewable, scored): 400 mg. diethylcarbamazine Tablet: 50 mg; 100 mg (dihydrogen citrate). ivermectin Tablet: 3 mg. 6.1.3 Antischistosomals and other antitrematode medicines Tablet: 150 mg, 500 mg. praziquantel Tablet (scored): 600 mg. triclabendazole Tablet (scored): 250 mg. Complementary List Capsule: 250 mg. oxamniquine* Oral liquid: 250 mg/5 mL. *For use when praziquantel treatment fails. 6.1.4 Cysticidal medicines Complementary List Tablet (chewable): 200 mg [c]. albendazole Tablet (chewable, scored): 400 mg. mebendazole Tablet (chewable): 100 mg [c], 500 mg. Tablet: 150 mg, 500 mg. praziquantel Tablet (scored): 600 mg. WHO Model List of Essential Medicines – 23rd List (2023) page 7 WHO Model List of Essential Medicines – 23rd List (2023) 6.2 Antibacterials To assist in the development of tools for antibiotic stewardship at local, national and global levels and to reduce antimicrobial resistance, the Access, Watch, Reserve (AWaRe) classification of antibiotics was developed – where antibiotics are classified into different groups to emphasize the importance of their appropriate use. ACCESS GROUP ANTIBIOTICS This group includes antibiotics that have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups. Selected Access group antibiotics are recommended as essential first or second choice empiric treatment options for infectious syndromes reviewed by the EML Expert Committee and are listed as individual medicines on the Model Lists to improve access and promote appropriate use. They are essential antibiotics that should be widely available, affordable and quality assured. WATCH GROUP ANTIBIOTICS This group includes antibiotic classes that have higher resistance potential and includes most of the highest priority agents among the Critically Important Antimicrobials for Human Medicine and/or antibiotics that are at relatively high risk of selection of bacterial resistance. These medicines should be prioritized as key targets of stewardship programs and monitoring. Selected Watch group antibiotics are recommended as essential first or second choice empiric treatment options for a limited number of specific infectious syndromes and are listed as individual medicines on the Model Lists. RESERVE GROUP ANTIBIOTICS This group includes antibiotics and antibiotic classes that should be reserved for treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Reserve group antibiotics should be treated as “last resort” options. Selected Reserve group antibiotics are listed as individual medicines on the Model Lists when they have a favourable risk- benefit profile and proven activity against “Critical Priority” or “High Priority” pathogens identified by the WHO Priority Pathogens List, notably carbapenem resistant Enterobacteriaceae. These antibiotics should be accessible, but their use should be tailored to highly specific patients and settings, when all alternatives have failed or are not suitable. These medicines could be protected and prioritized as key targets of national and international stewardship programs involving monitoring and utilization reporting, to preserve their effectiveness. WHO Model List of Essential Medicines – 23rd List (2023) page 8 WHO Model List of Essential Medicines – 23rd List (2023) 6.2.1 Access group antibiotics Injection: 50 mg/mL (as sulfate) [c]; 250 mg/mL (as sulfate) in 2 mL vial. FIRST CHOICE SECOND CHOICE amikacin − High-risk febrile neutropenia − Sepsis in neonates and children [c] − Pyelonephritis or prostatitis (severe) Powder for injection: 250 mg; 500 mg; 1 g (as sodium) in vial. Powder for oral liquid: 125 mg/5 mL; 250 mg/5 mL (as trihydrate) [c]. Solid oral dosage form: 250 mg; 500 mg; 1g (as trihydrate). Tablet (dispersible, scored): 250 mg; 500 mg (as trihydrate) [c]. FIRST CHOICE SECOND CHOICE − Community acquired pneumonia − Acute bacterial meningitis (mild to moderate) amoxicillin − Community acquired pneumonia (severe) [c] − Complicated severe acute malnutrition [c] − Exacerbations of COPD − Otitis media − Pharyngitis − Progressive apical dental abscess − Sepsis in neonates and children [c] − Sinusitis − Uncomplicated severe acute malnutrition [c] Powder for injection: 500 mg (as sodium) + 100 mg (as potassium salt); 1000 mg (as sodium) + 200 mg (as potassium salt) in vial. Powder for oral liquid: 125 mg (as trihydrate)+ 31.25 mg (as potassium salt)/5 mL; 250 mg (as trihydrate) + 62.5 mg (as potassium salt)/5mL [c]. Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt); 875 mg (as trihydrate) + 125 mg (as potassium salt). Tablet (dispersible): 200 mg (as trihydrate) + 28.5 mg (as potassium salt) [c]; 250 mg (as trihydrate) + 62.5 mg (as potassium salt) [c]. amoxicillin + clavulanic acid SECOND CHOICE FIRST CHOICE − Bone and joint infections − Community acquired pneumonia − Community-acquired pneumonia (mild to (severe) [c] moderate) − Complicated intraabdominal − Community acquired pneumonia infections (mild to moderate) (severe) − Exacerbations of COPD − Otitis media − Hospital acquired pneumonia − Surgical prophylaxis − Low-risk febrile neutropenia − Lower urinary tract infections − Sinusitis − Skin and soft tissue infections WHO Model List of Essential Medicines – 23rd List (2023) page 9 WHO Model List of Essential Medicines – 23rd List (2023) Powder for injection: 500 mg; 1 g (as sodium) in vial. FIRST CHOICE SECOND CHOICE − Community acquired pneumonia − Acute bacterial meningitis (severe) [c] ampicillin − Complicated intraabdominal infections [c] − Complicated severe acute malnutrition [c] − Sepsis in neonates and children [c] Powder for injection: 1.2 million IU (≈ 900 mg) in vial [c]; 2.4 million IU (≈ 1.8 g) in vial. benzathine benzylpenicillin FIRST CHOICE SECOND CHOICE − Syphilis Powder for injection: 600 mg (= 1 million IU); 3 g (= 5 million IU) (sodium or potassium salt) in vial. FIRST CHOICE SECOND CHOICE benzylpenicillin − Acute bacterial meningitis − Community acquired pneumonia (severe) [c] − Complicated severe acute malnutrition [c] − Sepsis in neonates and children [c] − Syphilis Powder for oral liquid: 125 mg/5 mL; 250 mg/5 mL (anhydrous). Solid oral dosage form: 250 mg; 500 mg (as monohydrate). cefalexin Tablet (dispersible): 125 mg [c]; 250 mg [c]. FIRST CHOICE SECOND CHOICE − Skin and soft tissue infections − Exacerbations of COPD − Pharyngitis Powder for injection: 1 g (as sodium salt) in vial. a > 1 month. cefazolin a FIRST CHOICE SECOND CHOICE − Surgical prophylaxis − Bone and joint infections Oily suspension for injection*: 0.5 g/mL (as sodium succinate) in 2 mL ampoule. *Only for the presumptive treatment of epidemic meningitis in children older than 2 years and in adults. chloramphenicol Powder for injection: 1 g (as sodium succinate) in vial. FIRST CHOICE SECOND CHOICE − Acute bacterial meningitis WHO Model List of Essential Medicines – 23rd List (2023) page 10 WHO Model List of Essential Medicines – 23rd List (2023) Capsule: 150 mg (as hydrochloride). Injection: 150 mg/mL (as phosphate); 600 mg/4 mL (as phosphate); 900 mg/6 mL (as phosphate). clindamycin Powder for oral liquid: 75 mg/5 mL (as palmitate hydrochloride) [c]. FIRST CHOICE SECOND CHOICE − Necrotizing fasciitis − Bone and joint infections Capsule: 250 mg [c], 500 mg; 1 g (as sodium). Powder for injection: 250 mg [c], 500 mg (as sodium) in vial.  cloxacillin* Powder for oral liquid: 125 mg/5 mL, 250 mg/5 mL (as sodium) [c]. Therapeutic alternatives: *cloxacillin, dicloxacillin and flucloxacillin are preferred for oral administration due to - 4th level ATC chemical subgroup better bioavailability. (J01CF Beta-lactamase resistant penicillins) FIRST CHOICE SECOND CHOICE − Bone and joint infections − Sepsis in neonates and children [c] − Skin and soft tissue infections Oral liquid: 50 mg/5 mL (calcium) [c]. Powder for oral liquid: 25 mg/5 mL (monohydrate) [c]. Powder for injection: 100 mg in vial. Solid oral dosage form: 50 mg [c]; 100 mg (as hyclate). Tablet (dispersible): 100 mg (as monohydrate) [c]. doxycycline a a Use in children 41 weeks corrected gestational age. FIRST CHOICE SECOND CHOICE − Acute bacterial meningitis − Acute invasive bacterial diarrhoea / − Community acquired pneumonia dysentery (severe) − Bone and joint infections ceftriaxone* a − Complicated intraabdominal − Pyelonephritis or prostatitis (mild to infections (mild to moderate) moderate) − Complicated intrabdominal − Sepsis in neonates and children [c] infections (severe) − Endophthalmitis − Enteric fever − Gonorrhoea − Hospital acquired pneumonia − Necrotizing fasciitis − Pyelonephritis or prostatitis (severe) Powder for injection: 250 mg; 750 mg; 1.5 g (as sodium) in vial. cefuroxime FIRST CHOICE SECOND CHOICE − Surgical prophylaxis Oral liquid: 250 mg/5 mL (anhydrous) [c]. Solution for IV infusion: 2 mg/mL (as hyclate) [c]. Solid oral dosage form: 100 mg [c]; 250 mg; 500 mg (as hydrochloride). ciprofloxacin FIRST CHOICE SECOND CHOICE − Acute invasive bacterial diarrhoea / − Cholera dysentery − Complicated intraabdominal infections − Enteric fever (mild to moderate) − Low-risk febrile neutropenia − Pyelonephritis or prostatitis (mild to moderate) Powder for oral liquid: 125 mg/5 mL; 250 mg/5 mL. Powder for injection: 500 mg in vial.  clarithromycin† Solid oral dosage form: 250 mg [c]; 500 mg. Therapeutic alternatives: - erythromycin* †clarithromycin is also listed for use in combination regimens for eradication of H. pylori in adults. *as second choice treatment for pharyngitis in children (EMLc only) FIRST CHOICE SECOND CHOICE Community acquired pneumonia − Pharyngitis (severe) WHO Model List of Essential Medicines – 23rd List (2023) page 14 WHO Model List of Essential Medicines – 23rd List (2023) Powder for injection: 2 g (as sodium) + 250 mg (as sodium); 4 g (as sodium) + 500 mg (as sodium) in vial. FIRST CHOICE SECOND CHOICE piperacillin + tazobactam − Complicated intraabdominal infections (severe) − High-risk febrile neutropenia − Hospital acquired pneumonia − Necrotizing fasciitis Capsule: 125 mg; 250 mg (as hydrochloride). *vancomycin powder for injection may also be used for oral administration vancomycin* FIRST CHOICE SECOND CHOICE − C. difficile infection Complementary List Powder for injection: 250 mg; 1 g (as pentahydrate) in vial. ceftazidime FIRST CHOICE SECOND CHOICE − Endophthalmitis  meropenem* a Powder for injection: 500 mg (as trihydrate); 1 g (as trihydrate) in vial. a > 3 months. Therapeutic alternatives*: FIRST CHOICE SECOND CHOICE - imipenem + cilastatin − Acute bacterial meningitis in neonates *complicated intraabdominal [c] infections and high-risk febrile neutropenia only. Meropenem is − Complicated intraabdominal infections the preferred choice for acute (severe) bacterial meningitis in neonates. − High-risk febrile neutropenia Powder for injection: 250 mg; 500 mg; 1 g (as hydrochloride) in vial. FIRST CHOICE vancomycin SECOND CHOICE − Endophthalmitis − High-risk febrile neutropenia − Necrotizing fasciitis 6.2.3 Reserve group antibiotics Complementary List cefiderocol Powder for injection: 1 g (as sulfate toxylate) in vial. ceftazidime + avibactam Powder for injection: 2 g + 0.5 g in vial. ceftolozane + tazobactam Powder for injection: 1 g + 0.5 g in vial. Powder for injection: 1 million IU (as colistemethate sodium) (equivalent colistin to 34 mg colistin base activity) in vial. fosfomycin Powder for injection: 2 g; 4 g (as sodium) in vial. Injection for intravenous administration: 2 mg/mL in 300 mL bag. o linezolid Powder for oral liquid: 100 mg/5 mL. Therapeutic alternatives: Tablet: 600 mg. - tedizolid phosphate Tablet (dispersible): 150 mg [c]. WHO Model List of Essential Medicines – 23rd List (2023) page 15 WHO Model List of Essential Medicines – 23rd List (2023) meropenem + vaborbactam Powder for injection: 1 g (as trihydrate) + 1 g in vial. plazomicin Injection: 500 mg/10 mL. Powder for injection: 500 000 IU (equivalent to 50 mg polymyxin B polymyxin B base) in vial. 6.2.4 Antileprosy medicines Medicines used in the treatment of leprosy should never be used except in combination. Combination therapy is essential to prevent the emergence of drug resistance. Colour-coded blister packs (MDT blister packs) containing standard two-medicine (paucibacillary leprosy) or three-medicine (multibacillary leprosy) combinations for adult and childhood leprosy should be used. MDT blister packs can be supplied free of charge through WHO. clofazimine Solid oral dosage form: 50 mg; 100 mg. dapsone Tablet: 25 mg; 50 mg; 100 mg. Oral liquid: 20 mg/mL [c]. rifampicin Solid oral dosage form: 150 mg; 300 mg. 6.2.5 Antituberculosis medicines WHO recommends and endorses the use of fixed-dose combinations and the development of appropriate new fixed-dose combinations, including modified dosage forms, non-refrigerated products and paediatric dosage forms of assured pharmaceutical quality. Tablet: 100 mg; 400 mg (hydrochloride). ethambutol Tablet (dispersible): 100 mg [c] ethambutol + isoniazid + pyrazinamide + Tablet: 275 mg + 75 mg + 400 mg + 150 mg. rifampicin ethambutol + isoniazid + rifampicin Tablet: 275 mg + 75 mg + 150 mg. Tablet: 250 mg. ethionamide Tablet (dispersible): 125 mg [c]. Tablet: 100 mg; 300 mg. isoniazid Tablet (dispersible): 100 mg [c]. isoniazid + pyrazinamide + rifampicin Tablet (dispersible): 50 mg + 150 mg + 75 mg [c]. Tablet: 75 mg + 150 mg; 150 mg + 300 mg. isoniazid + rifampicin Tablet (dispersible): 50 mg + 75 mg [c]. isoniazid + rifapentine Tablet (scored): 300 mg + 300 mg. moxifloxacin Tablet: 400 mg. Tablet: 400 mg; 500 mg pyrazinamide Tablet (dispersible): 150 mg. Solid oral dosage form: 150 mg.* rifabutin *For use only in patients with HIV receiving protease inhibitors. Oral liquid: 20 mg/mL [c]. rifampicin Solid oral dosage form: 150 mg; 300 mg. rifapentine Tablet: 150 mg; 300 mg. WHO Model List of Essential Medicines – 23rd List (2023) page 16 WHO Model List of Essential Medicines – 23rd List (2023) Complementary List Medicines for the treatment of multidrug-resistant tuberculosis (MDR-TB) should be used in specialized centres adhering to WHO standards for TB control. amikacin Injection: 250 mg/mL (as sulfate) in 2 mL vial. Powder for oral liquid: 250 mg (as trihydrate) + 62.5 mg (as potassium salt)/5mL [c]. amoxicillin + clavulanic acid* Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt). *For use only in combination with meropenem or imipenem+cilastatin. bedaquiline Tablet: 20 mg [c]; 100 mg. clofazimine Solid oral dosage form: 50 mg; 100 mg.  cycloserine Therapeutic alternatives: Solid oral dosage form: 125 mg [c]; 250 mg. - terizidone Tablet (dispersible): 25 mg [c]. delamanid Tablet: 50 mg.  ethionamide Tablet: 250 mg. Therapeutic alternatives: Tablet (dispersible): 125 mg [c]. - protionamide Tablet: 250mg; 500 mg; 750 mg. levofloxacin Tablet (dispersible): 100 mg [c]. Tablet: 600 mg. linezolid Tablet (dispersible): 150 mg [c].  meropenem Therapeutic alternatives: Powder for injection: 500 mg (as trihydrate); 1 g (as trihydrate) in vial. - imipenem + cilastatin Tablet: 400 mg. moxifloxacin Tablet (dispersible): 100 mg [c]. Powder for oral solution: 5.52 g in sachet (equivalent to 4 g p-aminosalicylate sodium p-aminosalicylic acid). pretomanid Tablet: 200 mg. streptomycin [c] Powder for injection: 1 g (as sulfate) in vial. WHO Model List of Essential Medicines – 23rd List (2023) page 17 WHO Model List of Essential Medicines – 23rd List (2023) 6.3 Antifungal medicines Powder for injection: 50 mg (liposomal complex) in vial. Powder for injection: 50 mg (as sodium deoxycholate) in vial amphotericin B* *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. Vaginal cream: 1%; 10%. clotrimazole Vaginal tablet: 100 mg; 500 mg. Capsule: 50 mg. Injection: 2 mg/mL in vial. fluconazole Oral liquid: 50 mg/5 mL. Powder for oral liquid: 50 mg/5 mL [c]. Capsule: 250 mg. flucytosine Infusion: 2.5 g in 250 mL. Oral liquid: 125 mg/5 mL [c]. griseofulvin Solid oral dosage form: 125 mg; 250 mg. Capsule: 100 mg. Oral liquid: 10 mg/mL. itraconazole* *For treatment of chronic pulmonary aspergillosis, histoplasmosis, sporotrichosis, paracoccidiodomycosis, mycoses caused by T. marneffei and chromoblastomycosis; and prophylaxis of histoplasmosis and infections caused by T. marneffei in AIDS patients. Lozenge: 100 000 IU. Oral liquid: 100 000 IU/mL [c]. nystatin Pessary: 100 000 IU. Solid oral dosage form: 500 000 IU. Tablet: 50 mg; 200 mg Powder for injection: 200 mg in vial voriconazole* Powder for oral liquid: 40 mg/mL *For treatment of chronic pulmonary aspergillosis and acute invasive aspergillosis. Complementary List  micafungin Therapeutic alternatives: Powder for injection: 50 mg (as sodium); 100 mg (as sodium) in vial. - anidulafungin - caspofungin potassium iodide Saturated solution. WHO Model List of Essential Medicines – 23rd List (2023) page 18 WHO Model List of Essential Medicines – 23rd List (2023) 6.4 Antiviral medicines 6.4.1 Antiherpes medicines  aciclovir Oral liquid: 200 mg/5 mL [c]. Therapeutic alternatives: Powder for injection: 250 mg (as sodium salt) in vial. - valaciclovir (oral) Tablet: 200 mg. 6.4.2 Antiretrovirals Based on current evidence and experience of use, medicines in the following classes of antiretrovirals are included as essential medicines for treatment and prevention of HIV (prevention of mother-to-child transmission, pre-exposure prophylaxsis (where indicated) and post-exposure prophylaxis). WHO emphasizes the importance of using these products in accordance with global and national guidelines. WHO recommends and endorses the use of fixed-dose combinations and the development of appropriate new fixed-dose combinations, including modified dosage forms, non-refrigerated products and paediatric dosage forms of assured pharmaceutical quality. Scored tablets can be used in children and therefore can be considered for inclusion in the listing of tablets, provided that adequate quality products are available. 6.4.2.1 Nucleoside/Nucleotide reverse transcriptase inhibitors abacavir Tablet: 300 mg (as sulfate). Oral liquid: 50 mg/5 mL [c]. lamivudine Tablet: 150 mg. Tablet: 300 mg (tenofovir disoproxil fumarate – equivalent to tenofovir disoproxil fumarate† 245 mg tenofovir disoproxil). †also indicated for pre-exposure prophylaxis. Capsule: 250 mg. Oral liquid: 50 mg/5 mL. zidovudine Solution for IV infusion: 10 mg/mL in 20 mL vial. Tablet: 300 mg. 6.4.2.2 Non-nucleoside reverse transcriptase inhibitors efavirenz Tablet: 600 mg. Oral liquid: 50 mg/5 mL. nevirapine a Tablet: 50 mg (dispersible); 200 mg. a > 6 weeks 6.4.2.3 Protease inhibitors Selection of protease inhibitor(s) from the Model List will need to be determined by each country after consideration of international and national treatment guidelines and experience. Ritonavir is recommended for use in combination as a pharmacological booster, and not as an antiretroviral in its own right. All other protease inhibitors should be used in boosted forms (e.g. with ritonavir). atazanavir + ritonavir Tablet (heat stable): 300 mg (as sulfate) + 100 mg. Tablet: 75 mg; 400 mg; 600 mg; 800 mg darunavira a > 3 years Solid oral dosage form: 40 mg + 10 mg [c]. lopinavir + ritonavir Tablet (heat stable): 100 mg + 25 mg; 200 mg + 50 mg. ritonavir Tablet (heat stable): 25 mg; 100 mg. WHO Model List of Essential Medicines – 23rd List (2023) page 19 WHO Model List of Essential Medicines – 23rd List (2023) 6.4.2.4 Integrase inhibitors Tablet (dispersible, scored): 10 mg [c]. a ≥ 4 weeks and ≥ 3 kg dolutegravir a Tablet: 50 mg a ≥ 25 kg Granules for oral suspension: 100 mg in sachet. Tablet (chewable): 25 mg. raltegravir* Tablet: 400 mg. *For use in pregnant women and in second-line regimens in accordance with WHO treatemnt guidelines. 6.4.2.5 Fixed-dose combinations of antiretroviral medicines abacavir + lamivudine Tablet (dispersible, scored): 120 mg (as sulfate) + 60 mg. Tablet: 50 mg + 300 mg + 300 mg (tenofovir disoproxil fumarate – dolutegravir + lamivudine + tenofovir equivalent to 245 mg tenofovir disoproxil) efavirenz +  emtricitabine + tenofovir Tablet: 600 mg + 200 mg + 300 mg (tenofovir disoproxil fumarate Therapeutic alternatives: – equivalent to 245 mg tenofovir disoproxil). - lamivudine (for emtricitabine) Tablet: 400 mg + 300 mg + 300 mg (tenofovir disoproxil fumarate efavirenz + lamivudine + tenofovir – equivalent to 245 mg tenofovir disoproxil)  emtricitabine + tenofovir† Tablet: 200 mg + 300 mg (tenofovir disoproxil fumarate – Therapeutic alternatives: equivalent to 245 mg tenofovir disoproxil). - lamivudine (for emtricitabine) † combination also indicated for pre-exposure prophylaxis lamivudine + zidovudine Tablet: 30 mg + 60 mg [c]; 150 mg + 300 mg. 6.4.2.6 Medicines for prevention of HIV-related opportunistic infections isoniazid + pyridoxine + sulfamethoxazole + Tablet (scored): 300 mg + 25 mg + 800 mg + 160 mg trimethoprim 6.4.3 Other antivirals Injection for intravenous administration: 800 mg and 1 g in 10 mL phosphate buffer solution. ribavirin* Solid oral dosage form: 200 mg; 400 mg; 600 mg. *For the treatment of viral haemorrhagic fevers Tablet: 450 mg. valganciclovir* *For the treatment of cytomegalovirus retinitis (CMVr). WHO Model List of Essential Medicines – 23rd List (2023) page 20 WHO Model List of Essential Medicines – 23rd List (2023) Complementary list Capsule: 30 mg; 45 mg; 75 mg (as phosphate). oseltamivir* *Severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients Powder for oral solution: 50 mg/mL valganciclovir*[c] Tablet: 450 mg. *For the treatment of cytomegalovirus retinitis (CMVr). 6.4.4 Antihepatitis medicines 6.4.4.1 Medicines for hepatitis B 6.4.4.1.1 Nucleoside/Nucleotide reverse transcriptase inhibitors Oral liquid: 0.05 mg/mL entecavir Tablet: 0.5 mg; 1 mg Tablet: 300 mg (tenofovir disoproxil fumarate – equivalent to tenofovir disoproxil fumarate 245 mg tenofovir disoproxil). 6.4.4.2 Medicines for hepatitis C Pangenotypic direct-acting antivirals should be considered as therapeutic alternatives for the purposes of selection and procurement at national level. 6.4.4.2.1 □ Pangenotypic direct-acting antiviral combinations Tablet: 30 mg; 60 mg (as hydrochloride). daclatasvir* *Pangenotypic when used in combination with sofosbuvir daclatasvir + sofosbuvir Tablet: 60 mg + 400 mg. Tablet: 100 mg + 40 mg. glecaprevir + pibrentasvir Granules: 50 mg + 20 mg in sachet [c]. Tablet: 200 mg. ravidasvir* *Pangenotypic when used in combination with sofosbuvir Tablet: 200 mg; 400 mg. sofosbuvir* *Pangenotypic when used in combination with daclatasvir or ravidasvir sofosbuvir + velpatasvir Tablet: 200 mg + 50 mg [c]; 400 mg + 100 mg. 6.4.4.2.2 Non-pangenotypic direct-acting antiviral combinations ledipasvir + sofosbuvir Tablet: 90 mg + 400 mg. 6.4.4.2.3 Other antivirals for hepatitis C Injection for intravenous administration: 800 mg and 1 g in 10 mL phosphate buffer solution. ribavirin* Solid oral dosage form: 200 mg; 400 mg; 600 mg. *For the treatment of hepatitis C, in combination with direct acting anti-viral medicines WHO Model List of Essential Medicines – 23rd List (2023) page 21 WHO Model List of Essential Medicines – 23rd List (2023) 6.5 Antiprotozoal medicines 6.5.1 Antiamoebic and antigiardiasis medicines Tablet: 500 mg (furoate). diloxanide a a > 25 kg.  metronidazole Injection: 500 mg in 100 mL vial. Therapeutic alternatives: Oral liquid: 200 mg/5 mL (as benzoate). - tinidazole Tablet: 200 mg; 250 mg; 400 mg; 500 mg. 6.5.2 Antileishmaniasis medicines Powder for injection: 50 mg (liposomal complex) in vial. Powder for injection: 50 mg (as sodium deoxycholate) in vial. amphotericin B* *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. meglumine antimoniate Injection: 1.5 g/5 mL in 5 mL ampoule. miltefosine Solid oral dosage form: 10 mg; 50 mg. paromomycin Solution for intramuscular injection: 750 mg of paromomycin base (as sulfate). sodium stibogluconate Injection: 100 mg/mL in 30 mL vial. 6.5.3 Antimalarial medicines 6.5.3.1 For curative treatment Medicines for the treatment of P. falciparum malaria cases should be used in combination. The list currently recommends combinations according to treatment guidelines. WHO recognizes that not all of the fixed dose combinations (FDCs) in the WHO treatment guidelines exist, and encourages their development and rigorous testing. WHO also encourages development and testing of rectal dosage formulations. Tablet: 153 mg or 200 mg (as hydrochloride). amodiaquine* *To be used in combination with artesunate 50 mg. Oily injection: 80 mg/mL in 1 mL ampoule. artemether* *For use in the management of severe malaria. Tablet: 20 mg + 120 mg. Tablet (dispersible): 20 mg + 120 mg [c]. artemether + lumefantrine* *Not recommended in the first trimester of pregnancy or in children below 5 kg. WHO Model List of Essential Medicines – 23rd List (2023) page 22 WHO Model List of Essential Medicines – 23rd List (2023) Injection: ampoules, containing 60 mg anhydrous artesunic acid with a separate ampoule of 5% sodium bicarbonate solution. For use in the management of severe malaria. Rectal dosage form: 50 mg [c]; 100 mg [c]; 200 mg capsules (for artesunate* pre-referral treatment of severe malaria only; patients should be taken to an appropriate health facility for follow-up care) [c]. Tablet: 50 mg. *To be used in combination with either amodiaquine, mefloquine or sulfadoxine + pyrimethamine. Tablet: 25 mg + 67.5 mg; 50 mg + 135 mg; 100 mg + 270 mg. artesunate + amodiaquine* *Other combinations that deliver the target doses required such as 153 mg or 200 mg (as hydrochloride) with 50 mg artesunate can be alternatives. artesunate + mefloquine Tablet: 25 mg + 55 mg; 100 mg + 220 mg. Granules: 20 mg + 60 mg [c]. artesunate + pyronaridine tetraphosphate a Tablet: 60 mg + 180 mg. a > 5 kg Oral liquid: 50 mg/5 mL (as phosphate or sulfate). chloroquine* Tablet: 100 mg; 150 mg (as phosphate or sulfate). *For use only for the treatment of Plasmodium vivax infection. Tablet: 20 mg + 160 mg; 40 mg + 320 mg. dihydroartemisinin + piperaquine phosphate a a > 5 kg Capsule: 100 mg (as hydrochloride or hyclate). doxycycline* Tablet (dispersible): 100 mg (as monohydrate). *For use only in combination with quinine. Tablet: 250 mg (as hydrochloride). mefloquine* *To be used in combination with artesunate 50 mg. Tablet: 7.5 mg; 15 mg (as diphosphate). primaquine* *Only for use to achieve radical cure of Plasmodium vivax and Plasmodium ovale infections, given for 14 days. Injection: 300 mg/mL (hydrochloride) in 2 mL ampoule. Tablet: 300 mg (sulfate) or 300 mg (bisulfate). quinine* *For use only in the management of severe malaria and should be used in combination with doxycycline. Tablet: 500 mg + 25 mg. sulfadoxine + pyrimethamine* *Only in combination with artesunate 50 mg. WHO Model List of Essential Medicines – 23rd List (2023) page 23 WHO Model List of Essential Medicines – 23rd List (2023) 6.5.3.2 For chemoprevention Co-packaged dispersible tablets: amodiaquine 76.5 mg (as hydrochloride) and sulfadoxine + amodiaquine – sulfadoxine + pyrimethamine [c] pyrimethamine 250 mg + 12.5 mg ; amodiaquine 153 mg (as hydrochloride) and sulfadoxine + pyrimethamine 500 mg + 25 mg. Oral liquid: 50 mg/5 mL (as phosphate or sulfate). Tablet: 150 mg (as phosphate or sulfate). chloroquine* *For use only in central American regions, for Plasmodium vivax infections. Solid oral dosage form: 100 mg (as hydrochloride or hyclate). doxycycline a a > 8 years. Tablet: 250 mg (as hydrochloride). mefloquine a a > 5 kg or > 3 months. Tablet: 100 mg (as hydrochloride). proguanil* *For use only in combination with chloroquine. sulfadoxine + pyrimethamine Tablet: 250 mg + 12.5 mg [c]; 500 mg + 25 mg. 6.5.4 Antipneumocystosis and antitoxoplasmosis medicines pyrimethamine Tablet: 25 mg. sulfadiazine Tablet: 500 mg. Injection: 80 mg + 16 mg/mL in 5 mL ampoule; 80 mg + 16 mg/mL in 10 mL ampoule. sulfamethoxazole + trimethoprim Oral liquid: 200 mg + 40 mg/5 mL [c]. Tablet: 100 mg + 20 mg; 400 mg + 80 mg [c]; 800 mg + 160 mg. Tablet (dispersible): 100 mg + 20 mg [c]. Complementary List pentamidine Tablet: 200 mg; 300 mg (as isethionate). 6.5.5 Antitrypanosomal medicines 6.5.5.1 African trypanosomiasis Tablet: 600 mg fexinidazole* *For the treatment of 1st and 2nd stage of human African trypanosomiasis due to Trypanosoma brucei gambiense infection. Medicines for the treatment of 1 stage African trypanosomiasis st Powder for injection: 300 mg (as isetionate) in vial. pentamidine* *To be used for the treatment of Trypanosoma brucei gambiense infection. Powder for injection: 1 g in vial. suramin sodium* *To be used for the treatment of the initial phase of Trypanosoma brucei rhodesiense infection. WHO Model List of Essential Medicines – 23rd List (2023) page 24 WHO Model List of Essential Medicines – 23rd List (2023) Medicines for the treatment of 2nd stage African trypanosomiasis Injection: 200 mg/mL (hydrochloride) in 50 mL bottle. eflornithine* *To be used for the treatment of Trypanosoma brucei gambiense infection. melarsoprol Injection: 180 mg/5 mL in 5 mL ampoule (3.6% solution). Tablet (scored): 30 mg; 120 mg. nifurtimox * *Only to be used in combination with eflornithine, for the treatment of Trypanosoma brucei gambiense infection. Complementary List melarsoprol [c] Injection: 180 mg/5 mL in 5 mL ampoule (3.6% solution). 6.5.5.2 American trypanosomiasis Tablet: 12.5 mg [c] benznidazole Tablet (scored): 50 mg; 100 mg. nifurtimox Tablet (scored): 30 mg; 120 mg. 6.6 Medicines for ectoparasitic infections ivermectin Tablet: 3 mg 6.7 Medicines for Ebola virus disease ansuvimab Powder for injection: 400 mg atoltivimab + maftivimab + odesivimab Injection: 241.7 mg + 241.7 mg + 241.7 mg in 14.5 mL vial 6.8 Medicines for COVID-19 WHO recommends that effective and safe therapeutics for prevention and treatment of COVID-19 should be considered as essential medicines in the context of the public health emergency. WHO recommendations are revised and updated regularly in WHO living guidelines for therapeutics for the treatment and prevention of COVID-19. Selection of essential therapeutics for COVID-19 at the national level should be informed by recommendations in these guidelines, and consideration of the latest evidence, epidemiology and national priorities. The latest WHO Therapeutics and COVID-19: living guideline is available online at: https://app.magicapp.org/#/guideline/nBkO1E The latest WHO Drugs to prevent COVID-19: living guideline is available online at: https://app.magicapp.org/#/guideline/L6RxYL WHO Model List of Essential Medicines – 23rd List (2023) page 25 WHO Model List of Essential Medicines – 23rd List (2023) 7. ANTIMIGRAINE MEDICINES 7.1 For treatment of acute attack acetylsalicylic acid Tablet: 300 mg to 500 mg. Oral liquid: 100 mg/5 mL [c]. ibuprofen [c] Tablet: 200 mg; 400 mg. Oral liquid: 120 mg/5 mL or 125 mg/5 mL*; 250 mg/5 mL [c]. *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. paracetamol (acetaminophen) Suppository: 250 mg [c]. Tablet: 250 mg; 325 mg; 500 mg. Tablet (dispersible): 100 mg, 250 mg [c]. sumatriptan Tablet: 50 mg 7.2 For prophylaxis  propranolol Tablet: 20 mg; 40 mg (hydrochloride). Therapeutic alternatives to be reviewed 8. IMMUNOMODULATORS AND ANTINEOPLASTICS 8.1 Immunomodulators for non-malignant disease Complementary List  adalimumab* Therapeutic alternatives*: - certolizumab pegol Injection: 10 mg/0.2 mL [c]; 20 mg/0.4 mL [c]; 40 mg/0.8 mL; - etanercept 40 mg/0.4 mL. - golimumab - infliximab *including quality-assured biosimilars Oral liquid: 10 mg/mL [c]. Powder for injection: 50 mg [c]; 100 mg (as sodium salt) in vial. azathioprine Tablet: 25 mg [c]. Tablet (scored): 50 mg. Capsule: 25 mg. ciclosporin Concentrate for injection: 50 mg/mL in 1 mL ampoule. Oral liquid: 100 mg/mL [c]. Capsule (immediate-release): 0.5 mg; 0.75 mg; 1 mg; 2 mg; 5 mg. tacrolimus Granules for oral supsension: 0.2 mg; 1 mg. Injection: 5 mg/mL in 1 mL vial. WHO Model List of Essential Medicines – 23rd List (2023) page 26 WHO Model List of Essential Medicines – 23rd List (2023) 8.2 Antineoplastics and supportive medicines Medicines listed below should be used according to protocols for treatment of the diseases. 8.2.1 Cytotoxic medicines Complementary List Concentrate for solution for infusion: 1 mg/mL; 2 mg/mL. arsenic trioxide − Acute promyelocytic leukaemia asparaginase* Powder for injection: 10 000 IU in vial. *including quality-assured biosimilars − Acute lymphoblastic leukaemia. Injection: 45 mg/0.5 mL; 180 mg/2 mL. bendamustine − Chronic lymphocytic leukaemia − Follicular lymphoma Powder for injection: 15 000 IU (as sulfate) in vial. − Hodgkin lymphoma bleomycin − Kaposi sarcoma − Ovarian germ cell tumour − Testicular germ cell tumour Injection: 3 mg/mL in 10 mL ampoule; 7.5 mg/mL in 2 mL ampoule; 10 mg/mL in 5 mL ampoule. Tablet: 5 mg; 15 mg; 25 mg. calcium folinate (leucovorin calcium) − Burkitt lymphoma − Early stage colon cancer − Early stage rectal cancer − Gestational trophoblastic neoplasia − Metastatic colorectal cancer − Osteosarcoma Tablet: 150 mg; 500 mg. − Early stage colon cancer capecitabine − Early stage rectal cancer − Metastatic breast cancer − Metastatic colorectal cancer Injection: 50 mg/5 mL; 150 mg/15 mL; 450 mg/45 mL; 600 mg/60 mL. − Cervical cancer − Early stage breast cancer − Epithelial ovarian cancer − Head and neck cancer (as a radio-sensitizer) carboplatin − Low-grade glioma − Nasopharyngeal cancer − Nephroblastoma (Wilms tumour) − Non-small cell lung cancer − Osteosarcoma − Ovarian germ cell tumour − Retinoblastoma − Testicular germ cell tumour Tablet: 2 mg. chlorambucil − Chronic lymphocytic leukaemia WHO Model List of Essential Medicines – 23rd List (2023) page 27 WHO Model List of Essential Medicines – 23rd List (2023) Injection: 10 mg/10 mL; 20 mg/20 mL; 50 mg/50 mL; 100 mg/100 mL. − Cervical cancer − Head and neck cancer (as a radio-sensitizer) cisplatin − Low-grade glioma − Nasopharyngeal cancer (as a radio-sensitizer) − Non-small cell lung cancer − Osteosarcoma − Ovarian germ cell tumour − Testicular germ cell tumour Powder for injection: 500 mg; 1 g; 2 g in vial. Solid oral dosage form: 25 mg; 50 mg. − Acute lymphoblastic leukaemia − Anaplastic large cell lymphoma − Burkitt lymphoma − Chronic lymphocytic leukaemia − Diffuse large B-cell lymphoma − Early stage breast cancer cyclophosphamide − Ewing sarcoma − Follicular lymphoma − Gestational trophoblastic neoplasia − Hodgkin lymphoma − Low-grade glioma − Metastatic breast cancer − Multiple myeloma − Nephroblastoma (Wilms tumour) − Rhabdomyosarcoma Injection: 100 mg/mL in vial Powder for injection: 100 mg in vial. − Acute lymphoblastic leukaemia cytarabine − Acute myeloid leukaemia − Acute promyelocytic leukaemia − Anaplastic large cell lymphoma − Burkitt lymphoma − Langerhans cell histiocytosis Powder for injection: 100 mg; 200 mg in vial. dacarbazine − Hodgkin lymphoma Powder for injection: 500 micrograms in vial. dactinomycin − Ewing sarcoma − Gestational trophoblastic neoplasia − Nephroblastoma (Wilms tumour) − Rhabdomyosarcoma Injection: 2 mg/mL; 5 mg/mL (as hydrochloride) in vial. Powder for injection: 20 mg; 50 mg (as hydrochloride) in vial. daunorubicin − Acute lymphoblastic leukaemia − Acute myeloid leukaemia − Acute promyelocytic leukaemia WHO Model List of Essential Medicines – 23rd List (2023) page 28 WHO Model List of Essential Medicines – 23rd List (2023) Injection: 20 mg/mL; 40 mg/mL. docetaxel − Early stage breast cancer − Metastatic breast cancer