ESSENTIAL DRUG LIST

ESSENTIAL DRUGS/MEDICINES

Essential medicines are those medicines that satisfy the health care needs of majority of
population.

They should therefore be available at all times in adequate amounts and in the appropriate
dosage forms.

SELECTION CRITERIA

They are selected with due regard to

 public health relevance,

 disease prevalence,
 evidence on efficacy and safety,
 comparative cost-effectiveness
 availability

PURPOSE OF ESSENTAIL MEDICINES

Essential medicines are intended to be available within the context of functioning health
systems at all times in adequate amounts, in the appropriate dosage forms, with assured
quality and adequate information, and at a price the individual and the community can afford.

CONCEPT OF ESSENTIAL DRUG LIST

 The concept of essential medicine list was launched by WHO in 1977.

 Model List of Essential Medicine.
 The first list was published in 1977 and included 212 medications.
 The WHO updates the list every two years.
 The 14th list was published in 2005 and contained 306 medications.
 In 2015, the 19th edition of the list was published and contained around 410
medications.
 The 20th edition was published in 2017, and comprises 433 drugs.
 The 21st list was published in 2019 with 460 drugs.
 The list is frequently used by countries to help develop their own national lists of
essential medicine.

NATIONAL ESSENTIAL MEDICINES LIST (NEML) OF PAKISTAN

 The NEML of Pakistan was first prepared in 1994.

 The list was reviewed in 1995, 2000, 2003, 2007, and 2013.
 The last one was published in 2016.
  Current edition 0f NEML has been published in 2018 and contain 428 drugs under 30
categories.

CRITERIA ON THE SELECTION OF ESSENTIAL DRUGS

 Each country should appoint a committee to establish a list of essential drugs. The
Committee should include individuals competent in the fields of clinical medicine,
pharmacology and pharmacy.
 Drug selection should be based on the results of benefit and safety evaluations
obtained in controlled clinical trials and/or epidemiological studies.
 The international non-proprietary (generic) names for drugs or pharmaceutical
substances should be used whenever available.
 Regulations and facilities should be available to ensure that the quality of selected
pharmaceutical products meet adequate quality control standards, including stability
and, when necessary bioavailability.
 Cost represents a major selection criterion. In cost comparisons between drugs, the
cost of the total treatment, and not only the unit cost, must be considered. In addition,
the cost of non-pharmaceutical therapeutic modalities should be taken into account.
 Local health authorities should decide the level of expertise required to prescribe
single drugs or a group of drugs in a therapeutic category. Consideration should also
be given to the competence of the personnel to make a correct diagnosis. In some
instances, while individuals with advanced training are necessary to prescribe initial
therapy, individuals with less training could be responsible for maintenance therapy.
 The influence of local diseases or condition on pharmacokinetic and
pharmacodynamics parameters should be considered in making the selection e.g.
malnutrition, liver disease.
 When several drugs are available for the same indication, select the drug,
pharmaceutical product and dosage form that provide the highest benefit/risk ratio.
 When two or more drugs are therapeutically equivalent, preference should be given
to:
o The drug which has been most thoroughly investigated.
o the drug with the most favorable pharmacokinetic properties, e.g. to
improve compliance, to minimize risk in various pathophysiological states;
o drug for which local, reliable manufacturing facilities for pharmaceutical
products exist;
o Drugs, pharmaceutical products and dosage forms with favorable stability,
or for which storage facilities exist.
 Fixed ratio combinations are only acceptable if the following criteria are met:
o Clinical documentation justifies the concomitant use of more than one drug.
o the therapeutic effect is greater than the sum of the effect of each;
o the cost of the combination product is less than the sum of the individual
products;
o compliance is improved;
 o Sufficient drug ratios are provided to allow dosage adjustment satisfactory for
the majority of the population.
 The list should be reviewed at least once a year and whenever necessary. New drugs
should be introduced only if they offer distinct advantages over drugs previously
selected. If new information becomes available on drugs already in the list that clearly
shows that they no longer have a favorable benefit/risk ratio, they should be deleted
and replaced by a safer drug. It should be remembered that for the treatment of certain
conditions, non-pharmacological forms of therapy or no therapy at all, may be
preferable.

DEVELOPMENT OF EDL

ADVANTAGES OF EDL

 Limited number of drugs.

 Easily available.
 Easily controlled and managed.
 Promotes safe and effective use of drug.
 Cost minimization.
 Better medical outcome.

DISADVANTAGES

 Needs efforts and time for updating.

 Limit the prescriber’s liberty to select other drugs.

EXTRA

Pharmacopoeia
 Is an official book describing medicines or other pharmacological substances, especially
their use, preparation, and regulation. E.g. British pharmacopoeia

Formulary

It is a list of available drugs, particularly prescription drugs.

Monographs (institution level like industry and involves a particular topic)

A monograph includes the name of the ingredient or preparation; the definition; packaging,
storage, and labeling requirements; and the specification. The specification consists of a
series of tests