National list of essential medicines - nepal

Final Draft

NATIONAL LIST OF
ESSENTIAL MEDICINES
DEPARTMENT OF DRUG ADMINISTRATION
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Final Draft
NATIONAL LIST OF ESSENTIAL MEDICINES - NEPAL
Fourth revision, 2009
________________________________________________________________
Generic Name
Dosage Form
Anaesthetics
General Anaesthetics and Oxygen
injection, 50 mg/ml (as hydrochloride) in 10-ml vial powder for injection, 0.5g, 1.0g (sodium salt) in ampoule Complementary
Local Anaesthetics
injection, 0.25%, 0.5% (hydrochloride) in vial injection, 1%, 2% (hydrochloride) in vial; injection for spinal anaesthesia, 5% (hydrochloride) in 2-ml ampoule to be mixed with 7.5% glucose solution injection, lignocaine 2%(hydrochloride) + epinephrine Complementary
injection, 30 mg (hydrochloride)/ml in 1-ml ampoule (For use in spinal anaesthesia during delivery, to prevent hypotension) Preoperative Medication and Sedation for Short-term Procedures
injection, 1 mg (sulfate) in 1-ml ampoule injection, 10 mg (sulfate or hydrochloride) in 1-ml
2. Analgesics, Antipyretics, Non-Steroidal Anti-inflammatory Medicines (NSAIMs) and
Medicines Used to Treat Gout and Disease-Modifying Agents Used in Rheumatic Disorders
(DMARDs)

2.1. Non-opioids Analgesics & NSAIMs
tablet, 500mg; injection, 150 mg/ml; oral liquid, 125 Complementary
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009
2.2. Opioid
Analgesics
injection, 10 mg (sulfate or hydrochloride) in 1- ml ampoule; tablet, 10mg; prolonged release tablet, 10mg, 30mg, 60 mg (sulfate); oral liquid 10 mg/5ml (sulfate) injection, 50mg (hydrochloride) in 1-ml ampoule Medicines Used to Treat Gout
Complementary
Disease Modifying Agents Used in Rheumatic Disorders (DMARDs)
Antiallergics and Medicines Used in Anaphylaxis
Antiallergics
injection, 4 mg (as sodium salt) in 1-ml ampoule powder for injection, 100 mg (as sodium succinate) in vial Medicines Used in Shock
Antidotes and Other Substances Used in Poisonings
Non-Specific
Specific
injection, 1 mg (sulfate) in ampoule; powder for injection injection in oil, 50 mg/ml in 2-ml ampoule injection, 400 mcg (hydrochloride) in 1-ml ampoule injection, 500 mg or 1 g (mesilate, chloride or iodide) in Complementary
powder for injection, 500 mg (mesilate) in vial Methylthioninium chloride (Methylene injection, 10 mg/ml in 10-ml ampoule Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Antiepileptics / Anticonvulsants
tablet, 100 mg, 200 mg; chewable tablet 100 mg, 200 mg injection, 5mg/ml in 2-ml ampoule (intravenous or rectal) * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders capsule or tablet, 25 mg, 50 mg, 100 mg (sodium salt); injection, 50 mg /ml (sodium salt) in 5-ml vial tablet (enteric coated), 200 mg (sodium salt) Complementary
Anti-infective Medicines
6.1 Anthelmintics
6.1.1 Intestinal Anthelmintics

Complementary
6.1.2 Antifilarials
tablet, 50 mg, 100 mg (dihydrogen citrate) Antibacterials

6.2.1 Beta-lactum medicines

capsule or tablet, 250mg, 500mg (as trihydrate); dispersible tablet 125 mg (as trihydrate) powder for injection, 500 mg (sodium salt) for injection, 600 000 IU, 1200 000 IU, 2400 000 powder for injection, 300 mg (0.5 million IU), 600 mg (1 million IU) (as sodium or potassium salt) in vial #Only listed for single-dose treatment of uncomplicated powder for injection, 1g, 500 mg (as sodium salt) in vial capsule, 250 mg, 500 mg; powder for oral liquid, 125 mg / 5ml; powder for injection, 500 mg (as sodium salt) in vial Phenoxymethylpenicillin (Penicillin V) tablet, 250mg (as potassium salt); powder for oral liquid, powder for injection, 300,000 IU in vial Complementary
powder for injection, 1 g (as sodium salt) in vial powder for injection, 250 mg (as sodium salt) in vial Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 6.2.2 Other
Antibacterials
capsule or tablet 250 mg, 500 mg; oral liquid, 200 mg *Only listed for single-dose treatment of genital Chlamydia trachomatis and of trachoma. capsule, 250 mg, 500 mg; oral liquid, 125 mg / 5ml (as palmitate), powder for injection, 1g (as sodium succinate) in vial tablet, 250 mg, 500 mg (as hydrochloride) injection, 10 mg, 40 mg / ml (as sulfate) in 2-ml vial tablet, 200 mg, 400 mg; injection, 500 mg in 100-ml vial; oral liquid, 100 mg, 200 mg (as benzoate) / 5ml dispersible tablet, 100mg+20 mg, 200 mg+ 40 mg; tablet 400 mg + 80 mg, 800 mg + 160 mg; oral liquid, 200mg + 40mg /5ml Complementary
tablet, 250 mg (stearate); oral liquid, 250 mg / 5ml
6.2.3 Antileprosy
Medicines
6.2.4 Antitubercular
Medicines
powder for injection, 1 g (as sulfate) in vial Complementary list:
Second-line medicines for the treatment of multi-drug resistant tuberculosis (MDR-TB) - to be made available only in specialised centres adhering to standard treatment protocol. Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Antifungal Medicines

6.4 Antiviral
Medicines
6.4.1 Antiherpes
Medicines
powder for injection 250 mg (as sodium salt) in vials, 6.4.2 Antiretrovirals
6.4.2.1 Nucleoside/Nucleotide Reverse Transcriptase Inhibitors

tablet, 300 mg (as sulfate); oral liquid, 100 mg (as capsule, 15 mg, 20 mg, 30 mg; powder for oral liquid, 5 tablet, 300 mg (equivalent to 245 mg tenofovir disoproxil) capsule, 100 mg; tablet 300 mg; oral liquid 50 mg/ 5ml 6.4.2.2 Non-nucleoside Reverse Transcriptase Inhibitors

6.4.2.3 Protease Inhibitors

6.4.2.4 Fixed-dose Combination


6.5 Antiprotozoal
Medicines
6.5.1 Antiamoebic and Antigiardiasis Medicines
tablet, 200mg, 400mg; oral liquid, 200 mg (as benzoate) / Complementary
6.5.2 Antileishmaniasis Medicines

Complementary

6.5.3 Antimalarial Medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 injection, ampoules, containing 60 mg anhydrous artesunic acid with a separate ampoule of 5% sodium bicarbonate solution; tablet 50 mg oily injection, 80 mg/ml in 1-ml ampoule. * For use in the management of severe malaria. # Not recommended in the first trimester of pregnancy or in children below 5 kg. tablet, 150 mg base (as phosphate or sulfate); oral liquid, 50 mg/5ml (as phosphate or sulfate); injection, 40mg/ml in 5-ml ampoule (as phosphate, sulfate or hydrochloride) Complementary
tablet, 300 mg (as bisulfate or sulfate) injection, 300mg (as dihydrochloride)/ ml in 2-ml ampoule. Antimigraine Medicines
For Treatment of Acute Attack
Prophylaxis
Antineoplastic, Immunosuppressives and Medicines Used in Palliative Care
8.1 Immunosuppressive
Medicines
8.2 Cytotoxic Medicines

Calcium folinate (Calcium leucovorin) tablet, 15 mg powder for injection, 10 mg, 50 mg in vial. tablet, 25 mg; powder for injection, 200 mg, 500 mg, 1 g powder for injection, 10 mg, 50 mg in vial injection 50 mg/ml in 5-ml, 10-ml ampoule Granulocyte Colony Stimulating Factor injection, 30 million (GCSF) unit in vial tablet, 2 mg, 5 mg; powder for injection, 50mg in vial tablet, 2.5 mg (as sodium salt); powder for injection 15 powder for injection, 2mg, 10mg, 20mg in vial injection, 2 mg/ml in 2-ml, 4-ml vial; tablet 2mg, 4mg powder for injection, 1 mg (sulfate) in vial Complementary
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 powder for injection, 15mg (as sulfate) in vial powder for injection 20 mg (as hydrochloride) in vial injection, 10 mg, 50 mg (hydrochloride) in vial powder for injection 10 mg (sulfate) in vial Hormones and Antihormones
powder for injection, 100 mg (as sodium succinate) in vial Complementary
4 mg /ml (as sodium salt) in 2-ml ampoule
9. Antiparkinsonism
Medicines
Medicines Affecting the Blood
10.1 Antianaemia Medicines
tablet, equivalent to 60 mg Iron; oral liquid, equivalent to tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. Complementay
injection, equivalent to 50 mg iron/ml in 2-ml ampoule 10.2 Medicines Affecting Coagulation
injection, 1000 IU / ml, 5000 IU / ml, 20000 IU / ml in 1- injection, 10mg / ml in 5-ml ampoule; tablet 10 mg Complementary
Blood Products and Plasma Substitutes
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 11.1 Plasma
Substitutes
11.2 Plasma Fractions For Specific Use

12. Cardiovascular
Medicines
12.1 Antianginal
Medicines
tablet, 40 mg, 80 mg (hydrochloride); injection, 2.5 mg / 12.2 Antiarrhythmic Medicines
tablet, 62.5mcg, 250mcg; oral liquid, 50 mcg / ml; injection, 1 mg (hydrochloride)/ml in vial Complementary
tablet, 250mg (hydrochloride); injection, 100 mg /ml in 10-ml ampoule Antihypertensive
Complementary
12.4 Medicines Used in Heart Failure
tablet, 62.5 mcg, 250 mcg; oral solution, 50 mcg / ml; Complemenary
Antithrombotic Medicines
injection 750 000 IU, 1500 000 IU in vial 12.6 Lipid Lowering Agent

tablet, 10 mg, 20 mg (as calcium trihydrate)
13. Dermatological
Medicines
13.1 Antifungal
Medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Complementary
13.2 Anti-infective Medicines
Complementary

13.3 Anti-inflammatory and Antipruritic Medicines
13.4 Medicines Affecting Skin Differentiation and Proliferation
13.5 Scabicides and Pediculicides
Complementary
Diagnostic Agents
14.1 Ophthalmic Medicines
eye drops, 1%, 2% (sodium salt); injection, 10%, 14.2 Radiocontrast Media

injection, 140-420 mg iodine/ml (as sodium or meglumine injection, 140-350 mg iodine/ml in 5-ml, 10-ml ampoule Complementary
Disinfectants and Antiseptics
15.1 Antiseptics
powder, (0.1% available chlorine) for solution Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 15.2 Disinfectants

Diuretics
tablet, 40 mg; injection, 10 mg/ml in 2-ml ampoule
17. Gastrointestinal
Medicines
17.1 Antacids and Other Anti-ulcer Medicines

tablet, 150 mg, 300 mg (as hydrochloride); injection 25 Complementary
17.2 Antiemetic Medicines
tablet, 10 mg (hydrochloride); injection,5mg tablet, 25 mg (theoclate); oral liquid, 5 mg (hydrochloride)/ 5ml; injection, 25 mg (hydrochloride) / ml in 2-ml ampoule 17.3 Anti-inflammatory Medicines
17.4 Laxatives
Complementary

17.5 Medicines Used in Diarrhoea
17.5.1 Oral Rehydration

Dextrose, anhydrous 13.5 g, Sodium chloride 2.6 g, Potassium chloride 1.5 g, Trisodium citrate dihydrate 2.9 g, appropriate flavour q.s. Dissolved to produce 1 litre, provides dextrose 75 mEq, sodium 75 mEq or mmol/l, chloride 65 mEq or mmol/l, potasium 20 mEq or mmol/l, citrate 10 mmol/l and osmolarity 245 mOsm/l * In case of cholera a higher concentration of sodium may 17.5.2 Medicine for Diarrhoea in Children
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 dispersible tablet, equivalent to Zinc 10 mg, 20 mg * In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts
17.6 Antispasmodic Medicines

tablet, 10 mg, 20 mg; injection, 20mg/ml in 1-ml ampoule Hormones, Other Endocrine Medicines and Contraceptives
18.1 Adrenal Hormones and Synthetic Substitutes
tablet, 500 mcg; injection, 4 mg/ml (as sodium phosphate) powder for injection, 100 mg (as sodium succinate) in Complementry

18.2 Androgens

18.3 Contraceptives
18.3.1 Oral Harmonal Contraceptives

18.3.2 Injectable Hormonal Contraceptive

depot injection, 150 mg / ml in 1-ml vial
18.3.3 Intrauterine Devices
Copper-containing
18.3.4 Barrier Methods
18.3.5 Implantable Contraceptives

Two-rod levonorgeatrel-releasing implant, each rod containing 75 mg of levonorgestrel (150 mg total) 18.4 Estrogens
18.5 Insulins and Other Antidiabetic Agents

injection, 40 IU / ml in 10- ml vial (as compound insulin Complementary
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Ovulation Inducers
18.7 Progestogens
18.8 Thyroid Hormones and Antithyroid Medicines

oral solution (Iodine 5%+Potassium iodide 10%) 18.9 Posterior Pituitary Hormone
injection, 4 mcg/ml; nasal spray 10 mcg / metered spray
19. Immunologicals
19.1 Diagnostic Agents
Tuberculin, purified protein derivative injection (PPD)
19.2 Sera and Immunoglobulins
19.3 Vaccines
19.3.1 For Universal Immunization

Diphtheria-Tetanus-Pertussis-Hepatitis B vaccine 19.3.2 For Specific Groups of Individuals

SA 14-14-2 strain live attenuated vaccine Muscle Relaxants (Peripherally Acting) and Cholinesterase Inhibitors
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 tablet, 15 mg (bromide); injection 500 mcg, 2.5 mg Ophthalmological, Ear, Nose and Throat Preparations
21.1 Ophthalmological
Preparations
21.1.1 Anti-infective Agents

Complementary
eye/ear drops, 0.3% (as hydrochloride); eye ointment, 21.1.2 Anti-inflammatory agents
21.1.3 Local Anaesthetics
Complementary
21.1.4 Miotics and antiglaucoma medicines
solution (eye drops), 2%, 4% (hydrochloride) 21.1.5 Mydriatics
21.2. Ear, Nose and Throat Preparations


21.3 Dental

Oxytocics and Antioxytocics
22.1 Oxytocics
tablet, 200mcg (hydrogen maleate); injection, 200mcg 1- Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Complementary
* Combi-pack, containing 1 tablet of mifepristone and 4-tablet of misoprostol. Requires close medical supervision. Approved for abortion services only in listed sites. 22.2 Anti-oxytocics
Isoxsuprine
Peritoneal Dialysis Solution
parenteral solution of appropriate composition 24. Psychotherapeutic
Medicines
24.1 Medicines Used in Psychotic Disorders

tablet, 50 mg, 100mg (hydrochloride); oral liquid, 25 mg (hydrochloride) / 5ml; injection, 25 mg (hydrochloride) / 5ml in 2-ml ampoule injection, 25 mg (decanoate or enantate) in 1-ml ampoule tablet 2 mg, 5 mg; injection, 5 mg in 1-ml ampoule Complementary

24.2 Medicines Used in Mood Disorders
24.2.1 Medicines used in depressive disorders

tablet, 10 mg, 25 mg, 75mg (hydrochloride) capsule or tablet, 20 mg (as hydrochloride) 24.2.2 Medicines Used in Bipolar Disorders
Medicines Used in Generalised Anxiety and Sleep Disorders
Medicines Used for Obsessive Compulsive Disorders and Panic Attacks
Medicines Used in Substance Dependence Programmes
concentrate for oral liquid, 5 mg/ml, 10 mg/ml (hydrochloride), oral liquid, 5 mg/5ml, 10 mg/5 ml *The medicines should only be used within an established support Medicines Acting on the Respiratory Tract
25.1 Antiasthmatic and Medicines for Chronic Obstructive Pulmonary Disease
injection, 1 mg (as hydrochloride or hydrogen tartrate) in (sodium succinate) 100 mg, 200 mg in vial; Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 tablet, 2 mg, 4 mg (as sulfate); rotacap 200 mcg (as sulfate) per dose; oral liquid, 2mg (as sulfate)/5ml; injection 50mcg /ml in 5-ml ampoule inhalation (aerosol), 5 mg, 20 mg per dose Complementary
inhalation (aerosol), 50mcg (as dipropionate) per dose Solution Correcting Water, Electrolyte and Acid Base Disturbances
26.1 Oral
Dextrose, anhydrous 13.5 g, Sodium chloride 2.6 g, Potassium chloride 1.5 g, Trisodium citrate dihydrate 2.9 g, appropriate flavour q.s. Dissolved to produce 1 litre, provides Dextrose 75 mEq, sodium 75 mEq or mmol/l, chloride 65 mEq or mmol/l, potasium 20 mEq o mmol/l, citrate 10 mmol/l and osmolarity 245 mOsm/l
26.2 Parenteral
injectable solution, 5% isotonic, 50% hypertonic injectable solution, 5% glucose, 0.9% sodium chloride injectable solution 1.4%, 8.4% solution in 10-ml ampoule 26.3 Miscellaneous

Complementary
Vitamins and Minerals
capsule or tablet, 1.25 mg (50 000 IU) oral tablet (sugar coated), 10000 IU (5.5mg. capsule, IU (as palmitate 110 mg; oral oily solution, 100 000 IU/ ml; water miscible injection, 100 000 IU (as palmitate) 55 mg in 2-ml ampoule Retinol (as palmitate)+DL-alpha-tocopherol or tocopheryl acetate, soft gel capsule, 200 000 IU+ 40 IU, 100 000 IU+ 20 IU, 50 000 IU+ 20 IU Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 thiamine mononitrate 5 mg, riboflavin 5 mg, pyridoxine hydrochloride 1.5 mg, nicotinamide 50 mg, calcium pantothenate 25 mg. LIST OF ESSENTIAL MEDICINES
FOR DISTRICT HOSPITAL, PRIMARY HEALTH CARE CENTRE,
HEALTH POST AND SUB-HEALTH POST
(Note: The main list is for District hospital. Column at right hand side mentions which medicines are listed
below district hospital. PHC: Primary Health Care Centre, HP: Health Post, SHP: Sub-health Post.
"y" in the chart indicates that the medicine is included and (-) indicates the medicine is not included in the list
of essential medicines for that level of health facility. (C) or "complementary" indicates that the medicine is
complementary for that level of health facility.
@ indicates the medicines listed for free health care. y@ means the medicine is listed for free healthcare
service at that level of health facility. (For example. 4.1 Charcoal activated is listed for district hospital, PHC
and HP, but not for SHP. If @ is only in the name of medicine, it means that it is listed for free health care
service at district hospital only, for example, 2.1 Aspirin. )
_____________________________________________________________________________________
Generic name
Dosage Form
Health facility
PHC HP SHP
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 -------------------------------------------------------------------------------------------------------------------------------------------------------
1. Anaesthetics
General Anaesthetics and Oxygen
powder for injection, 0.5 g, 1.0 g in ampoule Local anaesthetics
Analgesics, Antipyretics, Non-Steroidal Anti-inflammatory Medicines (NSAIMs), Medicines Used to Treat Gout
and Disease-Modifying Agents Used in Rheumatic Disorders (DMARDs)
Non-opioids and Nonsteroidal Anti-inflammatory Medicines (NSAIMs)
Complementary
2.2 Opioid
Analgesics
injection, 50mg (hydrochloride) in 1-ml ampoule Drugs Used to Treat Gout
Complementary
Antiallergics and Medicines Used in Anaphylaxis
3.1 Antiallergics
powder for injection, 100mg (as sodium succinate) Drugs Used in Shock
Antidotes and Other Substances Used in Poisonings
Non-Specific
Specific
injection, 1g or 500mg (mesilate, chloride or iodide) Complementary
Antiepileptics / Anticonvulsants
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 injection, 5mg/ml in 2-ml (intravenous or rectal) * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders Anti-infective Medicines
Anthelmintics
Intestinal Anthelmintics
Complementary
Antifilarials
tablet,50 mg, 100 mg (dihydrogen citrate) Antibacterials
6.2.1 Beta-lactum
Medicines
dispersible tablet, 125 mg, 250 mg (as trihydrate) powder for injection, 500mg (as sodium salt) in vial powder for injection, 1 200 000 IU in vial injection, 300 mg (0.5 m IU), 600 mg (1 m IU) injection, 250 mg, 500 mg (as sodium salt) in vial Complementary
#Only listed for single-dose treatment of uncomplicated ano-genital gonorrhoea 6.2.2 Other
Antibacterials
*Only listed for single-dose treatment of genital Chlamydia trachomatis and trachoma. @oral liquid, 125 mg / 5ml (as palmitate), powder for injection, 1g (as sodium succinate) in vial tablet, 250 mg,@ 500 mg (as hydrochloride) injection, 10 mg, 40 mg / ml @in 2-ml vial @oral suspension, 200 mg (as benzoate) / 5ml dispersible tablet, 100mg+20 mg, 200 mg+ 40 mg; Complementary
oral suspension, 250 mg / 5ml (stearate) Antileprosy Medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Antitubercular Medicines
Rifampicin+isoniazid+ethambutol tablet, 150 mg+ 75 mg+2 75 mg powder for injection, 1 g (as sulfate) in vial Complementary list:
Second-line medicines for the treatment of multi-drug resistant tuberculosis (MDR-TB) - to be made available only in specialised centres adhering to standard treatment protocol. Antifungal Medicines
6.4 Antiprotozoal
Medicines
Antiamoebic and Antigiardiasis Medicines
oral liquid, 200 mg (as benzoate) / 5 ml. Complementary
6.4.2 Antileishmaniasis
Medicines
Complementary
Antimalarial Medicines
artesunic acid with a separate ampoule of 5% sodium oily injection, 80 mg/ml in 1-ml ampoule. * For use in the management of severe malaria. # Not recommended in the first trimester of pregnancy or in children below 5 kg. tablet, 150 mg base (as phosphate or sulfate); oral liquid, 50 mg / 5ml (as phosphate or sulfate); injection, 40mg /ml in 5- ml ampoule (as phosphate, sulfate or hydrochloride) y Complementary
tablet, 300 mg (as bisulfate or sulfate) injection, 300mg (as dihydrochloride)/ ml in 2-ml ampoule. Medicines Affecting the Blood
Antianaemia Medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 oral liquid, equivalent to 25 mg iron/ ml tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. 7.2 Medicines
Affecting Coagulation
Complementary
Blood Products and Plasma Substitutes
9. Cardiovascular
Medicines
Antianginal Medicines
Complementary

Antihypertensive
Complementary
Medicines Used in Heart Failure
10. Dermatological
Medicines
Antifungal Medicines
Anti-infective Medicines
Complementary
Anti-inflammatory and Antipruritic Medicines
Complementary
Scabicides and Pediculicides
Complementary
Disinfectants and Antiseptics
11.1 Antiseptics
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 11.2 Disinfectants
Complementary
powder (0.1% available chlorine) for solution Diuretics
Complementary
Gastrointestinal Medicines
Antacids and Other Anti-ulcer Medicines
Complementary
13.2 Antiemetic
Medicines
@injection, 5 mg (hydrochloride)/ml in 2-ml ampoule Laxatives
Medicines used in Diarrhoea
13.4.1 Oral Rehydration

Dextrose, anhydrous 13.5 g, Sodium chloride 2.6 g, Potassium chloride 1.5 g, Trisodium citrate dihydrate 2.9 g, appropriate flavour q.s. Dissolved to produce 1 litre, provides Dextrose 75 mEq, sodium 75 mEq or mmol/l, chloride 65 mEq or mmol/l, potasium 20 mEq or mmol/l, citrate 10 mmol/l and osmolarity 245 mOsm/l y@ * In case of cholera a higher concentration of sodium may be required. 13.4.2 Medicine for Diarrhoea in Children

dispersible tablet, equivalent to Zinc 20 mg (scored) Antispasmodic Medicines
Hormones, Other Endocrine Medicines and Contraceptives
Adrenal Hormones and Synthetic Substitutes
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 14.2 Contraceptives
14.2.1 Oral Harmonal Contraceptives
14.2.2 Injectable Hormonal Contraceptive

depot injection, 150 mg / ml in 1-ml vial 14.2.3 Intrauterine
14.2.4 Barrier
Insulins and Other Atidiabetic Agents
15. Immunologicals
Sera and immunoglobulins
Vaccines
15.2.1 For universal immunization

15.2.2 For specific groups of individuals

Muscle relaxants (peripherally acting) and cholinesterase inhibitors
Complementary

injection 500 mcg, 2.5 mg in 1-ml ampoule Ophthalmological, ear, nose and throat preparations
Ophthalmological preparations
17.1.1 Anti-infective
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Complementary
17.1.2 Miotics and Antiglaucoma Medicines
Ear, Nose and Throat Preparations
Oxytocics and Antioxytocics
18.1 Oxytocics
Methylergometrine
Complementary
* Combi-pack, containing 1 tablet of mifepristone and 4 tablets of misoprostol. Requires close medical supervision. For health facilities approved for abortion services only. Anti-oxytocics
Complementary
Psychotherapeutic medicines
injection, 25 mg (hydrochloride)/5ml in 2-ml ampoule Medicines Acting on the Respiratory Tract
Antiasthmatic and Medicines for Chronic Obstructive Pulmonary Disease
Complementary
Solution Correcting Water, Electrolyte and Acid Base Disturbances
21.1 Oral
Dextrose, anhydrous 13.5 g, Sodium chloride 2.6 g, Potassium chloride 1.5 g, Trisodium citrate dihydrate 2.9 g, appropriate flavour q.s. Dissolved to produce 1 litre, provides Dextrose 75 mEq, sodium 75 mEq or mmol/l, chloride 65 mEq or mmol/l, potasium 20 mEq or mmol/l, citrate 10 mmol/l and osmolarity 245 mOsm/l y@ Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Parenteral
injectable solution, 5% glucose, 0.9% sodium chloride 21.3 Miscellaneous

Vitamins and Minerals
Retinol (as palmitate)+DL-alpha-tocopherol or tocopheryl acetate, soft gel capsule, 200 000 IU+ 40 IU, 100 000 IU+ 20 IU, 50 000 IU+ 20 IU thiamine mononitrate 5 mg, riboflavin 5 mg, pyridoxine hydrochloride1.5 mg, nicotinamide 50 mg, National List of Essential Medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Glycerine ear drop see Ichthammol or Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Ringer's lactate solution see Compound PenicillinV see Phenoxymethylpenicillin Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 List of Essential Medicines for District Hospital
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Glycerine ear drop see with Ichthammol or Iodine see Lugol's iodine and Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Ringer's lactate solution see Compound Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 SUMMARY SHEET
Changes made in National List of Essential Medicines 2009 with respect to
National List of Essential Drugs 2002
NATIONAL LIST
1. Anaesthetics
Deleted: Compressed air.
Added: Lignocaine injection for spinal anaesthesia 5% (hydrochloride) in 2-ml ampoule to be mixed
with 7.5% glucose solution; Lignocaine + epinephrine: Lignocaine 2% (hydrochloride) + epinephrine 1:200 000, in vial; Ephedrine injection, 30 mg (hydrochloride)/ml in 1-ml ampoule (Complementary). Analgesics, Antipyretics, NSAIMs and Medicines Used to Treat Gout and Disease-Modifying
Agents Used in Rheumatic Disorders (DMARDs)
Changes: Aspirin tablet in complementary list, 100 mg deleted; Morphine 20 mg tablet deleted,
prolonged release tablet 10 mg, 30 mg, 60 mg (sulfate) added; Diclofenac tablet changed from 25 mg to 50 mg; Allopurinol tablet and Colchicine tablet in complementary list. Deleted: Chloroquine tablet
Antiallergics and Drugs Used in Anaphylaxis
Deleted : Hydrocortisone tablet, 10 mg
Added: Dexamethasone phosphate injection, 4 mg (as sodium salt) in 1 ml ampoule
Antidotes and Other Substances Used in Poisonings
Added: (Complementary list) Calcium gluconate, Deferoxamine, Methylene blue, Prussian blue,
Antiepileptics / Anticonvulsants
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Carbamazepine chewable tablet 100 mg, 200 mg; Diazepam rectal Anti-infective Medicines : Anthelminthics
Deleted : Albendazole suspension
Antibacterials, 6.2.1 Beta-lactum medicines
Deleted: Amoxicillin dry syrup 125 mg/5ml & powder for injection 500 mg
Added: Ampicillin powder for injection 500 mg; Cefazolin powder for injection 1 g (as sodium salt)
in vial (Complementary); Cefixime tablet 400 mg; Amoxicillin dispersible tablet 125 mg 6.2.2 Other
antibacterials
Added: Azithromycin capsule or tablet 250 mg, 500 mg; oral liquid, 200 mg /5ml.
Deleted :Tetracycline capsule
Changes: Doxycycline capsule in main list; Erythromycin stearate in complementary list, estolate
6.2.3 Antilaprosy
Medicine
Deleted: Minocycline capsule, 50 mg, 100 mg (as hydrochloride)
6.2.4 Antitubercular
medicines (revised as per national programme)
Added: Isoniazid + rifampicin tablet, 30 mg+ 60 mg; Rifampicin +isoniazid + ethambutol tablet, 50
mg+ 75 mg+275 mg; Rifampicin+ isoniazid+ pyrazinamide tablet, 60 mg+ 30 mg+150 mg; Rifampicin+isoniazid+pyrazinamide+ ethambutol, tablet, 150 mg+ 75 mg + 400 mg + 275 mg; Kanamycin powder for injection 1 g in vial; Ofloxacin tablet, 200 mg Deleted: Ethambutol tablet 200 mg, 600 mg (as hydrochloride); Rifampicin capsule or tablet 450
mg; Streptomycin powder for injection 0.75 mg; Isoniazid + rifampicin tablet, 300 mg+ 450 mg, 300 mg+ 600 mg; Isoniazid + ethambutol tablet 300 mg+800 mg; Thaiacetazone+ isoniazid tablet Changes: Pyrazinamide tablet 400 mg instead of 500 mg and 750 mg
6.3 Antifungal
medicines
Added: Fluconazole capsule or tablet 150 mg; Nystatin lozenge 100 000 IU
Deleted: Griseofulvin; Clotrimazole pessary 200 mg, 500 mg
6.5.2 Antileishmaniasis
Medicines
Added: Miltefosine Deleted: Pentamidine
6.5.3 Antimalarial
Medicines
Added: Artesunate; Artemether; Artemether+ lumfantrine Deleted: Mefloquine
7.1 Antimigraine
medicines
8. Antineoplastic & Immunosuppressives and Medicines Used in Palliative Care
Deleted: Azathioprine; Busulphan; Procarbazine; Stilboestrol; Flutamide
Added: Ciclosporin , Dacarbazine, Dexamethasone injection; Hydrocortisone Powder for injection;
Prednisolone; Bicalutamide
10.1 Antianaemia
Medicines
Deleted: Hydroxocobalamin injection
12.1 Antianginal
medicines
Atenolol Deleted: Isosorbide dinitrate
12.2 Antiarrhythmic
medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Atenolol Deleted: Lignocaine
12.3 Antihypertensive
medicines
Deleted: Methyldopa; Hydralazine
12.5 Antithrombotic
medicine
Added: Aspirin 75 mg
12.6 Lipid lowering agent
Added: Atrovastatin
13.1 Antifungal
medicines
Changes:
Miconazole replaced by Clotrimazole
13.2 Anti-infective
medicines
Deleted: Mercurochrome; Nitrofurazone; Potassium permanganate solution
Changes: Gentian violet in complementary list
13.4 Astringent
medicines: heading and Aluminium diacetate deleted
13.4 Medicine affecting skin differentiation and prolifiration
Deleted:
13.5 Scabicides and pediculocides
Added: Permethrin lotion or cream in complementary list
Deleted: Benzyl benzoate emulsion
14.2 Radiocontrast Media
Iohexol; Meglumine iotroxate Deleted: Iopanoic acid; Metrizamide; Sodium iodide
Disinfectants and Antiseptics
Deleted: Cresol soap solution, Iodine solution, 2.5%, Phenol solution, Potassium Permanganate
solution Added: Glutaraldehyde solution
Changes: Rectified spirit instead of Methylated spirit; Sodium hypochlorite changed to Chlorine
17.1 Antacids and other anti-ulcer medicines
Changes:
17.2 Antiemetic
medicines
Changes: Promethazine tablet 10 mg deleted, hydrochloride changed to theoclate
17.3 Title of Antihaemorrhoidal drugs deleted
17.4 Laxative
Deleted: Senna Added: Bisacodyl
17.5 Medicines used in diarrhoea
17.5.1 Oral rehydration
Composition of Oral rehydration salt changed according to WHO's new formula 17.5.2 Medicine for diarrhoea in children
Added: Zinc sulfate dispersible tablet, 10 mg, 20 mg
17.6 Antispasmodic
medicines
Deleted: Atropine
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 18.1 Adrenal hormone and synthetic substitute
Deleted: Hydrocortisone tablet
18.3.1 Oral hormonal contraceptives
Added: Levonorgestrel tablet 2X750 mg
Deleted: Ethinyl estradiol +norethisterone 50 mcg + 1g
18.3.2 Injectable Hormonal Contraceptive
Deleted: Medroxyprogesterone depot 3 ml
18.3.3 Intrauterine Devices
Added: Copper-containing devices; Ring pessary
18.3.5 Implantable Contraceptives
Added: Levonorgestrel-releasing implant: Two-rod, each rod containing 75 mg of levonorgestrel
18.5 Insulins and Other Antidiabetic Agents
Deleted:
Protamine Zinc Insulin - injection (long acting) 18.8 Thyroid hormones and antithyroid medicines
Deleted: Iodine injection
18.5 Insulins and Other Antidiabetic Agents
Deleted: Protamine Zinc Insulin - injection (long acting); Iodine - injection
19. Immunologicals
19.3 Vaccines
19.3.1For universal immunization
Added: Diphtheria- tetanus- pertussis-Hepatitis B vaccine; Diphtheria- tetanus- pertussis Hepatitis B
Deleted: Diphtheria- tetanus- pertussis vaccine; Diphtheria- tetanus vaccine
19.3.2 For Specific Groups of Individuals
Ophthalmological, Ear, Nose and Throat Preparations
21.1 Ophthalmological
preparations
Added: Aciclovir ointment; Chloramphenicol eye applicap
Deleted: Sulfacetamide, Betamethasone, Homatropine, Tropicamide eye drops; Idoxuridine
21.2. Ear, Nose and Throat Preparations
Deleted: Silver nitrate solution (nasal); Ephedrine nasal drops; Acetic Acid solution; 25% Dextrose
in Glycerine nasal drops; Chromic Acid solution Deleted: Tannic acid+ glycerin solution
Oxytocics and Antioxytocics
Changes: Ergometrine changed to methylergometrine; Oxyticin: "5 IU/ml in 1-ml ampoule" instead
Added: Mesoprostol tablet, Mifepristone-misoprostol tablet
24. Psychotherapeutic
medicines
24.2.1 Medicines used in depressive disorders
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Added: Fluoxetine
Medicines Used in Generalised Anxiety and Sleep Disorders
Added: Diazepam tablet 2 mg, 5 mg
Medicines Used in Substance Dependence Programmes
Added: Methadone
Solution Correcting Water, Electrolyte and Acid Base Disturbances
26.1 Oral
Change: Oral rehydration salts according to WHO's new formula
26.2 Parenteral
Change: Glucose with Sodium chloride injectable solution, strength changed to 5% glucose, 0.9%
sodium chloride instead of glucose 4%, sodium chloride 0.18% Vitamins & Minerals
Retinol +DL-alpha-tocopherol soft gelatin capsule; B-complex tablet for institution supply Deleted: Nicotinamide tablet, Thiamine tablet
1. Anaesthetics
Deleted: Compressed air.
Added: Lignocaine + epinephrine: Lignocaine 2% (hydrochloride) + epinephrine 1:200 000, in vial
Analgesics, Antipyretics, Non-Steroidal Anti-inflammatory Medicines (NSAIMs), Medicines
Used to Treat Gout and Disease-Modifying Agents Used in Rheumatic Disorders (DMARDs).
Deleted: Aspirin 100 mg, Paracetamol suppository
Changes: Diclofenac tablet changed from 25 mg to 50 mg; Allopurinol tablet and Colchicine tablet in
3.1 Antiallergics
Deleted: Hydrocortisone tablet
6.1.1 Intestinal anthelmintics
Deleted: Albendazole suspension
6.2 Antibacterials
Changes:
Erythromycin (stearate) to complementary list, estolate deleted; Doxycycline to main list. Sulfamethoxazole+trimethoprim, tablet 100 mg + 20 mg, 200 mg + 40 mg changed to dispersible Deleted: Tetracycline; Amixicillin dry syrup125 mg/5ml & powder for injection 500 mg (as sodium
Added: Ampicillin powder for injection 500 mg; Cefixime tablet 400 mg; Amoxicillin dispersible
tablet 125 mg ; Azithromycin capsule or tablet 250 mg, 500 mg; oral liquid, 200 mg /5ml 6.2.3 Antilaprosy
medicines
Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Deleted: Minocycline capsule, 50 mg, 100 mg; Rifampicin 450 mg capsule or tablet.
6.2.4 Antitubercular
medicines (revised as per national programme)
Added: Isoniazid + rifampicin tablet, 30 mg+ 60 mg; Rifampicin +isoniazid + ethambutol tablet, 50
Rifampicin+ isoniazid+ pyrazinamide tablet, 60 mg+ 30 mg+150 mg; Rifampicin+isoniazid+pyrazinamide+ ethambutol, tablet, 150 mg+ 75 mg + 400 mg + 275 mg; Kanamycin powder for injection 1 g in vial; Deleted: Ethambutol tablet 200 mg, 600 mg (as hydrochloride); Rifampicin capsule or tablet 450
mg; Streptomycin powder for injection 0.75 mg; Isoniazid + rifampicin tablet, 300 mg+ 450 mg, 300 mg+ 600 mg; Isoniazid + ethambutol tablet 300 mg+800 mg; Thaiacetazone+ isoniazid tablet Changes: Pyrazinamide tablet "400 mg' instead of "500 mg and 750 mg"
6.3 Antifungal
medicines
Added: Fluconazole capsule or tablet 150 mg
Deleted: Griseofulvin; Clotrimazole pessary 200 mg, 500 mg
6.4.1 Antiamoebic and Antigiardiasis Medicines
Deleted:
Diloxanide furoate; Metronidazole oral suspension 100 mg/5 ml 6.4.2 Antileishmaniasis
Medicines
Added: Miltefosine
Deleted: Pentamidine
6.4.3 Antimalarial
Medicines
Added: Artesunate; Artemether; Artemether+ lumfantrine
Deleted: Mefloquine
7.1 Antianaemia
Medicines
Deleted: Hydroxocobalamin injection
Changes: Folic acid (With Iron) changed to "400 mcg" from "250 mcg" ; Folic acid tablet changed
9. Cardiovascular
Medicines
Deleted: Isosorbide dinitrate, Lignocaine, Methyldopa; Hydralazine
10. Dermatological
medicines
Deleted: Mercurochrome, Nitrofurazone, Potassium permanganate solution, Aluminium diacetate,
Added: Permethrin lotion or cream (complementary list).
Changes: Miconazole replaced by Clotrimazole; Gentian violet, Calamine lotion, Hydrocortisone to
Disinfectants and Antiseptics
Deleted: Iodine solution 2.5%, Phenol solution, Potassium permanganate solution
Changes: Methylated spirit replaced by Rectified spirit; Sodium hypochlorite replaced by Chlorine
12. Diuretics
Deleted: Triamterene
13. Gastrointestinal
Deleted: Senna Added: Zinc tablet. .
Title of anihaemorrhoidal drugs deleted. ORS as per WHO's new formula. Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 14.1 Adrenal Hormones and Synthetic Substitutes
Added: Prednisolone tablet 10 mg, Levonorgestrel tablet 2X750
Deleted: Hydrocortisone tablet,
14.2 Contraceptive
Added: Levonorgestrel tablet 2X750 mcg (total 1.5 mg); IUD (copper containing devices)
Change: Ethinyl estradiol +norethisterone, low dose 35 mg only included not 50 mg;
Medroxyprogesterone depot 1 ml only included, 3 ml deleted 14.3 Insulins and Other Antidiabetic Agents
Deleted: Insulin intermediate acting
15. Immunologicals
Deleted:
Added: DTP HepB; DTP HepB, Hib vaccine
Muscle relaxants (peripherally acting) and cholinesterase inhibitors
Deleted : Suxamethonium chloride, Pancuronium bromide
17.1 Ophthalmological
preparations
Added: Chloramphenicol eye applicap, Ciprofloxacin eye/ear drops, eye ointment.
Deleted :Gentamicin eye drop, Sulphacetamide eye drop, Prednisolone eye drop, Pilocarpine eye
drop, Iodoxuridine , Betamethasone, Homatropine ; Lignocaine injection 17.2. Ear, Nose and Throat Preparations

Deleted: Lignocaine topical, Oxymetazoline nasal drop, Silver nitrate nasal solution, Ephedrine
nasal drop, Sodium cromoglycate spray, Acetic acid solution, Dextrose in glycerine, Chromic acid
solution, Chlorhexidine solution; Tannic acid+glycerine .
Change: Chloramphenicol ear drop "5%" instead of "2%";
Oxytocics and Antioxytocics
Added: Mesoprostol; mifepristone-misoprostol tablet.
Change: Methylergometrine instead of ergometirne; Isoxuprine in Complementary list
19. Psychotherapeutic
medicines
Added: Diazepam tablet
Deleted: Fluphenazine, Chlordiazepoxide
21.3 Miscellaneous
Deleted: Ethyl alcohol
Vitamins and Minerals
Deleted: Ascorbic acid, Ergocalciferol, Nicotinamide, Retinol, Riboflavin, Thiamine
Added: Retinol+DL-alpha-tocopherol soft gelatin capsule, Vitamin B complex tablet
CORRECTIONS
National List
"Drug" changed to "Medicine" "Syrup" or "suspension" changed to "Oral liquid" 1. Anaesthetics
Sub-heading changed as per WHO Model List Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 4. Antidote
"10g in sachet" deleted, "slurry in sorbitol" added "or 0.65 mg in" deleted, "powder for injection 200 mg (sulfate) in 5. Antiepileptics/Anticonvulsants
* For use in eclampsia and severe pre-clampsia and not for other convulsant disorders 6.1.1 Intestinal Anthelmintics
"500 mg" changed to "600 mg" DISTRICT LEVEL
4. Antidote
'10g in sachet" deleted, "slurry in sorbitol" added "or 0.65 mg in" deleted, "powder for injection 200 mg (sulfate) in Comments
National List of Essential Drugs was first published in 1986. The list was revised in 1992, 1997 and 2002. The fundamental principle behind the preparation the list is as fellows: Definition: Essential medicines are those that satisfy the priority health care needs of the population. Selection criteria: Essential medicines are selected with due regard to disease prevalence, evidence on safety and efficacy, and comparative cost-effectiveness. Purpose: 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 at price the individual and the community can afford. The fourth revision of the list is also based on the same principles. During preparation of the draft extensive consultation with concerned institutions and experts was done. Now a formal process for the approval of the list by the government has been initiated. Experts are requested to provide their comments at the earliest for further improvement of this list. The three-year interim plan (2007/08-2009/10) mentions that there will be provision for operating their own pharmacy in central, regional and zonal hospitals. Government of Nepal has already announced to provide free basic healthcare, including medicine, at sub-health post, health post, primary healthcare centre and district hospital. So, providing pharmaceutical care and implementing concept of essential medicine has become indispensable at present situation. Medicines in the national list are categorised as main and complementary. The complementary list presents essential medicines for priority diseases, for which specialised diagnostic or monitoring facilities, and/or specialist medical care and/or specialist training are needed. Essential medicines for which the government does not have priority at this moment for making available are also listed in the complementary list. Institutions should decide on individual basis whether these medicines are necessary to make available at present. Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009 Another list of essential medicines is for the district hospital. Since smaller number of medicines is required
at the health facilities below district hospital, these are indicated as "y" if the medicines are listed for that
level of health facility and "-" if the medicine is not listed for that level of health facility. For example,
serial number 9.2, Hydrochlorothiazide is listed for district hospital, primary healthcare centre and health
post but not for sub-health post.
The government has decided to provide selected medicine free of cost at and below district hospital. Such
medicines are marked "@". For example, serial number 12, Furosemide will be available free of cost at
district hospital and primary health care centre, but not at health post. If the medicine is available free of cost
at district hospital only, mark "@" is placed with the generic name of the medicine, for example, serial
number 2.1 Aspirin.
We thank experts and institutions for their valuable comments and interest during the preparation of the
draft.
Please send your comment to:
Government of Nepal, Ministry of Health and Population
Department of Drug Administration
Madan Bhandari Path, Bijulibazar, Kathmandu
e-mail: [email protected]; Telephone (01) 4780432; 4780227; Fax (01) 4780572
This draft is also available at: dda.gov.np

Source: http://www.unfpa.org/sowmy/resources/docs/library/R085_MOHNEPAL_2009_EssentialDrugs_Medicines.pdf