Final Draft

NATIONAL LIST OF ESSENTIAL MEDICINES NEPAL

(Fourth Revision)

Government of Nepal
MINISTRY OF HEALTH AND POPULATION

DEPARTMENT OF DRUG ADMINISTRATION

2009

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Final Draft

NATIONAL LIST OF ESSENTIAL MEDICINES - NEPAL

Fourth revision, 2009 ________________________________________________________________

1. 1.1

Generic Name Anaesthetics General Anaesthetics and Oxygen Halothane Isoflurane Ketamine Nitrous oxide Oxygen Thiopental Complementary Propofol

Dosage Form

inhalation inhalation injection, 50 mg/ml (as hydrochloride) in 10-ml vial inhalation inhalation (medicinal gas) powder for injection, 0.5g, 1.0g (sodium salt) in ampoule

injection, 10mg/ml in 20-ml ampoule

1.2

Local Anaesthetics Bupivacaine Lidocaine (Lignocaine)

Lidocaine + epinephrine (adrenaline) Complementary Ephedrine

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 1:200 000, in vial

1.3

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 Atropine injection, 1 mg (sulfate) in 1-ml ampoule Diazepam injection, 5mg/ml in 2-ml ampoule Morphine injection, 10 mg (sulfate or hydrochloride) in 1-ml ampoule Analgesics, Antipyretics, Non-Steroidal Anti-inflammatory Medicines (NSAIMs) and Medicines Used to Treat Gout and Disease-Modifying Agents Used in Rheumatic Disorders (DMARDs) Non-opioids Analgesics & NSAIMs Ibuprofen Paracetamol Complementary Aspirin Diclofenac sodium

2.

2.1.

tablet, 200 mg, 400 mg tablet, 500mg; injection, 150 mg/ml; oral liquid, 125 mg/5ml tablet, 300 mg tablet, 50 mg; injection, 25 mg/ml

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

2.2.

Opioid Analgesics Morphine

2.3

2.4

Pethidine Medicines Used to Treat Gout Complementary Allopurinol tablet, 100 mg Colchicine tablet, 500 mcg Disease Modifying Agents Used in Rheumatic Disorders (DMARDs) Methotrexate tablet, 2.5mg (as sodium salt)

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

3. 3.1

Antiallergics and Medicines Used in Anaphylaxis Antiallergics Chlorpheniramine tablet, 4 mg (maleate) Dexamethasone phosphate injection, 4 mg (as sodium salt) in 1-ml ampoule Epinephrine (adrenaline) injection, 1mg (as hydrochloride or tartrate) in 1-ml ampoule Hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial Pheniramine Prednisolone Medicines Used in Shock Dopamine Epinephrine (Adrenaline) injection, 22.75 mg (maleate) /ml tablet, 5mg injection, 40 mg/ml injection, 1:10 000 in 1-ml ampoule

3.2

4. 4.1 4.2

Antidotes and Other Substances Used in Poisonings Non-Specific Charcoal, activated powder; slurry in sorbitol Specific Atropine injection, 1 mg (sulfate) in ampoule; powder for injection 200 mg (sulfate) in vial Dimercaprol injection in oil, 50 mg/ml in 2-ml ampoule Naloxone Pralidoxime Complementary Acetylcysteine Calcium gluconate Deferoxamine Methylthioninium chloride (Methylene blue) Potassium ferric hexacyano-ferrate (II).2H2O (Prussian blue) Sodium calcium edetate Sodium nitrite injection, 400 mcg (hydrochloride) in 1-ml ampoule injection, 500 mg or 1 g (mesilate, chloride or iodide) in ampoule injection, 200 mg/ml in 10-ml ampoule injection, 100 mg/ml in 10-ml ampoule powder for injection, 500 mg (mesilate) in vial injection, 10 mg/ml in 10-ml ampoule powder for oral administration injection, 200 mg/ml in 5-ml ampoule injection, 30 mg/ml in 10-ml ampoule

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

5.

Antiepileptics / Anticonvulsants Carbamazepine tablet, 100 mg, 200 mg; chewable tablet 100 mg, 200 mg Diazepam injection, 5mg/ml in 2-ml ampoule (intravenous or rectal) Magnesium sulfate* injection, 500 mg/ml in 2-ml ampoule. * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders Phenobarbital tablet, 15 mg, 30 mg Phenytoin capsule or tablet, 25 mg, 50 mg, 100 mg (sodium salt); injection, 50 mg /ml (sodium salt) in 5-ml vial Valproic acid tablet (enteric coated), 200 mg (sodium salt) Complementary Paraldehyde injection, 500 mg/ml in 2-ml ampoule

6. Anti-infective Medicines 6.1 Anthelmintics 6.1.1 Intestinal Anthelmintics Albendazole Complementary Niclosamide Praziquantel 6.1.2 Antifilarials Diethylcarbamazine 6.2 Antibacterials

tablet (chewable), 400 mg tablet (chewable), 500mg tablet, 150 mg, 600 mg

tablet, 50 mg, 100 mg (dihydrogen citrate)

6.2.1 Beta-lactum medicines Amoxicillin

capsule or tablet, 250mg, 500mg (as trihydrate); dispersible tablet 125 mg (as trihydrate) Ampicillin powder for injection, 500 mg (sodium salt) Benzathine benzylpenicillin powder for injection, 600 000 IU, 1200 000 IU, 2400 000 IU in vial Benzylpenicillin (Penicillin G) powder for injection, 300 mg (0.5 million IU), 600 mg (1 million IU) (as sodium or potassium salt) in vial Cefixime# tablet, 400 mg #Only listed for single-dose treatment of uncomplicated ano-genital gonorrhoea Cefotaxime powder for injection, 1g, 500 mg (as sodium salt) in vial Cloxacillin 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, 250 mg Procaine benzylpenicillin powder for injection, 300,000 IU in vial Complementary Cefazolin* powder for injection, 1 g (as sodium salt) in vial *For surgical prophylaxis Ceftriaxone 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 Azithromycin*

capsule or tablet 250 mg, 500 mg; oral liquid, 200 mg /5ml. *Only listed for single-dose treatment of genital Chlamydia trachomatis and of trachoma. Chloramphenicol capsule, 250 mg, 500 mg; oral liquid, 125 mg / 5ml (as palmitate), powder for injection, 1g (as sodium succinate) in vial Ciprofloxacin tablet, 250 mg, 500 mg (as hydrochloride) Doxycycline capsule, 100mg (as hydrochloride) Gentamicin injection, 10 mg, 40 mg / ml (as sulfate) in 2-ml vial Metronidazole tablet, 200 mg, 400 mg; injection, 500 mg in 100-ml vial; oral liquid, 100 mg, 200 mg (as benzoate) / 5ml Nitrofurantoin tablet, 100 mg Sulfamethoxazole+Trimethoprim dispersible tablet, 100mg+20 mg, 200 mg+ 40 mg; tablet 400 mg + 80 mg, 800 mg + 160 mg; oral liquid, 200mg + 40mg /5ml Complementary Erythromycin Nalidixic acid

tablet, 250 mg (stearate); oral liquid, 250 mg / 5ml (stearate) tablet, 250 mg, 500 mg

6.2.3 Antileprosy Medicines Clofazimine Dapsone Rifampicin 6.2.4 Antitubercular Medicines Ethambutol Isoniazid Isoniazid+ethambutol Rifampicin Rifampicin+isoniazid Rifampicin+isoniazid+ethambutol Rifampicin+isoniazid+pyrazinamide Rifampicin+isoniazid+pyrazinamide+ ethambutol Streptomycin Complementary list:

capsule, 50 mg, 100 mg tablet, 50 mg, 100 mg capsule or tablet 150 mg, 300 mg

tablet, 400 mg (hydrochloride) tablet, 100 mg, 300 mg tablet, 150mg + 400mg capsule or tablet, 150mg, 300mg tablet, 60 mg+ 30 mg, 150mg + 75 mg tablet, 150 mg+ 75 mg+275 mg tablet, 60 mg+ 30 mg+150 mg tablet, 150 mg+ 75 mg + 400 mg + 275 mg powder for injection, 1 g (as sulfate) in vial 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. tablet, 250 mg tablet, 250 mg powder for injection 1 g in vial tablet, 200 mg granules, 4 g in sachet; tablet 500 mg

Cycloserine Ethionamide Kanamycin Ofloxacin p-aminosalicylic acid (PAS)

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

6.3

Pyrazinamide Antifungal Medicines Clotrimazole Fluconazole Nystatin

tablet, 400mg cream, 1%; pessary 100 mg capsule or tablet, 150 mg lozenge, 100 000 IU

6.4 Antiviral Medicines 6.4.1 Antiherpes Medicines Aciclovir

powder for injection 250 mg (as sodium salt) in vials, tablet 200 mg

6.4.2 Antiretrovirals 6.4.2.1 Nucleoside/Nucleotide Reverse Transcriptase Inhibitors Abacavir (ABC) tablet, 300 mg (as sulfate); oral liquid, 100 mg (as sulfate)/5ml Didanosine (ddI) enteric coated capsules 250 mg, 400 mg Lamivudine (3TC) tablet, 150 mg; oral liquid 50 mg/5ml Stavudine (d4T) capsule, 15 mg, 20 mg, 30 mg; powder for oral liquid, 5 mg/5 ml Tenofovir disoproxil fumarate (TDF) tablet, 300 mg (equivalent to 245 mg tenofovir disoproxil) Zidovudine (ZDV or AZT) capsule, 100 mg; tablet 300 mg; oral liquid 50 mg/ 5ml 6.4.2.2 Non-nucleoside Reverse Transcriptase Inhibitors Efavirenz (EFV or EFZ) capsule, 200 mg; tablet, 600 mg Nevirapine (NVP) tablet, 200 mg; oral liquid, 50 mg/5ml 6.4.2.3 Protease Inhibitors Indinavir (IDV) capsule, 400 mg ( as sulfate) Lopinavir + ritonavir (LPV/r) capsule 200 mg + 50 mg Nelfinavir (NFV) tablet, 250 mg (as mesilate) Saquinavir (SQV)+ritonavir oral dosage form, 1g+100 mg 6.4.2.4 Fixed-dose Combination Lamivudine + stavudine tablet, 150 mg + 30 mg Stavudine + lamivudine + nevirapine tablet, 30 mg + 150 mg + 200 mg Zidovudine + lamivudine tablet, 300 mg + 150 mg Zidovudine + lamivudine + nevirapine tablet, 300 mg + 150 mg + 200 mg 6.5 Antiprotozoal Medicines 6.5.1 Antiamoebic and Antigiardiasis Medicines Diloxanide tablet, 500 mg (furoate) Metronidazole tablet, 200mg, 400mg; oral liquid, 200 mg (as benzoate) / 5 ml. Complementary Tinidazole tablet, 500mg 6.5.2 Antileishmaniasis Medicines Miltefosine Complementary Amphotericin B Sodium stibogluconate 6.5.3 Antimalarial Medicines

capsule, 50 mg powder for injection, 50 mg in vial injection, 100mg/ml

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Artesunate

injection, ampoules, containing 60 mg anhydrous artesunic acid with a separate ampoule of 5% sodium bicarbonate solution; tablet 50 mg Artemether* oily injection, 80 mg/ml in 1-ml ampoule. * For use in the management of severe malaria. Artemether+lumefantrine# tablet, 20 mg+ 120 mg # Not recommended in the first trimester of pregnancy or in children below 5 kg. Chloroquine 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) Primaquine tablet, 7.5 mg, 15 mg (as diphosphate) Sulfadoxine + Pyrimethamine tablet, 500 mg + 25 mg

Complementary Quinine 7. 7.1 Antimigraine Medicines For Treatment of Acute Attack Paracetamol Ergotamine For Prophylaxis Propranolol

tablet, 300 mg (as bisulfate or sulfate) injection, 300mg (as dihydrochloride)/ ml in 2-ml ampoule.

tablet, 500 mg tablet, 1 mg (tartrate) tablet 20 mg, 40mg (hydrochloride)

7.2

8. 8.1 8.2

Antineoplastic, Immunosuppressives and Medicines Used in Palliative Care Immunosuppressive Medicines Ciclosporin capsule 25 mg Cytotoxic Medicines L-Asparaginase injection, 5 000 IU, 10 000 IU in vial Calcium folinate (Calcium leucovorin) tablet, 15 mg Cisplatin powder for injection, 10 mg, 50 mg in vial. Cyclophosphamide tablet, 25 mg; powder for injection, 200 mg, 500 mg, 1 g in vial Cytarabine injection 100 mg, 500 mg in vial Doxorubicin powder for injection, 10 mg, 50 mg in vial Etoposide injection 20 mg/ml in 5-ml ampoule Fluorouracil injection 50 mg/ml in 5-ml, 10-ml ampoule Granulocyte Colony Stimulating Factor injection, 30 million (GCSF) unit in vial Hydroxy urea capsule 500 mg Ifosfamide + Mensa injection, 1g + 200 mg, in vial Melphalan tablet, 2 mg, 5 mg; powder for injection, 50mg in vial Mercaptopurine tablet, 50 mg Methotrexate tablet, 2.5 mg (as sodium salt); powder for injection 15 mg, 50 mg (as sodium salt) in vial Mitomycin powder for injection, 2mg, 10mg, 20mg in vial Ondansetron injection, 2 mg/ml in 2-ml, 4-ml vial; tablet 2mg, 4mg Vincristine powder for injection, 1 mg (sulfate) in vial Complementary

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Bleomycin Carboplatin Chlorambucil Dactinomycin Daunorubicin Dacarbazine Epirubicin Interferon Lomustine Mitoxantrone Vinblastine 8.3 Hormones and Antihormones Hydrocortisone Tamoxifen Complementary Bicalitumide Dexamethasone phosphate Prednisolone 9. Antiparkinsonism Medicines Levodopa + Carbidopa Trihexyphenidyl Medicines Affecting the Blood Antianaemia Medicines Ferrous salt (Ferrous sulfate)* Ferrous salt (sulfate)*+Folic acid Folic acid *Other salts of Iron may be used Complementay Iron Dextran 10.2 Medicines Affecting Coagulation Heparin sodium

powder for injection, 15mg (as sulfate) in vial injection 150 mg, 450 mg in vial tablet, 2 mg, 5 mg powder for injection, 500 mcg in vial powder for injection 20 mg (as hydrochloride) in vial powder for injection, 100 mg in vial injection, 10 mg, 50 mg (hydrochloride) in vial injection, 5 million units/ml in vial capsule, 40 mg injection, 2 mg/ml in 10ml ampoule powder for injection 10 mg (sulfate) in vial

powder for injection, 100 mg (as sodium succinate) in vial tablet, 20mg (as citrate)

tablet or capsule 50 mg 4 mg /ml (as sodium salt) in 2-ml ampoule tablet, 5 mg, 10 mg, 20 mg

tablet, 100 mg + 10 mg, 250 mg + 25 mg tablet, 2 mg (hydrochloride)

10. 10.1

tablet, equivalent to 60 mg Iron; oral liquid, equivalent to 25 mg iron/ ml tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. tablet, 5mg

injection, equivalent to 50 mg iron/ml in 2-ml ampoule

injection, 1000 IU / ml, 5000 IU / ml, 20000 IU / ml in 1ml ampoule injection, 10mg / ml in 5-ml ampoule; tablet 10 mg injection, 10mg/ml in 5-ml ampoule tablet, 5 mg (sodium salt)

Phytomenadione Protamine sulfate Warfarin Complementary Acenocoumarol 11.

tablet, 1mg

Blood Products and Plasma Substitutes

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

11.1

11.2

Plasma Substitutes Albumin, human Polygeline Plasma Fractions For Specific Use Factor VIII Concentrate Factor IX complex Cardiovascular Medicines Antianginal Medicines Atenolol Glyceryl trinitrate Verapamil Antiarrhythmic Medicines Atenolol Digoxin Isoprenaline Complementary Disopyramide Procainamide

injectable solution, 20 or 25% injectable solution, 3.5% dried concentrate dried concentrate

12. 12.1

tablet, 50 mg, 100 mg tablet (sublingual), 500 mcg tablet, 40 mg, 80 mg (hydrochloride); injection, 2.5 mg / ml in 2-ml ampoule tablet 25 mg, 50 mg, 100 mg tablet, 62.5mcg, 250mcg; oral liquid, 50 mcg / ml; injection, 250 mcg / ml in 2-ml ampoule injection, 1 mg (hydrochloride)/ml in vial capsule, 100 mg, 150 mg tablet, 250mg (hydrochloride); injection, 100 mg /ml in 10-ml ampoule tablet, 50 mg, 100 mg tablet, 5 mg, 10 mg, 20 mg tablet, 25 mg, 50 mg capsule or tablet, 10 mg, 20 mg

12.2

12.3

Antihypertensive Atenolol Enalapril Hydrochlorothiazide Nifedipine Complementary Prazosin Sodium nitroprusside

tablet 500 mcg, 1mg (mesilate) powder for infusion, 50 mg in ampoule

12.4

Medicines Used in Heart Failure Digoxin Captopril

tablet, 62.5 mcg, 250 mcg; oral solution, 50 mcg / ml; injection, 250 mcg / ml in 2-ml ampoule tablet, 12.5 mg, 25 mg

Complemenary Dobutamine 12.5 Antithrombotic Medicines Aspirin Streptokinase 12.6 Lipid Lowering Agent Atorvastatin 13. 13.1 Dermatological Medicines Antifungal Medicines Benzoic acid + Salicylic acid

injection 250 mg/ 20ml, 50 mg/ml tablet, 50mg, 75 mg, 100mg injection 750 000 IU, 1500 000 IU in vial tablet, 10 mg, 20 mg (as calcium trihydrate)

ointment or cream, 6% + 3%

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Clotrimazole Complementary Selenium sulfide 13.2 Anti-infective Medicines Povidone iodine Silver sulfadiazine Complementary Gentian violet (Methylrosanilinium chloride)

cream, 1% detergent-based suspension, 2%

solution, 5% cream, 0.2% aqueous solution 1%

13.3

Anti-inflammatory and Antipruritic Medicines Betamethasone ointment or cream, 0.1% (as valerate) Calamine lotion lotion, 15% Hydrocortisone ointment or cream, 1% (acetate) Medicines Affecting Skin Differentiation and Proliferation Benzoyl peroxide cream or lotion, 5% Coal tar solution, topical 5% Scabicides and Pediculicides Lindane (Gamma benzene hexachloride) Complementary Permethrin Diagnostic Agents Ophthalmic Medicines Fluorescein

13.4

13.5

cream or lotion, 1%

lotion 1%, cream 5%

14. 14.1

eye drops, 1%, 2% (sodium salt); injection, 10%, 20% (sodium salt) in 5-ml ampoule

14.2

Radiocontrast Media Amidotrizoate Barium sulfate Iohexol Complementary Meglumine iotroxate

injection, 140-420 mg iodine/ml (as sodium or meglumine salt) in 20ml ampoule aqueous suspension injection, 140-350 mg iodine/ml in 5-ml, 10-ml ampoule solution, 5-8 g iodine in 100-250 ml

15. 15.1

Disinfectants and Antiseptics Antiseptics Chlorhexidine Chlorine based compound Gentian violet (Methylrosanilinium chloride) Povidone iodine Rectified spirit

solution, 5% (digluconate) for dilution powder, (0.1% available chlorine) for solution aqeous solution 1% solution, 5% liquid

Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

15.2

Disinfectants Formaldehyde Glutaraldehyde Cetrimide Diuretics Furosemide Hydrochlorothiazide Mannitol Spironolactone Triamterene

solution, 3% solution, 2% solution, 20% for dilution

16.

tablet, 40 mg; injection, 10 mg/ml in 2-ml ampoule tablet, 25mg, 50mg injectable solution, 10%, 20% tablet, 25mg, 100mg tablet, 50mg

17. 17.1

Gastrointestinal Medicines Antacids and Other Anti-ulcer Medicines Dried aluminium hydroxide gel + tablet, 250mg + 250 mg Magnesium hydroxide Ranitidine tablet, 150 mg, 300 mg (as hydrochloride); injection 25 mg/ml in 2-ml ampoule Complementary Omeprazole tablet, 20 mg Antiemetic Medicines Metoclopramide Promethazine

17.2

tablet, 10 mg (hydrochloride); injection,5mg (hydrochloride)/ml in 2-ml ampoule tablet, 25 mg (theoclate); oral liquid, 5 mg (hydrochloride)/ 5ml; injection, 25 mg (hydrochloride) / ml in 2-ml ampoule tablet, 500 mg

17.3

Anti-inflammatory Medicines Sulfasalazine Laxatives Magnesium sulfate Lactulose Complementary Bisacodyl

17.4

powder, 500 g solution, 3.35 mg / 5ml

tablet, 10 mg

17.5 Medicines Used in Diarrhoea 17.5.1 Oral Rehydration Oral rehydration salts*

sachet containing: 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 be required.

17.5.2 Medicine for Diarrhoea in Children

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Zinc sulfate*

dispersible tablet, equivalent to Zinc 10 mg, 20 mg (scored) * In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts 17.6 Antispasmodic Medicines Hyoscine butylbromide

tablet, 10 mg, 20 mg; injection, 20mg/ml in 1-ml ampoule

18. 18.1

Hormones, Other Endocrine Medicines and Contraceptives Adrenal Hormones and Synthetic Substitutes Dexamethasone tablet, 500 mcg; injection, 4 mg/ml (as sodium phosphate) in 1-ml ampoule Hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial; tablet, 10 mg, 20 mg Prednisolone tablet, 5 mg, 10 mg Complementry Fludrocortisone tablet, 100 mcg (acetate) Androgens Testosterone

18.2

injection, 200 mg in 1-ml ampoule

18.3 Contraceptives 18.3.1 Oral Harmonal Contraceptives Ethinylestradiol + Levonorgestrel Ethinylestradiol + Norethisterone Levonorgestrel 18.3.2 Injectable Hormonal Contraceptive Medroxyprogesterone acetate 18.3.3 Intrauterine Devices Copper-containing devices Ring pessary 18.3.4 Barrier Methods Condoms 18.3.5 Implantable Contraceptives Levonorgestrel-releasing implant 18.4 Estrogens Ethinylestradiol

tablet, 30 mcg +150 mcg tablet, 35 mcg + 1.0 mg tablet, 750 mcg (pack of two), 1.5 mg depot injection, 150 mg / ml in 1-ml vial

Two-rod levonorgeatrel-releasing implant, each rod containing 75 mg of levonorgestrel (150 mg total) tablet, 50 mcg

18.5

Insulins and Other Antidiabetic Agents Glibenclamide tablet, 2.5mg, 5 mg Insulin - injection (soluble) injection, 40 IU / ml in 10- ml vial Intermediate acting insulin injection, 40 IU / ml in 10- ml vial (as compound insulin zinc suspension or isophane insulin) Metformin tablet, 500mg (hydrochloride) Complementary Glipizide tablet, 2.5 mg, 5 mg

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18.6

Ovulation Inducers Clomifene Progestogens Norethisterone Medroxyprogesterone acetate

tablet, 50 mg (citrate)

18.7

tablet, 5 mg tablet, 5 mg

18.8

18.9

Thyroid Hormones and Antithyroid Medicines Carbimazole tablet, 5 mg Levothyroxine tablet, 100 mcg (sodium salt) Lugol's Iodine oral solution (Iodine 5%+Potassium iodide 10%) Posterior Pituitary Hormone Desmopressin injection, 4 mcg/ml; nasal spray 10 mcg / metered spray Immunologicals Diagnostic Agents Tuberculin, purified protein derivative (PPD) Sera and Immunoglobulins Anti-D immunoglobulin (human) Antirabies hyperimmune serum Polyvenum antisnake serum Tetanus antitoxin Tetanus immunoglobulin (human)

19. 19.1

injection

19.2

injection, 250 mcg in single dose vial injection, 1000 IU in 5-ml ampoule injection in vial injection, 1 000 IU, 3 000 IU in vial injection, 500 IU in vial

19.3 Vaccines 19.3.1 For Universal Immunization BCG vaccine Diphtheria-Tetanus-Pertussis-Hepatitis B vaccine Diphtheria- Tetanus- PertussisHepatitis B -Haemophilus type b vaccine Measles vaccine (live attenuated) Poliomyelitis (oral) vaccine Tetanus toxoid (Tetanus vaccine) vaccine 19.3.2 For Specific Groups of Individuals Hepatitis A vaccine Hepatitis B vaccine Influenza vaccine Japanese Encephalitis SA 14-14-2 strain live attenuated vaccine Meningococcal vaccine vaccine Mumps vaccine Rabies vaccine, freeze-dried vaccine Rubella vaccine Typhoid vaccine Yellow fever vaccine vaccine 20. Muscle Relaxants (Peripherally Acting) and Cholinesterase Inhibitors

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Neostigmine Pancuronium bromide Suxamethonium chloride

Vecuronium bromide

tablet, 15 mg (bromide); injection 500 mcg, 2.5 mg (metilsulfate) in 1-ml ampoule injection, 2 mg / ml in 2-ml ampoule injection, 50mg /ml in 2- ml ampoule
powder for injection 10 mg in vial

21. Ophthalmological, Ear, Nose and Throat Preparations 21.1 Ophthalmological Preparations 21.1.1 Anti-infective Agents Aciclovir ointment, 3%w/w Gentamicin solution (eye drops), 0.3% Complementary Chloramphenicol applicap 1% Ciprofloxacin eye/ear drops, 0.3% (as hydrochloride); eye ointment, 0.3% Tetracycline eye ointment, 1% (hydrochloride) 21.1.2 Anti-inflammatory agents Prednisolone 21.1.3 Local Anaesthetics Lignocaine (Lidocaine) Complementary Tetracaine 21.1.4 Miotics and antiglaucoma medicines Acetazolamide Pilocarpine Timolol 21.1.5 Mydriatics Atropine 21.2. Ear, Nose and Throat Preparations Lignocaine (Lidocaine) Bismuth Iodoform Paraffin Chloramphenicol Ichthammol + Glycerine Oxymetazoline Sodium bicarbonate + Glycerin 21.3 Dental Clove oil Chlorhexidine Zinc oxide Oxytocics and Antioxytocics Oxytocics Methylergometrine Oxytocin

solution (eye drops), 0.5% injection, 2%, 4% (topical) solution (eye drops), 0.5% tablet, 250 mg solution (eye drops), 2%, 4% (hydrochloride) solution (eye drops), 0.5 % (maleate) solution (eye drops), 1% (sulfate)

topical (viscous), 2%, 4% solution, 70% ear drops, 5% ear drop, 10%+5% solution (nasal drops), 0.025%, 0.05% ear drops, 1%+5%

oil solution, 0.2% powder

22. 22.1

tablet, 200mcg (hydrogen maleate); injection, 200mcg 1ml ampoule injection, 5 IU/ml in 2-ml ampoule

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Complementary Misoprostol vaginal or oral tablet, 25 mcg Mifepristone*-misoprostol tablet, 200mg- 200 mcg * 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 Intraperitoneal dialysis solution

injection, 5mg/ml

23.

parenteral solution of appropriate composition

24. 24.1

Psychotherapeutic Medicines Medicines Used in Psychotic Disorders Chlorpromazine tablet, 50 mg, 100mg (hydrochloride); oral liquid, 25 mg (hydrochloride) / 5ml; injection, 25 mg (hydrochloride) / 5ml in 2-ml ampoule Fluphenazine injection, 25 mg (decanoate or enantate) in 1-ml ampoule Haloperidol tablet 2 mg, 5 mg; injection, 5 mg in 1-ml ampoule Complementary Thioridazine tablet, 10mg, 25mg, 100mg

24.2 Medicines Used in Mood Disorders 24.2.1 Medicines used in depressive disorders Amitriptyline tablet, 10 mg, 25 mg, 75mg (hydrochloride) Fluoxetine capsule or tablet, 20 mg (as hydrochloride) 24.2.2 Medicines Used in Bipolar Disorders Lithium carbonate capsule or tablet, 300mg 24.3 Medicines Used in Generalised Anxiety and Sleep Disorders Alprazolam tablet, 0.25 mg, 0.5 mg, 1 mg Chlordiazepoxide tablet, 10 mg, 25 mg Diazepam tablet 2 mg, 5 mg Medicines Used for Obsessive Compulsive Disorders and Panic Attacks Clomipramine capsules, 10 mg, 25 mg (hydrochloride) Medicines Used in Substance Dependence Programmes Methadone* 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 Antiasthmatic and Medicines for Chronic Obstructive Pulmonary Disease Aminophylline Injection, 25 mg/ml Epinephrine (Adrenaline) injection, 1 mg (as hydrochloride or hydrogen tartrate) in 1-ml ampoule. Hydrocortisone injection (sodium succinate) 100 mg, 200 mg in vial; tablet, 10 mg Ipratropium bromide inhalation, 20 mcg/ dose

24.4 24.5

25. 25.1

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Salbutamol

Sodium cromoglicate Complementary Beclomethasone Theophylline 26. 26.1

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

inhalation (aerosol), 50mcg (as dipropionate) per dose tablet, 300 mg

Solution Correcting Water, Electrolyte and Acid Base Disturbances Oral Oral rehydration salts* sachet containing: 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 Parenteral Compound solution of Sodium lactate (Ringer's Lactate) Glucose Glucose with Sodium chloride Potassium chloride Sodium chloride Sodium bi-carbonate Miscellaneous Water for injection Ethyl alcohol Complementary Disulfiram Vitamins and Minerals Ascorbic acid Calcium gluconate Ergocalciferol Pyridoxine Retinol

26.2

injectable solution injectable solution, 5% isotonic, 50% hypertonic injectable solution, 5% glucose, 0.9% sodium chloride injection, 11.2% in 20ml ampoule injectable solution, 0.9% isotonic injectable solution 1.4%, 8.4% solution in 10-ml ampoule

26.3

5-ml, 10-ml ampoule injection tablet, 200 mg tablet, 50mg injection, 100 mg / ml in 10-ml ampoule capsule or tablet, 1.25 mg (50 000 IU) oral solution, 250 mcg/ ml (10000 IU / ml) tablet, 25mg (hydrochloride) tablet (sugar coated), 10000 IU (5.5mg. capsule, 20000 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 tablet, 5 mg tablet containing:

27.

Retinol +DL-alpha-tocopherol

Riboflavin Vitamin B complex

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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

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

------------------------------------------------------------------------------------------------------------------------------------------------------1. 1.1 Anaesthetics General Anaesthetics and Oxygen Halothane Ketamine Oxygen Thiopental Local anaesthetics Lignocaine@ (lidocaine) Lignocaine + epinephrine (Lidocaine+adrenaline)

inhalation injection, 50 mg /ml in 10 ml vial inhalation (medicinal gas) powder for injection, 0.5 g, 1.0 g in ampoule

y y -

1.2

injection, 2% in vial Lignocaine 2% (hydrochloride) + epinephrine 1:200 000, in vial

y@ -

y@ -

y@ -

2. 2.1

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) Ibuprofen tablet, 200 mg, 400 mg y y y Paracetamol@ tablet, 500mg; oral liquid, 125 mg/5ml; injection, 150 mg/ml y@ y@ y@ Complementary Aspirin@ 300 mg y y y Diclofenac sodium tablet, 50 mg y injection, 25 mg in 1-ml vial y y Opioid Analgesics Pethidine Drugs Used to Treat Gout Complementary Allopurinol Colchicine

2.2

injection, 50mg (hydrochloride) in 1-ml ampoule

2.3

tablet, 100 mg tablet, 500 mcg

y y

3. 3.1

3.2

Antiallergics and Medicines Used in Anaphylaxis Antiallergics Chlorpheniramine@ tablet, 4 mg (maleate) Epinephrine (adrenaline) injection, 1mg in 1-ml ampoule Hydrocortisone powder for injection, 100mg (as sodium succinate) Pheniramine@ injection, 22.75 mg (maleate) /ml Prednisolone tablet, 5mg Drugs Used in Shock Dopamine injection, 40 mg/ml Epinephrine injection, 1:10 000 in 1-ml ampoule Antidotes and Other Substances Used in Poisonings Non-Specific Charcoal, activated @ powder Specific Atropine@ injection, 1 mg (sulfate) Naloxone injection, 400 mcg in 1-ml ampoule Pralidoxime injection, 1g or 500mg (mesilate, chloride or iodide) in ampoule Complementary Acetylcysteine injection, 200 mg/ml in 10-ml vial Antiepileptics / Anticonvulsants

y@ y y y@ y y y

y@ y y@ -

y@ y y@ -

4. 4.1 4.2

y@ y@ y y -

y@ y@ -

5.

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Diazepam Carbamazepine Phenobarbital@ Phenytoin

injection, 5mg/ml in 2-ml (intravenous or rectal) tablet, 100 mg, 200 mg tablet, 15 mg, 30 mg@ capsule or tablet, 25 mg, 50 mg, 100 mg injection, 50 mg/ml in 5-ml vial Magnesium sulphate * @ injection, 50 mg/ml in 2 ml ampoule * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders 6. 6.1 6.1.1 Anti-infective Medicines Anthelmintics Intestinal Anthelmintics Albendazole@ Complementary Praziquantel Antifilarials Diethylcarbamazine Antibacterials Beta-lactum Medicines Amoxicillin@ Ampicillin Benzathine benzylpenicillin Benzylpenicillin (Penicillin G) Cloxacillin

y y y y y@

y y@

y@

tablet (chewable), 400 mg tablet, 150 mg, 600 mg tablet,50 mg, 100 mg (dihydrogen citrate)

y@ y

y@ y

y@ y

6.1.2

6.2 6.2.1

capsule, 500mg (as trihydrate); 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) (as sodium or potassium salt) in vial capsule, 250 mg, 500 mg powder for oral liquid, 125 mg / 5ml injection, 250 mg, 500 mg (as sodium salt) in vial

y@ y (C) y(C) y y y y y(C)

y@ -

y@ -

6.2.2

Complementary Cefixime# capsule, 200 mg #Only listed for single-dose treatment of uncomplicated ano-genital gonorrhoea Other Antibacterials Azithromycin* capsule or tablet 250 mg, 500 mg; oral liquid, 200 mg /5ml. *Only listed for single-dose treatment of genital Chlamydia trachomatis and trachoma. Chloramphenicol@ @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) capsule, 100mg (as hydrochloride) injection, 10 mg, 40 mg / ml @in 2-ml vial @tablet, 200 mg, 400 mg @oral suspension, 200 mg (as benzoate) / 5ml injection, 500 mg in 100-ml vial tablet, 100 mg dispersible tablet, 100mg+20 mg, 200 mg+ 40 mg; tablet 400 mg + 80 mg, 800 mg+ 160 mg tablet, 250 mg (stearate); oral suspension, 250 mg / 5ml (stearate) tablet, 250 mg, 500 mg capsule, 50 mg, 100 mg tablet, 50 mg, 100 mg

y(C) y(C)

y(C) y(C)

y (C) y(C)

Ciprofloxacin @ Doxycycline Gentamycin@ Metronidazole@

Nitrofurantoin Sulfamethoxazole+Trimethoprim@ Complementary Erythromycin Nalidixic acid Antileprosy Medicines Clofazimine Dapsone

y y y y@ y y@ y@ y@ y(C) y y@

y@ y y@ y@ y@ y@

y y y@ y@ y@ y@

y y y y

y y

6.2.3

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6.2.4

Rifampicin Antitubercular Medicines Ethambutol Isoniazid Isoniazid+Ethambutol Rifampicin Rifampicin+isoniazid Rifampicin+isoniazid+ethambutol Rifampicin+isoniazid+pyrazinamide Rifampicin+isoniazid+pyrazinamide+ ethambutol Streptomycin Complementary list:

capsule or tablet 150 mg, 300 mg tablet, 400 mg (hydrochloride) tablet, 100 mg, 300 mg tablet, 150mg + 400mg capsule or tablet, 150mg, 300mg tablet, 60 mg+ 30 mg, 150mg + 75 mg tablet, 150 mg+ 75 mg+2 75 mg tablet, 60 mg+ 30 mg+150 mg

y y y y y

y y -

y y

6.3

Cycloserine Ethionamide Kanamycin Ofloxacin p-aminosalicylic acid (PAS) Pyrazinamide Antifungal Medicines Clotrimazole Fluconazole

tablet, 150 mg+ 75 mg + 400 mg + 275 mg y powder for injection, 1 g (as sulfate) in vial y Second-line medicines for the treatment of multi-drug resistant (MDR-TB) - to be made available only in specialised centres standard treatment protocol. tablet, 250 mg tablet, 250 mg powder for injection 1 g in vial tablet, 200 mg granules, 4 g in sachet; tablet 500 mg tablet, 400mg cream 1%, pessary 100 mg capsule or tablet, 150 mg y(C) y(C)

tuberculosis adhering to y(C) -

6.4 6.4.1

6.4.2

6.4.3

Antiprotozoal Medicines Antiamoebic and Antigiardiasis Medicines Metronidazole@ tablet, 200mg, 400mg; oral liquid, 200 mg (as benzoate) / 5 ml. y@ Complementary Tinidazole tablet, 500mg y Antileishmaniasis Medicines Miltefosine capsule, 50 mg y Complementary Amphotericin B powder for injection, 50 mg in vial y Sodium stibogluconate injection, 100mg/ml y Antimalarial Medicines Artesunate injection, ampoules, containing 60 mg anhydrous artesunic acid with a separate ampoule of 5% sodium bicarbonate solution; tablet 50 mg y Artemether* oily injection, 80 mg/ml in 1-ml ampoule. y * For use in the management of severe malaria. Artemether+lumefantrine# tablet, 20 mg+ 120 mg y # Not recommended in the first trimester of pregnancy or in children below 5 kg. Chloroquine 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 Primaquine tablet, 7.5 mg, 15 mg (as diphosphate) y Sulfadoxine + Pyrimethamine tablet, 500 mg + 25 mg y Complementary Quinine tablet, 300 mg (as bisulfate or sulfate) injection, 300mg (as dihydrochloride)/ ml in 2-ml ampoule. y Medicines Affecting the Blood Antianaemia Medicines

y@ -

y@ -

7. 7.1

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Ferrous salt (Ferrous sulfate)* Ferrous salt (sulfate)*+Folic acid@ Folic acid *Other salts of Iron may be used Medicines Affecting Coagulation Complementary Phytomenadione

tablet, equivalent to 60 mg Iron; oral liquid, equivalent to 25 mg iron/ ml tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. tablet, 5mg

y y y@ y

y y y@ -

y y y@ -

7.2

injection, 10mg/ml in 5-ml ampoule

8.

Blood Products and Plasma Substitutes Polygeline injectable solution, 3.5% Cardiovascular Medicines Antianginal Medicines Complementary Glyceryl trinitrate Antihypertensive Amlodipine Atenolol@ Hydrochlorothiazide Nifedipine Complementary Enalapril Medicines Used in Heart Failure Digoxin Dermatological Medicines Antifungal Medicines Benzoic acid + Salicylic acid@ Clotrimazole Anti-infective Medicines Povidone iodine@ Silver sulfadiazine Complementary Gentian violet (methylrosanilinium chloride)

y (C)

9. 9.1

tablet (sublingual), 500 mcg

9.2

tablet, 5 mg tablet, 50 mg tablet, 25 mg capsule or tablet, 10 mg tablet, 5 mg

y y@ y y y

y(C) y@ y y -

9.3

tablet, 62.5 mcg, 250 mcg

10. 10.1

ointment or cream, 6% + 3% ointment or cream, 2% solution, 5% cream, 0.2%

y@ y y@ y

y@ y@ y

y y@ -

10.2

aqueous solution 1%

10.3

Anti-inflammatory and Antipruritic Medicines Betamethasone ointment or cream, 0.1% (as valerate) Complementary Calamine lotion@ Hydrocortisone

lotion, 15% ointment or cream, 1% (acetate)

y@ y

y@ -

y@ -

10.4

Scabicides and Pediculicides Lindane@ (Gamma benzene hexachloride) Complementary Permethrin

cream or lotion, 1%

y@

y@

y@

lotion 1%, cream 5%

11. 11.1

Disinfectants and Antiseptics Antiseptics

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Chlorhexidine Povidone iodine@ Rectified spirit 11.2 Disinfectants Formaldehyde Cetrimide Complementary Gentian violet (methylrosanilinium chloride) Chlorine base compound 12. Diuretics Furosemide@ Hydrochlorothiazide Mannitol Complementary Spironolactone 13. 13.1

solution, 5% (digluconate) for dilution solution, 5% liquid

y y@ y

y y@ y

y y@ y

solution, 3% solution, 20% for dilution

y y

aqueous solution 1% powder (0.1% available chlorine) for solution

y y

y y

y y

tablet, 40 mg injection, 10 mg/ml in 2-ml ampoule tablet, 25mg injectable solution, 20%

y@ y y y(C)

y y y -

tablet, 25mg

Gastrointestinal Medicines Antacids and Other Anti-ulcer Medicines Dried aluminium hydroxide gel + tablet, 250mg +250 mg Magnesium hydroxide@ Ranitidine tablet, 150 mg (as hydrochloride) Complementary Omeprazole tablet, 20 mg Antiemetic Medicines Metoclopramide

y@ y y

y@ y -

y@ -

13.2

Promethazine@ Laxatives Bisacodyl 13.4 Medicines used in Diarrhoea 13.4.1 Oral Rehydration Oral rehydration salts*@ 13.3

tablet, 10 mg (hydrochloride) @injection, 5 mg (hydrochloride)/ml in 2-ml ampoule tablet, 25 mg (as theoclate) tablet, 10mg

y y@ y@ y

y y@ y@ y

y y@ y y

Sachet containing: 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 be required. 13.4.2 Medicine for Diarrhoea in Children Zinc sulfate dispersible tablet, equivalent to Zinc 20 mg (scored) 13.5 Antispasmodic Medicines Hyoscine butylbromide @ @tablet, 10 mg, 20 mg; injection, 20mg / ml in 1- ml ampoule y 14. 14.1 Hormones, Other Endocrine Medicines and Contraceptives Adrenal Hormones and Synthetic Substitutes Dexamethasone tablet, 500 mcg @injection, 4 mg/ml in 1-ml ampoule

y@

y@

y@

y y@ -

y y@ -

y y@

y@

y y@

y y

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

14.2 14.2.1

14.2.2 14.2.3 14.2.4 14.3

Hydrocortisone Prednisolone Contraceptives Oral Harmonal Contraceptives Ethinylestradiol + Levonorgestrel Ethinylestradiol + Norethisterone Levonorgestrel Injectable Hormonal Contraceptive Medroxyprogesterone acetate Intrauterine Devices Copper-containing devices Barrier Methods Condoms Insulins and Other Atidiabetic Agents Glibenclamide Insulin - injection (soluble) Metformin Immunologicals Sera and immunoglobulins Anti-D immunoglobulin (human) Antirabies hyperimmune serum Polyvenum antisnake serum Tetanus antitoxin Tetanus immunoglobulin (human)

powder for injection, 100 mg in vial tablet, 5 mg, 10 mg

y y

tablet, 30 mcg +150 mcg tablet, 35 mcg + 1.0 mg tablet, 750 mcg (pack of two), 1.5 mg depot injection, 150 mg / ml in 1-ml vial

y y y y y y

y y y y y y -

y y y y y -

tablet, 2.5mg, 5 mg injection, 40 IU / ml in 10-ml vial tablet, 500 mg (hydrochloride)

y y y

15. 15.1

injection, 250 mcg in single dose vial injection, 1000 IU in 5-ml ampoule injection in vial injection, 1 000 IU, 3 000 IU in vial injection, 500 IU in vial

y y y y y

15.2 Vaccines 15.2.1 For universal immunization BCG (freeze-dried) Diphtheria-pertussis-tetanus-Hepatitis B Diphtheria-pertussis-tetanus-Hepatitis B -Haemophilus influenza b Measles Poliomyelitis (Oral) Tetanus toxoid (Tetanus vaccine) 15.2.2 For specific groups of individuals Hepatitis B vaccine Influenza Japanese Encephalitis Meningococcal vaccine Mumps Rabies vaccine Rubella Typhoid Yellow fever vaccine

vaccine vaccine vaccine vaccine (live attenuated) vaccine vaccine vaccine vaccine SA 14-14-2 strain freeze dried vaccine vaccine vaccine vaccine vaccine vaccine vaccine

y y y y y y y y y y y y y y y

16.

Muscle relaxants (peripherally acting) and cholinesterase inhibitors Complementary Neostigmine injection 500 mcg, 2.5 mg in 1-ml ampoule Ophthalmological, ear, nose and throat preparations

17.

17.1 Ophthalmological preparations 17.1.1 Anti-infective agents Chloramphenicol@

applicap 1%

y@

y@

y@

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Ciprofloxacin@ Ciprofloxacin@ Complementary Tetracycline 17.1.2 Miotics and Antiglaucoma Medicines Acetazolamide 17.2. Ear, Nose and Throat Preparations Bismuth Iodoform Paraffin Chloramphenicol Ichthammol+Glycerine Sodium bicarbonate +glycerine 17.3 Dental Clove oil@ 18. 18.1 Oxytocics and Antioxytocics Oxytocics Methylergometrine

eye/ear drpos, 0.3% (hydrochloride) eye ointment 0.3% (hydrochloride) eye ointment, 1% (hydrochloride) tablet, 250 mg solution ear drops, 5% ear drop ear drop oil

y@ y@ y y y y@

y@ y@ y y y@

y@ y y y@

18.2

Oxytocin@ Complementary Mesoprostol vaginal or oral tablet, 25 mcg Mifepristone*+misoprostol tablet, 200mg+ 200 mcg * 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 Isoxsuprine injection, 5mg/ml Psychotherapeutic medicines Alprazolam@ Amitriptyline Chlorpromazine Diazepam

tablet, 200mcg (maleate) injection, 200mcg 1-ml ampoule injection, 5 IU/ml in 1-ml ampoule

y y y@ y y

y y y@ -

y@ -

19.

tablet, 0.25 mg tablet,10 mg, 25 mg (hydrochloride) tablet,50 mg (hydrochloride) injection, 25 mg (hydrochloride)/5ml in 2-ml ampoule tablet 5 mg

y y y y y

20. 20.1

Medicines Acting on the Respiratory Tract Antiasthmatic and Medicines for Chronic Obstructive Pulmonary Disease Aminophylline tablet, 100 mg Epinephrine injection, 1 mg in 1-ml ampoule. Salbutamol@ tablet, 4 mg @ (as sulfate); oral liquid, 2mg (as sulfate)/5ml; rotacap, 200 mcg (as sulfate) per dose Complementary Theophylline Tablet, 300 mg

y y y@ y y y

y y y@ y y

y@ y y y

21. 21.1

Solution Correcting Water, Electrolyte and Acid Base Disturbances Oral Oral rehydration salts@ Sachet containing: 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@

y@

y@

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

21.2

Parenteral Compound solution of Sodium lactate (Ringer's Lactate)@ Glucose @ Glucose with Sodium chloride Potassium chloride Sodium chloride@ Sodium bi-carbonate

injectable solution

y@

y@ y y y y y@ y

y@ y y@ y y -

injectable solution, 5% isotonic, 50% hypertonic injectable solution, 5% glucose, 0.9% sodium chloride injection, 11.2% in 20ml ampoule injectable solution, 0.9% isotonic injection, 1.4%, 8.4% solution

21.3

Miscellaneous Water for injection Vitamins and Minerals Calcium gluconate Pyridoxine Retinol +DL-alpha-tocopherol

5-ml ampoule

22.

Vitamin B complex@

injection, 100 mg / ml in 10-ml ampoule tablet, 25mg (hydrochloride) 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 tablet containing: thiamine mononitrate 5 mg, riboflavin 5 mg, pyridoxine hydrochloride1.5 mg, nicotinamide 50 mg, calcium pantothenate 25 mg.

y@

y@

y@

*******

Index
National List of Essential Medicines
A Abacavir (ABC) 5 Acenocoumarol 8 Acetazolamide 13 Acetylcysteine 2 Acetylsalicylic acid see Aspirin Aciclovir 5,13 Adrenaline see Epinephrine Albendazole 3 Albumin, human 8 Allopurinol 2 Alprazolam 14 Aluminium hydroxide gel, dried 10 Amidotrizoate 9 Aminophylline 15 Amitriptyline 15 Amoxicillin 3 Amphotericin B 6 Ampicillin 3 Anti-D immunoglobulin (human) 12 Antirabies hyperimmune serum 12 Artemether 6 Artesunate 6 Ascorbic acid 16 Aspirin 1,9 Atenolol 8 Atorvastatin 9 Atropine 1,2,13 Azithromycin 3 B Barium sulfate 9

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BCG vaccine 12 Beclomethasone 15 Benzathine benzylpenicillin 3 Benzoic acid 9 Benzoyl peroxide 9 Benzylpenicillin 3 Betamethasone 9 Bicalitumide 7 Bisacodyl 10 Bismuth Iodoform Paraffin 13 Bleomycin 7 Bupivacaine 1

C Calamine lotion 9 Calcium folinate 6 Calcium gluconate 2,16 Calcium leucovorin see Calcium folinate Calcium pantothenate see Vitamin B complex Captopril 8 Carbamazepine 3 Carbidopa see Levodopa Carbimazole 12 Carboplatin 7 Cefazolin 3 Cefixime 3 Cefotaxime 3 Ceftriaxone 4 Cetrimide 10 Charcoal, activated 2 Chlorambucil 7 Chloramphenicol 4 Chloramphenicol eye applicap 13 Chloramphenicol ear drop13 Chlordiazepoxide 14 Chlorhexidine solution 10 Chlorhexidine gargle 14 Chlorine based compound 10 Chloroquine 6 Chlorpheniramine 2 Chlorpromazine 14 Ciclosporin 6 Ciprofloxacin 4 Ciprofloxacin eye/ear drops 13 Ciproflpxacin eye ointment 13 Cisplatin 6 Clofazimine 4 Clomifene 12

Clomipramine 15 Clotrimazole 5,9 Clove oil 14 Cloxacillin 3 Coal tar 9 Colchicine 2 Compound solution of sodium lactate 15 Condoms 11 Copper-containing devices 11 Cromoglicate see Sodium cromoclicate Cyclophosphamide 6 Cycloserine 4 Cytarabine 6 D Dacarbazine 7 Dactinomycin 7 Dapsone 4 Daunorubicin 7 Deferoxamine 2 Desmopressin 12 Dexamethasone 2,7,11 Dextrose see Oral Rehydration Salt Diazepam 1,3,14 Diclofenac Sodium 1 Didanosine (ddI) 5 Diethylcarbamazine 3 Digoxin 8 Diloxanide 5 Dimercaprol 2 Diphtheria-Tetanus-PertussisHepatitis B vaccine 12 Diphtheria-Tetanus-PertussisHepatitis B-Haemophilus type b 12 Disopyramide 8 Disulfiram 15 DL-alpha-tocopherol 16 Dobutamine 8 Dopamine 2 Doxorubicin 6 Doxycycline 4 E Efavirenz (EFV or EFZ) 5 Enalapril 8 Ephedrine 1 Epinephrine 1,2,15 Epirubicin 7 Ergocalciferol 16 Ergotamine 6 Erythromycin 4

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Ethambutol 4 Ethinylestradiol 12 Ethionamide 4 Ethyl alcohol 15 Etoposide 6 F Factor IX complex 8 Factor VIII concentrate 8 Ferrous salt 7 Fluconazole 5 Fludrocortisone 11 Fluorescein 9 Fluorouracil 6 Fluoxetine 14 Fluphenazine 14 Flutamide Folic acid 7 Formaldehyde 10 Furosemide 10 G Gamma benzene hexachloride see Lindane Gentian violet 10 Gentamicin 4 Gentamicin eye drops 13 Glibenclamide 12 Glipizide 12 Glucose injectable 15 Glutaraldehyde 10 Glycerine ear drop see Ichthammol or Sodium bicarbonate Glyceryl trinitrate 8 Granulocyte Colony Stimulating Factor 6 H Haloperidol 14 Halothane 1 Heparin sodium 7 Hepatitis A vaccine 13 Hepatitis B vaccine 13 Hydrochlorothiazide 8,10 Hydrocortisone 2,7,11 Hydrocortisone ointment 9 Hydroxy urea 6 Hyoscine butylbromide 11 I Ibuprofen 1 Ichthammol 14 Idoxuridine 6 Ifosfamide 6

Indinavir (IDV) 5 Influenza vaccine 13 Insulin injection 12 Interferon 7 Intermediate acting insulin 12 Intraperitoneal dialysis solution 14 Iodine see Lugol's iodine and Povidone iodine Iohexol 9 Ipratropium bromide 15 Iron Dextran 7 Isoflurane 1 Isoniazid 4 Isoprenaline 8 Isoxsuprine 14 J Japanese Encephalitis vaccine 13 K Kanamicin 5 Ketamine 1 L Lactulose 10 L-Asparaginase 6 Lamivudine (3TC) 5 Levodopa 7 Levonorgestrel 11 Levothyroxine 12 Lidocaine see Lignocaine Lignocaine 1,13 Lindane 9 Lithium carbonate 14 Lomustine 7 Lopinavir 5 Lugol's iodine 12 Lumefantrine 6 M Magnesium hydroxide 10 Magnesium sulfate injection 3 Magnesium sulfate powder 10 Mannitol 10 Measles vaccine 12 Medroxyprogesterone acetate 11,12 Meglumine iotroxate 9 Melphalan 6 Meningococcal vaccine 13 Mensa 6 Mercaptopurine 6 Metformin 12 Methotrexate 2,7 Methylene blue 2 Methylergometrine 14

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Mifepristone 14 Misoprostol 14 Methadone 15 Methylrosanilinium chloride see Gentian violet Methylthioninium chloride see Methylene blue Metoclopramide 10 Metronidazole 4,5 Miltefosine 5 Mitomycin 7 Mitoxantrone 7 Morphine 2 Mumps vaccine 13 N Nalidixic acid 4 Naloxone 2 Nelfinavir (NFV) 5 Neostigmine 13 Nevirapine (NVP) 5 Niclosamide 3 Nicotinamide see Vitamin B Complex Nifedipine 8 Nitrofurantoin 4 Nitrous oxide 1 Norethisterone 11,12 Nystatin 5 O Ofloxacin 5 Omeprazole 10 Ondansetron 7 Oral rehydration salts 11,15 Oxygen 1 Oxymetazoline 14 Oxytocin 14 P Pancuronium bromide 13 Para Amino Salicylic Acid (PAS) 5 Paracetamol 1,6 Paradehyde 3 Penicillin G see Benzylpenicillin PenicillinV see Phenoxymethylpenicillin Permethrin 9 Pethidine 2 Pheniramine 2 Phenobarbital 3 Phenoxymethylpenicillin 3 Phenytoin 3 Phytomenadione 8 Pilocarpine 13 Poliomyelitis vaccine 12

Polygeline 8 Polyvenum antisnake serum 12 Potassium ferric hexacyano-ferrate see Prussian blue Potassium chloride see Oral Rehydration Salt Potassium chloride injection 15 Povidone Iodine 10 Pralidoxime 2 Praziquantel 3 Prazosin 8 Prednisolone 2,7,11 Prednisolone eye drop 13 Primaquine 6 Procainamide 8 Procaine benzylpenicillin 3 Promethazine 10 Propofol 1 Propranolol 6 Protamine sulfate 8 Pyrazinamide 5 Pyridoxine 16 Pyrimethamine see Sulfadoxine Prussian blue 2 Q Quinine 6 R Ring pessary 11 Ringer's lactate solution see Compound solution of sodium lactate Ritonavir 5 Rabies vaccine 12 Ranitidine 10 Rectified spirit 10 Retinol 16 Riboflavin 16 Rifampicin 4 Rubella vaccine 13 S Salbutamol 15 Salicylic acid 9 Saquinavir (SQV) 5 Selenium sulfide 9 Silver sulfadiazine 9 Sodium bicarbonate injection15 Sodium bicarbonate +Glycerine ear drop 14 Sodium calcium edetate 2 Sodium chloride see Oral Rehydration Salt Sodium chloride injection15 Sodium cromoclicate 15 Sodium nitrite 2

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Sodium nitroprusside 8 Sodium stibogluconate 6 Spironolactone 10 Stavudine (d4T) 5 Streptokinase 9 Streptomycin 4 Sulfadoxine 6 Sulfamethoxazole 4 Sulphasalazine 10 Suxamethonium chloride 13 T Tamoxifen 7 Tenofovir disoproxil fumarate (TDF) 5 Testosterone 11 Tetanus antitoxin 12 Tetanus immunoglobulin (human) 12 Tetanus toxoid 12 Tetracaine 13 Tetracyline eye ointment 13 Theophylline 15 Thiamine see Vitamin B complex Thiopental 1 Thioridazine 14 Timolol 13 Tinidazole 5

Triamterene 10 Trihexyphenidyl 7 Trimethoprim see Sulfamethoxazole Trisodium citrate see Oral Rehydration Salt Tuberculin, purified protien derivative (PPD) injection 12 Typhoid vaccine 13 V Valproic acid 3 Vecuronium bromide 13 Verapamil 8 Vinblastine 7 Vincristine 7 Vitamin B complex 16 W Warfarin 8 Water for injection 15 Y Yellow fever vaccine 13 Z Zidovudine (ZDV or AZT) 5 Zinc oxide 14 Zinc sulfate 11

List of Essential Medicines for District Hospital

A Acetazolamide 23 Acetylcysteine 18 Acetylsalicylic acid see Aspirin Adrenaline see Epinephrine Albendazole 18 Allopurinol 17 Alprazolam 23 Aluminium hydroxide gel, dried 21 Aminophylline 24 Amitriptyline 23 Amlodipine 20 Amoxicillin 18 Amphotericin B 19 Ampicillin 18 Anti-D immunoglobulin (human) 22 Antirabies hyperimmune serum 22 Artemether 20 Artesunate 20 Aspirin 17 Atenolol 20 Atropine 18 Azithromycin 18 B BCG vaccine 22 Benzathine benzylpenicillin 18 Benzoic acid 20 Benzylpenicillin 18 Betamethasone 21 Bisacodyl 21 Bismuth Iodoform Paraffin 23 C Calamine lotion 21 Calcium gluconate 24 Calcium pantothenate see Vitamin B complex Carbamazepine 18 Cefixime 18 Cetrimide 21 Charcoal, activated 18 Chloramphenicol 19 Chloramphenicol eye applicap 23 Chloramphenicol ear drop 23

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Chlorhexidine solution 21 Chlorine based compound 21 Chloroquine 20 Chlorpheniramine 17 Chlorpromazine 23 Ciprofloxacin 19 Ciprofloxacin eye/ear drops 23 Ciproflpxacin eye ointment 23 Clofazimine 19 Clotrimazole 19,20 Clove oil 23 Cloxacillin 18 Colchicine 17 Condoms 22 Compound solution of Sodium lactate 24 Copper-containing devices 22 Cycloserine 19 D Dapsone 19 Dexamethasone 22 Dextrose see Oral Rehydration Salt Diazepam 18,23 Diclofenac Sodium 17 Diethylcarbamazine 18 Digoxin 20 Diphtheria-Tetanus-PertussisHepatitis B vaccine 22 Diphtheria-Tetanus-PertussisHepatitis B-Haemophilus type b 22 DL-alpha-tocopherol 24 Dopamine 18 Doxorubicin Doxycycline 19 E Enalapril 20 Epinephrine 17,18,24 Erythromycin 19 Ethambutol 19 Ethinylestradiol 22 Ethionamide 19 F Ferrous salt 20 Fluconazole 19 Folic acid 20 Formaldehyde 21 Furosemide 21 G Gamma Benzene hexachloride see Lindane Gentian violet 21 Gentamicin 19

Glibenclamide 22 Glucose injectable 24 Glycerine ear drop see with Ichthammol or Sodium bicarbonate Glyceryl trinitrate 20 H Halothane 17 Hepatitis B vaccine 23 Hydrochlorothiazide 20,21 Hydrocortisone 17,22 Hydrocortisone ointment 21 Hyoscine butylbromide 22 Ibuprofen 17 Ichthammol 23 Ifosfamide 6 Influenza vaccine 23 Insulin injection 22 Iodine see Lugol's iodine and Povidone iodine Isoniazid 19 Isoxsuprine 23 J Japanese Encephalitis vaccine 23 K Kanamicin 19 Ketamine 17 L Levonorgestrel 22 Lidocaine see Lignocaine Lignocaine 17 Lindane 21 Lumefantrine 20 M Magnesium hydroxide 21 Magnesium sulfate injection 18 Mannitol 21 Measles vaccine 22 Medroxyprogesterone acetate 22 Meningococcal vaccine 23 Metformin 22 Methylergometrine 23 Mifepristone 23 Misoprostol 23 Methylrosanilinium chloride see Gentian violet Metoclopramide 21 Metronidazole 19 Miltefosine 19 Mumps vaccine 23 N Nalidixic acid 19 Naloxone 18

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Neostigmine 23 Nicotinamide see Vitamin B Complex Nifedipine 20 Nitrofurantoin 19 Norethisterone 22 O Ofloxacin 19 Omeprazole 21 Oral rehydration salts 22,24 Oxygen 17 Oxytocin 23 P Para Amino Salicylic Acid (PAS) 19 Paracetamol 17 Penicillin G see Benzylpenicillin Permethrin 21 Pethidine 17 Pheniramine 18 Phenobarbital 18 Phenytoin 18 Phytomenadione 20 Poliomyelitis vaccine 22 Polygeline 20 Polyvenum antisnake serum22 Potassium chloride see Oral Rehydration Salt Potassium chloride injection 24 Povidone Iodine 20,21 Pralidoxime 18 Praziquantel 18 Prednisolone 18,22 Primaquine 20 Promethazine 21 Pyrazinamide 19 Pyridoxine 24 Pyrimethamine see Sulfadoxine Q Quinine 20 R Ringer's lactate solution see Compound solution of sodium lactate Rabies vaccine 23 Ranitidine 21 Rectified spirit 21 Retinol 24 Riboflavin see Vitamin B complex Rifampicin 19 Rubella vaccine 23 S Salbutamol 24 Salicylic acid 20 Silver sulfadiazine 20 Sodium bicarbonate injection 24

Sodium bicarbonate +Glycerine ear drop 23 Sodium chloride see Oral Rehydration Salt Sodium chloride injection 24 Sodium stibogluconate 19 Spironolactone 21 Streptomycin 19 Sulfadoxine 20 Sulfamethoxazole 19 T Tetanus antitoxin 22 Tetanus immunoglobulin (human) 22 Tetanus toxoid 22 Tetracyline eye ointment 23 Theophylline 24 Thiamine see Vitamin B complex Thiopental 17 Tinidazole 19 Trimethoprim see Sulfamethoxazole Trisodium citrate see Oral Rehydration Salt Tuberculin, purified protien derivative (PPD) injection Typhoid vaccine 23 V Vitamin B complex 24 W Water for injection 24 Y Yellow fever vaccine 23 Z Zinc sulfate 22

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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 3. Antiallergics and Drugs Used in Anaphylaxis Deleted : Hydrocortisone tablet, 10 mg Added: Dexamethasone phosphate injection, 4 mg (as sodium salt) in 1 ml ampoule 4. Antidotes and Other Substances Used in Poisonings Added: (Complementary list) Calcium gluconate, Deferoxamine, Methylene blue, Prussian blue, Sodium calcium adetate; Sodium nitrite 5. Antiepileptics / Anticonvulsants

2.

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Added: Carbamazepine chewable tablet 100 mg, 200 mg; Diazepam rectal 6.1 6.2 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 deleted. 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 150 mg+ 300 mg. 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 6.5.3 Antimalarial Medicines Added: Artesunate; Artemether; Artemether+ lumfantrine 7.1 8. Antimigraine medicines Added: Paracetamol tablet 500 mg 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 12.2 Antianginal medicines Added: Atenolol Deleted: Isosorbide dinitrate Antiarrhythmic medicines Deleted: Mefloquine Deleted: Pentamidine

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Added: Atenolol 12.3 12.5 12.6 13.1 13.2

Deleted: Lignocaine

Antihypertensive medicines Deleted: Methyldopa; Hydralazine Antithrombotic medicine Added: Aspirin 75 mg Lipid lowering agent Added: Atrovastatin Antifungal medicines Changes: Miconazole replaced by Clotrimazole Anti-infective medicines Deleted: Mercurochrome; Nitrofurazone; Potassium permanganate solution Changes: Gentian violet in complementary list

13.4 13.4 13.5

Astringent medicines: heading and Aluminium diacetate deleted Medicine affecting skin differentiation and prolifiration Deleted: Salicylic acid solution Scabicides and pediculocides Added: Permethrin lotion or cream in complementary list Deleted: Benzyl benzoate emulsion

14.2 15.

Radiocontrast Media Added: Iohexol; Meglumine iotroxate 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 based compound Deleted: Iopanoic acid; Metrizamide; Sodium iodide

17.1 Antacids and other anti-ulcer medicines Added: Ranitidine injection Changes: Omiprazole in complementary list 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 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 Added: Bisacodyl 17.5 Medicines used in diarrhoea

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

18.1

Adrenal hormone and synthetic substitute Added: Prednisolone tablet 10 mg 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 (150 mg total) 18.5 18.8 18.5 Insulins and Other Antidiabetic Agents Deleted: Protamine Zinc Insulin - injection (long acting) Thyroid hormones and antithyroid medicines Deleted: Iodine injection Insulins and Other Antidiabetic Agents Deleted: Protamine Zinc Insulin - injection (long acting); Iodine - injection 19. 19.3 Immunologicals Vaccines Added: Diphtheria- tetanus- pertussis-Hepatitis B vaccine; Diphtheria- tetanus- pertussis Hepatitis B -Haemophilus type b vaccine Deleted: Diphtheria- tetanus- pertussis vaccine; Diphtheria- tetanus vaccine 19.3.2 For Specific Groups of Individuals Added: Hepatitis A vaccine 21. 21.1 Ophthalmological, Ear, Nose and Throat Preparations 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 Dental Deleted: Tannic acid+ glycerin solution Oxytocics and Antioxytocics Changes: Ergometrine changed to methylergometrine; Oxyticin: "5 IU/ml in 1-ml ampoule" instead of "10 IU in 1-ml ampoule" Added: Mesoprostol tablet, Mifepristone-misoprostol tablet 24. Psychotherapeutic medicines 24.2.1 Medicines used in depressive disorders

19.3.1For universal immunization

21.3 22.

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Added: Fluoxetine 24.3 24.5 26. 26.1 26.2 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 Oral Change: Oral rehydration salts according to WHO's new formula 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% 27. Vitamins & Minerals Added: Retinol +DL-alpha-tocopherol soft gelatin capsule; B-complex tablet for institution supply Deleted: Nicotinamide tablet, Thiamine tablet

DISTRICT LEVEL 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 complementary list 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 tablet; Deleted: Tetracycline; Amixicillin dry syrup125 mg/5ml & powder for injection 500 mg (as sodium salt). 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

2.

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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 mg+ 75 mg+2 75 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 150 mg+ 300 mg. 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 6.4.3 Antimalarial Medicines Added: Artesunate; Artemether; Artemether+ lumfantrine 7.1 Antianaemia Medicines Deleted: Hydroxocobalamin injection Changes: Folic acid (With Iron) changed to "400 mcg" from "250 mcg" ; Folic acid tablet changed to "5 mg" from "1 mg" 9. 10. Cardiovascular Medicines Deleted: Isosorbide dinitrate, Lignocaine, Methyldopa; Hydralazine Dermatological medicines Deleted: Mercurochrome, Nitrofurazone, Potassium permanganate solution, Aluminium diacetate, Salicylic acid, Benzyl benzoate Added: Permethrin lotion or cream (complementary list). Changes: Miconazole replaced by Clotrimazole; Gentian violet, Calamine lotion, Hydrocortisone to complementary list 11. 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 based compound 12. 13. Diuretics Deleted: Triamterene Gastrointestinal Drugs Deleted: Senna Added: Zinc tablet. . Title of anihaemorrhoidal drugs deleted. ORS as per WHO's new formula. Deleted: Mefloquine Deleted: Pentamidine

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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 15.

Insulins and Other Antidiabetic Agents Deleted: Insulin intermediate acting Immunologicals Deleted: PPD, DT vaccine, DPT vaccine Added: DTP HepB; DTP HepB, Hib vaccine

16.

Muscle relaxants (peripherally acting) and cholinesterase inhibitors Deleted : Suxamethonium chloride, Pancuronium bromide

Neostigmine in complementary list 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%"; 18. 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 22. 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

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Draft: National List of Essential Medicines - Nepal, Fourth Revision, 2009

Halothane, inhalation 4. Antidote Charcoal, activated Atropine 5. Antiepileptics/Anticonvulsants

"1-2%" deleted "10g in sachet" deleted, "slurry in sorbitol" added "or 0.65 mg in" deleted, "powder for injection 200 mg (sulfate) in vial" added

Content changed to: Magnesium sulfate* 6.1.1 Intestinal Anthelmintics Praziquantel 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 vial" added Charcoal, activated Atropine "500 mg" changed to "600 mg" injection, 500 mg/ml in 2-ml ampoule. * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders

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.

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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: director@dda.gov.np; Telephone (01) 4780432; 4780227; Fax (01) 4780572 This draft is also available at: dda.gov.np

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