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Final Draft

NATIONAL LIST OF ESSENTIAL 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

______Generic Name 1. Anaesthetics 1.1 General Anaesthetics and Oxygen inhalation , 50 mg/ml (as hydrochloride) in 10-ml vial inhalation Oxygen inhalation (medicinal gas) Thiopental for injection, 0.5g, 1.0g (sodium salt) in ampoule

Complementary injection, 10mg/ml in 20-ml ampoule

1.2 Local Anaesthetics Bupivacaine injection, 0.25%, 0.5% (hydrochloride) in vial (Lignocaine) injection, 1%, 2% (hydrochloride) in vial; injection for spinal anaesthesia, 5% (hydrochloride) in 2-ml ampoule to be mixed with 7.5% glucose Lidocaine + epinephrine () injection, lignocaine 2%(hydrochloride) + epinephrine 1:200 000, in vial Complementary injection, 30 mg (hydrochloride)/ml in 1-ml ampoule (For use in spinal anaesthesia during delivery, to prevent hypotension) 1.3 Preoperative Medication and Sedation for Short-term Procedures injection, 1 mg (sulfate) in 1-ml ampoule Diazepam injection, 5mg/ml in 2-ml ampoule injection, 10 mg (sulfate or hydrochloride) in 1-ml ampoule

2. , 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- Analgesics & NSAIMs Ibuprofen , 200 mg, 400 mg tablet, 500mg; injection, 150 mg/ml; oral , 125 mg/5ml Complementary Aspirin tablet, 300 mg Diclofenac sodium tablet, 50 mg; injection, 25 mg/ml

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

2.2. Analgesics Morphine 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 2.3 Medicines Used to Treat Gout Complementary Allopurinol tablet, 100 mg Colchicine tablet, 500 mcg 2.4 Disease Modifying Agents Used in Rheumatic Disorders (DMARDs) Methotrexate tablet, 2.5mg (as sodium salt)

3. Antiallergics and Medicines Used in Anaphylaxis 3.1 Antiallergics Chlorpheniramine tablet, 4 mg (maleate) phosphate injection, 4 mg (as sodium salt) in 1-ml ampoule Epinephrine (adrenaline) injection, 1mg (as hydrochloride or tartrate) in 1-ml ampoule powder for injection, 100 mg (as sodium succinate) in vial

Pheniramine injection, 22.75 mg (maleate) /ml tablet, 5mg 3.2 Medicines Used in Shock injection, 40 mg/ml Epinephrine (Adrenaline) injection, 1:10 000 in 1-ml ampoule

4. Antidotes and Other Substances Used in Poisonings 4.1 Non-Specific Charcoal, activated powder; slurry in sorbitol 4.2 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 injection, 400 mcg (hydrochloride) in 1-ml ampoule Pralidoxime injection, 500 mg or 1 g (mesilate, chloride or iodide) in ampoule Complementary Acetylcysteine injection, 200 mg/ml in 10-ml ampoule Calcium gluconate injection, 100 mg/ml in 10-ml ampoule Deferoxamine powder for injection, 500 mg (mesilate) in vial Methylthioninium chloride (Methylene injection, 10 mg/ml in 10-ml ampoule blue) Potassium ferric hexacyano-ferrate powder for (II).2H2O (Prussian blue) Sodium calcium edetate injection, 200 mg/ml in 5-ml ampoule Sodium nitrite injection, 30 mg/ml in 10-ml ampoule

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

5. Antiepileptics / 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 tablet, 15 mg, 30 mg Phenytoin 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 injection, 500 mg/ml in 2-ml ampoule

6. Anti-infective Medicines 6.1 Anthelmintics 6.1.1 Intestinal Anthelmintics Albendazole tablet (chewable), 400 mg Complementary Niclosamide tablet (chewable), 500mg Praziquantel tablet, 150 mg, 600 mg

6.1.2 Antifilarials Diethylcarbamazine tablet, 50 mg, 100 mg (dihydrogen citrate)

6.2 Antibacterials

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

3 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. 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) Doxycycline capsule, 100mg (as hydrochloride) 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 tablet, 250 mg (stearate); oral liquid, 250 mg / 5ml (stearate) Nalidixic acid tablet, 250 mg, 500 mg

6.2.3 Antileprosy Medicines Clofazimine capsule, 50 mg, 100 mg Dapsone tablet, 50 mg, 100 mg Rifampicin capsule or tablet 150 mg, 300 mg

6.2.4 Antitubercular Medicines Ethambutol tablet, 400 mg (hydrochloride) Isoniazid tablet, 100 mg, 300 mg Isoniazid+ethambutol tablet, 150mg + 400mg Rifampicin capsule or tablet, 150mg, 300mg Rifampicin+isoniazid tablet, 60 mg+ 30 mg, 150mg + 75 mg Rifampicin+isoniazid+ethambutol tablet, 150 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 Streptomycin 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. Cycloserine tablet, 250 mg Ethionamide tablet, 250 mg

Kanamycin powder for injection 1 g in vial tablet, 200 mg p-aminosalicylic acid (PAS) granules, 4 g in sachet; tablet 500 mg

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Pyrazinamide tablet, 400mg 6.3 Medicines Clotrimazole , 1%; 100 mg Fluconazole 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 (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 capsule, 50 mg Complementary Amphotericin B powder for injection, 50 mg in vial Sodium stibogluconate injection, 100mg/ml

6.5.3 Antimalarial Medicines

5 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 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 tablet, 300 mg (as bisulfate or sulfate) injection, 300mg (as dihydrochloride)/ ml in 2-ml ampoule. 7. Antimigraine Medicines 7.1 For Treatment of Acute Attack Paracetamol tablet, 500 mg tablet, 1 mg (tartrate) 7.2 For Prophylaxis tablet 20 mg, 40mg (hydrochloride)

8. Antineoplastic, Immunosuppressives and Medicines Used in Palliative Care 8.1 Immunosuppressive Medicines Ciclosporin capsule 25 mg 8.2 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 injection, 2 mg/ml in 2-ml, 4-ml vial; tablet 2mg, 4mg Vincristine powder for injection, 1 mg (sulfate) in vial

Complementary

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

Bleomycin powder for injection, 15mg (as sulfate) in vial Carboplatin injection 150 mg, 450 mg in vial Chlorambucil tablet, 2 mg, 5 mg Dactinomycin powder for injection, 500 mcg in vial Daunorubicin powder for injection 20 mg (as hydrochloride) in vial Dacarbazine powder for injection, 100 mg in vial Epirubicin injection, 10 mg, 50 mg (hydrochloride) in vial Interferon injection, 5 million units/ml in vial Lomustine capsule, 40 mg Mitoxantrone injection, 2 mg/ml in 10ml ampoule Vinblastine powder for injection 10 mg (sulfate) in vial

8.3 Hormones and Antihormones Hydrocortisone powder for injection, 100 mg (as sodium succinate) in vial Tamoxifen tablet, 20mg (as citrate)

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

9. Antiparkinsonism Medicines Levodopa + Carbidopa tablet, 100 mg + 10 mg, 250 mg + 25 mg tablet, 2 mg (hydrochloride)

10. Medicines Affecting the Blood 10.1 Antianaemia Medicines Ferrous salt (Ferrous sulfate)* tablet, equivalent to 60 mg Iron; oral liquid, equivalent to 25 mg iron/ ml Ferrous salt (sulfate)*+Folic acid tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. Folic acid tablet, 5mg *Other salts of Iron may be used

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

10.2 Medicines Affecting Coagulation Heparin sodium injection, 1000 IU / ml, 5000 IU / ml, 20000 IU / ml in 1- ml ampoule

Phytomenadione injection, 10mg / ml in 5-ml ampoule; tablet 10 mg Protamine sulfate injection, 10mg/ml in 5-ml ampoule Warfarin tablet, 5 mg (sodium salt)

Complementary Acenocoumarol tablet, 1mg

11. Blood Products and Plasma Substitutes

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

11.1 Plasma Substitutes Albumin, human injectable solution, 20 or 25% Polygeline injectable solution, 3.5% 11.2 Plasma Fractions For Specific Use Factor VIII Concentrate dried concentrate Factor IX complex dried concentrate

12. Cardiovascular Medicines 12.1 Antianginal Medicines tablet, 50 mg, 100 mg Glyceryl trinitrate tablet (sublingual), 500 mcg tablet, 40 mg, 80 mg (hydrochloride); injection, 2.5 mg / ml in 2-ml ampoule 12.2 Antiarrhythmic Medicines Atenolol tablet 25 mg, 50 mg, 100 mg Digoxin tablet, 62.5mcg, 250mcg; oral liquid, 50 mcg / ml; injection, 250 mcg / ml in 2-ml ampoule injection, 1 mg (hydrochloride)/ml in vial Complementary Disopyramide capsule, 100 mg, 150 mg Procainamide tablet, 250mg (hydrochloride); injection, 100 mg /ml in 10-ml ampoule 12.3 Antihypertensive Atenolol tablet, 50 mg, 100 mg Enalapril tablet, 5 mg, 10 mg, 20 mg Hydrochlorothiazide tablet, 25 mg, 50 mg Nifedipine capsule or tablet, 10 mg, 20 mg

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

12.4 Medicines Used in Heart Failure Digoxin tablet, 62.5 mcg, 250 mcg; oral solution, 50 mcg / ml; injection, 250 mcg / ml in 2-ml ampoule Captopril tablet, 12.5 mg, 25 mg

Complemenary injection 250 mg/ 20ml, 50 mg/ml 12.5 Antithrombotic Medicines Aspirin tablet, 50mg, 75 mg, 100mg Streptokinase injection 750 000 IU, 1500 000 IU in vial 12.6 Lipid Lowering Agent Atorvastatin tablet, 10 mg, 20 mg (as calcium trihydrate)

13. Dermatological Medicines 13.1 Antifungal Medicines Benzoic acid + Salicylic acid ointment or cream, 6% + 3%

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Clotrimazole cream, 1% Complementary Selenium sulfide detergent-based , 2%

13.2 Anti-infective Medicines Povidone iodine solution, 5% Silver sulfadiazine cream, 0.2% Complementary Gentian violet aqueous solution 1% (Methylrosanilinium chloride)

13.3 Anti-inflammatory and Antipruritic Medicines ointment or cream, 0.1% (as valerate) Calamine lotion, 15% Hydrocortisone ointment or cream, 1% (acetate)

13.4 Medicines Affecting Skin Differentiation and Proliferation Benzoyl peroxide cream or lotion, 5% Coal tar solution, topical 5%

13.5 Scabicides and Pediculicides Lindane cream or lotion, 1% (Gamma benzene hexachloride) Complementary Permethrin lotion 1%, cream 5%

14. Diagnostic Agents 14.1 Ophthalmic Medicines Fluorescein eye drops, 1%, 2% (sodium salt); injection, 10%,

20% (sodium salt) in 5-ml ampoule 14.2 Radiocontrast Media Amidotrizoate injection, 140-420 mg iodine/ml (as sodium or meglumine salt) in 20ml ampoule Barium sulfate aqueous suspension Iohexol injection, 140-350 mg iodine/ml in 5-ml, 10-ml ampoule Complementary Meglumine iotroxate solution, 5-8 g iodine in 100-250 ml

15. Disinfectants and Antiseptics 15.1 Antiseptics solution, 5% (digluconate) for dilution Chlorine based compound powder, (0.1% available chlorine) for solution Gentian violet aqeous solution 1% (Methylrosanilinium chloride) Povidone iodine solution, 5% Rectified spirit liquid

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

15.2 Disinfectants Formaldehyde solution, 3% Glutaraldehyde solution, 2% Cetrimide solution, 20% for dilution

16. Diuretics Furosemide tablet, 40 mg; injection, 10 mg/ml in 2-ml ampoule Hydrochlorothiazide tablet, 25mg, 50mg Mannitol injectable solution, 10%, 20% Spironolactone tablet, 25mg, 100mg Triamterene tablet, 50mg

17. Gastrointestinal Medicines 17.1 Antacids and Other Anti-ulcer Medicines Dried aluminium hydroxide + tablet, 250mg + 250 mg Magnesium hydroxide tablet, 150 mg, 300 mg (as hydrochloride); injection 25 mg/ml in 2-ml ampoule Complementary Omeprazole tablet, 20 mg

17.2 Antiemetic Medicines 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 17.3 Anti-inflammatory Medicines Sulfasalazine tablet, 500 mg

17.4 Laxatives Magnesium sulfate powder, 500 g Lactulose solution, 3.35 mg / 5ml

Complementary Bisacodyl 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 for Diarrhoea in Children

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

18. Hormones, Other Endocrine Medicines and Contraceptives 18.1 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)

18.2 Androgens Testosterone injection, 200 mg in 1-ml ampoule

18.3 Contraceptives 18.3.1 Oral Harmonal Contraceptives Ethinylestradiol + Levonorgestrel tablet, 30 mcg +150 mcg Ethinylestradiol + Norethisterone tablet, 35 mcg + 1.0 mg Levonorgestrel tablet, 750 mcg (pack of two), 1.5 mg 18.3.2 Injectable Hormonal Contraceptive Medroxyprogesterone acetate , 150 mg / ml in 1-ml vial

18.3.3 Intrauterine Devices Copper-containing devices Ring pessary 18.3.4 Barrier Methods Condoms 18.3.5 Implantable Contraceptives Levonorgestrel-releasing implant Two-rod levonorgeatrel-releasing implant, each rod containing 75 mg of levonorgestrel (150 mg total) 18.4 Estrogens Ethinylestradiol 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

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

18.6 Ovulation Inducers Clomifene tablet, 50 mg (citrate)

18.7 Norethisterone tablet, 5 mg Medroxyprogesterone acetate tablet, 5 mg

18.8 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%) 18.9 Posterior Pituitary Hormone Desmopressin injection, 4 mcg/ml; 10 mcg / metered spray

19. Immunologicals 19.1 Diagnostic Agents Tuberculin, purified protein derivative injection (PPD) 19.2 Sera and Immunoglobulins Anti-D immunoglobulin (human) injection, 250 mcg in single dose vial Antirabies hyperimmune serum injection, 1000 IU in 5-ml ampoule Polyvenum antisnake serum injection in vial Tetanus antitoxin injection, 1 000 IU, 3 000 IU in vial Tetanus immunoglobulin (human) injection, 500 IU in vial

19.3 Vaccines 19.3.1 For Universal Immunization BCG vaccine Diphtheria-Tetanus-Pertussis-Hepatitis B vaccine Diphtheria- Tetanus- Pertussis- Hepatitis 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 Inhibitors

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Neostigmine tablet, 15 mg (); injection 500 mcg, 2.5 mg (metilsulfate) in 1-ml ampoule Pancuronium bromide injection, 2 mg / ml in 2-ml ampoule Suxamethonium chloride injection, 50mg /ml in 2- ml ampoule Vecuronium bromide 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% eye ointment, 1% (hydrochloride)

21.1.2 Anti-inflammatory agents Prednisolone solution (eye drops), 0.5% 21.1.3 Local Anaesthetics Lignocaine (Lidocaine) injection, 2%, 4% (topical) Complementary Tetracaine solution (eye drops), 0.5% 21.1.4 Miotics and antiglaucoma medicines Acetazolamide tablet, 250 mg solution (eye drops), 2%, 4% (hydrochloride) solution (eye drops), 0.5 % (maleate) 21.1.5 Mydriatics Atropine solution (eye drops), 1% (sulfate)

21.2. Ear, Nose and Throat Preparations Lignocaine (Lidocaine) topical (viscous), 2%, 4% Bismuth Iodoform Paraffin solution, 70% Chloramphenicol ear drops, 5% Ichthammol + Glycerine ear drop, 10%+5% solution (nasal drops), 0.025%, 0.05% Sodium bicarbonate + Glycerin ear drops, 1%+5%

21.3 Dental Clove oil oil Chlorhexidine solution, 0.2% Zinc oxide powder

22. Oxytocics and Antioxytocics 22.1 Oxytocics tablet, 200mcg (hydrogen maleate); injection, 200mcg 1- ml ampoule injection, 5 IU/ml in 2-ml ampoule

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Complementary vaginal or oral tablet, 25 mcg *-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 injection, 5mg/ml

23. Peritoneal Dialysis Solution Intraperitoneal 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 tablet, 10mg, 25mg, 100mg

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 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 24.4 Medicines Used for Obsessive Compulsive Disorders and Panic Attacks capsules, 10 mg, 25 mg (hydrochloride) 24.5 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

25. Medicines Acting on the Respiratory Tract 25.1 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 inhalation, 20 mcg/ dose

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Salbutamol 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 Sodium cromoglicate inhalation (aerosol), 5 mg, 20 mg per dose

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

26. Solution Correcting Water, Electrolyte and Acid Base Disturbances 26.1 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

26.2 Parenteral Compound solution of Sodium lactate injectable solution (Ringer's Lactate) Glucose injectable solution, 5% isotonic, 50% hypertonic Glucose with Sodium chloride injectable solution, 5% glucose, 0.9% sodium chloride Potassium chloride injection, 11.2% in 20ml ampoule Sodium chloride injectable solution, 0.9% isotonic Sodium bi-carbonate injectable solution 1.4%, 8.4% solution in 10-ml ampoule

26.3 Miscellaneous Water for injection 5-ml, 10-ml ampoule Ethyl injection Complementary Disulfiram tablet, 200 mg 27. Vitamins and Minerals Ascorbic acid tablet, 50mg Calcium gluconate injection, 100 mg / ml in 10-ml ampoule Ergocalciferol capsule or tablet, 1.25 mg (50 000 IU) oral solution, 250 mcg/ ml (10000 IU / ml) Pyridoxine tablet, 25mg (hydrochloride) Retinol 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 +DL--tocopherol 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 Riboflavin tablet, 5 mg Vitamin B complex tablet containing:

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thiamine mononitrate 5 mg, riboflavin 5 mg, pyridoxine hydrochloride 1.5 mg, nicotinamide 50 mg, calcium pantothenate 25 mg.

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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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1. Anaesthetics 1.1 General Anaesthetics and Oxygen Halothane inhalation - - - Ketamine injection, 50 mg /ml in 10 ml vial y - - Oxygen inhalation (medicinal gas) y - - Thiopental powder for injection, 0.5 g, 1.0 g in ampoule - - -

1.2 Local anaesthetics Lignocaine@ (lidocaine) injection, 2% in vial y@ y@ y@ Lignocaine + epinephrine Lignocaine 2% (hydrochloride) + (Lidocaine+adrenaline) epinephrine 1:200 000, in vial - - -

2. Analgesics, Antipyretics, Non-Steroidal Anti-inflammatory Medicines (NSAIMs), Medicines Used to Treat Gout and Disease-Modifying Agents Used in Rheumatic Disorders (DMARDs) 2.1 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 -

2.2 Opioid Analgesics Pethidine injection, 50mg (hydrochloride) in 1-ml ampoule y - -

2.3 Drugs Used to Treat Gout Complementary Allopurinol tablet, 100 mg y - - Colchicine tablet, 500 mcg y - -

3. Antiallergics and Medicines Used in Anaphylaxis 3.1 Antiallergics Chlorpheniramine@ tablet, 4 mg (maleate) y@ y@ y@ Epinephrine (adrenaline) injection, 1mg in 1-ml ampoule y y y Hydrocortisone powder for injection, 100mg (as sodium succinate) y - - @ injection, 22.75 mg (maleate) /ml y@ y@ y@ Prednisolone tablet, 5mg y - - 3.2 Drugs Used in Shock Dopamine injection, 40 mg/ml y - - Epinephrine injection, 1:10 000 in 1-ml ampoule y - -

4. Antidotes and Other Substances Used in Poisonings 4.1 Non-Specific Charcoal, activated @ powder y@ y@ - 4.2 Specific Atropine@ injection, 1 mg (sulfate) y@ y@ - Naloxone injection, 400 mcg in 1-ml ampoule y - - Pralidoxime injection, 1g or 500mg (mesilate, chloride or iodide) in ampoule y - - Complementary Acetylcysteine injection, 200 mg/ml in 10-ml vial - - -

5. Antiepileptics / Anticonvulsants

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Diazepam injection, 5mg/ml in 2-ml (intravenous or rectal) y y - Carbamazepine tablet, 100 mg, 200 mg y - - Phenobarbital@ tablet, 15 mg, 30 mg@ y - - Phenytoin capsule or tablet, 25 mg, 50 mg, 100 mg injection, 50 mg/ml in 5-ml vial y - - Magnesium sulphate * @ injection, 50 mg/ml in 2 ml ampoule y@ y@ y@ * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders

6. Anti-infective Medicines

6.1 Anthelmintics 6.1.1 Intestinal Anthelmintics Albendazole@ tablet (chewable), 400 mg y@ y@ y@ Complementary Praziquantel tablet, 150 mg, 600 mg - - - 6.1.2 Antifilarials Diethylcarbamazine tablet,50 mg, 100 mg (dihydrogen citrate) y y y

6.2 Antibacterials 6.2.1 Beta-lactum Medicines Amoxicillin@ capsule, 500mg (as trihydrate); dispersible tablet, 125 mg, 250 mg (as trihydrate) y@ y@ y@ Ampicillin powder for injection, 500mg (as sodium salt) in vial y (C) - - Benzathine benzylpenicillin powder for injection, 1 200 000 IU in vial y(C) - - Benzylpenicillin injection, 300 mg (0.5 m IU), 600 mg (1 m IU) (Penicillin G) (as sodium or potassium salt) in vial y - - Cloxacillin capsule, 250 mg, 500 mg y - - powder for oral liquid, 125 mg / 5ml y - - injection, 250 mg, 500 mg (as sodium salt) in vial y - - Complementary Cefixime# capsule, 200 mg y(C) - - #Only listed for single-dose treatment of uncomplicated ano-genital gonorrhoea 6.2.2 Other Antibacterials Azithromycin* capsule or tablet 250 mg, 500 mg; y(C) y(C) y (C) oral liquid, 200 mg /5ml. y(C) y(C) y(C) *Only listed for single-dose treatment of genital Chlamydia trachomatis and trachoma.

Chloramphenicol@ @capsule, 250 mg, 500 mg; y - - @oral liquid, 125 mg / 5ml (as palmitate), y - - powder for injection, 1g (as sodium succinate) in vial y - - Ciprofloxacin @ tablet, 250 mg,@ 500 mg (as hydrochloride) y@ y@ y Doxycycline capsule, 100mg (as hydrochloride) y y y Gentamycin@ injection, 10 mg, 40 mg / ml @in 2-ml vial y@ y@ y@ Metronidazole@ @tablet, 200 mg, 400 mg y@ y@ y@ @oral suspension, 200 mg (as benzoate) / 5ml y@ y@ y@ injection, 500 mg in 100-ml vial y(C) - - Nitrofurantoin tablet, 100 mg y - - Sulfamethoxazole+Trimethoprim@ dispersible tablet, 100mg+20 mg, 200 mg+ 40 mg; tablet 400 mg + 80 mg, 800 mg+ 160 mg y@ y@ y@ Complementary Erythromycin tablet, 250 mg (stearate); oral suspension, 250 mg / 5ml (stearate) y - - Nalidixic acid tablet, 250 mg, 500 mg y - - 6.2.3 Antileprosy Medicines Clofazimine capsule, 50 mg, 100 mg y y - Dapsone tablet, 50 mg, 100 mg y y -

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Rifampicin capsule or tablet 150 mg, 300 mg y y - 6.2.4 Antitubercular Medicines Ethambutol tablet, 400 mg (hydrochloride) y - - Isoniazid tablet, 100 mg, 300 mg y - - Isoniazid+Ethambutol tablet, 150mg + 400mg y - - Rifampicin capsule or tablet, 150mg, 300mg y - - Rifampicin+isoniazid tablet, 60 mg+ 30 mg, 150mg + 75 mg y - - Rifampicin+isoniazid+ethambutol tablet, 150 mg+ 75 mg+2 75 mg y - - Rifampicin+isoniazid+pyrazinamide tablet, 60 mg+ 30 mg+150 mg y - - Rifampicin+isoniazid+pyrazinamide+ ethambutol tablet, 150 mg+ 75 mg + 400 mg + 275 mg y - - Streptomycin powder for injection, 1 g (as sulfate) in vial y - - 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. Cycloserine tablet, 250 mg - - - Ethionamide tablet, 250 mg - - - Kanamycin powder for injection 1 g in vial - - - Ofloxacin tablet, 200 mg - - - p-aminosalicylic acid (PAS) granules, 4 g in sachet; tablet 500 mg - - - Pyrazinamide tablet, 400mg - - - 6.3 Antifungal Medicines Clotrimazole cream 1%, pessary 100 mg y(C) - - Fluconazole capsule or tablet, 150 mg y(C) y(C) -

6.4 Antiprotozoal Medicines 6.4.1 Antiamoebic and Antigiardiasis Medicines Metronidazole@ tablet, 200mg, 400mg; oral liquid, 200 mg (as benzoate) / 5 ml. y@ y@ y@ Complementary Tinidazole tablet, 500mg y - - 6.4.2 Antileishmaniasis Medicines Miltefosine capsule, 50 mg y - - Complementary Amphotericin B powder for injection, 50 mg in vial y - - Sodium stibogluconate injection, 100mg/ml y - - 6.4.3 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 - -

7. Medicines Affecting the Blood 7.1 Antianaemia Medicines

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Ferrous salt (Ferrous sulfate)* tablet, equivalent to 60 mg Iron; y y y oral liquid, equivalent to 25 mg iron/ ml y y y Ferrous salt (sulfate)*+Folic acid@ tablet, equivalent to 60 mg Iron+ 400 mcg Folic acid. y@ y@ y@ Folic acid tablet, 5mg y - - *Other salts of Iron may be used 7.2 Medicines Affecting Coagulation Complementary Phytomenadione injection, 10mg/ml in 5-ml ampoule - - -

8. Blood Products and Plasma Substitutes Polygeline injectable solution, 3.5% y (C) - -

9. Cardiovascular Medicines 9.1 Antianginal Medicines Complementary Glyceryl trinitrate tablet (sublingual), 500 mcg y - -

9.2 Antihypertensive Amlodipine tablet, 5 mg y y(C) - Atenolol@ tablet, 50 mg y@ y@ - Hydrochlorothiazide tablet, 25 mg y y - Nifedipine capsule or tablet, 10 mg y y - Complementary Enalapril tablet, 5 mg y - -

9.3 Medicines Used in Heart Failure Digoxin tablet, 62.5 mcg, 250 mcg y - -

10. Dermatological Medicines 10.1 Antifungal Medicines Benzoic acid + Salicylic acid@ ointment or cream, 6% + 3% y@ y@ y Clotrimazole ointment or cream, 2% y - - 10.2 Anti-infective Medicines Povidone iodine@ solution, 5% y@ y@ y@ Silver sulfadiazine cream, 0.2% y y -

Complementary Gentian violet aqueous solution 1% y y y (methylrosanilinium chloride)

10.3 Anti-inflammatory and Antipruritic Medicines Betamethasone ointment or cream, 0.1% (as valerate) y - -

Complementary Calamine lotion@ lotion, 15% y@ y@ y@ Hydrocortisone ointment or cream, 1% (acetate) y - -

10.4 Scabicides and Pediculicides Lindane@ cream or lotion, 1% y@ y@ y@ (Gamma benzene hexachloride)

Complementary Permethrin lotion 1%, cream 5% y y y

11. Disinfectants and Antiseptics 11.1 Antiseptics

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Chlorhexidine solution, 5% (digluconate) for dilution y y y Povidone iodine@ solution, 5% y@ y@ y@ Rectified spirit liquid y y y

11.2 Disinfectants Formaldehyde solution, 3% y - - Cetrimide solution, 20% for dilution y y y

Complementary Gentian violet aqueous solution 1% y y y (methylrosanilinium chloride) Chlorine base compound powder (0.1% available chlorine) for solution y y y

12. Diuretics Furosemide@ tablet, 40 mg y@ y - injection, 10 mg/ml in 2-ml ampoule y y - Hydrochlorothiazide tablet, 25mg y y - Mannitol injectable solution, 20% y(C) - -

Complementary Spironolactone tablet, 25mg y - -

13. Gastrointestinal Medicines 13.1 Antacids and Other Anti-ulcer Medicines Dried aluminium hydroxide gel + tablet, 250mg +250 mg y@ y@ y@ Magnesium hydroxide@ Ranitidine tablet, 150 mg (as hydrochloride) y y - Complementary Omeprazole tablet, 20 mg y - -

13.2 Antiemetic Medicines Metoclopramide tablet, 10 mg (hydrochloride) y y y @injection, 5 mg (hydrochloride)/ml in 2-ml ampoule y@ y@ y@ Promethazine@ tablet, 25 mg (as theoclate) y@ y@ y 13.3 Laxatives Bisacodyl tablet, 10mg y y y 13.4 Medicines used in Diarrhoea 13.4.1 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 y@ y@ y@ * 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) y y y 13.5 Antispasmodic Medicines Hyoscine butylbromide @ @tablet, 10 mg, 20 mg; y@ y@ y@ injection, 20mg / ml in 1- ml ampoule y - -

14. Hormones, Other Endocrine Medicines and Contraceptives 14.1 Adrenal Hormones and Synthetic Substitutes Dexamethasone tablet, 500 mcg y y y @injection, 4 mg/ml in 1-ml ampoule y@ y@ y

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Hydrocortisone powder for injection, 100 mg in vial y - - Prednisolone tablet, 5 mg, 10 mg y - - 14.2 Contraceptives 14.2.1 Oral Harmonal Contraceptives Ethinylestradiol + Levonorgestrel tablet, 30 mcg +150 mcg y y y Ethinylestradiol + Norethisterone tablet, 35 mcg + 1.0 mg y y y Levonorgestrel tablet, 750 mcg (pack of two), 1.5 mg y y y 14.2.2 Injectable Hormonal Contraceptive Medroxyprogesterone acetate depot injection, 150 mg / ml in 1-ml vial y y y 14.2.3 Intrauterine Devices Copper-containing devices y y - 14.2.4 Barrier Methods Condoms y y y 14.3 Insulins and Other Atidiabetic Agents Glibenclamide tablet, 2.5mg, 5 mg y - - Insulin - injection (soluble) injection, 40 IU / ml in 10-ml vial y - - Metformin tablet, 500 mg (hydrochloride) y - -

15. Immunologicals 15.1 Sera and immunoglobulins Anti-D immunoglobulin (human) injection, 250 mcg in single dose vial y - - Antirabies hyperimmune serum injection, 1000 IU in 5-ml ampoule y - - Polyvenum antisnake serum injection in vial y - - Tetanus antitoxin injection, 1 000 IU, 3 000 IU in vial y - - Tetanus immunoglobulin (human) injection, 500 IU in vial y - -

15.2 Vaccines 15.2.1 For universal immunization BCG (freeze-dried) vaccine y - - Diphtheria-pertussis-tetanus-Hepatitis B vaccine y - - Diphtheria-pertussis-tetanus-Hepatitis B vaccine y - - -Haemophilus influenza b Measles vaccine (live attenuated) y - - Poliomyelitis (Oral) vaccine y - - Tetanus toxoid (Tetanus vaccine) vaccine y - - 15.2.2 For specific groups of individuals Hepatitis B vaccine vaccine y - - Influenza vaccine y - - Japanese Encephalitis SA 14-14-2 strain freeze dried vaccine y - - Meningococcal vaccine vaccine y - - Mumps vaccine y - - Rabies vaccine vaccine y - - Rubella vaccine y - - Typhoid vaccine y - - Yellow fever vaccine vaccine y - -

16. Muscle relaxants (peripherally acting) and cholinesterase inhibitors Complementary Neostigmine injection 500 mcg, 2.5 mg in 1-ml ampoule - - -

17. Ophthalmological, ear, nose and throat preparations

17.1 Ophthalmological preparations 17.1.1 Anti-infective agents Chloramphenicol@ applicap 1% y@ y@ y@

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Ciprofloxacin@ eye/ear drpos, 0.3% (hydrochloride) y@ y@ y@ Ciprofloxacin@ eye ointment 0.3% (hydrochloride) y@ y@ - Complementary Tetracycline eye ointment, 1% (hydrochloride) y y y 17.1.2 Miotics and Antiglaucoma Medicines Acetazolamide tablet, 250 mg y - - 17.2. Ear, Nose and Throat Preparations Bismuth Iodoform Paraffin solution - - - Chloramphenicol ear drops, 5% y y y Ichthammol+Glycerine ear drop - - - Sodium bicarbonate +glycerine ear drop - - - 17.3 Dental Clove oil@ oil y@ y@ y@

18. Oxytocics and Antioxytocics 18.1 Oxytocics Methylergometrine tablet, 200mcg (maleate) y y - injection, 200mcg 1-ml ampoule y y - Oxytocin@ injection, 5 IU/ml in 1-ml ampoule y@ y@ y@ Complementary Mesoprostol vaginal or oral tablet, 25 mcg y - - Mifepristone*+misoprostol tablet, 200mg+ 200 mcg y - - * Combi-pack, containing 1 tablet of mifepristone and 4 tablets of misoprostol. Requires close medical supervision. For health facilities approved for abortion services only. 18.2 Anti-oxytocics Complementary Isoxsuprine injection, 5mg/ml - - -

19. Psychotherapeutic medicines Alprazolam@ tablet, 0.25 mg y - - Amitriptyline tablet,10 mg, 25 mg (hydrochloride) y - - Chlorpromazine tablet,50 mg (hydrochloride) y - - injection, 25 mg (hydrochloride)/5ml in 2-ml ampoule y - - Diazepam tablet 5 mg y - -

20. Medicines Acting on the Respiratory Tract

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

21. Solution Correcting Water, Electrolyte and Acid Base Disturbances 21.1 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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21.2 Parenteral Compound solution of Sodium lactate injectable solution y@ y@ y@ (Ringer's Lactate)@ Glucose @ injectable solution, 5% isotonic, y y y 50% hypertonic y - - Glucose with Sodium chloride injectable solution, 5% glucose, 0.9% sodium chloride y - - Potassium chloride injection, 11.2% in 20ml ampoule y - - Sodium chloride@ injectable solution, 0.9% isotonic y@ y@ y Sodium bi-carbonate injection, 1.4%, 8.4% solution y - -

21.3 Miscellaneous Water for injection 5-ml ampoule y y -

22. Vitamins and Minerals Calcium gluconate injection, 100 mg / ml in 10-ml ampoule - - - Pyridoxine tablet, 25mg (hydrochloride) y - - Retinol +DL-alpha-tocopherol 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 y y y Vitamin B complex@ tablet containing: thiamine mononitrate 5 mg, riboflavin 5 mg, pyridoxine hydrochloride1.5 mg, nicotinamide 50 mg, calcium pantothenate 25 mg. y@ y@ y@

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Index National List of Essential Medicines

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

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BCG vaccine 12 Clomipramine 15 Beclomethasone 15 Clotrimazole 5,9 Benzathine benzylpenicillin 3 Clove oil 14 Benzoic acid 9 Cloxacillin 3 Benzoyl peroxide 9 Coal tar 9 Benzylpenicillin 3 Colchicine 2 Betamethasone 9 Compound solution of sodium lactate 15 Bicalitumide 7 Condoms 11 Bisacodyl 10 Copper-containing devices 11 Bismuth Iodoform Paraffin 13 Cromoglicate see Sodium Bleomycin 7 cromoclicate Bupivacaine 1 Cyclophosphamide 6 Cycloserine 4 Cytarabine 6 D C Dacarbazine 7 Calamine lotion 9 Dactinomycin 7 Calcium folinate 6 Dapsone 4 Calcium gluconate 2,16 Daunorubicin 7 Calcium leucovorin Deferoxamine 2 see Calcium folinate Desmopressin 12 Calcium pantothenate see Vitamin B complex Dexamethasone 2,7,11 Captopril 8 Dextrose see Oral Rehydration Salt Carbamazepine 3 Diazepam 1,3,14 Carbidopa see Levodopa Diclofenac Sodium 1 Carbimazole 12 Didanosine (ddI) 5 Carboplatin 7 Diethylcarbamazine 3 Cefazolin 3 Digoxin 8 Cefixime 3 Diloxanide 5 Cefotaxime 3 Dimercaprol 2 Ceftriaxone 4 Diphtheria-Tetanus-Pertussis- Cetrimide 10 Hepatitis B vaccine 12 Charcoal, activated 2 Diphtheria-Tetanus-Pertussis- Chlorambucil 7 Hepatitis B-Haemophilus type b 12 Chloramphenicol 4 Disopyramide 8 Chloramphenicol eye applicap 13 Disulfiram 15 Chloramphenicol ear drop13 DL-alpha-tocopherol 16 Chlordiazepoxide 14 Dobutamine 8 Chlorhexidine solution 10 Dopamine 2 Chlorhexidine gargle 14 Doxorubicin 6 Chlorine based compound 10 Doxycycline 4 Chloroquine 6 Chlorpheniramine 2 E Chlorpromazine 14 Efavirenz (EFV or EFZ) 5 Ciclosporin 6 Enalapril 8 Ciprofloxacin 4 Ephedrine 1 Ciprofloxacin eye/ear drops 13 Epinephrine 1,2,15 Ciproflpxacin eye ointment 13 Epirubicin 7 Cisplatin 6 Ergocalciferol 16 Clofazimine 4 Ergotamine 6 Clomifene 12 Erythromycin 4

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Ethambutol 4 Indinavir (IDV) 5 Ethinylestradiol 12 Influenza vaccine 13 Ethionamide 4 Insulin injection 12 Ethyl alcohol 15 Interferon 7 Etoposide 6 Intermediate acting insulin 12 Intraperitoneal dialysis solution 14 F Iodine see Lugol's iodine and Factor IX complex 8 Povidone iodine Factor VIII concentrate 8 Iohexol 9 Ferrous salt 7 Ipratropium bromide 15 Fluconazole 5 Iron Dextran 7 Fludrocortisone 11 Isoflurane 1 Fluorescein 9 Isoniazid 4 Fluorouracil 6 Isoprenaline 8 Fluoxetine 14 Isoxsuprine 14 Fluphenazine 14 J Flutamide Japanese Encephalitis vaccine 13 Folic acid 7 K Formaldehyde 10 Kanamicin 5 Furosemide 10 Ketamine 1 G L Gamma benzene hexachloride Lactulose 10 see Lindane L-Asparaginase 6 Gentian violet 10 Lamivudine (3TC) 5 Gentamicin 4 Levodopa 7 Gentamicin eye drops 13 Levonorgestrel 11 Glibenclamide 12 Levothyroxine 12 Glipizide 12 Lidocaine see Lignocaine Glucose injectable 15 Lignocaine 1,13 Glutaraldehyde 10 Lindane 9 Glycerine ear drop see Ichthammol or Lithium carbonate 14 Sodium bicarbonate Lomustine 7 Glyceryl trinitrate 8 Lopinavir 5 Granulocyte Colony Stimulating Lugol's iodine 12 Factor 6 Lumefantrine 6 H M Haloperidol 14 Magnesium hydroxide 10 Halothane 1 Magnesium sulfate injection 3 Heparin sodium 7 Magnesium sulfate powder 10 Hepatitis A vaccine 13 Mannitol 10 Hepatitis B vaccine 13 Measles vaccine 12 Hydrochlorothiazide 8,10 Medroxyprogesterone acetate 11,12 Hydrocortisone 2,7,11 Meglumine iotroxate 9 Hydrocortisone ointment 9 Melphalan 6 Hydroxy urea 6 Meningococcal vaccine 13 Hyoscine butylbromide 11 Mensa 6 I Mercaptopurine 6 Ibuprofen 1 Metformin 12 Ichthammol 14 Methotrexate 2,7 Idoxuridine 6 Methylene blue 2 Ifosfamide 6 Methylergometrine 14

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Mifepristone 14 Polygeline 8 Misoprostol 14 Polyvenum antisnake serum 12 Methadone 15 Potassium ferric hexacyano-ferrate Methylrosanilinium chloride see Prussian blue see Gentian violet Potassium chloride see Oral Rehydration Salt Methylthioninium chloride Potassium chloride injection 15 see Methylene blue Povidone Iodine 10 Metoclopramide 10 Pralidoxime 2 Metronidazole 4,5 Praziquantel 3 Miltefosine 5 Prazosin 8 Mitomycin 7 Prednisolone 2,7,11 Mitoxantrone 7 Prednisolone 13 Morphine 2 Primaquine 6 Mumps vaccine 13 Procainamide 8 N Procaine benzylpenicillin 3 Nalidixic acid 4 Promethazine 10 Naloxone 2 Propofol 1 Nelfinavir (NFV) 5 Propranolol 6 Neostigmine 13 Protamine sulfate 8 Nevirapine (NVP) 5 Pyrazinamide 5 Niclosamide 3 Pyridoxine 16 Nicotinamide see Vitamin B Complex Pyrimethamine see Sulfadoxine Nifedipine 8 Prussian blue 2 Nitrofurantoin 4 Q Nitrous oxide 1 Quinine 6 Norethisterone 11,12 R Nystatin 5 Ring pessary 11 O Ringer's lactate solution see Compound Ofloxacin 5 solution of sodium lactate Omeprazole 10 Ritonavir 5 Ondansetron 7 Rabies vaccine 12 Oral rehydration salts 11,15 Ranitidine 10 Oxygen 1 Rectified spirit 10 Oxymetazoline 14 Retinol 16 Oxytocin 14 Riboflavin 16 P Rifampicin 4 Pancuronium bromide 13 Rubella vaccine 13 Para Amino Salicylic Acid (PAS) 5 S Paracetamol 1,6 Salbutamol 15 Paradehyde 3 Salicylic acid 9 Penicillin G see Benzylpenicillin Saquinavir (SQV) 5 PenicillinV see Phenoxymethylpenicillin Selenium sulfide 9 Permethrin 9 Silver sulfadiazine 9 Pethidine 2 Sodium bicarbonate injection15 Pheniramine 2 Sodium bicarbonate +Glycerine Phenobarbital 3 ear drop 14 Phenoxymethylpenicillin 3 Sodium calcium edetate 2 Phenytoin 3 Sodium chloride see Oral Rehydration Salt Phytomenadione 8 Sodium chloride injection15 Pilocarpine 13 Sodium cromoclicate 15 Poliomyelitis vaccine 12 Sodium nitrite 2

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Sodium nitroprusside 8 Triamterene 10 Sodium stibogluconate 6 Trihexyphenidyl 7 Spironolactone 10 Trimethoprim see Sulfamethoxazole Stavudine (d4T) 5 Trisodium citrate see Oral Rehydration Salt Streptokinase 9 Tuberculin, purified protien derivative Streptomycin 4 (PPD) injection 12 Sulfadoxine 6 Typhoid vaccine 13 Sulfamethoxazole 4 V Sulphasalazine 10 Valproic acid 3 Suxamethonium chloride 13 Vecuronium bromide 13 T Verapamil 8 Tamoxifen 7 Vinblastine 7 Tenofovir disoproxil fumarate (TDF) 5 Vincristine 7 Testosterone 11 Vitamin B complex 16 Tetanus antitoxin 12 W Tetanus immunoglobulin (human) 12 Warfarin 8 Tetanus toxoid 12 Water for injection 15 Tetracaine 13 Tetracyline eye ointment 13 Y Theophylline 15 Yellow fever vaccine 13 Thiamine see Vitamin B complex Z Thiopental 1 Zidovudine (ZDV or AZT) 5 Thioridazine 14 Zinc oxide 14 Timolol 13 Zinc sulfate 11 Tinidazole 5

List of Essential Medicines for District Hospital

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

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

Chlorhexidine solution 21 Glibenclamide 22 Chlorine based compound 21 Glucose injectable 24 Chloroquine 20 Glycerine ear drop see with Ichthammol or Chlorpheniramine 17 Sodium bicarbonate Chlorpromazine 23 Glyceryl trinitrate 20 Ciprofloxacin 19 H Ciprofloxacin eye/ear drops 23 Halothane 17 Ciproflpxacin eye ointment 23 Hepatitis B vaccine 23 Clofazimine 19 Hydrochlorothiazide 20,21 Clotrimazole 19,20 Hydrocortisone 17,22 Clove oil 23 Hydrocortisone ointment 21 Cloxacillin 18 Hyoscine butylbromide 22 Colchicine 17 Ibuprofen 17 Condoms 22 Ichthammol 23 Compound solution of Sodium lactate 24 Ifosfamide 6 Copper-containing devices 22 Influenza vaccine 23 Cycloserine 19 Insulin injection 22 D Iodine see Lugol's iodine and Dapsone 19 Povidone iodine Dexamethasone 22 Isoniazid 19 Dextrose see Oral Rehydration Salt Isoxsuprine 23 Diazepam 18,23 J Diclofenac Sodium 17 Japanese Encephalitis vaccine 23 Diethylcarbamazine 18 K Digoxin 20 Kanamicin 19 Diphtheria-Tetanus-Pertussis- Ketamine 17 Hepatitis B vaccine 22 L Diphtheria-Tetanus-Pertussis- Levonorgestrel 22 Hepatitis B-Haemophilus type b 22 Lidocaine see Lignocaine DL-alpha-tocopherol 24 Lignocaine 17 Dopamine 18 Lindane 21 Doxorubicin Lumefantrine 20 Doxycycline 19 M E Magnesium hydroxide 21 Enalapril 20 Magnesium sulfate injection 18 Epinephrine 17,18,24 Mannitol 21 Erythromycin 19 Measles vaccine 22 Ethambutol 19 Medroxyprogesterone acetate 22 Ethinylestradiol 22 Meningococcal vaccine 23 Ethionamide 19 Metformin 22 F Methylergometrine 23 Ferrous salt 20 Mifepristone 23 Fluconazole 19 Misoprostol 23 Folic acid 20 Methylrosanilinium chloride Formaldehyde 21 see Gentian violet Furosemide 21 Metoclopramide 21 Metronidazole 19 G Miltefosine 19 Gamma Benzene hexachloride Mumps vaccine 23 see Lindane N Gentian violet 21 Nalidixic acid 19 Gentamicin 19 Naloxone 18

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

Neostigmine 23 Sodium bicarbonate +Glycerine Nicotinamide see Vitamin B Complex ear drop 23 Nifedipine 20 Sodium chloride see Oral Rehydration Salt Nitrofurantoin 19 Sodium chloride injection 24 Norethisterone 22 Sodium stibogluconate 19 O Spironolactone 21 Ofloxacin 19 Streptomycin 19 Omeprazole 21 Sulfadoxine 20 Oral rehydration salts 22,24 Sulfamethoxazole 19 Oxygen 17 T Oxytocin 23 Tetanus antitoxin 22 P Tetanus immunoglobulin (human) 22 Para Amino Salicylic Acid (PAS) 19 Tetanus toxoid 22 Paracetamol 17 Tetracyline eye ointment 23 Penicillin G see Benzylpenicillin Theophylline 24 Permethrin 21 Thiamine see Vitamin B complex Pethidine 17 Thiopental 17 Pheniramine 18 Tinidazole 19 Phenobarbital 18 Trimethoprim see Sulfamethoxazole Phenytoin 18 Trisodium citrate see Oral Rehydration Salt Phytomenadione 20 Tuberculin, purified protien derivative Poliomyelitis vaccine 22 (PPD) injection Polygeline 20 Typhoid vaccine 23 Polyvenum antisnake serum22 V Potassium chloride see Oral Rehydration Salt Vitamin B complex 24 Potassium chloride injection 24 W Povidone Iodine 20,21 Water for injection 24 Pralidoxime 18 Y Praziquantel 18 Yellow fever vaccine 23 Prednisolone 18,22 Primaquine 20 Z Promethazine 21 Zinc sulfate 22 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

30 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). 2. 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

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

Added: Carbamazepine chewable tablet 100 mg, 200 mg; Diazepam rectal 6.1 Anti-infective Medicines : Anthelminthics Deleted : Albendazole suspension 6.2 Antibacterials, 6.2.1 Beta-lactum medicines Deleted: Amoxicillin dry 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 Deleted: Pentamidine 6.5.3 Antimalarial Medicines Added: Artesunate; Artemether; Artemether+ lumfantrine Deleted: Mefloquine 7.1 Antimigraine medicines Added: Paracetamol tablet 500 mg 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 Added: Atenolol Deleted: Isosorbide dinitrate 12.2 Antiarrhythmic medicines

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

Added: Atenolol Deleted: Lignocaine 12.3 Antihypertensive medicines Deleted: ; Hydralazine 12.5 Antithrombotic medicine Added: Aspirin 75 mg 12.6 Lipid lowering agent Added: Atrovastatin 13.1 Antifungal medicines Changes: replaced by Clotrimazole 13.2 Anti-infective medicines Deleted: Mercurochrome; ; 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: Salicylic acid solution 13.5 Scabicides and pediculocides Added: Permethrin lotion or cream in complementary list Deleted: Benzyl benzoate

14.2 Radiocontrast Media Added: Iohexol; Meglumine iotroxate Deleted: Iopanoic acid; Metrizamide; Sodium iodide 15. Disinfectants and Antiseptics Deleted: Cresol soap solution, Iodine solution, 2.5%, solution, Potassium Permanganate solution Added: Glutaraldehyde solution Changes: Rectified spirit instead of Methylated spirit; Sodium hypochlorite changed to Chlorine based compound 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 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

33 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 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 -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. Ophthalmological, Ear, Nose and Throat Preparations 21.1 Ophthalmological preparations Added: Aciclovir ointment; Chloramphenicol eye applicap Deleted: Sulfacetamide, Betamethasone, , eye drops; Idoxuridine 21.2. Ear, Nose and Throat Preparations Deleted: Silver nitrate solution (nasal); Ephedrine nasal drops; solution; 25% Dextrose in Glycerine nasal drops; Chromic Acid solution 21.3 Dental Deleted: Tannic acid+ glycerin solution 22. Oxytocics and Antioxytocics Changes: 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

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

Added: Fluoxetine 24.3 Medicines Used in Generalised Anxiety and Sleep Disorders Added: Diazepam tablet 2 mg, 5 mg 24.5 Medicines Used in Substance Dependence Programmes Added: Methadone 26. 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% 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

2. 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 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

35 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 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 to "5 mg" from "1 mg" 9. Cardiovascular Medicines Deleted: Isosorbide dinitrate, Lignocaine, Methyldopa; Hydralazine 10. 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. Diuretics Deleted: Triamterene 13. Gastrointestinal Drugs Deleted: Senna Added: Zinc tablet. . Title of anihaemorrhoidal drugs deleted. ORS as per WHO's new formula.

36 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: 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 Miscellaneous Deleted: Ethyl alcohol 22. 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

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

Halothane, inhalation "1-2%" deleted 4. Antidote Charcoal, activated "10g in sachet" deleted, "slurry in sorbitol" added Atropine "or 0.65 mg in" deleted, "powder for injection 200 mg (sulfate) in vial" added 5. Antiepileptics/Anticonvulsants Content changed to: Magnesium sulfate* injection, 500 mg/ml in 2-ml ampoule. * For use in eclampsia and severe pre-clampsia and not for other convulsant disorders 6.1.1 Intestinal Anthelmintics Praziquantel "500 mg" changed to "600 mg"

DISTRICT LEVEL 4. Antidote Charcoal, activated '10g in sachet" deleted, "slurry in sorbitol" added Atropine "or 0.65 mg in" deleted, "powder for injection 200 mg (sulfate) in vial" added

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.

38 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

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