The concept of Essential Medicines List (EML)

Essential Medicines (EM) are those that satisfy the health care needs of the majority of the population and therefore should be available at all times in appropriate amounts and in appropriate dosage forms. आवश्यक दवाएं (Essential Medicines/EM) वे दवाएं हैं जो अधिकांश आबादी की स्वास्थ्य देखभाल की जरूरतों को पूरा करती हैं तथा हर समय उचित मात्रा और उचित खुराक के रूप में स्वास्थ्य केन्द्रों पर उपलब्ध होनी चाहिए।

The concept of essential medicines, first introduced by WHO in 1977, has now been adopted by many countries, non-governmental organizations and international non-profit supply agencies. डब्ल्यूएचओ द्वारा पहली बार 1977 में शुरू की गई आवश्यक दवाओं की अवधारणा (concept of essential medicines) को अब कई देशों और गैर-सरकारी संगठनों द्वारा अपनाया जा रहा है।

WHO published the first Essential Medicine List (EML) in 1977, which has been updated successively every 5 year in view of changing world scenario about the medical needs and availability of new and better drugs. डब्ल्यूएचओ/WHO ने 1977 में पहली आवश्यक चिकित्सा सूची (Essential Medicine List ) प्रकाशित की| चिकित्सा जरूरतों और नई और बेहतर दवाओं की उपलब्धता को देखते हुए, WHO हर 5 साल में आवश्यक दवाओं की सूची को क्रमिक रूप से अपडेट करता है|

The first Essential Medicines List for Children was published in 2007 by WHO. बच्चों के लिए पहली आवश्यक दवाओं की सूची WHO द्वारा 2007 में प्रकाशित की गई थी।

National List of Essential Medicines (NLEM)

In the India, The Government of India, Ministry of Health & Family Welfare (MOHFW) is mandated to ensure the quality healthcare system by assuring availability of safe and efficacious medicines for its population. MOHFW publishes National List of Essential Medicines (NLEM). भारत में, स्वास्थ्य और परिवार कल्याण मंत्रालय (MOHFW) अपनी आबादी के लिए सुरक्षित और प्रभावकारी दवाओं की उपलब्धता सुनिश्चित करने व गुणवत्तापूर्ण स्वास्थ्य देखभाल प्रणाली सुनिश्चित करने के लिए जिम्मेदार है। MOHFW समय-समय पर आवश्यक दवाओं की राष्ट्रीय सूची (National List of Essential Medicines/NLEM) प्रकाशित करता है|

NLEM is developed in concordance with the standard treatment guidelines keeping in mind the healthcare needs of the majority of the population. NLEM को अधिकांश आबादी की स्वास्थ्य संबंधी जरूरतों (healthcare needs ) को ध्यान में रखते हुए मानक उपचार दिशानिर्देशों (standard treatment guidelines) के अनुरूप विकसित किया गया है।

Ministry of Health and Family Welfare, Government of India hence prepared and released the first National List of Essential Medicines of India in 1996 consisting of 279 medicines. This list was subsequently revised in 2003 and had 354 medicines. Later in 2011, the list was revised and had 348 medicines. Till 2021, 399 medicines (including 4 medical devices i.e. Cardiac stents, drug eluting stents, condoms and intra uterine devices) are regulated under Revised Schedule – I based on National List of Essential Medicines, 2015 (NLEM, 2015). स्वास्थ्य और परिवार कल्याण मंत्रालय, भारत सरकार ने 1996 में भारत की आवश्यक दवाओं की पहली राष्ट्रीय सूची (National List of Essential Medicines) तैयार की और जारी की जिसमें 279 दवाएं शामिल थीं। इस सूची को बाद में 2003 में संशोधित किया गया और इसमें 354 दवाएं थीं। बाद में 2011 में, सूची को संशोधित किया गया और इसमें 348 दवाएं थीं। 2021 तक, आवश्यक दवाओं की राष्ट्रीय सूची, 2015 (National List of Essential Medicines, NLEM , 2015) में 399 दवाएं (4 चिकित्सा उपकरण यानी कार्डियक स्टेंट, ड्रग एल्यूटिंग स्टेंट, कंडोम और इंट्रा यूटेराइन डिवाइस सहित) जोड़ी गई हैं।

NLEM list is revised and the ceiling prices are fixed every five years. NLEM 2015, which was implemented from 2016 has ended in March 2021.

Purpose of the National List of Essential Medicines

• The primary purpose of NLEM is to promote rational use of medicines considering the three important aspects i.e.
  • cost,
  • safety and
  • efficacy.
• Furthermore it promotes prescription by generic names. Healthcare delivery institutions, health insurance bodies, standards setting institutions for medicines, medicine price control bodies, health economists and other healthcare stakeholders will be immensely benefitted in framing their policies.
• The medicines in National List of Essential Medicines (NLEM) should be available at affordable costs and with assured quality.
• To Promote the rational use of medicines
• Optimize the available health resources of a country
• It can also be a guiding document for:
  • State governments to prepare their list of essential medicines
  • Procurement and supply of medicines in the public sector
  • Reimbursement of cost of medicines by organizations to its employees
  • Reimbursement by insurance companies

आवश्यक दवाओं की राष्ट्रीय सूची का उद्देश्य

• दवाओं के तर्कसंगत उपयोग (rational use of medicines) को बढ़ावा देना: एनएलईएम( NLEM) का प्राथमिक उद्देश्य तीन महत्वपूर्ण पहलुओं यानी लागत, सुरक्षा और दक्षता को ध्यान में रखते हुए दवाओं के तर्कसंगत उपयोग (rational use of medicines) को बढ़ावा देना है।
• जेनेरिक नामों (generic names) से नुस्खे (prescription) को बढ़ावा देने के लिए।
• एनईएमएल (NLEM) की सूची की मदद से स्वास्थ्य सेवा वितरण संस्थान, स्वास्थ्य बीमा निकाय, दवाओं के लिए मानक निर्धारित करने वाले संस्थान, दवा मूल्य नियंत्रण निकाय, स्वास्थ्य अर्थशास्त्री और अन्य स्वास्थ्य हितधारक अपनी नीतियां (policies) तैयार करने में लाभान्वित (benefitted) होंगे।
• आम लोगों को सस्ती कीमत और गुणवत्ता दवाओं की उपलब्धा करवाना|

Selection of Essential medicines

The selection of these medicines is based on public health relevance, evidence of efficacy and safety and comparative cost-effectiveness. These priority medicines should be available at each functioning health care facility with assured quality and adequate information at a price the individual and the community can afford.

Also the selection of essential medicines depends upon level of health care facility, adequate data on the efficacy, safety, suitability and comparative cost effectiveness of available treatments.

Most essential medicines are formulated as single compound. However, fixed dose combinations are selected only when it has proven pharmacokinetic and/or pharmacodynamic advantages over single compound administered separately.

While comparing the cost of medicines among the alternative treatments, the cost of total treatment and not the unit cost is considered. Other factors taken into account include pattern of diseases, treatment facilities, training and experience of the available personnel, financial resources etc.

आवश्यक दवाओं का चयन

• इन दवाओं का चयन सार्वजनिक स्वास्थ्य प्रासंगिकता, प्रभावकारिता और सुरक्षा के प्रमाण और तुलनात्मक लागत-प्रभावशीलता पर आधारित है। ये दवाएं प्रत्येक स्वास्थ्य केंद्र पर सुनिश्चित गुणवत्ता के साथ रोगी/समुदाय द्वारा वहन की जा सकने वाली कीमत पर उपलब्ध होनी चाहिए।
• इसके अलावा आवश्यक दवाओं का चयन स्वास्थ्य देखभाल सुविधा के स्तर, प्रभावकारिता, सुरक्षा, उपयुक्तता और उपलब्ध उपचारों की तुलनात्मक लागत प्रभावशीलता पर पर्याप्त डेटा पर निर्भर करता है।
• अधिकांश आवश्यक दवाएं एकल यौगिक के रूप में तैयार की जाती हैं। हालांकि, निश्चित खुराक संयोजनों का चयन केवल तभी किया जाता है जब यह अलग से प्रशासित एकल यौगिक पर फार्माकोकाइनेटिक और/या फार्माकोडायनामिक लाभ सिद्ध कर चुका हो।
• वैकल्पिक उपचारों के बीच दवाओं की लागत की तुलना करते समय, कुल उपचार की लागत पर विचार किया जाता है, न कि इकाई लागत पर। अन्य कारकों में बीमारियों का पैटर्न, उपचार सुविधाएं, उपलब्ध कर्मियों का प्रशिक्षण और अनुभव, वित्तीय संसाधन आदि शामिल हैं|

Advantages of Essential Medicines List (EML)

The concept of EM has several logistic and prescribing advantages mentioned below

• Better management of medicines: easier procurement, storage, distribution, more manageable stock, better quality assurance, easier dispensing, less fragmentation of budget with improve drug availability.
• Prescribing improves due to focused training and drug information, better recognition of adverse drug reactions, drug interactions and focused education efforts
• The list of EM closely relates to treatment guidelines for clinical diseases
• Is also used for the procurement and supply of medicines in public sector, schemes for reimburses medicines costs and local medicine production

Salient features of Latest NLEM 2015

1. There were 348 medicines listed in NLEM 2011. A total of 106 Medicines have been added, and 70 medicines have been deleted to prepare NLEM 2015 which now contains a total of 376 medicines.
2. Medicines in NLEM are listed with reference to the levels of healthcare, namely, Primary (P), Secondary (S) and Tertiary (T). There are 209 medicine formulations listed for all levels of health care (P, S, T), 115 medicine formulations for secondary and tertiary levels (S, T) and 79 medicine formulations for the tertiary level (T).
3. NLEM 2015 has total 30 sections.

List of Sections of NLEM 2015

There are Total 30 Sections in NLEM 2015 (In NLEM 2011, there were 27 sections)

Alphabetical list of NLEM

1. 25% Dextrose 2. 5-Amino salicylic Acid 3. 5-Fluorouracil 4. Acetazolamide 5. Acetyl Salicylic Acid 6. Acriflavin+Glycerin 7. Actinomycin D 8. Activated Charcoal 9. Acyclovir 10. Adenosine 11. Adrenaline Bitartrate 12. Albendazole 13. Albumin 14. Allopurinol 15. Alpha Interferon 16. Alprazolam 17. Aluminium Hydroxide + Magnesium Hydroxide 18. Amikacin 19. Amiodarone 20. Amitriptyline 21. Amlodipine 22. Amoxicillin 23. Amoxicillin+Clavulinic acid 24. Amphotericin B 25. Ampicillin 26. Anti-D immunoglobin (human) 27. Antitetanus Human immunoglobin 28. Artesunate (To be used only in combination with Sulfadoxine + Pyrimethamine) 29. Ascorbic Acid 30. Atenolol 31. Atorvastatin 32. Atracurium besylate 33. Atropine Sulphate 34. Azathioprine 35. Azithromycin 36. B.C.G Vaccine 37. Barium Sulphate 38. Beclomethasone Dipropionate 39. Benzathine Benzylpenicillin 40. Benzoin Compound 41. Benzyl benzoate 42. Betamethasone 43. Betamethasone Dipropionate 44. Betaxolol Hydrochloride 45. Bisacodyl 46. Bleaching Powder 47. Bleomycin 48. Bromocriptine Mesylate 49. Bupivacaine Hydrochloride 50. Busulphan 51. Calamine 52. Calcium carbonate 53. Calcium gluconate 54. Calcium Ipodate 55. Carbamazepine 56. Carbimazole 57. Carboplatin 58. Cefixime 59. Cefotaxime 60. Ceftazidime 61. Ceftriaxone 62. Cephalexin 63. Cetrimide 64. Cetrizine 65. Chlorambucil 66. Chloramphenicol 67. Chlorhexidine 68. Chloroquine phosphate 69. Chlorpheniramine Maleate 70. Chlorpromazine hydrochloride 71. Ciprofloxacin Hydrochloride 72. Cisplatin 73. Clindamycin 74. Clofazimine 75. Clomiphene citrate 76. Clopidogrel 77. Clotrimazole 78. Cloxacillin 79. Coal Tar 80. Codeine phosphate 81. Colchicine 82. Condoms 83. Co-Trimoxazole (Trimethoprim + Sulphamethoxazole) 84. Cryoprecipitate 85. Cyanocobalamin 86. Cyclophosphamide 87. Cyclosporine 88. Cytosine arabinoside 89. D.P.T Vaccine 90. Dacarbazine 91. Danazol 92. Dapsone 93. Daunorubicin 94. Desferrioxamine mesylate 95. Dexamethasone 96. Dexchlorpheniramine Maleate 97. Dextran-40 98. Dextran-70 99. Dextromethorphan 100. Diazepam 101. Diclofenac  102. Dicyclomine Hydrochloride 103. Didanosine 104. Diethylcarbamazine citrate 105. Digoxin 106. Dihydroergotamine 107. Diloxanide Furoate 108. Diltiazem 109. Dimercaprol 110. Diphtheria Antitoxin 111. Dithranol 112. Dobutamine 113. Domperidone 114. Dopamine Hydrochloride 115. Doxorubicin 116. Doxycycline 117. Efavirenz 118. EMLA cream 119. Enalapril Maleate 120. Enoxaparin 121. Erythromycin Estolate 122. Esmolol 123. Ethambutol 124. Ether 125. Ethinylestradiol 126. Ethinylestradiol + Levonorgesterol 127. Ethinylestradiol + Norethisterone P 128. Ethyl Alcohol 70% 129. Etoposide 130. Factor IX Complex (Coagulation Factors II,VII, IX, X) 131. Factor VIII Concentrate 132. Famotidine 133. Fentanyl 134. Ferrous Salt 135. Filgrastim 136. Fluconazole 137. Flumazenil 138. Fluorescein 139. Fluoxetine hydrochloride 140. Flutamide 141. Folic Acid 142. Folinic Acid 143. Formaldehyde IP 144. Framycetin Sulphate 145. Fresh frozen plasma 146. Furosemide 147. Gemcitabine hydrochloride 148. Gentamicin 149. Gentian Violet 150. Glibenclamide 151. Glucagon 152. Glucose 153. Glucose with sodium chloride  154. Glutaraldehyde 155. Glycerin 156. Glyceryl Trinitrate 157. Griseofulvin 158. Haloperidol 159. Halothane with vaporizer 160. Heparin Sodium 161. Hepatitis B Vaccine 162. Homatropine 163. Hormone Releasing IUD 164. Hydrochlorothiazide 165. Hydrocortisone sodium succinate 166. Hydrogen Peroxide 167. Hydroxychloroquine phosphate 168. Hydroxyethyl Starch (Hetastarch) 169. Hyoscine Butyl Bromide 170. Ibuprofen 171. Ifosfamide 172. Imatinib 173. Imipramine 174. Indinavir 175. Insulin Injection(Soluble) 176. Intermediate Acting(Lente/NPH Insulin) 177. Intraperitoneal Dialysis Solution 178. Iodine 179. Iopanoic Acid 180. Ipratropium bromide 181. Iron Dextran 182. Isoflurane 183. Isoniazid 184. Isosorbide 5 Mononitrate/Dinitrate 185. Ispaghula 186. IUD containing Copper 187. Ketamine Hydrochloride 188. L- Asparaginase 189. Lamivudine 190. Lamivudine + Nevirapine + Stavudine 191. Lamivudine + Zidovudine 192. Leflunomide 193. Levodopa+ Carbidopa 194. Levothyroxine 195. Lignocaine 196. Lignocaine Hydrochloride 197. Lignocaine Hydrochloride + Adrenaline 198. Lithium Carbonate 199. Lorazepam 200. Losartan Potassium 201. Magnesium sulphate 202. Mannitol 203. Measles Vaccine 204. Medroxy Progesterone Acetate 205. Mefloquine  206. Meglumine Iothalamate 207. Meglumine Iotroxate 208. Melphalan 209. Mercaptopurine 210. Mesna 211. Metformin 212. Methotrexate 213. Methyl Cellulose 214. Methyl Ergometrine 215. Methyldopa 216. MethylPrednisolone 217. Methylrosanilinium Chloride (Gentian Violet) 218. Methylthioninium chloride (Methylene blue) 219. Metoclopramide 220. Metoprolol 221. Metronidazole 222. Miconazole 223. Midazolam 224. Mifepristone 225. Misoprostol 226. Mitomycin-C 227. Morphine Sulphate 228. Multivitamins (As per Schedule V of Drugs and Cosmetics Rules) 229. N/2 Saline 230. N/5 Saline  231. N-acetylcysteine 232. Naloxone 233. Nelfinavir 234. Neomycin + Bacitracin 235. Neostigmine 236. Nevirapine 237. Nicotinamide 238. Nifedipine 239. Nitrofurantoin 240. Nitrous Oxide 241. Norethisterone 242. Normal Saline 243. Nystatin 244. Ofloxacin 245. Olanzapine 246. Omeprazole 247. Ondansetron 248. Oral Poliomyelitis vaccine (LA) 249. Oral Rehydration Salts 250. Oxaliplatin 251. Oxygen 252. Oxytocin 253. Paclitaxel 254. Pantoprazole 255. Paracetamol 256. Penicillamine  257. Pentamidine Isothionate 258. Permethrin 259. Pheniramine Maleate 260. Phenobarbitone 261. Phenylephrine 262. Phenytoin Sodium 263. Phytomenadione 264. Pilocarpine 265. Piperazine 266. Platelet Rich Plasma 267. Polygeline 268. Polyvalent Antisnake Venom 269. Potassium Chloride 270. Potassium Permanganate 271. Povidone Iodine 272. Pralidoxime Chloride(2-PAM) 273. Praziquantel 274. Prednisolone 275. Prednisolone Acetate 276. Prednisolone Sodium Phosphate 277. Premix Insulin 30:70 injection 278. Primaquine 279. Procainamide Hydrochloride 280. Procarbazine 281. Promethazine 282. Propofol  283. Propranolol hydrochloride 284. Propyliodone 285. Protamine Sulphate 286. Pyrazinamide 287. Pyridostigmine 288. Pyridoxine 289. Pyrimethamine 290. Quinine sulphate 291. Rabies immunoglobin 292. Rabies Vaccine 293. Raloxifene 294. Ranitidine 295. Riboflavin 296. Rifampicin 297. Ringer Lactate 298. Ritonavir 299. Salbutamol sulphate 300. Salicylic Acid 301. Saquinavir 302. Sevoflurane 303. Silver Sulphadiazine 304. Sodium Bicarbonate 305. Sodium Iothalamate 306. Sodium Meglumine Diatrizoate 307. Sodium Nitrite 308. Sodium Nitroprusside  309. Sodium Stibogluconate 310. Sodium Thiosulphate 311. Sodium Valproate 312. Specific antisnake venom 313. Spironolactone 314. Stavudine 315. Stavudine+Lamivudine 316. Streptokinase 317. Streptomycin Sulphate 318. Succinyl choline chloride 319. Sulfadoxine + Pyrimethamine 320. Sulfasalazine 321. Sulphacetamide Sodium 322. Sulphadiazine 323. Tamoxifen Citrate 324. Terbutaline Sulphate 325. Testosterone 326. Tetanus Toxoid 327. Tetracaine Hydrochloride 328. Thiamine 329. Thiopentone Sodium 330. Timolol Maleate 331. Tramadol 332. Trihexyphenidyl Hydrochloride 333. Tropicamide 334. Tuberculin, Purified Protein derivative 335. Urokinase 336. Vancomycin Hydrochloride 337. Vecuronium 338. Verapamil 339. Vinblastine sulphate 340. Vincristine 341. Vitamin A 342. Vitamin D (Ergocalciferol) 343. Warfarin sodium 344. Water for Injection 345. Zidovudine 346. Zidovudine+ Lamivudine+ Nevirapine 347. Zinc Oxide 348. Zinc Sulfate

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