Acknowledgements iii Abbreviations iv



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Contents


Contents i

Acknowledgements iii

Abbreviations iv

Introduction v

Changes to the WHO Model List of Essential Medicines 1

General advice to prescribers 6

Drugs used in anaesthesia 23

Analgesics, antipyretics, nonsteroidal anti-inflammatory drugs, drugs used to treat gout, and disease-modifying antirheumatic drugs 46

Antiallergics and drugs used in anaphylaxis 63

Antidotes and other substances used in poisonings 71

Anticonvulsants/antiepileptics 84

Anti-infective drugs 97

Antineoplastic and immunosuppressive drugs and drugs used in palliative care 234

Antiparkinson drugs 260

Drugs affecting the blood 265

Blood products and plasma substitutes 275

Cardiovascular drugs 280

Dermatological drugs (topical) 313

Diagnostics 333

Disinfectants and antiseptics 342

Diuretics 348

Gastrointestinal drugs 357

Hormones and other endocrine drugs and contraceptives 376

Immunologicals 412

Muscle relaxants (peripherally acting) and cholinesterase inhibitors 443

Ophthalmological preparations 447

Drugs used in obstetrics 460

Peritoneal dialysis solution 467

Psychotherapeutic drugs 470

Drugs acting on the respiratory tract 486

Solutions correcting water, electrolyte and acid-base disturbances 498

Vitamins and minerals 508

Appendix 1: Interactions 518

Appendix 2: Pregnancy 696

Appendix 3: Breastfeeding 707

Appendix 4: Renal impairment 715

Appendix 5: Hepatic impairment 722

Index 727



Acknowledgements



Editors

Dinesh K. Mehta (1)

Rachel S.M. Ryan (1)

Hans V. Hogerzeil (2)

(1) Royal Pharmaceutical Society of Great Britain, London

(2) Department of Essential Drugs and Medicines Policy, World Health Organization, Geneva


Acknowledgements

The first WHO Model Formulary (2002) was edited by Mary R. Couper of the WHO Department of Essential Drugs and Medicines Policy and Dinesh K. Mehta, of the Royal Pharmaceutical Society of Great Britain. It was developed over a period of several years and with the input of a large number of individuals and organizations whose help was gratefully acknowledged.

Sincere thanks for their contributions and comments on the current edition are due to the following WHO staff: J.M. Bertolote, M. Cham, M.N. Cherian, T. Cherian, D.P.J. Daumerie, B. de Benoist, P.M.P. Desjeux, D.A .Engels, o. Fontaine, S. Groth, K. S. Hurst, J.G. Jannin, R. Kabra, N. Khaltaev, P.M. Matricardi, K.N. Mendis, S.P.B. Mendis, F.J. Ndowa, H. Ostensen, S.N. Pal, J.H. Perri ens, H.B. Peterson, G. Roglic,

J.H. Tempowski, and M. Zignol.


The editors of the 2004 edition wish to thank Lalit Dwivedi and Robin Gray of the WHO Department of Essential Drugs and Medicines Policy for their contribution to the production process.
Special gratitude is due once again to Mildred Davis and Sheenagh M. Townsend-Smith for a thorough review of the entire formulary. Anne Prasad provided valuable comments on the text.
Eric I. ,Connor, Charles Fry, John Martin, Karl A.Parsons, Vinaya K. Sharma, John Wilson, and the BNF Editorial team all made a valuable contribution to the

preparation of the text and to the production process.



Abbreviations




ACE

angiotensin-converting enzyme

ADR

adverse drug reaction

AIDS

acquired immunodeficiency syndrome

AV

atrioventricular

BP

British Pharmacopoeia

BSA

body surface area

CNS

central nervous system

CSF

cerebrospinal fluid

DMARD

disease-modifying antirheumatic drug

ECG

electrocardiogram

EEG

electroencephalogram

G6PD

glucose 6-phosphate dehydrogenase

GFR

glomerular filtration rate

HIV

human immunodeficiency virus

HRT

hormone replacement therapy

INR

international normalized ratio

MDI

metered dose inhaler

NSAID

nonsteroidal anti-inflammatory drug

spp.

species

SSRI

selective serotonin reuptake inhibitor

USP

United States Pharmacopeia

WHO

World Health Organization


Introduction


In 1995 the WHO Expert Committee on the Use of Essential Drugs recommended that WHO develop a Model Formulary which would complement the WHO Model List of Essential Drugs (the ‘Model List’). It was considered that such a Model Formulary would be a useful resource for countries wishing to develop their own national formulary. The first edition of the Model Formulary was issued in August 2002; it was based on the 12th Model List (revised 2002).

It has proved difficult in practice to maintain in the Model Formulary the section headings and numbering system of the Model List. The main reason was that the sections of the Model List are not always useful as therapeutic categories, and do not easily lend themselves to introductory evaluative statements. Small changes were therefore introduced. The Model Formulary has also been relatively generous in repeating information about essential medicines under other relevant therapeutic categories. The small differences between the classification system of the Model List and the Model Formulary should not be a major problem for users who can access information through the contents list or through the main index, which includes both drug names and disease terms. The Model List and the Model Formulary are available electronically on the WHO Essential Medicines Library website (http://mednet3.who.int/eml); search facilities and links between the Model Formulary and the Model List provide easy access to relevant information.

The electronic version of the Model Formulary is also available on CD-ROM, intended as a starting point for developing national or institutional formularies. National or institutional committees can use the text of the Model Formulary for their own needs by adapting the text, or by adding or deleting entries to align the formulary to their own list of essential medicines. The Model Formulary is also being translated.

This edition of the Model Formulary is fully compatible with the 13th WHO Model List of Essential Medicines as recommended by the WHO Expert Committee on the Selection and Use of Essential Medicines at its meeting of March-April 2003. For a list of the more significant changes in this edition see Changes to the WHO Model List of Essential Medicines, p. XVIII.

This second edition was again prepared in close collaboration between the WHO Department of Essential Drugs and Medicines Policy and the editorial team of the British National Formulary. Comments and suggestions for corrections or changes are very welcome and should be sent to:

The Editor (WMF)

BNF

Royal Pharmaceutical Society of Great Britain



1 Lambeth High Street

London SE1 7JN

United Kingdom

Email: modelformulary@who.int



Changes to the WHO Model List of Essential Medicines


Changes made to the 12th Model List (2002) to produce the 13th Model List (2003) are listed below.

Additions


Drugs added to the 13th Model List (revised April 2003)

 Amodiaquine tablet, 153 mg or 200 mg (base)

 Azithromycin 250, 500 mg capsule and suspension 200 mg/5 ml

 Enalapril replaces captopril

 Levonorgestrel 1.5 mg single tablet (new dosage form)

 Ranitidine to replace cimetidine


Deletions


Drugs deleted from the 13th Model List (revised April 2003)

 Captopril replaced by enalapril

 Chloral hydrate

 Cimetidine replaced by ranitidine

 Cyclophosphamide from section 2.4 (due to unfavourable benefit/risk ratio)

 Desmopressin

 Dextromethorphan

 Ethinylestradiol + levonorgestrel tablet, 50 micrograms + 250 micrograms (pack of four)

 Fludrocortisone

 Folic acid injection

 Human immunoglobulin

Ipecacuanha syrup

 Iron dextran injection

 Nonoxinol and spermicides (for use with condoms and diaphragms)

 Pethidine

 Prazosin

 Reserpine

 Trimethoprim injection



Note.

The following 2 drugs were deleted in the 13th revision of the Model List but they were subsequently reinstated on the List:

 Cloxacillin (dicloxacillin is a suitable substitute where cloxacillin is not available)

 Hydralazine

Square box symbol removed


Drugs no longer listed as an example of their pharmacological class in 13th Model List (revised April 2003)

 Amiloride

 Amoxicillin

 Amoxicillin/clavulanic acid

 Antitetanus immunoglobulin

Azathioprine

 Charcoal, Activated

 Chloramphenicol

 Chloroquine

 Ciclosporin

 Clomifene

 Codeine

 Cycloserine

 Dexamethasone

 Diloxanide

 DL-methionine

 Doxorubicin

 Doxycycline

 Epinephrine (Adrenaline)

 Ethionamide

 Glibenclamide

Hydrocortisone injection

 Ibuprofen

 Mannitol

 Morphine

 Neostigmine

 Promethazine

 Quinine

 Retinol

 Sodium nitroprusside

 Sulfadiazine

 Sulfadoxine/pyrimethamine

 Sulfamethoxazole/trimethoprim

 Verapamil


Moved from core to complementary list


Drugs moved from the core to the complementary list for 13th Model List (revised April 2003)

 Aminophylline

 Amphotericin B

 Azathioprine

 Clomifene

 Diethylcarbamazine

 Dopamine

 Ethosuximide

 Hydrocortisone rectal preparations

 Intraperitoneal dialysis solution

 Methotrexate

 Penicillamine (section 2.4)

 Pentamidine

 Pyridostigmine

 Sulfadiazine

 Sulfasalazine (section 2.4)


Moved from complementary to core list


Drugs moved from the complementary to the core list for 13th Model List (revised April 2003)

 Amoxicillin/clavulanic acid

 Chloramphenicol oily solution

 Epinephrine (adrenaline) injection

 Levonorgestrel

 Mannitol

 Norethisterone enantate

Formulation changes


Formulas changed for 13th Model List (revised April 2003)

 Oral Rehydration Salts (now 75 mEq/litre sodium (sodium chloride 2.6 g/litre) and 75 mmol/litre (13.5 g/litre) glucose)


Dosage changes


Dosages changed for 13th Model List (revised April 2003)

 Streptokinase (now powder for injection 1.5 million units in vial)






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