2008 TUVALU ESSENTIAL MEDICINE LIST WHO Drug name, strength and dosage form Outer Restrict use Cost $A COMMENTS Island 1 ANAESTHETICS 1.1 GENERAL ANAESTHETICS Halothane inhalation 39 Isoflurane inhalation 56 Ketamine 50mg/ml injection 2.1 Nitrous oxide gas inhalation Oxygen gas inhalation 98(G) Need more G size Soda lime powder 5.63 Thiopentone 0.5% injection 1.1 1.2 LOCAL ANAESTHETICS Bupivacaine 0.5% plain injection 1 Bup c Adr -sep Bupivacaine 0.5% heavy (spinal) injection 1.3 Lignocaine 2%plain injection Yes 1 Lig 1% delete Lignocaine 2% + adrenaline 1:80,000 dental cart Yes 0.4 Lig c Adr-sep Lignocaine 10% pump spray Anaesthetist 11.25 1.3 PRE-OPERATIVE MEDICATION Atropine 1mg/ml injection 0.1 Diazepam 10mg/2ml injection 0.15 Droperidol 10mg/2.5ml injection Anaesthetist 3.38 Diazepam 5mg tablet 0.01 Fentanyl 100mcg/2ml injection 0.73 Midazolam 15mg/3ml injection Anaesthetist 2.4 Morphine 10mg/ml injection 0.34 Pethidine 50mg/ml injection O&G only 0.3 Promethazine 50mg/2ml injection 0.26 ANALGESICS, ANTIPYRETICS, NSAID's, 2 DRUGS TO TREAT GOUT 2.1 NON-OPIOIDS Allopurinol 100mg tablet 0.02 Colchicine del Aspirin 300mg tablet Yes 0.01 Ibuprofen 400mg tablet Yes 0.01 Diclof, indo del Paracetamol 500mg tablet Yes 0.01 Paracetamol 500mg Suppos ICU only 0.95 Paracetamol 250mg Suppos Paed, ICU use only 0.1 Paracetamol 120mg/5ml elixir 0.42 Phase out to tabs Probenecid 500mg tablet 0.1 Reduced usage Del Diclofenac inj 2.2 OPIOID ANALGESICS Codeine 30mg tablet Yes 0.07 Fentanyl 100mcg/2ml injection 0.73 Morphine SR 10mg tablet Morphine 10mg/ml injection Yes 0.34 Pethidine 50mg/ml injection O&G only 0.3 Peth 100 deleted ANTI-ALLERGICS & DRUGS USED IN 3 ANAPHYLAXIS Adrenaline 1mg/ml injection Yes 0.43 Chlorpheniramine 4mg tablet Yes 0.01 cheaper than prom Dexamethasone 4mg/ml injection 0.2 Dexamethasone 500mcg tablet 0.07 Delete 4mg, 2mg Hydrocortisone sodium succinate 100mg injection 0.46 Promethazine 50mg/ml injection Yes 0.26 Del Diphenhyd Inj Del Cyprohept tab Promethazine Tablets 10mg Included 2008 ed. ANTIDOTES & OTHER SUBSTANCES USED IN 4 POISONINGS 4.1 GENERAL
Charcoal and Sorbitol Soln Yes 2-3 for O/D 4.2 SPECIFIC Acetycysteine 200mg/ml injection 10ml Paracetamol OD only 6.8 1 course only Atropine 1mg/ml injection 0.1 Naloxone 400mcg/ml injection 1.08 5 ANTIEPILEPTICS Carbamazepine 200mg tablet Indiv patients 0.02 Diazepam 10mg/2ml injection Yes 0.15 Diazepam 5mg tablet Yes 0.01 Phenobarbitone 200mg injection Paed use 1.23 Tabs deleted Phenytoin 250mg/5ml injection 2.88 Phenytoin 100mg tablet Yes 0.01 Syrup deleted Sod.Valproate 150mg tablet Others ineffective 0.11 6 ANTI-INFECTIVE DRUGS 6.1.1 INTESTINAL ANTHELMINTICS Mebendazole 100mg tablet Yes 0.01 Pyrantal deleted 6.1.2 ANTIFILARIALS Albendazole 400mg tablet Diethylcarbamazine 50mg tablet Yes - campaign Yes - campaign WHO Filiariasis WHO Filiariasis 6.2 ANTIBACTERIALS 6.2.1 Penicillins Amoxycillin 250mg tablet Yes 0.02 Amoxycillin 500mg/Clavulanic acid 125mg tablet Resistant cases only 0.24 Amoxycillin 125mg/5ml Susp 0.56 Replace by tabs Ampicillin 1g injection 0.18 replace 500mg Benzathine penicillin 1.2 mega injection 0.16 2.4mega deleted Benzyl penicillin 600mg injection Yes 0.08 Cloxacillin 500mg injection 0.23 Cloxacillin 250mg tablet Yes 0.02 Replaces fluclox Phenoxymethylpenicillin 250mg tablet Yes 0.03 Replaces syrup Procaine penicillin 4mega injection Yes 0.25 6.2.2 Other Antibacterials Azithromycin 250mg/500mg tablet Yes STI for chlymydia 0.42 Stat dose Ceftriaxone 1g injection For resistant organisms 1.72 1g only;c'clor del Chloramphenicol 250mg capsule 0.02 Chloramphenicol 1g injection 0.58 Chloramphenicol 125mg/5ml suspension 1.88 Keep as only caps Ciprofloxacin 500mg tablet Yes STI for gonorrhoea 0.07 Stat dose Co-trimoxazole 480mg tablet Yes 0.01 delete syrup Doxycycline 100mg tablet / capsule Yes 0.02 Erythromycin 250 tablet 0.12 Syrup deleted Gentamicin 80mg/2ml injection 0.08 Metronidazole 5mg/ml IV solution 100ml 1.3 Metronidazole 200mg tablet Yes 0.01 MTZ Syrup del Tinidazole 500mg tablet Yes 0.04 Stat dose MTZ Tc, Nitro deleted 6.2.3 Antileprosy drugs Clofazimine 50mg tablet only combipacks Free WHO combipacks only Dapsone 100mg tablet only combipacks Free WHO Free from WHO Rifampicin 150mg/300mg capsule only combipacks Free WHO - need PB?
6.2.4 Anti-tuberculosis drugs Ethambutol 400mg tablet patients TB 0.05 Isoniazid 100mg tablet patients 0.02 300mg deleted Pyrazinamide 4/500mg tablet patients TB 0.05 Rifampicin 150mg tablet / capsule patients 0.05 300mg, syrup del Rifampicin 150mg/Isoniazid 75mg tablet patients TB 0.04 Streptomycin 1g injection TB 0.56 6.2.5 Antiviral Drugs Aciclovir 200mg tablet Severe herpes 0.03 Aciclovir Eye Ointment Herpes of eye 0.56 HIV Drugs - as per Global Fund HIV/AIDS Free Global Fund pays 6.3 ANTIFUNGAL DRUGS Clotrimazole 500mg Pessary Yes 1.32 stat dose Clotrimazole Cream 20g Yes 0.34 cheaper Griseofulvin 500mg tablet 0.04 delete 250mg Nystatin oral suspension 100,000 units 1.13 Terbinafine del 6.4 ANTIPROTOZOAL DRUGS 6.4.1 Antiamoebic Metronidazole 5mg/ml IV solution 100ml Where oral not possible 1.3 Metronidazole 200mg tablet Yes 0.01 Tinidazole 500mg tablet Yes 0.04 Stat dose 6.4.2 Antimalarial Drugs Chloroquine 150mg base tablet 0.01 Doxycycline 100mg tab/cap 0.02 Fansidar tablet P.falciparum 0.05 Primaquine 15mg tablet P.vivax eradication 0.02 for indiv patient Quinine 300mg/ml injection Cerebral malaria 0.23 Quinine sulphate 300mg tablet 0.05 7 ANTI-MIGRAINE DRUGS 7.1 FOR TREATMENT Aspirin 300mg tablet Yes 0.01 Chlorpromazine 50mg injection 0.19 Low dose only Metoclopramide 10mg injection 0.15 Paracetamol 500mg tablet Yes 0.01 7.2 FOR PROPHYLAXIS Propranolol 10mg tablet Thyroid storm 0.01 40mg deleted Propranolol Injection or similar Thyroid storm 0.67?supplier ANTINEOPLASTICS & 8 IMMUNOSUPPRESSANTS 8.1 IMMUNOSUPPRESSIVE DRUGS Dexamethasone 500mcg tablet Prednisolone 5mg tablet 0.07 not 2mg,4mg 0.01 Not prednisone 8.2 ANTINEOPLASTIC DRUGS Cyclophosphamide injection Indiv patients 7.68 Drug Comm 5-Fluorouracil 500mg injection Indiv patients 7.34 Drug Comm Methotrexate 50mg injection Indiv patients 5.56 Drug Comm Methotrexate 2.5mg tablets Indiv patients 0.13 8.3 HORMONES AND ANTI_HORMONES Tamoxifen 10/20mg tablet Indiv.patients 0.1
9 ANTIPARKINSONIAN DRUGS Benzhexol 2mg tablet 0.01 10 DRUGS AFFECTING THE BLOOD 10.1 ANTI-ANAEMIA DRUGS Ferrous sulphate 200mg tablet 0.01 Ferrous sulphate/gluconate syrup 5.54/100ml Ferrous sulphate 200mg + folic acid 0.25mg tablet Yes 0.01 Fe Dextran 5% Inj Folic acid 5mg tablet 0.01 Small supply Hydroxocobalamin 1mg injection 0.45 10.2 DRUGS AFFECTING COAGULATION Heparin sodium 5000iu/ml 5ml injection 1.53 Phytomenadione 1mg in 0.5ml injection Yes 0.3 10mg deleted Warfarin 1mg tablet 0.04 Keep same brand Warfarin 3mg tablet 0.06 Delete 2mg Warfarin 5mg tablet 0.06 11 BLOOD PRODUCTS & PLASMA SUBSTITUTES Polygeline IV solution 500ml (Haemacel/Gelofusine) 5.93 12 CARDIOVASCULAR DRUGS 12.1 ANTI-ANGINAL DRUGS Atenolol 50mg tablet 0.02 Glyceryl trinitrate 600mcg tablet Yes 0.06 Isosorbide dinitrate 10mg tablet 0.01 change from 5mg Nifedipine 20mg SR tablet Yes 0.01 change from 10mg Propranolol 10mg tablet 0.01 change from 40mg Verapamil 40mg tablet 0.05 12.2 ANTI ARRHYTHMIC DRUGS Atenolol 50mg tablet 0.02 Lignocaine 2% injection 10ml 0.42 Propranolol 10mg tablet 0.01 Verapamil 2.5mg/ml injection 2.7 Verapamil 40mg tablet 0.05 12.3 ANTIHYPERTENSIVE DRUGS Atenolol 50mg tablet 0.02 Enalapril 5mg tablets Indiv patient 0.02 Hydralazine 20mg/ml injection 7.16 Tabs deleted Hydrochlorothiazide 25mg tablet Indiv patient 0.01 50mg deleted Methyldopa 250mg tablet Indiv patient 0.05 pregnancy only Nifedipine 20mg ST tablet Indiv patient 0.01 Prazosin 2mg tablet BPH treatment Propranolol 10mg tablet Thyroid storm 0.01 Delete Labetalol 12.4 DRUGS USED IN HEART FAILURE Digoxin 500mcg/2ml injection 1.72 Digoxin 250mcg tablet 0.04 62.5mcg deleted Enalapril 5mg tablet 0.02 Isosorbide dinitrate 10mg tablet 0.01 12.5 DRUGS USED IN VASCULAR SHOCK Adrenaline 1mg/ml injection 0.43 Ephedrine 30mg/ml injection 0.19 12.6 ANTITHROMBIC DRUGS Aspirin 300mg tablet 0.01 Streptokinase 1,500,000 units injection Documented MI 82 Keep 1-2 only
12.9 LIPID LOWERING AGENTS Simvastatin 20mg tablets Indiv patients Drug Comm 13 DERMATOLOGICAL DRUGS 13.1 ANTFUNGAL DRUGS (TOPICAL) Compound benzoic + salicylic acid oint (Whitfields) Yes 1.1/50g Compound benzoic + salicylic acid lotion (Whitfields) Yes 1.15/100ml Rep Sal ac 10% Clotrimazole cream Yes 0.34 13.2 ANTI-INFECTIVE DRUGS Neomycin + bacitracin + polymyxin ointment Yes 0.63 Delete CB Oint Silver sulphadiazine 1% cream Yes 0.67/50g Order 50g packs Chlorhexidine 1% Cream Yes 13.3 ANTI-INFLAMMATORY & ANTI-PRURITIC DRUGS Betamethasone 0.1% cream 0.7 Hydrocortisone 1% cream Yes 0.51 Deleted Calamine Zinc Oxide oint 1.23 13.5 SCABICIDES AND PEDICULOCIDES Benzyl benzoate 25% lotion Yes 4.42/1L Permethrin Lotion Child, 3.67/100ml pregnant women 13.6 OTHER DERMATOLOGICAL PREPARATIONS Lubricating Jelly 1.76 14 DIAGNOSTIC AGENTS OPHTHALMIC DRUGS Fluorescein ophthalmic strips 64/100 Tropicamide 1% Drops 2.1 14.2 IMMUNOLOGICAL AGENTS PPD Human Tuberculin 100U/ml 44.84 14.3 OTHER AGENTS ECG Electrode Gel 3.34 Ultrasound Gel 15 DISINFECTANTS & ANTISEPTICS Calcium hypochlorite/milton for solution Chlorhexidine 1.5% + cetrimide 15% conc. Yes 3.3/500ml Chlorhexidine 1% cream Yes 3.5/500g Hydrogen peroxide 3% solution 1.27/100ml Methylated spirits 70% SVM Povidine iodine 10% aqueous solution Yes 6.97/500ml 16 DIURETICS Acetazolamide 250mg tablet Glaucoma 0.04 Frusemide 20mg/2ml injection 0.26 Frusemide 40mg tablet Yes 0.01 Hydrochlorothiazide 25mg tablet Yes 0.01 Mannitol 20% injection 3.25 Spironolactone 25mg tablet 0.04 17 GASTROINTESTINAL DRUGS 17.1 ANTACIDS & OTHER ANTIULCER DRUGS Magnesium trisilicate compound tablet Yes 0.01 Omeprazole 20mg capsule 0.02 Rep Ranitidine Ranitidine 50mg injection ICU use only 0.38 17.2 ANTIEMETIC DRUGS Metoclopramide 10mg/2ml injection 0.09 Metoclopramide 10mg tablet 0.01 Prochlorperazine 12.5mg/ml injection 0.51 Promethazine 50mg injection 0.26 17.3 ANTIHAEMORRHOIDAL DRUGS Haemorrhoidal ointment Yes 1.23 All else deleted
17.5 ANTISPASMODIC DRUGS Hyoscine N Butylbromide 20mg injection 0.16 Hyoscine N Butylbromide 10mg tablet 0.02 17.6 LAXATIVE DRUGS Bisacodyl 10mg suppository 0.1 Bisacodyl 5mg tablet 0.01 Delete senna Xray Prep Kits 17.7 DRUGS USED IN DIARRHOEA Codeine phosphate 30mg tablet Yes 0.07 Oral rehydration salts Yes 0.11 HORMONES, OTHER ENDOCRINE DRUGS & 18 CONTRACEPTIVES 18.1 ADRENAL HORMONES & SYNTHETIC SUBSTITUTES Dexamethasone 500mcg tablet 0.07 Hydrocortisone sodium succinate 100mg injection 0.46 Prednisolone 5mg tablet 0.01 18.2 CONTRACEPTIVES 18.21 Hormonal contraceptives Ethinyloestradiol 30mcg + levonorgestrel 150mcg (Microgynon) Yes UNFPA Eugynon deleted Levonorgestrol 750mcg tablet (Postinor) UNFPA Estigyn deleted Levonorgestrel 30mcg (Microlut) Yes UNFPA Provera 10mg del Medroxyprogesterone acetate 150mg/ml injection Yes UNFPA Progest Inj del Medroxyprogesterone acetate implant (Norplant) UNFPA UNFPA donation 18.22 Intrauterine Devices Premarin donation Copper-containing IUD UNFPA 18.23 Barrier Methods Condoms with or without spermicide (nonoxicol) Yes UNFPA 18.4 Insulins and other Antidiabetic Agent Glibenclamide 5mg tabs Yes 0.01 Glipizide 5mg tablet renal pts 0.03 Insulin soluble 100IU/ml 10ml 12.4 Insulin Isophane 100IU/ml 10ml 12.4 Mixtard if needed Metformin 500mg tablet Yes 0.02 18.5 OVULATION INDUCERS Clomiphene 50mg tablet O&G only 18.6 PROGESTERONES Norethisterone 5mg tablet 0.02 18.7 THYROID HORM & ANTITHYROID DRUGS Carbimazole 5mg tablet 0.02 Thyroxine 100mcg tablet 0.02 18.8 OTHER Finasteride 5mg tablet Indiv pat only 1.2 Very expensive 19 IMMUNOLOGICALS 19.1 SERA & IMMUNOGLOBULINS HBV immunoglobulin 400U/ml 19.2 For universal immunisation BCG Vaccine Yes Pub Health DPT Vaccine Yes Pub Health Hepatitis B Vaccine Yes Pub Health Measles-Rubella Yes Pub Health Polio (Sabin) Yes Pub Health Tetanus Toxoid Adsorbed Yes Pub Health
MUSCLE RELAXANTS(PERIPHERALLY ACT) & 20 C'ESTERASE INHIBITORS Atracurium 25mg/2.5ml injection 6.77 small supply only Neostigmine 2.5mg injection 0.47 Suxamethonium 100mg/2ml injection 0.55 Pancur deleted Vecuronium 10mg injection 5.56 21 OPTHALMOLOGICAL & ENT PREPARATIONS 21.1 ANTI-INFECTIVE AGENTS Aciclovir Eye Ointment Ocular herpes 0.56 Chloramphenicol 5% ear drops Yes 0.59 Chloramphenicol 0.5% eye drops Yes 0.38 Chloramphenicol 1% eye ointment Yes 0.3 Gentamicin 0.3% eye drops 0.58 Tetracycline 1% eye ointment Yes 0.18 21.2 ANTI-INFLAMMATORY AGENTS Dexamethasone 1mg/ml eye drops 1.83 21.3 LOCAL ANAESTHETICS Amethocaine 0.5% eye drops 2.27 21.4 MIOTICS & ANTIGLAUCOMA DRUGS Acetazolamide 250mg tablets 0.04 Pilocarpine 2% eye drops 1.28 Timolol - indiv.pat 21.5 MYDRIATICS Tropicamide 1% eye drops 1.05 Atropine dr del Phenylephrine 10% Drops/Minims 1.26 22 OXYTOCICS & ANTIOXYTOCICS 22.1 OXYTOCICS Ergometrine 500mcg + oxytocin 5iu injection Yes 1.84 Oxytocin 10iu injection Yes 0.23 Misoprostol 200mcg tablet O&G only 0.32 22.2 ANTIOXYTOCICS Nifedipine 20mg SR tablet Yes 0.01 Salbutamol 500mcg/ml injection 0.25 24 PYSCHOTHERAPEUTIC DRUGS Amitriptylline 25mg tablets 0.01 Chlorpromazine25 mg tablets 0.02 prev.100mg Chlorpromazine 50mg injection 0.1 Diazepam 5mg tablets Yes 0.01 Fluphenazine Depot 25mg/ml injection Indiv patient 0.99 Haloperidol 5mg injection 0.33 DRUGS ACTING ON THE RESPIRATORY 25 TRACT Adrenaline 1mg/ml injection Yes 0.43 Aminophylline 250mg/10ml injection 0.72 Del theophylline Beclomethasone 50/100mcg inhaler 4.42 Del Beconase Salbutamol 100mcg Inhaler Yes 2.16 Salbutamol 5mg/ml Resp.Soln 30ml 5.75 Salbutamol 500mcg/ml injection 0.1 Delete Fenoterol Salbutamol 4mg tablet 0.01 Delete over time, encourage spray SOLNS CORRECTING WATER, ELECTROLYTE 26 & ACID BASE DISTURB 26.1 ORAL Oral rehydration salts Yes 0.11 Potassium chloride SR 600mg tablet 0.01 Limit supply Sod.citrotartrate sachets (Ural) 26.2 PARENTERAL
Calcium Chloride 10% injection 3.62 Compound solution of sodium lactate (Hartmanns) 1L Yes 1.3 Dextrose 10% injection 10ml O&G only Dextrose 5% 1L 1.3 Dextrose 50% 50ml Yes 1.5 Dextrose 3% in 1/3 NS 1L 1.4 Gelofusine Plasma Expander 500ml 5.93 Magnesium Sulphate 50% injection Eclampsia 1.33 Mannitol 20% 500ml 3.25 Potassium chloride 1.5g/10ml 0.5 Sodium bicarbonate 8.4% 10ml 0.86 Sodium chloride 0.9% 1L Yes 1.3 Water for injection 10ml Yes 0.07 Keep only 10ml 27 VITAMINS & MINERALS Hydroxocobalamin 1mg/ml injection (VitB12) 0.45 Del Vit B gp tabs Multivitamin tablet Yes 0.01 Del Calcium carb Pyridoxine 50mg tablet 0.02 Deleted Vit C Phytomenadione 1mg in 0.5ml injection (Vit K1) Yes 0.3 10mg deleted