ation <strong>of</strong> changes madee changes made in NLEM <strong>2008</strong> whether generic names or their formulations, based onutic classes are as follows:nalgesics, Antipyretics, Non-steroidal Anti-inflammatory Medicines, Medicinessed to treat gout.1 Opioid AnalgesicsSufentanyl in the form <strong>of</strong> citrate 50 mcg/ml, was taken out from the list, because <strong>of</strong>poor availability in the market..2 Non-opioid AnalgesicsMethampyron i.m. inj. 250 mg/ml was taken out from the list for safety reason, wherein the form <strong>of</strong> injection may cause anaphylactic shock. Suggestion to add ketopr<strong>of</strong>ensupp 100 mg and paracetamol supp 120 mg and 240 mg were accepted, recallingthat ketopr<strong>of</strong>en supp is used for post-surgical patients who cannot yet receive oralmedicine forms, while it is non-irritant to the stomach. While paracetamol supp isneeded to prevent febrile convulsion cases, post-surgery in children, in line withpediatric procedures. Availability and procurement <strong>of</strong> paracetamol supp, are limitedto district level hospitals..3 Anti-goutColchicine tablets 500 mcg has been listed in NLEMs from the start. But with theavailability <strong>of</strong> many NSAIDs, its efficacy is valued not much different from otherNSAID medicines, while their safety is lower than colchicine. Thus colchicine wastaken out from the list. The WHO Model List 2007 did not contain colchicines either.nesthetics.1 Local AnestheticsLidocaine inj 5% + glucose 7.5% 2 ml amp was suggested to be added, especially forspinal anesthesia, in areas where bupivacaine are difficult to get. Besides, toxiceffects against the heart is smaller. Lidocaine inj 1% (HCl) + epinefrin 1 : 200,000 inpackaging <strong>of</strong> 20 and 30 ml were deleted from the list, because the packaging is seento be too large, so it would cause spoilage if not finished..2 General Anesthetics and OxygenSuggested liquid is<strong>of</strong>lurane liq 3 - 3.5 % 250 ml are accepted, because <strong>of</strong> advantagesto the heart and are used for patients with specific certain conditions. Midazolam inji.v. 1 mcg/ml and i.v. inj 5 mg/ml are choice medicine for patients with fragile vitalsigns, as sedative, hypnotic, and pre-anaesthetics. While liquid enflurane ih btl 250ml was taken out <strong>of</strong> the list with the reason being less advantageous if compared withis<strong>of</strong>lurane and halothane. While Thiopental i.v. powder inj 1000 mg/ml was taken outfrom the list because <strong>of</strong> safety consideration.ileptic-Anticonvulsantstion <strong>of</strong> addition in the dosage form <strong>of</strong> syrup and chewable tablet for pediatric patients areed. So, in this class were listed: fenitoin syrup 50 mcg/5 ml, carbamazepin 100 mg/ml20 ml, chewable tablets 100 mg. Phenobarbital tab 50 mg was added, because it was stille and cheap.6. Anti-infectiveIn several previous revisions <strong>of</strong> NLEMs, cephalosporinbut only this time the National Committee, gave way to csurgery prophylaxis inj 1 g/vial. Cephazolin is a choprevent surgical wounds infection. The same thing hachosen medicine for meningitis and is used forchloramphenicol and cypr<strong>of</strong>loxacin. The delay <strong>of</strong> entry oby the fast growing anti-infective resistance in hospitalsExpert team agreed to accept the inclusion <strong>of</strong> vanco(methicillin resistant S. aureus) infection, a serious nasvial 50 mg was requested and accepted for inclusion, bmainly for pulmonary fungal infection. In the list it wasexpertise in its use”.For anti-amoebic diloxanide furoate tab 500 mg watreatment <strong>of</strong> cysts that does not show physical symptoi.v. inj 60 mg/ml was added, that was valued to be havininj although from the side <strong>of</strong> usage artemether is morehealth service units).In the antiviral protease inhibitor group lopinavir werHIV/AIDS, although their prices are higher. In anti-tubemedicines are provided, listed were some combinationin the case <strong>of</strong> dosage forms, it was left to program ne(fixed dose combination), or combipack. Single prepaservices which are not yet able to carry out direct oprogram.8. Antineoplastic, Immunosuppressive and MedicinesChlormetin and levamisol were taken out <strong>of</strong> the list,anticancer medicines, because <strong>of</strong> their efficacy and sainj was suggested and accepted by expert team, as weltablet 2 mg. Daunorubicin is a main medication in Acutefound in children. Chlorambucil is low priced, registerethe WHO Model List. Melfalan is a cheap medicine anmyeloma.14. Dental Medication and Oral HealthFrom this therapeutic class many are evaluated as obstaught by Dental Schools, for example sulpha cones psome which are causing environmental damage, likeagreed upon that composite be used.17. Cardiovascular MedicinesIn this therapeutic category a few changes in subclasbecause they are no longer in production and areprocainamide, reserpine and quinidine. In the subclassand digoxin. In the antihypertension class sodium nitrspecific efficacy in surgery needing hypotension techniqtial Medicines <strong>2008</strong>1314
tological Medicinesedicines were deleted because <strong>of</strong> obsolescence, for example gentian violet, liver oilnt. These liquids like lotio kummerfeldi, if needed, can be entered into a hospital formulary.dditions which are accepted are permethrine as an antiscabicide that is less toxic ton, in place <strong>of</strong> Gamexan. Other addition is Liquor Veilli (diluted salicylic acid), a simplee medicine for wet dermatitis.lytes and Nutrientshydration salt in 1000 ml sacchets are deleted from the list, because the packaging is toonefficient to store and it does not maintain freshness for long time. Only 200 ml sachets arele.ase <strong>of</strong> parenteral nutrition liquid namely liquid nutrients i.v. all <strong>of</strong> them were deleted from. The National Committee, especially expert team and consultants, are well aware <strong>of</strong> thence <strong>of</strong> this preparation, but compositions which are available in the market vary and wereny, with uses which may be different.ldren use and neonates in this therapeutic class liquid nutrients were added: glucose 4% +.18% infusion, and sodium bicarbonate inj 1.4% isotonic.otherapeutic Medicineslam was deleted because valued to be non-essential and tend to cause overuse andence. In subclass therapy antidepression and antimania it was suggested addition <strong>of</strong>ine, sertraline and paroxetine. Fluoxetine cap/tab10 mg and cap/tab 20 mg were acceptedice medicines for category SSRI.antipsychotic subclass racemic methylphenidat addition was suggested in the form <strong>of</strong>release and extended release to be used for Attention Deficit Hyperactive Disorder). Although evidence has not fully supported, but all these times it has been a choicene for ADHD. Addition <strong>of</strong> chlozapine was accepted because it is a selected medicine foresistant antipsychotic medicines. This medicine is effective but it is necessary to watch forlocytosis side effect. Periodic leucocytes counts must be taken.atment, Nose, and Throatnt changes took place in looking at ear treatment, nose and throat. Experts consideredatment <strong>of</strong> ear infection does not need to use antibiotics or corticosteroids. Other than thattic preparations in the form <strong>of</strong> nose or ear drops are not listed in the WHO Model List.<strong>of</strong> NLEM <strong>2008</strong>sential medicines concept, NLEM <strong>2008</strong> must be spread to health service facilities in thesia. Socialization can be in the form <strong>of</strong> printed books which are delivered to all healthnd publicized in electronic form.tial Medicines <strong>2008</strong>15
- Page 1 and 2: 651.1IndPNATIONAL LIST of ESSENTIAL
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- Page 59 and 60: APPENDIX IIDECREE OF THE MINISTER O
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iaAkhmaduliati, Apt.i, S.Si, Apt, M
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::STATEMENT OF COMPLIANCEHAIRMAN/VI
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CONFLICT OF INTEREST STATEMENTndone
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yASSESSMENT FORM APPLICATIONFOR ADD
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DRUG INDEX1, 74, see acetosal64, 43
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X-Y-Z, 59, 84zidovudine, 30zinc oxi