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Research

Development of a preliminary essential medicines list for Canada

Michael S. Taglione, Haroon Ahmad, Morgan Slater, Babak Aliarzadeh, Richard H. Glazier, Andreas Laupacis and Nav Persaud
February 27, 2017 5 (1) E137-E143; DOI: https://doi.org/10.9778/cmajo.20160122
Michael S. Taglione
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
BSc
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Haroon Ahmad
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
BAMA
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Morgan Slater
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
PhDMSc
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Babak Aliarzadeh
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
MPHMD
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Richard H. Glazier
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
MDMPH
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Andreas Laupacis
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
MDMScBA
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Nav Persaud
Faculty of Medicine (Taglione), University of Toronto; Li Ka Shing Knowledge Institute (Taglione, Ahmad, Glazier, Laupacis, Persaud); Department of Family and Community Medicine (Slater, Glazier, Persaud), St. Michael's Hospital; Department of Family and Community Medicine (Aliarzadeh, Glazier, Laupacis, Persaud), University of Toronto; University of Toronto Practice Based Research Network (Aliarzadeh); Institute for Clinical Evaluative Sciences (Glazier), Toronto, Ont.
BABScMDMSc
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    Figure 1

    Additions, removals and replacements to the list of essential medications throughout development.

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    Table 1: Preliminary list of essential medicines
    World Health Organization (WHO) class1Medicines
    Antiallergics and medicines used in anaphylaxisCetirizine*Diphenhydramine*Epinephrine†
    Anticonvulsive medicationCarbamazepine, gabapentin*PhenytoinValproic acid†
    Anti-infective medicinesAbacavir*, amoxicillin, amoxicillin/clavulanic acid, azithromycin, cephalexin, ciprofloxacin, clindamycin, clotrimazoleCloxacillin, dolutegravir*, doxycycline, efavirenz, emtricitabine, fluconazole, gentamicin†, lamivudineLevofloxacin, metronidazole, nitrofurantoin, nystatin, sulfamethoxazole/trimethoprim, tenofovir, trimethoprim, valacyclovir*
    Antimigraine medicinesEletriptan*
    Antineoplastic and immunosuppressivesMethylprednisolonePrednisone*Tretinoin
    Antiparkinsonism medicinesBenztropine*Levodopa/carbidopa
    Cardiovascular medicinesAmlodipine, atorvastatin*, bisoprolol, candesartan*Clopidogrel, diltiazem*, labetalol*Pravastatin*, ramipril*, nitroglycerin*
    Dermatological (topical)Benzoyl peroxide, betamethasone, fusidic acid*Hydrocortisone†, mupirocin, permethrinSalicylic acid, urea
    DiureticsChlorthalidone*Furosemide†Spironolactone†
    Eye preparationsLatanoprostOlopatadine*Pilocarpine
    Gastrointestinal medicinesMetoclopramide†, pantoprazole*Polyethylene glycol 3350*, ranitidineSenna†, sulfasalazine†
    Hormones, other endocrine medicines, and contraceptivesAlendronate*, conjugated estrogens*, copper-containing IUD, estradiol*, ethinyl estradiol/levonorgestrel, GliclazideInsulin - long acting, Insulin - short acting, Levonorgestrel‐releasing implant, Levothyroxine, medroxyprogesterone, metforminMethimazole*, potassium, propylthiouracil, testosterone, vaginal ring eluting etonogestrel and ethinyl estradiol
    Medicines acting on the respiratory tractBeclomethasone, budesonide†, fluticasone*Ipratropium, salbutamolSalmeterol*, tiotropium*
    Medicines affecting the bloodFerrous fumarate, folic acidRivaroxaban*Warfarin
    Medicines for diseases of jointsAllopurinol†Methotrexate†
    Medicines for mental and behavioural disordersAtomoxetine*, clozapine, diazepam†, fluoxetine†, haloperidol†Lithium, methadone, naltrexone*, nicotine replacement therapyNortriptyline*, risperidone, sertraline*, varenicline*
    Medicines for pain and palliative careAcetaminophen, ASA†, baclofen*Dexamethasone†, hydromorphone, Ibuprofen†Loperamide, morphine†, naproxen*
    Vitamins and mineralsVitamin B12*Vitamin D
    Medicines that do not fall under a WHO classFinasteride*, oxybutynin*Sildenafil*Tamsulosin*

    Note: IUD = intrauterine device.

    *indicates medicines not on the WHO list of essential medicines.

    †indicates medicines listed under multiple WHO classes.

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      Table 2: Patient characteristics at the audit sites
      Inner city siteSuburban site
      No. of patients477735 544
      Sex, no. (%)Male: 2063 (43)
      Female: 2714 (57)
      Male: 11 643 (33)
      Female: 23 900 (67)
      Not specified: 1
      Age, yr,
      mean ± SD
      44 ± 2050 ± 22

      Note: SD = standard deviation.

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        Table 3: Medication coverage at the audit sites
        Inner city siteSuburban site
        No. of medications prescribed19 074119 862
        No. (%) of medications included on the list (%)10 238 (53.7)59 108 (49.3)
        No. of medications with equivalents on the list7077 (37.1)51 873 (43.3)
        No. of medications without list coverage1759 (9.2)8881 (7.4)
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      Development of a preliminary essential medicines list for Canada
      Michael S. Taglione, Haroon Ahmad, Morgan Slater, Babak Aliarzadeh, Richard H. Glazier, Andreas Laupacis, Nav Persaud
      Feb 2017, 5 (1) E137-E143; DOI: 10.9778/cmajo.20160122

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      Development of a preliminary essential medicines list for Canada
      Michael S. Taglione, Haroon Ahmad, Morgan Slater, Babak Aliarzadeh, Richard H. Glazier, Andreas Laupacis, Nav Persaud
      Feb 2017, 5 (1) E137-E143; DOI: 10.9778/cmajo.20160122
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