DNA Explainer: Why is Ranitidine no more an essential medicine? Check updated list of 384 drugs here

As many as 34 new drugs have been added and 26 dropped in the much-hyped revision of the National List of Essential Medicines (NLEM). The Union Health Ministry announced the revised list of 384 essential drugs across 27 categories. 

Popular antacid salt Ranitidine has been removed from the list over cancer-causing concerns. Ranitidine is sold under brand names like Aciloc, Rantac and Zinetac among others, and is commonly prescribed for acid-related cough, indigestion, stomach pain and heartburn.

The salt has been under investigation since 2019 when the US-based Food and Drug Administration found probable cancer-causing impurity in the drug. Drug-regulators found cancer-causing impurity N-nitrosodimethylamine (NDMA) at “unacceptable levels” in samples of drugs containing ranitidine.

Zantac was one of the world's first drugs to top USD 1 billion in annual sales way back in 1988.

Meanwhile, several anti-cancer drugs, antibiotics and vaccines will now become more affordable as they are among 34 new additions to the NLEM, with the government saying this will reduce "patients' out-of-pocket expenditure".

Anti-infectives like Ivermectin, Mupirocin and Meropenem have also been added to the list, taking the total drugs under it to 384. Four major anti-cancer drugs -- Bendamustine Hydrochloride, Irinotecan HCI Trihydrate, Lenalidomide and Leuprolide acetate which are effective in various types of cancers -- and psychotherapeutic medicines -- Nicotine Replacement Therapy and Buprenorphine -- have been added to the list.

The 26 drugs which have been excluded from the list of essential medicines include: 

1. Alteplase
2. Atenolol
3. Bleaching Powder
4. Capreomycin
5. Cetrimide
6. Chlorpheniramine
7. Diloxanide furoate
8. Dimercaprol
9. Erythromycin
10. Ethinylestradiol
11. Ethinylestradiol(A) Norethisterone (B)
12. Ganciclovir
13. Kanamycin
14. Lamivudine (A) + Nevirapine (B) + Stavudine (C)
15. Leflunomide
16. Methyldopa
17. Nicotinamide
18. Pegylated interferon alfa 2a, Pegylated interferon alfa 2b
19. Pentamidine
20. Prilocaine (A) + Lignocaine (B)
21. Procarbazine
22. Ranitidine
23. Rifabutin
24. Stavudine (A) + Lamivudine (B) 25. Sucralfate
26. White Petrolatum

Here is the revised list of 384 drugs in the essential medicines' list:

1. 5-aminosalicylic acid (Mesalazine/Mesalaine)
2. 5-Fluorouracil
3. 6-Mercaptopurine
4. Abacavir
5. Abacavir (A) + Lamivudine (B)
6. Acetazolamide
7. Acetylsalicylic acid
8. Actinomycin D
9. Activated Charcoal
10. Acyclovir
11. Adenosine
12. Adrenaline
13. Albendazole
14. Allopurinol
15. All-trans retinoic acid
16. Alprostadil
17. Amikacin
18. Amiodarone
19. Amitriptyline
20. Amlodipine
21. Amoxicillin
22. Amoxicillin (A) + Clavulanic acid (B)
23. Amphotericin B
a) Amphotericin B (conventional)
b) Lipid Amphotericin B
c) Liposomal Amphotericin B
24. Ampicillin
25. Anti-D immunoglobulin
26. Anti-rabies immunoglobulin
27. Anti-tetanus immunoglobulin
28. Arsenic trioxide
29. Artemether (A) + Lumefantrine (B)
30. Artesunate
31. Artesunate (A) + Sulphadoxine Pyrimethamine (B)
32. Ascorbic acid (Vitamin C)
33. Atazanavir (A) + Ritonavir (B)
34. Atorvastatin
35. Atracurium
36. Atropine
37. Azathioprine
38. Azithromycin
39. Baclofen
40. Barium sulphate
41. BCG vaccine
42. Bedaquiline
43. Bendamustine Hydrochloride
44. Benzathine benzylpenicillin
45. Benzoyl peroxide
46. Benzylpenicillin
47. Betamethasone
48. Betamethasone (valerate)
49. Bicalutamide
50. Bisacodyl
51. Bleomycin
52. Bortezomib
53. Budesonide
54. Budesonide (A) +Formoterol (B)
55. Bupivacaine
56. Buprenorphine
57. Buprenorphine (A) + Naloxone (B)
58. Caffeine
59. Calamine
60. Calcium carbonate
61. Calcium folinate
62. Calcium gluconate
63. Capecitabine
64. Carbamazepine
65. Carbimazole
66. Carboplatin
67. Carboxymethyl cellulose
68. Cefadroxil
69. Cefazolin
70. Cefixime
71. Cefotaxime
72. Ceftazidime
73. Ceftriaxone
74. Cefuroxime
75. Cetirizine
76. Chlorambucil
77. Chlorhexidine
78. Chloroquine
79. Cholecalciferol
80. Ciprofloxacin
81. Cisplatin
82. Clarithromycin
83. Clindamycin
84. Clobazam
85. Clofazimine
86. Clomiphene citrate
87. Clomipramine
88. Clonazepam
89. Clopidogrel
90. Clotrimazole
91. Cloxacillin
92. Clozapine
93. Coagulation factor IX
94. Coagulation factor VIII
95. Coal tar (A) + Salicylic Acid (B)
96. Colchicine
97. Condom
98. Co-trimoxazole [Sulphamethoxazole (A) + Trimethoprim (B)]
99. Cryoprecipitate
100. Cyclophosphamide
101. Cycloserine
102. Cyclosporine
103. Cytosine arabinoside
104. D- Penicillamine
105. Dabigatran
106. Dacarbazine
107. Daclatasvir
108. Dapsone
109. Darunavir
110. Darunavir (A) + Ritonavir (B)
111. Daunorubicin
112. Delamanid
113. Desferrioxamine
114. Dexamethasone
115. Dextran-40
116. Diazepam
117. Diclofenac
118. Dicyclomine
119. Diethylcarbamazine
120. Digoxin
121. Diltiazem
122. Dinoprostone
123. Diphtheria antitoxin
124. Dobutamine
125. Docetaxel
126. Dolutegravir
127. Domperidone
128. Donepezil
129. Dopamine
130. Doxorubicin
131. Doxycycline
132. DPT vaccine
133. DPT+ Hib+ Hep B vaccine
134. Efavirenz
135. Enalapril
136. Enoxaparin
137. Entecavir
138. Erythropoietin
139. Escitalopram
140. Esmolol
141. Ethambutol
142. Ethinylestradiol (A) + Levonorgestrel (B)
143. Ethionamide
144. Ethyl alcohol (Denatured)
145. Etoposide
146. Fentanyl
147. Ferrous Salts (A) + Folic Acid (B)
148. Ferrous salts
149. Filgrastim
150. Fluconazole
151. Fludrocortisone
152. Flunarizine
153. Fluorescein
154. Fluoxetine
155. Fluphenazine
156. Folic Acid
157. Framycetin
158. Fresh frozen plasma
159. Furosemide
160. Fusidic acid
161. Gadobenate dimeglumine
162. Gefitinib
163. Gemcitabine
164. Gentamicin
165. Glimepiride
166. Glucose
167. Glucose(A) + Sodium chloride (B)
168. Glutaraldehyde
169. Glycerin
170. Glyceryl trinitrate
171. Glycopyrrolate
172. Griseofulvin
173. Haemodialysis fluid
174. Haloperidol
175. Halothane
176. Heparin
177. Hepatitis B immunoglobulin
178. Hepatitis B vaccine
179. Homatropine
180. Hormone releasing IUD
181. Human chorionic gonadotropin
182. Human normal immunoglobulin
183. Hydrochlorothiazide
184. Hydrocortisone
185. Hydrogen Peroxide
186. Hydroxocobalamine
187. Hydroxychloroquine
188. Hydroxypropyl methylcellulose
189. Hydroxyurea
190. Hyoscine butylbromide
191. Ibuprofen
192. Ifosfamide
193. Imatinib
194. Insulin (Soluble)
195. Insulin Glargine
196. Insulin Intermediate Acting (NPH)
197. Insulin Premix Injection 30:70 (Regular : NPH)
198. Iohexol
199. Ipratropium
200. Irinotecan HCI Trihydrate
201. Iron sucrose
202. Isoflurane
203. Isoniazid
204. Isosorbide dinitrate
205. Ispaghula
206. Itraconazole
207. IUD containing Copper
208. Ivermectin
209. Japanese Encephalitis Vaccine
210. Ketamine
211. Labetalol
212. Lactulose
213. Lamivudine
214. L-Asparaginase
215. Latanoprost
216. Lenalidomide
217. Letrozole
218. Leuprolide acetate
219. Levetiracetam
220. Levodopa (A) + Carbidopa (B)
221. Levofloxacin
222. Levonorgestrel
223. Levothyroxine
224. Lignocaine
225. Lignocaine (A) + Adrenaline (B)
226. Linezolid
227. Lithium
228. Loperamide
229. Lopinavir (A) + Ritonavir (B)
230. Lorazepam
231. Magnesium sulphate
232. Mannitol
233. Measles vaccine
234. Mebendazole
235. Medroxyprogesterone acetate
236. Mefenamic acid
237. Mefloquine
238. Meglumine diatrizoate
239. Melphalan
240. Meropenem
241. Mesna
242. Metformin
243. Methotrexate
244. Methylergometrine
245. Methylprednisolone
246. Methylrosanilinium chloride (Gentian Violet)
247. Methylthioninium chloride (Methylene blue)
248. Metoclopramide
249. Metoprolol
250. Metronidazole
251. Midazolam
252. Mifepristone
253. Miltefosine
254. Misoprostol
255. Montelukast
256. Morphine
257. Moxifloxacin
258. Mupirocin
259. Mycophenolate mofetil
260. N-acetylcysteine
261. Naloxone
262. Natamycin
263. Neostigmine
264. Nevirapine
265. Nicotine replacement therapy (NRT)
266. Nifedipine
267. Nitrofurantoin
268. Nitrous oxide
269. Noradrenaline
270. Norethisterone
271. Nystatin
272. Omeprazole
273. Ondansetron
274. Oral poliomyelitis vaccine
275. Oral rehydration salts
276. Ormeloxifene (Centchroman)
277. Oxaliplatin
278. Oxygen
279. Oxytocin
280. Paclitaxel
281. Pantoprazole
282. Para- aminosalicylic acid
283. Paracetamol
284. Paromomycin
285. Peritoneal dialysis solution
286. Permethrin
287. Pheniramine
288. Phenobarbitone
289. Phenoxymethyl penicillin
290. Phenylephrine
291. Phenytoin
292. Phytomenadione(Vitamin K1)
293. Pilocarpine
294. Piperacillin (A) + Tazobactam (B)*
295. Platelet rich plasma/ Platelet concentrates
296. Podophyllin resin
297. Potassium chloride
298. Potassium permanganate
299. Povidone iodine
300. Pralidoxime chloride (2-PAM)
301. Praziquantel
302. Prednisolone
303. Primaquine
304. Procaine Benzylpenicillin
305. Proparacaine
306. Propofol
307. Propranolol
308. Protamine Sulphate
309. Pyrazinamide
310. Pyridoxine
311. Quinine
312. Rabies vaccine
313. Raltegravir
314. Ramipril
315. Red blood cells/ Packed RBCs
316. Ribavirin
317. Riboflavin
318. Rifampicin
319. Ringer lactate
320. Risperidone
321. Ritonavir
322. Rituximab
323. Rotavirus vaccine
324. Salbutamol
325. Salicylic acid
326. Sevoflurane
327. Silver sulphadiazine
328. Snake Venom Antiserum
a. Soluble/ liquid polyvalent
b. Lyophilized polyvalent
329. Sodium bicarbonate
330. Sodium chloride
331. Sodium nitrite
332. Sodium nitroprusside
333. Sodium thiosulphate
334. Sodium Valproate
335. Sofosbuvir
336. Somatostatin
337. Spironolactone
338. Streptokinase
339. Streptomycin
340. Succinylcholine
341. Sulfasalazine
342. Sumatriptan
343. Surfactant
344. Tacrolimus
345. Tamoxifen
346. Telmisartan
347. Temozolomide
348. Tenecteplase
349. Teneligliptin
350. Tenofovir (A) + Lamivudine (B)
351. Tenofovir (A) + Lamivudine (B) + Dolutegravir (C)
352. Tenofovir (A) + Lamivudine (B) + Efavirenz (C)
353. Tenofovir Alafenamide Fumarate (TAF)
354. Tenofovir Disproxil Fumarate (TDF)
355. Terbinafine
356. Tetanus toxoid
357. Thalidomide
358. Thiamine
359. Thiopentone
360. Timolol
361. Tiotropium
362. Tramadol
363. Tranexamic acid
364. Trastuzumab
365. Trihexyphenidyl
366. Tropicamide
367. Tuberculin, Purified Protein derivative
368. Valganciclovir
369. Vancomycin
370. Vecuronium
371. Verapamil
372. Vinblastine
373. Vincristine
374. Vitamin A
375. Warfarin
376. Water for Injection
377. Whole blood
378. Xylometazoline
379. Zidovudine
380. Zidovudine (A) + Lamivudine (B)
381. Zidovudine (A) + Lamivudine (B) + Nevirapine (C)
382. Zinc Sulphate
383. Zoledronic acid
384. Zolpidem 

The primary purpose of NLEM is to promote rational use of medicines considering the three important aspects -- cost, safety and efficacy, Union Health Minister Mansukh Mandaviya said.

He said the NLEM is a dynamic document and is revised on a regular basis considering the changing public health priorities as well as advancement in pharmaceutical knowledge. The NLEM was formulated in 1996 and it was revised thrice earlier in 2003, 2011, and 2015.

Revision of NLEM 2022 has been done after constant consultation with stakeholders spanning from academia, industrialists and public policy experts etc., and crucial documents like WHO EML 2021.

In the revised list, endocrine medicines and contraceptives Fludrocortisone, Ormeloxifene, Insulin Glargine and Teneliglitin have been added.
Montelukast, which acts on the respiratory track, and ophthalmological drug Latanoprost also figure in the list.

Besides, cardiovascular medicines Dabigatran and Tenecteplase too find place in the list besides medicines used in palliative care.

"Antinfectives such as Ivermectine, Meropenem, Cefuroxime, Amikacin, Bedaquiline, Delamanid, Itraconazole ABC Dolutegravir have been added to the NLM," Dr Y K Gupta, Vice Chairman of the Standing National Committee on Medicines, said.