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. 

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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. Alteplase2. Atenolol3. Bleaching Powder4. Capreomycin5. Cetrimide6. Chlorpheniramine7. Diloxanide furoate8. Dimercaprol9. Erythromycin10. Ethinylestradiol11. Ethinylestradiol(A) Norethisterone (B)12. Ganciclovir13. Kanamycin14. Lamivudine (A) + Nevirapine (B) + Stavudine (C)15. Leflunomide16. Methyldopa17. Nicotinamide18. Pegylated interferon alfa 2a, Pegylated interferon alfa 2b19. Pentamidine20. Prilocaine (A) + Lignocaine (B)21. Procarbazine22. Ranitidine23. Rifabutin24. Stavudine (A) + Lamivudine (B) 25. Sucralfate26. White Petrolatum

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

1. 5-aminosalicylic acid (Mesalazine/Mesalaine)2. 5-Fluorouracil3. 6-Mercaptopurine4. Abacavir5. Abacavir (A) + Lamivudine (B)6. Acetazolamide7. Acetylsalicylic acid8. Actinomycin D9. Activated Charcoal10. Acyclovir11. Adenosine12. Adrenaline13. Albendazole14. Allopurinol15. All-trans retinoic acid16. Alprostadil17. Amikacin18. Amiodarone19. Amitriptyline20. Amlodipine21. Amoxicillin22. Amoxicillin (A) + Clavulanic acid (B)23. Amphotericin Ba) Amphotericin B (conventional)b) Lipid Amphotericin Bc) Liposomal Amphotericin B24. Ampicillin25. Anti-D immunoglobulin26. Anti-rabies immunoglobulin27. Anti-tetanus immunoglobulin28. Arsenic trioxide29. Artemether (A) + Lumefantrine (B)30. Artesunate31. Artesunate (A) + Sulphadoxine Pyrimethamine (B)32. Ascorbic acid (Vitamin C)33. Atazanavir (A) + Ritonavir (B)34. Atorvastatin35. Atracurium36. Atropine37. Azathioprine38. Azithromycin39. Baclofen40. Barium sulphate41. BCG vaccine42. Bedaquiline43. Bendamustine Hydrochloride44. Benzathine benzylpenicillin45. Benzoyl peroxide46. Benzylpenicillin47. Betamethasone48. Betamethasone (valerate)49. Bicalutamide50. Bisacodyl51. Bleomycin52. Bortezomib53. Budesonide54. Budesonide (A) +Formoterol (B)55. Bupivacaine56. Buprenorphine57. Buprenorphine (A) + Naloxone (B)58. Caffeine59. Calamine60. Calcium carbonate61. Calcium folinate62. Calcium gluconate63. Capecitabine64. Carbamazepine65. Carbimazole66. Carboplatin67. Carboxymethyl cellulose68. Cefadroxil69. Cefazolin70. Cefixime71. Cefotaxime72. Ceftazidime73. Ceftriaxone74. Cefuroxime75. Cetirizine76. Chlorambucil77. Chlorhexidine78. Chloroquine79. Cholecalciferol80. Ciprofloxacin81. Cisplatin82. Clarithromycin83. Clindamycin84. Clobazam85. Clofazimine86. Clomiphene citrate87. Clomipramine88. Clonazepam89. Clopidogrel90. Clotrimazole91. Cloxacillin92. Clozapine93. Coagulation factor IX94. Coagulation factor VIII95. Coal tar (A) + Salicylic Acid (B)96. Colchicine97. Condom98. Co-trimoxazole [Sulphamethoxazole (A) + Trimethoprim (B)]99. Cryoprecipitate100. Cyclophosphamide101. Cycloserine102. Cyclosporine103. Cytosine arabinoside104. D- Penicillamine105. Dabigatran106. Dacarbazine107. Daclatasvir108. Dapsone109. Darunavir110. Darunavir (A) + Ritonavir (B)111. Daunorubicin112. Delamanid113. Desferrioxamine114. Dexamethasone115. Dextran-40116. Diazepam117. Diclofenac118. Dicyclomine119. Diethylcarbamazine120. Digoxin121. Diltiazem122. Dinoprostone123. Diphtheria antitoxin124. Dobutamine125. Docetaxel126. Dolutegravir127. Domperidone128. Donepezil129. Dopamine130. Doxorubicin131. Doxycycline132. DPT vaccine133. DPT+ Hib+ Hep B vaccine134. Efavirenz135. Enalapril136. Enoxaparin137. Entecavir138. Erythropoietin139. Escitalopram140. Esmolol141. Ethambutol142. Ethinylestradiol (A) + Levonorgestrel (B)143. Ethionamide144. Ethyl alcohol (Denatured)145. Etoposide146. Fentanyl147. Ferrous Salts (A) + Folic Acid (B)148. Ferrous salts149. Filgrastim150. Fluconazole151. Fludrocortisone152. Flunarizine153. Fluorescein154. Fluoxetine155. Fluphenazine156. Folic Acid157. Framycetin158. Fresh frozen plasma159. Furosemide160. Fusidic acid161. Gadobenate dimeglumine162. Gefitinib163. Gemcitabine164. Gentamicin165. Glimepiride166. Glucose167. Glucose(A) + Sodium chloride (B)168. Glutaraldehyde169. Glycerin170. Glyceryl trinitrate171. Glycopyrrolate172. Griseofulvin173. Haemodialysis fluid174. Haloperidol175. Halothane176. Heparin177. Hepatitis B immunoglobulin178. Hepatitis B vaccine179. Homatropine180. Hormone releasing IUD181. Human chorionic gonadotropin182. Human normal immunoglobulin183. Hydrochlorothiazide184. Hydrocortisone185. Hydrogen Peroxide186. Hydroxocobalamine187. Hydroxychloroquine188. Hydroxypropyl methylcellulose189. Hydroxyurea190. Hyoscine butylbromide191. Ibuprofen192. Ifosfamide193. Imatinib194. Insulin (Soluble)195. Insulin Glargine196. Insulin Intermediate Acting (NPH)197. Insulin Premix Injection 30:70 (Regular : NPH)198. Iohexol199. Ipratropium200. Irinotecan HCI Trihydrate201. Iron sucrose202. Isoflurane203. Isoniazid204. Isosorbide dinitrate205. Ispaghula206. Itraconazole207. IUD containing Copper208. Ivermectin209. Japanese Encephalitis Vaccine210. Ketamine211. Labetalol212. Lactulose213. Lamivudine214. L-Asparaginase215. Latanoprost216. Lenalidomide217. Letrozole218. Leuprolide acetate219. Levetiracetam220. Levodopa (A) + Carbidopa (B)221. Levofloxacin222. Levonorgestrel223. Levothyroxine224. Lignocaine225. Lignocaine (A) + Adrenaline (B)226. Linezolid227. Lithium228. Loperamide229. Lopinavir (A) + Ritonavir (B)230. Lorazepam231. Magnesium sulphate232. Mannitol233. Measles vaccine234. Mebendazole235. Medroxyprogesterone acetate236. Mefenamic acid237. Mefloquine238. Meglumine diatrizoate239. Melphalan240. Meropenem241. Mesna242. Metformin243. Methotrexate244. Methylergometrine245. Methylprednisolone246. Methylrosanilinium chloride (Gentian Violet)247. Methylthioninium chloride (Methylene blue)248. Metoclopramide249. Metoprolol250. Metronidazole251. Midazolam252. Mifepristone253. Miltefosine254. Misoprostol255. Montelukast256. Morphine257. Moxifloxacin258. Mupirocin259. Mycophenolate mofetil260. N-acetylcysteine261. Naloxone262. Natamycin263. Neostigmine264. Nevirapine265. Nicotine replacement therapy (NRT)266. Nifedipine267. Nitrofurantoin268. Nitrous oxide269. Noradrenaline270. Norethisterone271. Nystatin272. Omeprazole273. Ondansetron274. Oral poliomyelitis vaccine275. Oral rehydration salts276. Ormeloxifene (Centchroman)277. Oxaliplatin278. Oxygen279. Oxytocin280. Paclitaxel281. Pantoprazole282. Para- aminosalicylic acid283. Paracetamol284. Paromomycin285. Peritoneal dialysis solution286. Permethrin287. Pheniramine288. Phenobarbitone289. Phenoxymethyl penicillin290. Phenylephrine291. Phenytoin292. Phytomenadione(Vitamin K1)293. Pilocarpine294. Piperacillin (A) + Tazobactam (B)*295. Platelet rich plasma/ Platelet concentrates296. Podophyllin resin297. Potassium chloride298. Potassium permanganate299. Povidone iodine300. Pralidoxime chloride (2-PAM)301. Praziquantel302. Prednisolone303. Primaquine304. Procaine Benzylpenicillin305. Proparacaine306. Propofol307. Propranolol308. Protamine Sulphate309. Pyrazinamide310. Pyridoxine311. Quinine312. Rabies vaccine313. Raltegravir314. Ramipril315. Red blood cells/ Packed RBCs316. Ribavirin317. Riboflavin318. Rifampicin319. Ringer lactate320. Risperidone321. Ritonavir322. Rituximab323. Rotavirus vaccine324. Salbutamol325. Salicylic acid326. Sevoflurane327. Silver sulphadiazine328. Snake Venom Antiseruma. Soluble/ liquid polyvalentb. Lyophilized polyvalent329. Sodium bicarbonate330. Sodium chloride331. Sodium nitrite332. Sodium nitroprusside333. Sodium thiosulphate334. Sodium Valproate335. Sofosbuvir336. Somatostatin337. Spironolactone338. Streptokinase339. Streptomycin340. Succinylcholine341. Sulfasalazine342. Sumatriptan343. Surfactant344. Tacrolimus345. Tamoxifen346. Telmisartan347. Temozolomide348. Tenecteplase349. Teneligliptin350. 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. Terbinafine356. Tetanus toxoid357. Thalidomide358. Thiamine359. Thiopentone360. Timolol361. Tiotropium362. Tramadol363. Tranexamic acid364. Trastuzumab365. Trihexyphenidyl366. Tropicamide367. Tuberculin, Purified Protein derivative368. Valganciclovir369. Vancomycin370. Vecuronium371. Verapamil372. Vinblastine373. Vincristine374. Vitamin A375. Warfarin376. Water for Injection377. Whole blood378. Xylometazoline379. Zidovudine380. Zidovudine (A) + Lamivudine (B)381. Zidovudine (A) + Lamivudine (B) + Nevirapine (C)382. Zinc Sulphate383. Zoledronic acid384. 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.