Nearly all national essential medicines lists include withdrawn medicines: study

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Nearly all national essential medicines lists include withdrawn medicines: study

Toronto, December 10, 2019

By Jennifer Stranges

Dr. Nav Persaud
Dr. Nav Persaud

New research led by St. Michael’s Hospital of Unity Health Toronto analyzed the essential medicines lists of 137 countries and found all but one list included one or more medicines that have either been withdrawn by a regulator or not approved for marketing due to adverse effects in other countries. Somalia listed 83 medicines, and did not include a withdrawn medicine on its essential medicines list.

The study, published in PLOS ONE, identified 97 medicines that were withdrawn from markets between 1953 and 2014 but still included on a national essential medicines list. Eleven of these medicines were withdrawn worldwide because of their associations with harm, but were still included on up to 39 lists.

The findings shed light on the inconsistencies in national essential medicines lists worldwide. The World Health Organization (WHO) recommends that countries carefully select the medicines to be included in their national essential medicines list, which are designed to prioritize access to important treatments.

“The presence of withdrawn medicines on essential medicines lists may cause unnecessary harms to populations,” said Dr. Nav Persaud, a clinician-scientist at the Li Ka Shing Knowledge Institute of St. Michael’s and lead author of the study.

“These findings represent an opportunity for improvement in selecting medicines to include on essential medicines lists. Countries may want to apply special scrutiny to withdrawn medicines and prioritize the 11 medicines that have been withdrawn worldwide for removal from their essential medicines lists.”

The study found that 90 per cent of countries analyzed listed diclofenac, a nonsteroidal anti-inflammatory drug, which was refused for registration in the Philippines and Norway in 1983 and 1987 respectively. A 2014 study recommended the drug be removed from all essential medicines lists given its similar cardiovascular risks to a related drug, rofecoxib, which has been withdrawn worldwide.

Dr. Persaud said future studies could further guide the criteria and strategies used for selecting and editing medicines included on national essential medicines lists.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit

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