Bleaching powder and ranitidine, a common antacid sold under some of the most popular medicine brands in India, were amongst the ones dropped from the list of National List of Essential Medicines (NLEM) 2022 even as nicotine replacement therapy (NRT) and TB & diabetics treatment drugs were among the latest addition to the list.

As per data released by Union Ministry of Health and Family Welfare on Tuesday Ranitidine — sold under brands Rantac, Zinetac, among others — was taken off the list reportedly following safety concerns.

Nicotine replacement therapy focusses on providing the user with nicotine through gums, patches, sprays, inhalers or even lozenges; but it does not include the harmful chemicals of tobacco. The nicotine replacement therapy is used to relieve physical withdrawal symptoms that some experience.

The government terms “essential medicines” as those that satisfy the priority healthcare needs of most of the population. The NLEM effectively mentions medicines which are to be available at affordable costs. Many of these are used in various national health programmes, treating emerging and re-emerging infections and so on.

The NLEM 2022 includes 384 medicines spread across 27 categories that include cardiovascular ones, those used in anaesthesia, those for neurological disorders, anti-infective medicines, ear, nose, throat and gastrointestinal medicines, hormones, other endocrine medicines and contraceptives, among others.

“Several antibiotics, vaccines, anti-cancer drugs and many other important drugs will become more affordable & reduce patients’ out-of-pocket expenditure,” Mansukh Madaviya, the Union Health Minister, wrote on Twitter as he launched NLEM 2022.

Amongst the medicines 34 new medicines added are some used to treat TB such as amikacin (used for anti-bacterial infections in joints, urinary tracts and also for multi drug resistant TB) and bedaquiline. India has nearly 13 lakh TB patients.

Other additions were cefuroxime – to treat bacterial infections; dabigatran – used as anticoagulant to treat and prevent blood clots after hip or knee surgeries and also prevent stroke, diabetes medicines like insulin glargine (for Type I and Type II diabetes); ivermectin (an anti parasitic drug), montelukast (ashtma treatment); valganciclovir (an anti-viral used to treat cytomegalovirus infection in those with HIV/AIDS or following organ transplant), among others.

According to Vikas Bajpai, Centre of Community Medicine, JNU, none of these medicines (ones removed from essential medicines list) are required for disease control programmes in the country.

Medicines Removed

As many as 26 medicines were deleted from NLEM 2015.

Apart from bleaching powder, medicines like procarbazine – a chemotherapy medicine used to treat lymphoma; rifabutin – used as an antibiotic in TB treatment; sucralfate – to treat ulcers, stress ulcers; were among the other major medicines removed.

Suranjit Chatterjee, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospital-New Delhi, said

“The list of medicines added to the essential list is a welcome move. If the purpose is to get these medicines available and manufacture at a generic level then the Government also needs to ensure that strict quality is maintained in their manufacture.”

According to Sudarsan Jain, Secretary General, Indian Pharmaceutical Alliance, the NLEM 2022 looks to strike a balance between patient centricity and public health concerns. “Anti-microbial resistance is a critical issue NLEM has attempted to address,” he said.