Many drugs that have been marketed for decades have become such a part of routine practice that they are taken for granted. Some are useful, with demonstrated efficacy and an acceptable adverse effect profile. Some others have no demonstrated clinical value beyond that of a placebo, and it is debatable whether they should remain on the market.
But there is another category of drugs whose continued presence on the market is unacceptable: drugs that are more dangerous than beneficial, with an adverse effect profile that has worsened over time and is disproportionate given their lack of, or limited, efficacy.
In its 13th consecutive annual review of drugs to avoid, the French non-profit medical journal Prescrire has updated its list of medications that are more dangerous than beneficial in all of their authorised indications.
Such drugs include trimetazidine (Vastarel or other brands), which has no proven efficacy in preventing angina, and for which yet another serious adverse effect, drug reaction with eosinophilia and systemic symptoms (DRESS), has been identified more than 60 years after its market introduction.
They also include tianeptine (Stablon or other brands) used as an antidepressant, for which a warning was issued in the US in early 2024 concerning cases of abuse resulting in seizures, coma and death. And pseudoephedrine, with cerebral vasoconstriction identified as a new serious adverse effect in 2023, on top of its previously described cardiovascular and neurological adverse effects, making its use unjustifiable in a situation as minor as the common cold.
These substances have been included among Prescrire’s drugs to avoid since the first edition.
The list of their adverse effects has grown longer over time, along with the list of associated warnings. Yet companies persist in selling them for profit, and health authorities either fail to intervene or seem powerless to withdraw them from the market.
In response to this inertia, health professionals can take action by working with patients, informing them and involving them in the decision not to prescribe, represcribe or dispense these drugs.
Prescrire’s goal
The aim is to avoid harming patients or exposing them to disproportionate risks, and the drugs listed (sometimes only a particular form or dose strength) should be avoided in all the clinical situations for which they are authorised.
Of the drugs examined by Prescrire between 2010 and 2024 that are authorised in France or in the European Union, 106 are more dangerous than beneficial.
In its latest bulletin, it lists the main differences between the 2024 and 2025 versions.
Fenfluramine returns as a drug to avoid
Fenfluramine (Fintepla) is an amphetamine authorised in severe forms of epilepsy in children. It was removed from the 2024 edition of drugs to avoid while we evaluated its harm-benefit balance in a new authorised indication: Lennox-Gastaut syndrome in children. Analysis of the clinical evaluation data showed that fenfluramine also has an unfavourable harm-benefit balance in this situation. It is therefore once again back among Prescrire’s drugs to avoid.
One new drug to avoid: reboxetine
Reboxetine, which we examined as part of a systematic review of treatment options for adults with depression, is a noradrenaline reuptake inhibitor with a weaker effect on serotonin reuptake. It appears to be less effective than other antidepressants and causes antimuscarinic adverse effects, sexual dysfunction and loss of appetite.
One drug no longer among Prescrire’s drugs to avoid: ulipristal 5 mg
Ulipristal 5 mg (Esmya), a progesterone receptor antagonist and partial agonist, used for uterine fibroids, has been removed from Prescrire’s drugs to avoid after the withdrawal of its authorisation in the European Union. The withdrawal came at the request of the pharmaceutical company that markets this drug. Ulipristal can cause serious liver injury, sometimes requiring liver transplantation.
Prescrire article – Drugs to avoid (Open access)
See more from MedicalBrief archives:
Safety update on medicines containing pseudoephedrine
Anti-depressants more effective than placebos in treating acute depression