Here is the list of dangerous drugs to avoid in 2023

[Mise à jour le 12 décembre 2022 à 14h13] For the eleventh year, the medical journal Prescribe publish his black list of drugs to avoid for treatment. In the 2023 edition, 107 drugs “more dangerous than useful” are pointed out of the finger of which 88 marketed in France because their risk-benefit balance is unfavorable in all clinical situations in which they are authorized. “This report covers drugs whose detailed analysis was published in Prescrire from 2010 to 2022.analysis of new pharmaceutical specialtiesnew indications, evaluation follow-ups, both on the side effects than on the efficacy dataand sometimes updates of data concerning certain undesirable effects of a drug”, says the review. “One of the main objectives of Prescrire is to provide caregivers, and thus patients, with clear, synthetic, reliable and up-to-date, independent information commercial or corporate conflicts of interest, which they need for their practice.” Following this assessment, some drugs are addedothers are removed, either because their marketing has been stopped by decision of the firm or a health authority, or the time of a re-examination of their benefit-risk balance. The review states that it may be:

• Medications assetsbut which, given the clinical situation, expose to disproportionate risks in relation to the benefits they bring
• Medications old whose use is outdated, because other newer drugs have a more favorable benefit-risk balance
• Medications recentwhose risk-benefit balance is less favorable than that of older drugs
• Medicines includingeffectiveness is not proven beyond that of a placebo, and which lead to particularly serious adverse effects.

What drugs should be ruled out?

In the 2023 edition, these are 107 drugs pointed whose 88 marketed in France for which Prescrire believes that the benefit-risk balance is unfavorable in all clinical situations in which they are authorized. The full list 2023 is available on the journal’s website. Among these drugs, we find for example;

• In oncology : defibrotide (Defitelio®), mifamurtide (Mepact® not marketed in France), nintedanib (Vargatef® not marketed in France), panobinostat (Farydak®), roxadustat (Evrenzo® not marketed in France), trabectedin (Yondelis® or other), vandetanib (Caprelsa®), vinflunine (Javlor®)
• In cardiology : aliskiren (Rasilez® not marketed in France), bezafibrate (Befizal®), ciprofibrate (Lipanor® or other) and fenofibrate (Lipanthyl® or other), dronedarone (Multaq®), ivabradine (Procoralan ®), nicorandil (Ikorel® or other), olmesartan (Alteis®, Olmetec®), ranolazine (Ranexa® – not marketed in France), trimetazidine (Vastarel® or other).
• In dermatology and allergology : finasteride 1 mg (Propecia® or other), mequitazine (Primalan®)
• In diabetes and nutrition : alogliptin (Vipidia®), vildagliptin (Galvus®), sitagliptin (Januvia®, Xelevia®; and associated with metformin in Janumet®, Velmetia®), orlistat (Xenical® or other).
• In rheumatology / Pain relief : aceclofenac (Cartrex®), diclofenac (Voltarene® or other) orally, coxibs: celecoxib (Celebrex® or other), ketoprofen gel (ketum® gel or other), piroxicam (Feldene®), glucosamine (Flexea®), methocarbamol (Lumirelax®), capsaicin patches (Qutenza®), quinine (Hexaquine®)
• In gastroenterology : obeticholic acid (Ocaliva®), diosmectite (Smecta® or other), domperidone (Motilium® or other), metopimazine (Vogalene®, Vogalib®), beidellitic montmorillonite aka monmectite (Bedelix®)
• In gynecology-endocrinology: tibolone (Livial® or other), ulipristal 5 mg (Esmya® not marketed in France)
• In neurology: in the treatment of multiple sclerosis natalizumab (Tysabri®), flunarizine (Sibelium®) and oxetorone (Nocertone®), neuroleptics used to prevent migraine attacks.
• In case of sore throat or cough: alpha-amylase (Maxilase® or other) exposed to sometimes serious skin or allergic disorders; oxomemazine (Toplexil® or other), exposes to “disproportionate adverse effects”; tixocortol oral spray (a corticosteroid combined with chlorhexidine (Rhinadvil sore throats®)) exposes you to allergic reactions such as angioedema of the face, glossitiseven Quincke’s angioedema.
• In case of a cold: them oral or nasal decongestants (ephedrine, naphazoline, oxymetazoline, phenylephrine, pseudoephedrine, tuaminoheptane and xylometazoline (not marketed in France)).
• Depression, psychotropic: citalopram (Seropram® or other) and escitalopram (Seroplex® or other); duloxetine (Cymbalta® or other); etifoxine (stream®).

What changes compared to the Prescrire 2022 list?

► 3 more drugs to avoid: Peanut protein (Palforzia®) because it “increases the frequency of allergic reactions in the daily life of patients”Roxadustat (Evrenzo®) “a “soup” of various constituents of poppy (Papaver somniferum L.) authorized in severe diarrhoea, does not provide any clinical advantage compared to loperamide (Imodium° or other)” ,and Tincture of opium (Dropizal®).

► Return of nintedanib among the drugs to be ruled out: this medicinal product authorized in certain non-small cell lung cancers (under the name Vargatef®) and in certain chronic lung conditions (under the name of Ofev®), had been withdrawn from the list of drugs to be ruled out in 2020, in order to reassess its benefit-risk balance in new indications: certain pulmonary fibrosis, and diffuse interstitial pneumonia linked to systemic scleroderma. Analysis of clinical evaluation data has shown that also in these situations, the benefit-risk balance of nintedanib is unfavourable. It is therefore again among the drugs to be avoided.

►Two drugs withdrawn from the balance sheet for re-evaluation: idebenone and teriflunomide. Idebenone (Raxone®) has been removed from the list of drugs to be ruled out because Prescrire is reassessing its benefit-risk balance in Leber optic neuropathy. Teriflunomide (Aubagio®), an immunosuppressant authorized in multiple sclerosis, was also removed from the balance sheet because Prescrire assesses its benefit-risk balance in an extension of indication in children from the age of 10.

Source : “For better treatment, drugs to avoid: 2023 report” Revue Prescrire 2022 (pdf, free access)