France: medications published in a journal blacklist

For the seventh consecutive year, the journal identifies drugs whose dangers outweigh their benefits.

The list includes 93 drugs considered by the medical journal Prescrire to be more harmful than useful

For the seventh consecutive year, the independent French medical journal "Prescrire" has published its report "Pour mieux soigner, des médicaments à écarter" (In English: For better care, avoid these drugs). This analysis identifies drugs whose dangers outweigh their benefits and which should, therefore, be avoided. The goal is to help doctors choose high-quality treatments for patients.

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The French journal "Prescrire", engaged in independent scientific information in the pharmacological-diagnostic field, has recently updated the list of drugs that should be avoided or even withdrawn from the market since they seem to have a negative benefit-risk ratio.

The indications, formulated by a group of professionals and researchers working in various areas of health, and without conflicts of interest, are based on a rigorous investigation methodology that provides, for each drug, a search of the available scientific literature, the consideration of data from only high quality studies, the identification of important results from the point of view of patients, comparison with standard treatments, and the analysis of all known and potential adverse events.

The characteristics of the finished drugs in the blacklist can be summarized as follows:

The 2019 update, published in the February issue, covers a period of 9 years, from 2010 to 2018, and includes 93 drugs that cause more harm than good in all indications for which they have been authorized in France or the European Union.

Among the medications not to be prescribed are some cough sedatives whose side effects would be worse than the benefits. In particular, ambroxol, found in Muxol, and bromhexine, found, for example, in Bisolvon and other mucolytics, are indicated. According to Prescrire, these components could cause polymorphic erythema, Stevens-Johnson's syndrome and Lyell's syndrome. Oxomemazine is also on the list, which is present in drugs such as Toplexil, an antihistamine that can have disproportionate adverse effects in the symptomatic treatment of coughing. And then the pholcodine present in Biocalyptol that could cause sensitization to the treatment.

Also on the blacklist are some nasal decongestants containing ephedrine, naphazoline, oxymetazoline, phenylephrine, pseudoephedrine, and tuaminoheptane which expose them to the risk of serious cardiovascular disease. Considering that they are only intended to relieve the symptoms of the cold, it is thought that the side effects outweigh the benefits.

Then there is Zyban with the active ingredient bupropion which should help to quit smoking. According to Prescrire it could cause neuropsychic disorders such as aggression, depression, or suicidal tendencies.

The blacklist also includes non-steroidal anti-inflammatory drugs with diclofenac such as the oral Voltaren where the risks are related to heart failure and stroke. Finally, the ketoprofen gel, Ketum, is considered to cause photosensitization.

The complete list can be downloaded here (in French)

"Pour mieux soigner, des médicaments à écarter : bilan 2019" Rev Prescrire 2019 ; 39 (424) : 131-141. (pdf, accès libre)