Maxilase, Rhinadvil, Smecta, Voltarene… As every year in December, the medical journal Prescrire updated its blacklist of drugs to avoid. 88 medicines marketed in France are listed. List 2023.
[Mise à jour le 12 décembre 2022 à 14h13] For eleventh year, the medical journal Prescribe publish his blacklist of drugs to be avoided for treatment. In the 2023 edition, 107 substances are identified as “more dangerous than useful”. of whose finger 88 marketed in France because their the risk-benefit balance is unfavorable in all clinical situations where they are permitted. “This report covers medicines whose detailed analysis was published in Prescrire from 2010 to 2022.analysis of new pharmaceutical specialtiesnew indications, evaluation follow-ups, both on it side effects than on efficiency dataand sometimes updates to data regarding certain adverse effects of a drug”, says the review. “One of the main purposes of Prescrire is to empower caregivers and thus patients clear, synthetic, reliable and up-to-date, independent information commercial or corporate conflicts of interest that they need for their practice.” According to this assessment, some have drugs are addedothers is removed, either because their marketing has been stopped by decision of the company or a health authority, or the time of a re-examination of their benefit-risk balance. The review states that it can be:
- Medicine assetsbut as considering the clinical situation, exposed to disproportionate risks in relation to the benefits they bring
- Medicine old whose use is outdated because other newer drugs have a more favorable balance of benefits and risks
- Medicine recentwhose risk-benefit balance is less favorable than for older medicines
- Medicine incleffectiveness is not proven in addition to placebo, and which lead to particularly serious side effects.
Which substances must be excluded?
In the 2023 edition these are 107 substances pointed whose 88 marketed in France for which Prescrire thinks that the benefit-risk balance is unfavorable in all clinical situations where they are approved. The entire 2023 list is available on the journal’s website. Among these substances we find e.g.
- 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 (The Voltaires® 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 (The vowels®, 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.
- For sore throat or cough: alpha-amylase (Maxilase® or other) subject to sometimes severe skin or allergic disorders; oxomemazine (Toplexil® or otherwise), exposes to “disproportionate adverse effects”; tixocortol oral spray (a corticosteroid combined with chlorhexidine (Rhine valley sore throat®)) exposes you to allergic reactions such as facial angioedema, glossitiseven though 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 (power®).
What changes compared to the Prescrire 2022 list?
► 3 more substances to avoid: Peanut protein (Palforzia®), because it “increases the frequency of allergic reactions in patients’ daily life”Roxadustat (Evrenzo®) “a “soup” of various poppy constituents (Papaver somniferum L.) approved for severe diarrhea provides no clinical benefit compared to loperamide (Imodium° or other)” ,and Tincture of Opium (Dropizal®).
► Return of nintedanib among the drugs to be excluded: this drug approved for certain non-small cell lung cancers (under the name Vargatef®) and in certain chronic lung conditions (under the name Off®), had been removed from the list of drugs to be excluded in 2020 to reassess its benefit-risk balance in new indications: certain pulmonary fibrosis and diffuse interstitial pneumonitis associated with systemic sclerosis. Analysis of clinical evaluation data has shown that also in these situations, the benefit/risk ratio for nintedanib is unfavorable. It is therefore again among the substances to be avoided.
►Two drugs withdrawn from balance for re-evaluation: idebenone and teriflunomide. Idebenone (Raxone®) has been removed from the list of drugs to be excluded because Prescrire is reassessing its benefit-risk balance in Leber’s optic neuropathy. Teriflunomide (Aubagio®), an immunosuppressant approved for the treatment of multiple sclerosis, was also removed from balance due to Prescrire assesses its benefit-risk balance in extension of the indication in children from the age of 10.
Source: “For Better Treatment, Medicines to Avoid: 2023 Report” Revue Prescrire 2022 (pdf, free access)