Some drugs are more harmful than beneficial. They ought to be avoided, until such time as they are withdrawn from the market.

In the interest of choosing quality care, and to avoid harms, the independent French medical journal Prescrire has updated its list of drugs that ought to be avoided in the name of better patient care.

Prescrire’s assessment of a drug’s harm-benefit balance in a given situation is based on a rigorous procedure: a systematic and reproducible literature search, determination of the efficacy criteria most meaningful for patients, ranking of the scientific data on evidence-based grounds, comparison with a reference treatment, consideration of adverse effects and of the role of uncertainties.

The 2016 update is based on ongoing analysis carried out over 6 years, from 2010 through 2015. This analysis has revealed 74 drugs which have an unfavourable harm-benefit balance in all of the indications for which they are authorised.

In the case of treatment failure in a serious illness, it is not justified to expose patients to serious risks, when there is no proven efficacy. Using these drugs in the context of clinical trials may be acceptable, as long as patients are informed of the uncertainty surrounding their harm-benefit balance. Otherwise, it is preferable to focus on care options that will help patients to cope with the lack of any options that could improve their prognosis, or to maintain an acceptable quality of life, beyond the placebo effect.

Some significant additions this year. This year, several antidepressants and one anti-inflammatory that are widely used have been added to Prescrire’s list of drugs to avoid:  citalopram (Cipramil °, Celexa° or other brands), escitalopram (Cipralex °, Lexapro° or other brands) and diclofenac (Voltarol° or other brands), because of cardiac harms that are greater than those for similar drugs.

©Prescrire February 2016

FREE"Towards better patient care: drugs to avoid in 2016" Prescrire February 2016 (pdf, free).