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.

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 (see Prescrire Int January 2025).

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 (see Prescrire Int November 2024). 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 (see Prescrire Int September 2024).

These substances have been included among Prescrire's drugs to avoid ("Towards better patient care: drugs to avoid in 2025" Prescrire Int February 2025, FREE) 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 1 February 2025

Source: "Take action" Prescrire Int 2025; 34 (267): 31. FREE.