This is Prescrire’s thirteenth consecutive annual review of drugs to avoid. It identifies drugs that are more dangerous than beneficial, along with supporting references. The aim is to help choose high-quality treatments, and to avoid harming patients or exposing them to disproportionate risks. The drugs listed (sometimes only a particular form or dose strength) should be avoided in all the clinical situations for which they are authorised in France or in the European Union.
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106 authorised drugs that are more dangerous than beneficial
 106 of the drugs examined by Prescrire between 2010 and 2024 that are authorised in France or in the European Union are more dangerous than beneficial in all their authorised indications. They are listed based first on the therapeutic area in which they are used, and then in alphabetical order according to their international nonproprietary names (INNs).
These 106 drugs comprise:
- Substances with demonstrated efficacy, but, given the clinical situations in which they are used, their adverse effects are disproportionate to the benefits they provide;
- Older drugs that have been superseded by newer drugs with a better harm-benefit balance;
- Recent drugs that have a less favourable harm-benefit balance than existing options;
- Drugs that have no proven efficacy beyond that of a placebo, but that carry a risk of particularly severe adverse effects.
For each drug, we give the main reasons why it is considered to have an unfavourable harm-benefit balance, together with one or more Prescrire references where subscribers will find further details, as well as the external references on which our analysis was based. When better options are available, they are briefly mentioned, as are situations (serious or non-serious) in which there is no suitable treatment.
 The differences between this year's and last year's versions are detailed > HERE. |
Our 2025 review of drugs to avoid is based on the drugs and indications analysed in detail in our French edition between 2010 and 2024. Some were examined for the first time, while others were re-evaluated as new data on efficacy or adverse effects have become available.
One of the main objectives of our publications is to provide health professionals (and thereby their patients) with clear, independent, reliable and up-to-date information that is free from all conflicts of interest and supports high-quality care.
Prescrire is structured in such a way as to guarantee the quality of the information provided to our subscribers. The Editorial Staff comprise a broad range of health professionals working in various sectors, with no conflicts of interest. We also call on an extensive network of external reviewers (specialists in the relevant area, methodologists, and practitioners representative of our readership), and each article undergoes multiple quality controls and cross-checking at each step of the editorial process.
About Prescrire: How we work > HERE
Our editorial process is a collective one, as symbolised by the “©Prescrire” byline. Prescrire is also fiercely independent. We are funded entirely by our subscribers, carry no paid advertising, receive no grants or subsidies of any kind, and have no shareholders. No company, professional organisation, insurance system or authority involved in the field of health care has any influence, financial or otherwise over the content of our publications.
About Prescrire: Financing > HERE
Comparison with standard treatments
A drug's harm-benefit balance and the choice of treatment options must be continually re-evaluated as new data on efficacy or adverse effects and new treatments become available. Not all drugs are equal, and not all new drugs represent a clinical advance. Some drugs are useful in certain situations, offering a therapeutic advantage over other available treatment options, while other drugs are more dangerous than beneficial and should never be used.
Prescrire's assessments of drugs and indications are based on a systematic and reproducible literature search, and collective analysis of the resulting data by our Editorial Staff, using an established procedure:
- Efficacy data are prioritised so that most weight is given to studies providing robust supporting evidence, i.e. double-blind, randomised controlled trials;
- The drug is compared with the standard treatment (not necessarily a drug) when one exists, after careful determination of the best comparator;
- The results analysed are those based on the clinical endpoints most relevant to the patients concerned, (such as mortality, the most troublesome symptoms, or quality of life, depending on the situation), or on surrogate endpoints (such as laboratory markers or imaging findings) where they have been shown to correlate with relevant clinical endpoints.
Careful analysis of adverse effects
A drug's adverse effects can be more difficult to analyse, as they are often less thoroughly documented than its efficacy. This discrepancy must be taken into account when determining the drug's harm-benefit balance.
The adverse effect profile of each drug is assessed by examining various safety signals that emerged during clinical trials and animal pharmacotoxicology studies, and by considering its pharmacological similarities with other drugs.
When a new drug is approved, many uncertainties remain. Some rare and serious adverse effects may have been overlooked during clinical trials and may only emerge after several years of routine use by a large number of patients.
Empirical data and personal experience: risk of major bias
Empirical assessment of a drug's harm-benefit balance, based on individual experience, can help to guide further research, but it is subject to major bias that strongly reduces the level of evidence of the findings. For example, it can be difficult to attribute a specific outcome to a particular drug, as other factors must be taken into account, including the natural history of the disease, the placebo effect, the effect of another treatment, or a change in diet or lifestyle. Similarly, a doctor who observes an improvement in certain patients cannot know how many other patients' conditions worsened when they received the same treatment.
The best way to minimise subjective bias caused by non-comparative, non-blinded evaluations in a small number of patients is to prioritise experimental data obtained in patients who agreed to participate in clinical trials, especially double-blind randomised trials versus standard care.
Serious conditions with no effective treatment: patients should be informed of the consequences of interventions
When faced with a serious condition for which there is no effective treatment, some patients opt to forgo treatment, while others are willing to try any drug if it offers the slightest chance of even temporary relief, despite a risk of serious adverse effects.
But patients in this situation must not be treated as guinea pigs. Drug evaluations belong in the sphere of formal, properly conducted clinical research, not health care. It is of course useful to enrol patients in clinical trials, provided they are aware of the known or foreseeable risks and the uncertain nature of the possible benefits. And the results of these trials must be published in detail (whether positive, negative or inconclusive) in order to advance medical knowledge.
However, all patients must be made aware that they have the option of refusing to participate in a clinical trial or of refusing a "last-chance" treatment with an uncertain harm-benefit balance.They must be reassured that these are genuine options, and that if they do refuse, they will not be abandoned but will continue to receive the best available care. Even though support, attention and symptomatic treatments are not intended to cure or slow progression of the underlying disease, they are useful elements of patient care.
While a great deal of uncertainty surrounds the harm-benefit balance of drugs that are undergoing evaluation in clinical trials, drugs used for routine care must have a favourable harm-benefit balance. It is in the common interest that drugs should only be granted marketing authorisation on the basis of proven efficacy relative to standard care, along with an adverse effect profile that is acceptable in the situation concerned, because in general, little if any additional information on efficacy is collected once marketing authorisation has been granted. And in the rare cases where drugs with an unfavourable harm-benefit balance are withdrawn, it is a slow process.
> OPEN ACCESS "Towards better patient care: drugs to avoid in 2025" Prescrire Int 2025; 34 (267): 52-1 - 52-11.
For more about this year's update:
- Drugs to avoid in the name of better patient care: 2025 update > HERE
- Drugs to avoid: main changes in the 2025 update > HERE
©Prescrire 1 February 2025
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