Main changes in the 2025 update of Prescrire's drugs to avoid

Fenfluramine returns as a drug to avoid

Fenfluramine (Fintepla°) is an amphetamine authorised in severe forms of epilepsy in children. It was removed from the 2024 edition of drugs to avoid while we evaluated its harm-benefit balance in a new authorised indication: Lennox-Gastaut syndrome in children. Analysis of the clinical evaluation data showed that fenfluramine also has an unfavourable harm-benefit balance in this situation (Prescrire Int October 2024). It is therefore once again back among Prescrire’s drugs to avoid in order to provide better patient care.

One new drug to avoid: reboxetine

Reboxetine, which we examined as part of a systematic review of treatment options for adults with depression, is a noradrenaline reuptake inhibitor with a weaker effect on serotonin reuptake. It appears to be less effective than other antidepressants and causes antimuscarinic adverse effects, sexual dysfunction and loss of appetite.

One drug no longer among Prescrire’s drugs to avoid: ulipristal 5 mg

Ulipristal 5 mg (Esmya°), a progesterone receptor antagonist and partial agonist, used for uterine fibroids, has been removed from Prescrire’s drugs to avoid following the withdrawal of its authorisation in the European Union. The withdrawal came at the request of the pharmaceutical company that markets this drug (Rev Prescrire November 2024). Ulipristal can cause serious liver injury, sometimes requiring liver transplantation.