Main changes in the 2026 update of Prescrire's drugs to avoid

Four new drugs to avoid: andexanet alfa, chondroitin, fezolinetant and gefapixant

These four drugs were added to Prescrire’s 2026 edition of drugs to avoid due to their disproportionate adverse effects, given that they have no demonstrated clinical efficacy or that their efficacy is uncertain or too modest in comparison with placebo.

Andexanet alfa (Ondexxya°), an antidote to anticoagulants of the direct factor Xa inhibitor (xaban) class, authorised for use in xaban-treated patients with severe bleeding, carries a higher risk of serious thromboembolic events than usual care (Prescrire Int June 2025).

Chondroitin (various brands), an acid mucopolysaccharide used in some European countries in osteoarthritis although it has no demonstrated clinical efficacy, provokes sometimes serious adverse effects, including hypersensitivity reactions (erythema, urticaria or angioedema) (Rev Prescrire February 2025).

Fezolinetant (Veoza°), a drug intended to block neurokinin-3 (NK3) receptors, which are involved in thermoregulation, and that is authorised for menopause-related hot flushes, has disproportionate adverse effects including hepatotoxicity, gastrointestinal and neuropsychiatric disorders, as well as pain at various sites (Prescrire Int January 2026).

Gefapixant (Lyfnua°), an antagonist of the purinergic receptors P2X3 and P2X2/3, is the first drug to have been authorised in the European Union for patients with refractory or unexplained chronic cough. It carries a risk of very frequent taste disturbance, as well as pneumonia and urolithiasis (Prescrire Int November 2025).

Two drugs no longer included among Prescrire’s drugs to avoid: obeticholic acid and piracetam

Obeticholic acid, a bile acid derivative formerly authorised in the European Union for primary biliary cholangitis as Ocaliva°, has been removed from the 2026 edition of drugs to avoid because its marketing authorisation has been revoked. It does not improve the health status of patients in this situation, when used either alone or in combination with ursodeoxycholic acid. It often exacerbates the main symptoms of the disease (pruritus and fatigue), and appears to carry a risk of serious and sometimes fatal hepatic adverse effects (Prescrire Int October 2018).

Piracetam (various brands), a “psychostimulant”, is authorised in some European countries for use in various clinical situations, including vertigo, cognitive and neurosensory impairment in older adults, dyslexia in children, and myoclonus of cortical origin. On re-examining its harm-benefit balance in cortical myoclonus in 2025, the evaluation data showed it to have possible, but uncertain, clinical value in this rare situation (Rev Prescrire October 2025). As our review of drugs to avoid only includes drugs that are more dangerous than beneficial in all their approved indications, piracetam has been removed from this year’s edition. Nevertheless, its harm-benefit balance remains unfavourable in its other authorised indications: its clinical efficacy has not been established, yet it carries a risk of haemorrhage, nervousness, agitation and weight gain (Rev Prescrire September 2020).