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Clomifene: serious, sometimes irreversible, vision disorders  Adverse effects   In 2023, a US team published a case report of a 39-year-old woman who had, for 3 days, been taking 100 mg per day of clomifene (Clomid° or other brands), an oestrogen agonist/antagonist used to treat infertility by inducing ovulation. The woman described visual disturbances characterised by a blurry trail of multiple images persisting behind her hand as she moved it across her field of view. Full article available for download by subscribers 1 February 2024

Drugs that interfere with the placenta and affect the fetus  Adverse effects   The consequences of drug use on the placenta remain little studied as of 2023. Pharmacological knowledge about the substance in question helps to predict its impact on placental development and function, at all stages of pregnancy. Full article available for download by subscribers 1 February 2024

European Commission: taken to task by the Ombudsman for lack of transparency  Outlook   Following complaints on excessive response times, the European Ombudsman has reminded the European Commission that EU citizens have the right to access administrative documents and that access delayed is access denied. Full article available for download (free) 1 February 2024

Drugs to avoid in the name of better patient care: 2024 update  DRUGS TO AVOID - 2024 UPDATE   To make it easier to choose high-quality care, and to prevent disproportionate harm to patients, Prescrire has published its annual update of drugs to avoid. Full article (11 pages) available for download (free) 1 February 2024

Revision of European pharmaceutical legislation  Outlook   The European Parliament is set to vote on a proposed new regulation and directive in spring 2024. Prescrire has proposed a number of amendments. Full article available for download (free) 1 February 2024

Safety signals: why bother?  Editorial  A drug is a serious affair. With serious medical and ethical aspects, as well as economic and financial implications, to consider. It is the culmination of lengthy laboratory-based and clinical research. When the first safety signal appears, it would be unreasonable to tear down all that has been accomplished and waste all of the economic benefits at the drop of a hat. Full article available for download (free) 1 January 2024

Abemaciclib (Verzenios°), palbociclib (Ibrance°) and ribociclib (Kisqali°) added to an aromatase inhibitor in certain breast cancers  Marketing Authorisations   Abemaciclib, palbociclib and ribociclib have been authorised since the late 2010s for use in postmenopausal women with locally advanced or metastatic breast cancer, whose tumour cells express hormone receptors but do not overexpress the HER2 protein. According to the initial clinical evaluation of each of these CDK 4/6 inhibitors ("ciclibs"), none of them extended survival, while an increased incidence of serious adverse effects was reported. With longer follow-up, does the addition of a CDK 4/6 inhibitor to an aromatase inhibitor extend survival? And what more is known about their adverse effects? Full article (3 pages) available for download by subscribers 1 January 2024

When the cause of a disorder is not immediately obvious: could a drug be responsible?  Outlook   The potential role of a drug in the onset of a disorder is often overlooked or rarely considered. Yet many disorders are sometimes drug-induced, and in some cases this aetiology was long unsuspected or considered unlikely. This article discusses a few examples of clinical situations for which a drug-related cause was initially considered unlikely, but became credible over time. Full article available for download by subscribers 1 January 2024

Prescribing cascades: recognise them and take corrective action  Adverse effects   Using a systematic literature review, a research team identified situations in which a drug was prescribed to treat a disorder caused by another drug. Nine prescribing cascades turned out to be particularly problematic in older patients, due to their clinical consequences, the frequency with which the drugs involved were prescribed, or the severity of their potential adverse effects, yet alternatives were available. Full article available for download by subscribers 1 January 2024

When to take a safety signal into account: Prescrire's experience  Outlook   A large number of safety signals, suggesting the existence of previously unknown or incompletely documented adverse effects, can be found in numerous publications from a wide variety of sources. How can healthcare professionals tell which signals are worth taking into account in order to provide better patient care? This article is based on Prescrire's experience and continuous monitoring of the literature. Full article (4 pages) available for download by subscribers 1 January 2024

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