What medications should be banned in 2020?

2020's list of medications to avoid

For the past eight years, Prescrire has published its list of medications "to avoid", due to their disproportionately negative side-effects, their ineffectiveness or even the unnecessary treatment of rather benign pathologies. Conducting an in-depth analysis between 2010 à 2019; Prescrire's team listed 105 medications, of which 92 were commercially available in France, that presented more risks than benefits for patient health, in the clinical indication they're authorised for (France and continental Europe).

How is the balance between benefit and harm determined?

We should first note that all the information gathering in Prescrire was done in an environment that was free from commercial or corporate interests.

Medications are evaluated through thoroughly documented, methodical and verifiable research, including:

• - Ranking data on medication effectiveness
• - Comparisons between the medication and other leading treatments used to address an ailment (whether medical or not)
• - Research on the most pertinent clinical evaluation criteria demonstrating how effective a medication is at improving patient quality of life
• - An analysis of a medication's documented side-effects, observed either during clinical trials or following release onto the market

What types of side-effects are considered?

The evaluations take into account all of the side-effects reported by patients. The effects are rated by severity, frequency and imputability (how likely it is that the medication is responsible for the side-effect reported).

There are two levels of seriousness:

• - Serious side-effects include those which can cause patient death or pose a serious risk to patient health, can provoke hospitalisation (or prolongation of hospitalisation), significant handicap or incapacity, long-term impacts on patient health, deformities or birth defects
• - Non-serious side-effects cause none of the above

Certain rare but serious side-effects may remain undetected during clinical trials only to show up years after the medication has been put on the market. The evaluation of medications takes this unknown factor into account. A side-effect may very well be expected, that is to say, listed on the medication's Product Information Sheet, or unexpected if it's not mentioned there.

Pharmacovigilance is the practice of gathering/detecting, evaluating and alerting the public of side-effects in order to help select the best treatments for patient conditions, decide whether a medication should stay on the market or not, and inform physicians of its potential risks. In the United Kingdom, these actions are  carried out by the Medicines and Healthcare products Regulatory Agency (MHRA)

What medications are affected?

The medications on Prescrire's list include:

• - Active medications: expose patients to disproportionate risks compared to benefits in a given clinical situation
• - Outdated medications: medications that have already been superseded by newer medications which have a better benefit/risk profile
• - New medications: recently released medications whose benefit/risk profile is inferior to older and better-known medications
• - Medications who effectiveness is not proven beyond the placebo effect, and who may provoke potentially serious side-effects
• - Both over the counter and prescribed medications

What are the principal changes between the 2019 and 2020 list?

Every year, Prescrire updates its list, adding or removing medications. Certain medications have been removed from the 2020 list after they were pulled from the French market, as was the case with Mephenesin or because they've been rated more beneficial than harmful, like Uptravi.

On the other hand, twelve other medications were added to the 2020 "harmful" list:

• - For their unfavourable benefit to risk profile: Maxilase (alpha-amylase) for sore throats, Tanakan (Gingo Biloba extract) for cognitive issues in elderly patients, Praxilene for intermittent ischemic limpness due to reduced blood flow to the lower limbs, Elmiron (pentosan polysulfate sodium) to treat painful bladder syndrome, Vicks for dry cough, Tilcotil (Tenoxicam) a non-steroidal anti-inflammatory drug and xylometazoline hydrochloride, used to treat nasal congestion.
• - Because of lead contamination: Actapulgite (attapulgite mormoiron), Smecta (Diosmectite), Rennie Liquo (Hydrotalcite), Bedelix (Montmorillonite beidellitic) and Kaolin, all of which are clay-based medications used to treat digestive issues like diarrhoea.

To learn more, you can take a look at Prescribes list, (link in French). 

This article is for informative purposes only and does not constitute medical advice: Never stop a medical treatment without first consulting with your physician.