An evolving, independent safety barometer
Each year, an independent review weighs effectiveness against risk, spotlighting medicines whose harm may outweigh their help. The 2026 update identifies 108 drugs, including 89 still marketed in France, that present an unfavorable benefit‑risk profile in their current indications. The list shifts as new evidence arrives and older products leave the market.
The aim is not to fuel alarm, but to sharpen choices. As the editors emphasize, the issue is less about scandal than signal, ensuring treatments truly deliver value for patients.
“Treat better by excluding what harms too much for too little benefit” remains a crisp principle, and a pragmatic goal for rational prescribing.
What changed in 2026
Four additions stand out, each for a specific concern. Fezolinetant (Veoza), for menopausal hot flashes, shows only modest efficacy while raising potential liver toxicity signals. Gefapixant (Lyfnua), for refractory chronic cough, frequently alters taste and hints at possible pneumonia risks.
Two long‑debated options in musculoskeletal and emergency care also enter. Chondroitin for osteoarthritis continues to lack robust clinical benefit and has rare but serious allergic reactions. Andexanet alfa (Ondexxya), an in‑hospital antidote for factor Xa inhibitor bleeding, is linked to cardiovascular complications that temper its promise.
Two exits reflect changing contexts. Obeticholic acid, formerly used for primary biliary cholangitis, no longer has authorization in France. Piracetam is re‑appraised: in cortical myoclonus, there may be a possible though uncertain clinical benefit, while in other uses its profile remains unfavorable due to bleeding, agitation, and weight gain.
Familiar remedies under the microscope
Everyday products draw renewed scrutiny. Diosmectite (Smecta), a diarrhea mainstay, faces questions about modest efficacy and potential lead contamination. Alpha‑amylase (Maxilase), used for sore throats, is associated with allergic reactions that can outweigh limited relief.
Several cough suppressants remain on the watchlist: oxomemazine (Toplexil), ambroxol, bromhexine, and pentoxyverine show narrow benefits with adverse effects that feel disproportionate. Decongestants via oral or nasal routes—ephedrine, pseudoephedrine, and oxymetazoline—continue to raise cardiovascular concerns incongruent with a self‑limited cold.
Pain, joints, and the NSAID question
In pain and rheumatology, the pattern is increasingly clear. Certain NSAIDs—diclofenac, piroxicam, celecoxib, etoricoxib, ketoprofen gel, meloxicam, and tenoxicam—retain a less favorable profile, often due to gastrointestinal, renal, or cardiovascular harms. When first‑line options fall short, the comparative safety of ibuprofen or naproxen remains a key theme across independent assessments.
For osteoarthritis, long‑standing adjuncts such as chondroitin, glucosamine, and diacerein continue to miss convincing outcomes, while posing risks that are not purely theoretical. The signal is consistent: symptom relief must be measurable, and trade‑offs must be transparent.
Neurology and mental health signals
Cognitive and psychiatric therapies remain under review for real‑world impact versus harm. Alzheimer’s drugs—donepezil, galantamine, rivastigmine, memantine—are flagged for limited benefit beyond small short‑term effects and a nontrivial burden of side effects. Their place in care is nuanced and contested.
Among antidepressants, concerns span duloxetine, venlafaxine, agomelatine, citalopram, escitalopram, and tianeptine, reflecting issues from cardiac risk to withdrawal and liver injury. Etifoxine, an anxiolytic, also appears for safety signals that remain insufficiently reassuring.
Evidence, context, and evolving decisions
This kind of list is not a verdict, but a living map of where harms appear to outpace gains. It weighs trial data, post‑marketing signals, and everyday experience, acknowledging uncertainty and the realities of clinical trade‑offs. A drug can be risky in one indication, borderline in another, and plausibly useful in a very specific patient context.
Interpreting the signals benefits from clarity on active ingredients, precise indications, and personal risk factors. Names differ across brands, but molecules carry the same mechanisms, which means the same risks tend to follow the same substances.
Key points at a glance
The 2026 list includes 108 medicines, with 89 available in France, deemed more harmful than helpful in current indications.
New entries: fezolinetant, gefapixant, chondroitin, and andexanet alfa, each tied to specific safety or efficacy concerns.
Leavers: obeticholic acid (authorization withdrawn in France) and piracetam (possible, uncertain value in rare myoclonus only).
Common remedies under fire: diosmectite, alpha‑amylase, several antitussives, and oral/nasal decongestants for cardiovascular risk.
Pain care: certain NSAIDs retain unfavorable profiles; comparatively safer choices often include ibuprofen and naproxen when appropriate.
Central nervous system: cognitive drugs and multiple antidepressants flagged for limited benefit and notable harms.
The bigger picture for 2026
The annual tally is a reminder that “available” does not equal optimal, and that real‑world outcomes matter more than theoretical mechanisms. A shorter list of well‑chosen therapies can achieve more than a longer list of marginal ones.
As new studies refine estimates and regulators adjust labels, the map will keep changing. What endures is the commitment to independence, transparency, and the steady question at the heart of good medicine: does this treatment help more than it harms for this specific person at this specific time?