An expert, independent second opinion on more than 1,800 prescription drugs, over-the-counter medications, and supplements

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Frequently Asked Questions

About WorstPills.org

1. What is WorstPills.org?
2. What are the sources for the information on WorstPills.org?
3. How frequently is WorstPills.org updated?

Using WorstPills.org

4. My drug is listed as Do Not Use, Do Not Use for Seven Years After FDA Approval or Limited Use. What does that mean?
5. My drug is NOT listed as Do Not Use, Do Not Use for Seven Years After FDA Approval or Limited Use. What does that mean?
6. If my drug is not listed on WorstPills.org, does that mean it is safe?
7. I think I am suffering from an adverse drug reaction, but I do not see any information about this reaction on WorstPills.org. What should I do?
8. Can I obtain a list of all the Do Not Use drugs? 
9. I have a website or blog. How can I share WorstPills.org content with my readers?

Subscription Information

10. Can I purchase a subscription to the WorstPills.org and pay for it over the phone or by mail?
11. Is the information on this Web site available in a printed version?
12. I’m a Worst Pills, Best Pills News print subscriber, but I’d like to subscribe online to WorstPills.org. How can I convert my print subscription to the online version?
13. How can I cancel my online subscription?
14. Can I make copies of articles for distribution? 
15. How can I give a gift subscription?
16. How does billing work for gift subscriptions? 
17. I received information about the print newsletter Worst Pills, Best Pills in the mail. How can I sign up for a subscription to the newsletter?

Technical Questions

18. Why am I not receiving my monthly updates via e-mail and/or other e-mail messages from WorstPills.org?
19. I have forgotten my password. Can I still log in to WorstPills.org?
20. How do I change the email address associated with my account?
21. What is a cookie, and why must my Internet browser accept cookies to use WorstPills.org?
22. How do I enable my Internet browser to accept cookies?
23. Why am I sometimes asked to log in to WorstPills.org after I have already logged in?
24. What Internet browser should I use to view WorstPills.org?
25. How can I view PDF documents?
26. My question is not answered here – How can I contact you?

About WorstPills.org

1.   What is WorstPills.org?

WorstPills.org is online database written by an expert staff of doctors and pharmacists at Public Citizen. It is searchable by drug name; by family of drugs; by disease or condition; by drug-induced disease or condition; and by health policy issue. In this central source of information, you can find recommendations on drugs and dietary supplements based on unbiased, expert evaluations of the most up-to-date medical literature and the Food and Drug Administration’s (FDA’s) own unpublished data.

WorstPills.org includes in-depth information about the safety and efficacy of more than 500 top-selling drugs – including 212 that we recommend you not use under any circumstances. We also provide recommendations on safer alternatives to harmful drugs and up-to-the-minute email alerts about newly discovered drug dangers.

Click here to view an annotated sample of the types of information you can expect to find on WorstPills.org.

WorstPills.org is provided by Public Citizen, a national, nonprofit consumer advocacy organization. Public Citizen works to ban or re-label unsafe or ineffective drugs and to encourage greater transparency and accountability in the drug approval process. We also work toward improving the system for monitoring and responding to post-marketing safety concerns in the U.S., improving the information available to consumers regarding drugs and dietary supplements and helping doctors and patients make safe and economically wise decisions about drug treatment.

To maintain our independent status, we do not accept funding from corporations, government agencies or professional associations, and we do not accept outside advertising.

2. What are the sources for the information on WorstPills.org?

Our reviews of drugs and supplements are based on several major sources, including:

  • FDA medical officer reviews of information submitted to that agency by the manufacturer
  • FDA-approved professional labeling for pharmaceutical products
  • Reviews of the medical literature using the medical journal database PubMed

WorstPills.org focuses on publications respected for their independence from industry influence. These include The Medical Letter on Drugs and Therapeutics, Drug and Therapeutics Bulletin, and Prescrire International.

Other commonly used sources include Evaluation of Drug Interactions (EDI), United States Pharmacopeia Drug Information (USP DI) and others.

In our drug profiles (except for Do Not Use drugs), we include all drug interactions from the Evaluation of Drug Interactions that qualify as “clinically significant” or “highly clinically significant.” The information in the bulleted lists following each drug profile (again, excluding Do Not Use profiles) is drawn largely from the United States Pharmacopeia Drug Information.

3. How frequently is WorstPills.org updated?

The doctors and pharmacists at Public Citizen review the content on WorstPills.org every six months based on a literature search, a review of FDA labeling changes and new relevant side effect and effectiveness reports identified from the medical literature. Drug recalls are added to the site on a monthly basis.

Using WorstPills.org

4. My drug is listed as Do Not Use, Limited Use or Do Not Use for Seven Years After FDA Approval. What does that mean?

Do not use

After careful review, Public Citizen’s staff of expert physicians and pharmacists have recommended that this drug not be used and have suggested an alternative treatment.

If you discover that you are taking a Do Not Use drug, do not stop taking the drug without first consulting your physician. Suddenly stopping any medication may have serious withdrawal symptoms or side effects.

Drugs are labeled Do Not Use based on one or more of the following criteria:

  • Published references that explicitly state not to use the drug in certain populations.
  • Public Citizen’s opinion that the drug is not as safe as an alternative drug or other treatment. The suggested alternative is always listed in the drug’s profile.
  • Public Citizen’s opinion that the drug lacks evidence of effectiveness. 
  • Public Citizen’s opinion that the drug, a combination drug, does not meet scientific criteria justifying its use. Fixed combinations of drugs should only be used when their use is logical and well-studied. They should either aid compliance or improve the efficacy obtained with a single ingredient. Few fixed combinations meet this standard. Commonly, in the case of combination drugs, at least one ingredient has not been proven to be effective, or the second ingredient has not been proven to add significantly to the effectiveness of the first.
  • It is a “smoke and mirrors” drug, meaning the drug company has passed off as “new” a drug that is nearly chemically identical to an existing drug and received a new patent, thus allowing the company to rake in millions of dollars after the expiration of the patent on one of their top-selling drugs. “Smoke and mirrors” drugs are likely to function in an identical fashion as the original drug because they are chemically similar. These few drugs are Do Not Use for economic reasons. However, we understand that some insurance companies may reimburse for one drug and not the other. Unless otherwise noted, these drugs rarely pose a safety hazard not seen with the original drug.

Do Not Use for Seven Years After FDA Approval

This designation is made for the following reasons:

  • New drugs are the most dangerous because we know the least about their safety.
  • New drugs are tested in a relatively small number of people before they are approved, and much more is known about their effectiveness than their safety.
  • It is rarely known if the new drugs are more or less effective than older drugs.
  • Serious side effects or life-threatening drug interactions may not be detected until a new drug has been taken by hundreds of thousands of people.
  • A number of new drugs have been withdrawn from the market, or serious new adverse reaction warnings have been added to their labeling, usually within seven years after they have been approved by the FDA.

The exception to this rule is the unusual “breakthrough drug” that offers a documented therapeutic benefit over older, proven drugs. We recommend that the majority of new drugs we review on our site not be used for at least seven years after the date of FDA approval.

Do not assume that any drug is a Do Not Use for Seven Years After FDA Approval if no information is yet available about it on WorstPills.org. This designation is applied only after a thorough analysis of the drug in question.

Limited Use

Public Citizen labels drugs as Limited Use based on our experts’ belief that these drugs offer limited benefit or benefit only certain people or conditions.

Drugs were designated for Limited Use on the basis of one or more of the following criteria:

  • Published studies state that the drug should only be used if another drug does not work.
  • Published studies show that the drug is more dangerous than another preferable drug, but not to the extent that it merits being listed as Do Not Use.
  • Published evidence indicates that the drug, although effective and safe enough for treatment of certain conditions, is widely used for inappropriate and therefore unnecessarily unsafe purposes.
  • The drug is a combination drug that should be reserved for second-choice use (most are Do Not Use). For example, many combination high blood pressure drugs are required to carry a warning label stating that because it is a fixed combination drug, the drug is not indicated for initial treatment of high blood pressure.

5. My drug profile is NOT listed as Do Not Use, Do Not Use for Seven Years After FDA Approval or Limited Use. What does that mean?

For drugs not designated as Do Not Use, Limited Use, or Do Not Use for Seven Years After FDA Approval, we have assessed the drug’s safety and effectiveness with respect to the FDA-approved condition the drug treats (but not necessarily other uses) and have found the drug's use in that context acceptable in light of the risks of the drug for that condition only.

If a particular use for the drug is not discussed on WorstPills.org, you should not assume that that use is either appropriate or inappropriate. You should discuss any treatment decision that involves a drug's use in detail with your physician, and weigh its risks and benefits in light of your personal medical history.

6. If my drug is not listed on WorstPills.org, does that mean it is safe?

If a product is not listed on WorstPills.org, this does not mean that we endorse or reject it – it simply means that we have not researched or written about the product in question.

We select drugs to write in-depth profiles about based partly on data from the pharmacist newsmagazine Drug Topics Top 200, a listing of the 200 most commonly prescribed drugs in the United States.  As more drugs come on the market, they will be evaluated and added to the database if we feel they are likely to become part of the list of widely prescribed drugs. 

The list of drugs discussed on WorstPills.org is not meant to be an exhaustive list of all prescription or over-the-counter drugs and dietary supplements. Not included are drugs used primarily to treat hospitalized patients, such as certain antibiotics and drugs for general anesthesia. In addition, drugs for cancer and other less-common diseases generally are not included.

Do not assume that any drug is a Do Not Use for Seven Years After FDA Approval if no information is yet available about it on WorstPills.org. This designation is applied only after a thorough analysis of the drug in question.

Reviews of new drugs will be posted on WorstPills.org as the information necessary to complete thorough analyses of the drugs becomes available. You should discuss in detail any treatment decision that involves the use of a drug with your physician and weigh its risks and benefits in light of your personal medical history.

7. I think I am suffering from an adverse drug reaction, but I do not see any information about this reaction on WorstPills.org. What should I do?

We seek to include all major drug-induced side effects, diseases and conditions for all drugs discussed in profiles on WorstPills.org. However, we do not include every possible drug-induced condition on WorstPills.org, even for the drugs that we review.

If you are experiencing a disease or condition that you believe may be caused by a drug you are taking and do not see it mentioned on WorstPills.org, you should discuss whether it could be drug-induced with your physician. Assume that any new symptom you develop after starting a new drug may be caused by the drug.

8.  Can I obtain a list of all the Do Not Use drugs?

Public Citizen does not offer a list of all Do Not Use drugs. We want consumers and their physicians to have all the information available on the reasons why a drug is designated Do Not Use when they make a decision whether or not to use a particular drug. We do not believe having a list would allow for this detailed analysis.

Researchers at Public Citizen apply the designation Do Not Use to a particular prescription or over-the-counter drug or dietary supplement only after a thorough consideration of the available data on the safety and efficacy of each product.

You can find information about the designation of a particular drug by searching for it in our online database.

9. I have a website or blog. How can I share WorstPills.org content with my readers?

We would be delighted to see you link to WorstPills.org pages from your website or blog. However, our work is copyrighted, and, subject to fair use, you may not reproduce or republish our work on your website or blog or anywhere else without our written permission.

Subscription Information

10. Can I purchase a subscription to WorstPills.org and pay for it over the phone or by mail?

You may only pay for your WorstPills.org subscription online. We have gone to great lengths to ensure the security of financial transactions taking place on WorstPills.org.

11. Is the information on this Web site available in a printed version?

Worst Pills, Best Pills News, a monthly newsletter published by Public Citizen, provides monthly drug updates. The content from this newsletter is provided on WorstPills.org.

If you prefer to receive our updates in printed form, a one-year subscription to Worst Pills, Best Pills News is available for $20. Individual copies of previously published newsletters are available for $3 each.

To order individual copies of newsletters or subscribe to the print newsletter, send a check for the full amount of your order payable to PUBLIC CITIZEN to the following address:

Worst Pills, Best Pills News
1600 20th Street, NW
Washington, DC 20009

Please remember to indicate whether you are ordering a Worst Pills, Best Pills News subscription or individual newsletter copies, and include the address where you would like your subscription or copies to be sent.

Other Public Citizen publications may be ordered in the same manner. For information about other Public Citizen publications, please visit Public Citizen’s Web site.

Public Citizen is no longer selling the 2005 drug safety information book, “Worst Pills, Best Pills,” due to concerns that its information has become outdated. However, all the information contained in the book is available on WorstPills.org and is updated twice annually.

12. I’m a Worst Pills, Best Pills News print subscriber but I’d like to subscribe online to WorstPills.org – How can I convert my print subscription to the online version?

If you prefer to get the latest news about drug safety electronically, you can easily convert your subscription from Worst Pills, Best Pills News to WorstPills.org at no additional charge. You will receive a WorstPills.org subscription for as many months as you have left on your print subscription.

Simply visit this page to take advantage of this special offer. You may only convert a print subscription to an online subscription once.

13. How can I cancel my online subscription?

WorstPills.org subscribers receive continuous service, with renewals taking place each year. Service will be terminated when canceled by the user.

Annual renewals are only refundable within the first three months of the renewal. Simply make this request in an e-mail to member@citizen.org. Please be sure to include your name, address, customer ID#, and the reason for your decision. You will receive a confirmation e-mail indicating that we have received your request. We also will notify you by e-mail when the refund has been fully processed and the card used to establish the account has been properly credited. Please allow four weeks for this process to be completed.

For information about continuous service, please click here.

14. Can I make copies of articles for distribution?

Portions of WorstPills.org may be printed out for personal use, but not for distribution. To obtain permission to reprint an article from worstpills.org, please e-mail hrg1@citizen.org with the subject line “WPBP reprint request.”

Alternatively, send a letter to the address below. Please include the purpose for which you would like to reprint the article, the venue that will be used to distribute it, and the amount you would like to distribute:

Worst Pills, Best Pills News
1600 20th Street, NW
Washington, DC 20009

15. How can I give a gift subscription?

Visit http://www.worstpills.org/gift_subscribe.cfm?promo=GIFT to create a gift subscription for a friend or loved one.

16. How does billing work for gift subscriptions?

Your friend or family member will not become enrolled in our continuous renewal program if you create a gift subscription for him or her. In a year, when his or her subscription expires, he or she will receive an email from us letting he or she know how to extend his or her subscription.

Gift subscriptions to WorstPills.org can only be purchased with a credit card.

17. I received information about the print newsletter Worst Pills, Best Pills in the mail. How can I sign up for a subscription to the newsletter?

If you want to subscribe to the print newsletter, send a check for the full amount of your order payable to PUBLIC CITIZEN to the following address:

Worst Pills, Best Pills News
1600 20th Street, NW
Washington, DC 20009
You cannot sign up for a print subscription on WorstPills.org. In addition, any offer you received for a discount on a print subscription is not valid on WorstPills.org.

Technical Questions

18. Why am I not receiving my monthly updates via e-mail and/or other e-mail messages from WorstPills.org?

When subscribers do not receive our monthly updates, the culprit is usually a SPAM filter. This may happen because of the large number of drug names in our e-mails – a tip-off for most filters that the message is spam. If you do find a message from us in your spam folder, please report to your e-mail provider that the message is not spam.

In addition to reporting individual e-mails as legitimate, most e-mail services allow you to designate specific e-mail addresses or domains as not spam. To make sure that messages from worstpills.org and Public Citizen arrive in your inbox, add the following e-mail addresses wpbpsupport@citizen.org to your contact list or address book.

If you are not sure how to do this, contact your e-mail provider for instructions. Here are instructions for Gmail and Yahoo!; instructions for Comcast and Hotmail users can be found in the "Help" or "Support" sections of those WorstPills.org messages. If you have a different provider, please contact them directly.

If you have tried the above method without success, e-mail wpbpsupport@citizen.org to ensure that you receive your monthly update. If you are a continuous service customer, it is important that you receive all the e-mails that WorstPills.org sends so that you will be alerted when your subscription automatically renews.

19. I have forgotten my password. Can I still log in to WorstPills.org?

If you have forgotten your password, please click here. You will be asked to provide your e-mail address, and we will send you your password.

If you have forgotten the e-mail address you used to register your account, please send an email to wpbpsupport@citizen.org with one of the following types of identifying information, and we will send you the e-mail address you need to log in:

  • Confirmation number (preferred), OR
  • Name of your credit card (Visa, etc.) and the last 4 digits of your card number, OR
  • Full name and address used in registering.

20. How do I change the email address associated with my account?

Follow these simple steps to change the email address for your account:

1. Log into your account with your old email address and password

2. Click the "Manage Account" button on the right

3. Click on the blue link "Update my email address" under the first section "Account Information"

21. What is a cookie and why must my Internet browser accept them to use WorstPills.org?

A cookie is a small piece of information from a Web site stored on your computer. We temporarily store a session-cookie on your computer so you may navigate password-protected portions of WorstPills.org without having to log in repeatedly. This session-cookie is deleted after your Internet browser has been inactive for 30 minutes.

22. How do I enable my Internet browser to accept cookies?

To enable your Internet browser to accept cookies, you have to choose a security or privacy level for your browser that allows cookies to be stored on your computer. To adjust your computer’s ability to accept cookies, follow these instructions for the appropriate Internet browser:

Internet Explorer 6.0:
1. Choose Tools, then
2. Internet Options.
3. Click the Privacy tab,
4. Set to medium or medium-high.

Internet Explorer 5.0:
1. Choose Tools, then
2. Internet Options.
3. Click the Security tab,
4. Click Internet, then Custom Level.
5. Scroll down to Cookies and choose Enable
.

Netscape Communicator 6.0 and above:
1. Choose Edit, then
2. Preferences.,
3. Click on Privacy and Security.
4. Click on Cookies and select Enable.

23. Why am I sometimes asked to log in to WorstPills.org after I have already logged in?

Our system deletes its session-cookie 30 minutes after it was placed on your computer, regardless of whether you are still using WorstPills.org. You are asked to log in to the system again to re-create the session-cookie and facilitate continued browsing of WorstPills.org. See our Privacy Policy for more information about why we delete session cookies.

24. What Internet browser should I use to view WorstPills.org?

WorstPills.org is best viewed with Microsoft Internet Explorer Version 5.0 and above, or Netscape Version 6.0 and above.

25. How can I view PDF documents?

A PDF document is a type of electronic file that can be viewed with Adobe Acrobat Reader. To download a free version of this software program, please click here.

Most articles are available in print-friendly HTML format (viewable with any Web browser such as Internet Explorer or Netscape). Drug labels will be the primary type of information available only as a PDF.

26. My question is not answered here – how can I contact you?

Click here for contact information.


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