Medicines containing fluorine – a type of per- and poly-fluoroalkyl substance (PFAS) often referred to as a 'forever chemical' – are not associated with higher rates of adverse drug reactions (ADRs), according to new research.
In a paper published in PLOS One, researchers from the University of Birmingham reviewed five years (2019-2024) of data from the MHRA Yellow Card scheme relating to 13 fluorinated medicines and six structurally similar non-fluorinated medicines.
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The analysis compared ADRs per one million items dispensed. The most frequently prescribed drug studied, lansoprazole – a proton pump inhibitor to reduce stomach acid – showed a low rate of 14.1 ADRs per one million items.
The study also found ‘no relationship’ between the number of fluorine atoms in a medicine and the number of ADRs reported.
Sitagliptin and flecainide, which contain high levels of fluorine, were not associated with higher numbers of reactions.
The researchers concluded that most ADRs recorded for fluorinated drugs were outside the scope of side effects usually associated with PFAS.
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Dr Alan Jones from the School of Pharmacy at the University of Birmingham, and corresponding author of the paper, said: 'PFAS are often referred to as "forever chemicals" due to their persistence in the environment and effects on human health.
'Recent changes to the classification of PFAS means certain essential medicines are now deemed to contain forever chemicals.
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‘Reassuringly, no statistical correlation between the fluorine content of the medicine and type of side effect emerged.’
The researchers noted, however, that the study was limited by the self-reported nature of Yellow Card data, which could lead to underreporting.
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