Skip to main content
SpringerLink
Log in

Metamizole: reassessment of its therapeutic role

  • Short Communications
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

The use of metamizole is controversial, as reflected in the very different national regulations affecting it. The striking disparities between policies for metamizole made us try to determine if there were reasons to ban, limit or liberalize its utilization.

After reviewing the literature, it was concluded that metamizole should not be withdrawn from the countries where its use is still relatively free. However, metamizole causes life-threatening adverse events that are usually unpredictable and can only be prevented by better prescribing habits, so it is suggested that its use as a first-line agent should be restricted to the treatment of the pain of acute colic and circumstances in which parenteral administration of a non-narcotic agent is mandatory.

Studies are needed to determine the role of second-line oral analgesics in terms of their overall toxicity and efficacy. In the meantime it is proposed that oral metamizole should be used only when other analgesics (e. g. paracetamol) have failed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Kiatboonsri P, Richter J (1988) Unethical trials of dipyrone in Thailand. Lancet II: 1491

    Google Scholar 

  2. Handpadungdhama A (1989) Trials of dipyrone in Thailand. Lancet I: 788

    Google Scholar 

  3. Sriwatanakul K (1989) Trials of dipyrone in Thailand. Lancet I: 788

    Google Scholar 

  4. Anonymous (1989) Dipyrone. A drug no one needs. Health Action International-Europe & BUKO Pharma-Campaign, Amsterdam

  5. Moffatt J (1986) Dipyrone-containing analgesics. S A Med J 70: 331–333

    Google Scholar 

  6. Bakke OM, Wardell WM, Lasagna L (1984) Drug discontinuations in the United Kingdom and the United States, 1964 to 1983: Issues of safety. Clin Pharmacol Ther 35: 559–567

    Google Scholar 

  7. Gomez-Jimenez J, Franco-Patino R, Chargoy-Vera J, Olivares-Sosa R (1980) Clinical efficacy of mild analgesics in pain following gynecological or dental surgery: report on multicentre studies. Br J Clin Pharmacol 10: 355S-358S

    Google Scholar 

  8. Florez J (1987) Análgesicos antitérmicos. Antirreumáticos no esteroideos. In: Flórez J, Armijo JA, Mediavilla A (eds) Farmacología Humana, Vol I. Eunsa, Pamplona, pp 242–264

    Google Scholar 

  9. Mehslich DR (1983) Review of the comparative analgesic efficacy of salicylates, acetaminophen and pyrazolones. Am J Med 75: 47–52

    Google Scholar 

  10. Gladtke E (1983) Use of antipyretic analgesics in the pediatric patient. Am J Med 75: 121–125

    Google Scholar 

  11. Patel CV, Koppikar MG, Patel MS, Parulkar GR, Pinto Pereira LM (1980) Management of pain after abdominal surgery: dipyrone compared with petidine. Br J Clin Pharmacol 10: 351S-354S

    Google Scholar 

  12. Brogden RN (1986) Pyrazolone derivatives. Drugs 32 [Suppl 4]: 60–70

    Google Scholar 

  13. Kewitz H (1986) Rare but serious risks associated with non-narcotic analgesics: clinical experience. Med Toxicol 1 [Suppl 1]: 86–92

    Google Scholar 

  14. Lloret J, Muñoz J, Monmany J, Puig X, Bonastre M, Brau J, Sola J, Domingo P, Jane F (1987) Treatment of renal colic with dipyrone. A double-blind comparison trial with hyoscine alone or combined with dipyrone. Curr Ther Res 42: 1119–1128

    Google Scholar 

  15. Miralles R, Cami J, Gutierrez J, Torne J, Garces JM, Badenas JM (1987) Diclofenac versus dipyrone in acute renal colic: a double-blind controlled trial. Eur J Clin Pharmacol 33: 527–528

    Google Scholar 

  16. Anderson JA, Adkinson NR Jr (1987) Allergic reactions to drugs and biologic agents. JAMA 258: 2891–2899

    Google Scholar 

  17. Arndt KA, Hick H (1976) Rates of cutaneous reactions to drugs. A report from the Boston Collaborative Drug Surveillance Program. JAMA 235: 918–922

    Google Scholar 

  18. Levy M, Lipsitz M, Eliakim M (1979) Hospital admissions due to adverse drug reactions. Am J Med Sci 277: 49–56

    Google Scholar 

  19. Italian Group of Intensive Care Evaluation (1987) Epidemiology of adverse drug reactions in intensive care units. Eur J Clin Pharmacol 31: 507–512

    Google Scholar 

  20. The International Agranulocytosis and Aplastic Anemia Study Group (1986) Risks of agranulocytosis and aplastic anemia. A first report of their relation to drug use with special reference to analgesics. JAMA 256: 1749–1757

    Google Scholar 

  21. Fosseus CG, Straughan H (1983) Sudden death due to intravenous avapyrazone and dipyrone. S A Med J 64: 81

    Google Scholar 

  22. Arellano F, Soto J, Antepara I, Terrones J, Candina R, Perez I, De Cos MA (1990) Epidermolisis necrótica tóxica por metamizol. A propósito de un caso. Rev Clin Esp (in press)

  23. Rummel W (1987) Metamizol: Kommentar zu Berichten über lebensbedrohliche Kreislauferkrankungen. Dtsch Ärzteblatt 84: B2408-B2412

    Google Scholar 

  24. Laporte J-R, Carne X (1987) Blood dyscrasias and the relative safety of non-narcotic analgesics. Lancet I: 809

    Google Scholar 

  25. Fowler PD (1987) Aspirin, paracetamol and non-steroidal anti-inflammatory drugs. A comparative review of side effects. Med Toxicol 2: 338–366

    Google Scholar 

  26. Duthie DJR, Nimmo WS (1987) Adverse effects of opioid analygesic drugs. Br J Anaesth 59: 61–77

    Google Scholar 

  27. Marks A, Abramson N (1980) Pentazocine and agranulocytosis. Ann Intern Med 92: 433

    Google Scholar 

  28. Sheehan M, Hyland RH, Norman C (1985) Pentazocine-induced agranulocytosis. Canad med Assoc J 132: 40

    Google Scholar 

  29. Hunter JAA, Davison AM (1973) Toxic epidermal necrolysis associated with pentazocin therapy and severe reversible renal failure. Br J Dermatol 88: 287–289

    Google Scholar 

  30. Paeile C, Gallardo F (1974) Analgesic activity of pentazocine and dipyrone in ambulatory oral patients. J Oral Surg 32: 191–194

    Google Scholar 

  31. Daftary SN, Mehta AC, Nanavati M (1980) A controlled comparation of dipyrone and paracetamol in post-episiotomy pain. Curr Med Res 6: 614–618

    Google Scholar 

  32. Mukherjee S, Sood S (1980) A controlled evaluation of orally administered aspirin, dipyrone and placebo in patients with post-operative pain. Curr Med Res 6: 619–623

    Google Scholar 

  33. Lehtonen T, Kellokumpu I, Permi J, Sarsila O (1983) Intravenous indomethacin in the treatment of ureteric colic. Ann Clin Res 15: 197–199

    Google Scholar 

  34. Comeri C, Radice GP, Duvia R, Manganini V, Monza G (1984) Efficacy and safety of non steroidal anti-inflammatory drugs in ureteral colic. A double-blind controlled trial (Abstract no 71) Urol Res 12: 45

    Google Scholar 

  35. Niinikoski J, Nelimarkka O, Pekkola P (1984) Intravenous indomethacin in biliary pain. Ann Chir Gynaecol 73: 69–72

    Google Scholar 

  36. Bentley KC, Head TW (1987) The additive analgesic efficacy of acetaminophen, 1000 mg and codeine, 60 mg, in dental pain. Clin Pharmacol Ther 42: 634–640

    Google Scholar 

  37. Barroso MH, Carranza JAU, Garcia JLG, Rodriguez LG (1982) Evaluación doble ciego de la eficacia analgésica y tolerancia de zomepirac sódico y dipirona, a dosis única en dolor postoperatorio. Invest Med Intern 9: 164–170

    Google Scholar 

  38. Mehta S (1967) Comparation of pethidine with sodium phenylalmethylpyrazolonemethylaminomethanesulphonate (Novalgin) and with a placebo in postoperative pain. Ind J Anaesth 232–237

  39. Lal A, Pandey K, Chandra P, Pande SB (1973) Dipyrone for treatment of post-operative pain. Anesthesiol 28: 43–47

    Google Scholar 

  40. Rejman F (1984) Intravenous indomethacin in biliary pain: a clinical investigation with metamizole as the control. IRCS Med Sci 12: 399–400

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Pharmacology Service, Hospital Marqués de Valdecilla, Santander, Spain

    F. Arellano & J. A. Sacristán

  2. Sandoz Pharma AG, Drug Monitoring Centre, CH-4002, Basel, Switzerland

    F. Arellano

Authors
  1. F. Arellano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. A. Sacristán
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arellano, F., Sacristán, J.A. Metamizole: reassessment of its therapeutic role. Eur J Clin Pharmacol 38, 617–619 (1990). https://doi.org/10.1007/BF00278592

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00278592

Key words

Search

Navigation