European Journal of Clinical Pharmacology

, Volume 71, Issue 2, pp 209–217 | Cite as

Hematological safety of metamizole: retrospective analysis of WHO and Swiss spontaneous safety reports

  • Lea S. Blaser
  • Alexandra Tramonti
  • Pascal Egger
  • Manuel Haschke
  • Stephan KrähenbühlEmail author
  • Alexandra E. Rätz Bravo
Pharmacoepidemiology and Prescription



Since the 1970s, the use of metamizole is controversial due to the risk of agranulocytosis. The aim of this study was to analyze individual case safety reports (ICSRs) of metamizole-associated hematological adverse drug reactions (ADRs).


International and Swiss metamizole-associated ICSR concerning selected hematological ADR were retrieved from VigiBase™, the World Health Organization Global Database of ICSR, and the Swiss Pharmacovigilance Database. We evaluated demographic data, co-medication, drug administration information, dose and duration of metamizole treatment, as well as the latency time of ADR, their course, and severity. The subgroup analysis of Swiss reports allowed us to analyze cases with fatal outcome more in depth and to estimate a rough minimal incidence rate.


A total of 1417 international and 77 Swiss reports were analyzed. Around 52 % of the international and 33 % of the Swiss metamizole-associated hematological ADR occurred within a latency time of ≤7 days. More women were affected. The annual number of hematological reports and those with fatal outcome increased over the last years parallel to metamizole sales figures. In Switzerland, the minimal incidence rate of agranulocytosis was 0.46–1.63 cases per million person-days of use (2006–2012). Female sex, old age, pancytopenia, and co-medication with methotrexate were striking characteristics of the seven Swiss fatal cases.


Metamizole-associated hematological ADR remain frequently reported. This is underscored by increasing annual reporting rates, which mainly reflect growing metamizole use. Early detection of myelotoxicity and avoidance of other myelotoxic substances such as methotrexate are important measures for preventing fatalities.


Metamizole (dipyrone) Agranulocytosis Hematological safety Pharmacovigilance 



The authors would like to thank Sara Hult, member of the analysis team of the Uppsala Monitoring Centre, the WHO Collaborating Centre for International Drug Monitoring, for providing the data and for answering our questions. We also would like to thank Guy Levy from the Vigilance Unit of Swissmedic for his collaboration. We thank also Sanofi-Aventis SA, Streuli Pharma AG, and Sintetica SA for providing the sales figures of their metamizole preparations in Switzerland. We thank also the Senglet-Foundation, the foundation for the promotion of young pharmaceutical researchers in Basel, for their financial support.

Author contribution

Performed research: LB, AT, PE, ARB. Analyzed data: LB, AT, MH, SK, ARB. Wrote manuscript: LB, SK, ARB. All authors contributed to the review and final approval of the manuscript.

Conflict of interest

The authors declare that there are no conflicts of interest regarding this work.

Supplementary material

228_2014_1781_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 27.0 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Lea S. Blaser
    • 1
  • Alexandra Tramonti
    • 1
  • Pascal Egger
    • 2
  • Manuel Haschke
    • 1
  • Stephan Krähenbühl
    • 1
    Email author
  • Alexandra E. Rätz Bravo
    • 1
    • 3
  1. 1.Division of Clinical Pharmacology and ToxicologyUniversity HospitalBaselSwitzerland
  2. 2.Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
  3. 3.Regional Pharmacovigilance CenterUniversity HospitalBaselSwitzerland

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