Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German‐speaking countries

Reist, Lauren; Erlenwein, Joachim; Meißner, Winfried; Stammschulte, Thomas; Stüber, Frank; Stamer, Ulrike

doi:10.1002/ejp.1194

Cited by 44 publications

(36 citation statements)

References 48 publications

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“…Dipyrone was removed from the market in India in 2013, only to be re‐introduced in 2014 subject to specific warning and indications. A 2016 survey of anaesthesiologists in German‐speaking countries reported that dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain …”

Section: Commentmentioning

confidence: 99%

“…A 2016 survey of anaesthesiologists in German-speaking countries reported that dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. 27 Interethnic differences in drug response are well known, and therefore, regulatory authorities require subset analysis of safety and efficacy data by demographic variables such as age, gender and ethnicity/race. 28 for use in the treatment of heart failure as an adjunct to standard therapy in self-identified Black patients.…”

Section: Commentmentioning

confidence: 99%

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Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity?

Shah

2018

J Clin Pharm Ther

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Summary What is known and objective Based on spontaneous reports from Spain, it is claimed that the British, Irish and Scandinavians are at a greater risk of dipyrone‐induced agranulocytosis. This report examines the evidence. Comment Although interethnic differences in drug response are well known, there are no reliable epidemiologic data to support the above claim. Available information on chlorpromazine suggests variable ethnic sensitivities to drug‐induced agranulocytosis. Agranulocytosis induced by at least four drugs has been associated with variant HLA alleles. Preliminary evidence also suggests that the presence of specific variant HLA alleles may sensitize individuals to dipyrone‐induced agranulocytosis. There are historical reasons to suspect that the three populations referred to may share some key genetic features, including the potentially culprit variant HLA alleles, that predispose them to dipyrone‐induced agranulocytosis. What is new and conclusion The possibility that the British, Irish and Scandinavians show higher susceptibility than other populations to dipyrone‐induced agranulocytosis cannot be ruled out. If this complication is linked to specific HLA allele(s), populations with higher frequency of variant HLA allele(s) may be at a greater risk. If confirmed, screening for the risk allele may be useful in reducing the risk of dipyrone‐induced agranulocytosis.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity?

Shah

2018

J Clin Pharm Ther

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“…So kam es 2016 im Vergleich zu 2011 bereits zu einer Zunahme der Verordnung von Metamizol um 9 % [11]. Gerade bei perioperativer Analgesie und chronischen Schmerzen ist es das beliebteste Nicht-Opioid-Analgetikum im deutschsprachigen Raum [12]. Dies ist wohl darauf zurückzuführen, dass viele der verordnenden Ärzte Metamizol aufgrund der guten analgetischen Wirkung bei geringerer Nebenwirkungsrate im Vergleich zu nichtsteroidalen Antirheumatika für das Nicht-Opioid-Analgetikum mit dem besten Risiko-Nutzen-Verhältnis halten [13,14].…”

Section: Introductionunclassified

Agranulozytose nach Metamizol-Einnahme – ein unterschätztes Risiko?

Schinz

Waldfahrer

Wüst

et al. 2020

Laryngorhinootologie

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Zusammenfassung Hintergrund Metamizol war 2018 das am zweithäufigsten verordnete Medikament in Deutschland trotz des bekannten Risikos einer Agranulozytose und der strengen Indikationsstellung. 25 % der Verordnungen sind laut Stammschulte et al. Off-Label-Use. Obwohl eine Blutbildkontrolle in der Fachinformation ausdrücklich empfohlen wird, findet diese seitens der Mehrheit der Metamizol-verschreibenden Ärzte nicht routinemäßig statt. Material und Methoden Retrospektive Untersuchung von 8 Fällen von Agranulozytose nach Metamizol-Einnahme im HNO-Universitätsklinikum Erlangen in den Jahren 2016–2020. Es handelte sich um 5 Männer und 3 Frauen. Das Durchschnittsalter bei Diagnosestellung lag bei 52,4 Jahren (± 25,6). Ergebnisse Agranulozytose nach Metamizol-Einnahme ist eine schwerwiegende unerwünschte Nebenwirkung, die prinzipiell Patienten jeden Alters betreffen kann. Oft führt erst eine Symptomatik in Form von Fieber, Dysphagie und Tonsillitis, meist in Kombination mit Abszessen im Kopf-Hals-Bereich, zur Erkennung einer Metamizol-induzierten Agranulozytose. Eine Agranulozytose erfordert teilweise radikal-chirurgische und intensivstationäre Maßnahmen und kann zur Sepsis mit Organversagen oder sogar zum Tod führen. Schlussfolgerungen Die beschriebenen Patientenfälle zeigen, dass Agranulozytose eine gefährliche bis teilweise sogar tödliche Nebenwirkung nach Metamizol-Einnahme darstellt. Auch wenn das Risiko einer Agranulozytose mit der Dauer der Anwendung anzusteigen scheint, sollten im Sinne der Patientensicherheit eine entsprechende Patientenaufklärung und die Dokumentation einer bereits einmaligen intraoperativen Gabe im Entlassbrief erfolgen. So könnte eine Agranulozytose früher erkannt und schwere Komplikationen bis hin zum Tod vermieden werden.

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“…29,30 In these countries, the drug is still commonly used for indications such as cancer pain, colic pain, postoperative pain, headache, or pain resulting from acute injuries, among others. 3,6,[32][33][34][35] For instance, metamizole was the third most prescribed analgesic drug in Switzerland in the period between 2006 and 2013, and in Germany it was the most prescribed analgesic substance in 2012, with more than 140 million defined daily doses. 28,36 In countries where metamizole is sold over the counter, the drug is used as a common self-medication and is the most taken analgesic agent in patients with chronic pain.…”

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confidence: 99%

Metamizole (Dipyrone) and the Liver: A Review of the Literature

Lutz

2019

The Journal of Clinical Pharma

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Metamizole, also known as dipyrone, was introduced to the market nearly a century ago. Due to its excellent analgesic, antipyretic, and spasmolytic properties combined with its mostly favorable gastrointestinal tolerability, the drug was extensively applied worldwide during the first decades after its market introduction. Although rare, agranulocytosis is a well‐known adverse event of metamizole and led to its withdrawal from the market in a number of countries beginning in the 1960s. Nevertheless, metamizole is still a frequently used drug worldwide either legally (by prescription in some countries, over the counter in other countries) or without official approval (especially by immigrants knowing the drug from their home countries) or even illegally (due to its growing application as an adulterant in illicit drugs). Metamizole undergoes extensive metabolism in the liver and cases of potential metamizole‐associated hepatotoxicity have been described. Here, the literature is extensively reviewed for the first time regarding hepatic effects associated with the use of metamizole.

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Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German‐speaking countries

Cited by 44 publications

References 48 publications

Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity?

Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity?

Agranulozytose nach Metamizol-Einnahme – ein unterschätztes Risiko?

Metamizole (Dipyrone) and the Liver: A Review of the Literature

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