Intravenous dipyrone for the acute treatment of episodic tension-type headache: A randomized, placebo-controlled, double-blind study

Bigal, ME; Bordini, CA; Speciali, José Geraldo

doi:10.1590/s0100-879x2002001000005

Cited by 26 publications

(21 citation statements)

References 19 publications

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“…Very good effects have been attained in treatment of acute pain using metamizole in combination with NSAIDs, including ketoprofen (Oberhofer et al 2005) or with opioid analgesics (López-Muñ oz et al 2008, Baumgartner et al 2009). The efficacy of metamizole in post-operative pain therapy has been confirmed in studies conducted on humans (Edwards et al 2001, Chaparro et al 2012) and on animals (Imagawa et al 2011). Bigal et al (2002 determined that metamizole administered intravenously was effective for the acute treatment of episodic tension-type headache.…”

Section: Clinical Applications In Peoplementioning

confidence: 93%

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Pharmacological characteristics of metamizole

Jasiecka¹,

Maślanka²,

Jaroszewski³

2014

Polish Journal of Veterinary Sciences

129

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Metamizole (dipyrone) is a popular analgetic, non-opioid drug, commonly used in human and veterinary medicine. In some cases, this agent is still incorrectly classified as a non-steroidal anti-inflammatory drug (NSAID). Metamizole is a pro-drug, which spontaneously breaks down after oral administration to structurally related pyrazolone compounds. Apart from its analgesic effect, the medication is an antipyretic and spasmolytic agent. The mechanism responsible for the analgesic effect is a complex one, and most probably rests on the inhibition of a central cyclooxygenase-3 and activation of the opioidergic system and cannabinoid system. Metamizole can block both PG-dependent and PG-independent pathways of fever induced by LPS, which suggests that this drug has a profile of antipyretic action distinctly different from that of NSAIDs. The mechanism responsible for the spasmolytic effect of metamizole is associated with the inhibited release of intracellular Ca 2+ as a result of the reduced synthesis of inositol phosphate. Metamizole is predominantly applied in the therapy of pain of different etiology, of spastic conditions, especially affecting the digestive tract, and of fever refractory to other treatments. Co-administration of morphine and metamizole produces superadditive, antinociceptive effects. Metamizole is a relatively safe pharmaceutical preparation although it is not completely free from undesirable effects. Among these side-effects, the most serious one that raises most controversy is the myelotoxic effect. It seems that in the past the risk of metamizole-induced agranulocytosis was exaggerated. Despite the evidence showing no risk of teratogenic and embryotoxic effects, the drug must not be administered to pregnant women, although it is allowed to be given to pregnant and lactating animals. This paper seeks to describe the characteristics of metamizole in the light of current knowledge.

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Section: Clinical Applications In Peoplementioning

confidence: 93%

“…Compared to other non-opioid analgesics, metamizole seems to be a relatively safe drug (Bigal et al 2002, Imagawa et al 2011. The most common adverse effects are: gastrointestinal disorders, such as nausea, vomiting, abdominal pain and diarrhea (Edwards et al 2001).…”

Section: Side Effectsmentioning

confidence: 99%

Pharmacological characteristics of metamizole

Jasiecka¹,

Maślanka²,

Jaroszewski³

2014

Polish Journal of Veterinary Sciences

129

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“…We used the same methodological approach that we utilized in other similar studies performed by our group 12,13 described above.…”

Section: Methodsmentioning

confidence: 99%

Intravenous chlorpromazine in the acute treatment of episodic tension-type headache: a randomized, placebo controlled, double-blind study

Bigal

Bordini

Speciali

2002

Arq. Neuro-Psiquiatr.

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-Acute headache is a very frequent symptom, responsible for a significant percentage of caseload at primary care units and emergency rooms. Chlorpromazine is easily available in such settings. The aim of this study is to conduct a randomized, placebo-controlled, double-blind study to assess the efficacy of chlorpromazine on the acute treatment of episodic tension-type headache. We randomized 30 patients to receive placebo (10 ml of saline intravenous injections) and 30 patients to receive 0.1 mg/Kg chlorpromazine intravenously. We used 7 parameters of analgesic evaluation. Patients receiving chlorpromazine showed a statistically significant improvement (p < 0.05 and p < 0.01) of pain compared to placebo, far up to 30 minutes after the drug administration. The therapeutic gain was 36.7% in 30 minutes and 56.6 % in 60 minutes. The number needed to treat (NNT, the reciprocal or the therapeutic gain) was 2.7 in 30 minutes and 1.8 in 60 minutes. There were reductions in the recurrence and in the use of rescue medication in the chlorpromazine group. We can conclude that intravenous chlorpromazine is an effective drug to relief the pain in tension-type headache.KEY WORDS: tension-type headache, acute treatment, chlorpromazine.Clorpromazina parenteral no tratamento agudo da cefaléia do tipo tensional episódica: estudo Clorpromazina parenteral no tratamento agudo da cefaléia do tipo tensional episódica: estudo Clorpromazina parenteral no tratamento agudo da cefaléia do tipo tensional episódica: estudo Clorpromazina parenteral no tratamento agudo da cefaléia do tipo tensional episódica: estudo Clorpromazina parenteral no tratamento agudo da cefaléia do tipo tensional episódica: estudo randomizado, com mascaramento duplo, controlado por placebo randomizado, com mascaramento duplo, controlado por placebo randomizado, com mascaramento duplo, controlado por placebo randomizado, com mascaramento duplo, controlado por placebo randomizado, com mascaramento duplo, controlado por placebo RESUMO -Cefaléia aguda é queixa frequente, responsável por percentual significativo dos casos atendidos em unidades básicas de saúde e unidades de emergência. A clorpromazina é droga usualmente disponível nessas unidades. Apresentamos dados de estudo randomizado, controlado por placebo e com mascaramento duplo, que avaliou a eficácia da clorpromazina no tratamento agudo da cefaléia do tipo tensional episódica. Trinta pacientes foram randomizados para receber placebo (10 ml de solução salina endovenosa) e 30 pacientes para receber clorpromazina endovenosa, na dose de 0,1 mg/Kg. Foram usados 7 parâmetros de avaliação analgésica. Pacientes que receberam clorpromazina mostraram significativa redução da dor quando comparados com o grupo placebo (p < 0,05 and p < 0,01), 30 minutos após a administração da droga. O ganho terapêutico foi de 36,7% em 30 minutos e 56,6 % em 60 minutos. O número que se necessita tratar (NNT, a recíproca do ganho terapêutico) foi 2,7 em 30 minutos e 1,8 em 60 minutos. Houve redução nos índices de recorrência e de util...

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“…Dipyrone, the main constituent of the combination product, has been evaluated extensively since its commercial introduction in 1922; oral or intravenous dipyrone has demonstrated efficacy in relieving episodic TTH or migraine headache pain [6,[32][33][34]. Indeed, dipyrone has also been the subject of controversy and discussion over the years, owing to reports in the 1950s and 1960s of a high incidence of agranulocytosis; in more recent years, the abnormally high incidences that were reported in the earlier studies have been apportioned to imprecise studies of adverse effects, and projected cases of agranulo cytosis with dipyrone are similar, or even lower than those with some other analgesic drugs [35].…”

Section: Special Reportmentioning

confidence: 99%

Efficacy and tolerability of combined dipyrone, isometheptene and caffeine in the treatment of mild-to-moderate primary headache episodes

Carvalho

Barea

Kowacs

et al. 2012

Expert Review of Neurotherapeutics

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The efficacy and tolerability of a combination of dipyrone 600 mg, isometheptene 60 mg and caffeine 60 mg for the acute treatment of mild-to-moderate episodic primary headaches were evaluated against paracetamol 1000 mg and placebo. A total of 84 adult patients with two to six primary headache episodes (mild or moderate severity) per month were enrolled in this prospective, multicenter, randomized, two-period crossover study. Patients had a mean of 4.4 headache episodes/month (mean duration: 13 h; mean severity: 50.5 mm; assessed by visual analog scale (VAS). In patients with no improvement, rescue medications were allowed after 2 h. The primary outcome parameter was sustained pain-free rate. Secondary outcomes were evolution of pain severity (at 30, 60, 90, 120 and 240 min after treatment), presence of associated symptoms, and recurrence of episodes. Analyses included 243 headache episodes (81 patients). Sustained pain-free rates were 57.1% for combination therapy, 46.8% for paracetamol and 46.8% for placebo (not statistically significant). Pain improvement (assessed by VAS) occurred in 72.5, 54.5 and 49.2% of patients, respectively, after 120 min. The mean reduction in pain severity (assessed by VAS) was significantly lower in those receiving placebo and paracetamol compared with combination therapy (p < 0.001 at 90 and 120 min). Fewer patients required rescue medication after receiving combination therapy (18.4%), compared with paracetamol (37.7%; p = 0.008) or placebo (43.8%; p = 0.0007). Adverse events were infrequent and mild. We conclude that, despite failing to meet the primary outcome, the combination of dipyrone, isometheptene and caffeine is effective for the acute treatment of mild-to-moderate primary headache episodes, with excellent tolerability.

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Intravenous dipyrone for the acute treatment of episodic tension-type headache: A randomized, placebo-controlled, double-blind study

Cited by 26 publications

References 19 publications

Pharmacological characteristics of metamizole

Pharmacological characteristics of metamizole

Intravenous chlorpromazine in the acute treatment of episodic tension-type headache: a randomized, placebo controlled, double-blind study

Efficacy and tolerability of combined dipyrone, isometheptene and caffeine in the treatment of mild-to-moderate primary headache episodes

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