Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti‐Inflammatory Drugs

Konijnenbelt-Peters, Jorieke; Heijden, Charlotte van der; Ekhart, Corine; Bos, Jacqueline M.; Bruhn, Jørgen; Kramers, Cornelis

doi:10.1111/papr.12467

Cited by 78 publications

(57 citation statements)

References 17 publications

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“…Apart from its efficacy, one particular advantage of dipyrone compared to NSAIDs is its apparent lack of any teratogenic adverse effects . It is particularly suitable for those in whom NSAIDs are contraindicated or pose a greater risk . It has remained a popular analgesic not only because it is effective but also is generally safer than NSAIDs and opioids and cheap.…”

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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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%

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

Shah

2018

J Clin Pharm Ther

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“…However, these studies, when applying the Jadad score, were classified as poor, making definite conclusions impossible. A recent literature review in adults suggested that, although firm evidence is lacking, the use of dipyrone in patients with an increased risk of gastrointestinal bleeding and/or renal disease may be safer than other NSAIDs …”

Section: Discussionmentioning

confidence: 99%

The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

Leeuw

Dirckx

Candel

et al. 2017

Pediatric Anesthesia

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Dipyrone has analgesic, spasmolytic, and antipyretic effects and is used to treat pain. Due to a possible risk of agranulocytosis with the use of dipyrone, it has been banned in a number of countries. The most commonly used data for the use of dipyrone are related to adults. Information relating to the use of dipyrone in children is scarce. Given the potential added value of dipyrone in the treatment of pain, a review of the literature was conducted to obtain more insight into the analgesic efficacy of dipyrone in children as well as the safety of dipyrone in terms of adverse events. A literature search was done for original articles (in English, German, or Spanish language) which met the following criteria: the use of dipyrone for pain and children up to the age of 17 years old. All titles and abstracts retrieved were reviewed, independently, by two of the authors, for their suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. The publications were categorized into case reports, observational studies, or randomized controlled trials. To assess the methodological quality of the studies, the Jadad score was used. In the limited available data, the analgesic efficacy of intravenous dipyrone appears similar to that of intravenous paracetamol. Evidence is lacking to support the claim that dipyrone is equivalent or even superior to Non-Steroid-Anti-Inflammatory-Drugs in pediatric pain. While the absolute risk of agranulocytosis with dipyrone in children, based on available literature, cannot be determined, case reports suggest that this risk is not negligible.

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“…The reason of this divergence is the nonenzymatic hydrolysis of metamizole in the gastrointestinal tract to its first metabolite, 4‐methylaminoantipyrine (4‐MAA), leading to its fast and nearly complete absorption when given orally. Mediated by its active metabolites, metamizole achieves an oral bioavailability of almost 100% . Following the results of a small study published decades ago, it was assumed that food intake does not influence the absorption of metamizole.…”

Section: Hepatic Metabolism Of Metamizolementioning

confidence: 99%

“…Mediated by its active metabolites, metamizole achieves an oral bioavailability of almost 100%. [57][58][59] Following the results of a small study published decades ago, it was assumed that food intake does not influence the absorption of metamizole. In this trial in 12 healthy male volunteers aged between 24 and 30 years, metamizole was delivered once after fasting for 8 hours and once immediately after a breakfast standardized within the study.…”

Section: Hepatic Metabolism Of Metamizolementioning

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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Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti‐Inflammatory Drugs

Cited by 78 publications

References 17 publications

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

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

The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review

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

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