Metamizole use during first trimester—A prospective observational cohort study on pregnancy outcome

Dathe, Katarina; Padberg, Stephanie; Hultzsch, Stefanie; Meixner, Katja; Tissen-Diabaté, Tatjana; Meister, Reinhard; Beck, Evelin; Schaefer, Christof

doi:10.1002/pds.4277

Cited by 15 publications

(15 citation statements)

References 24 publications

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“…Notwithstanding, it is still available, with or without a prescription, in a number of countries, including Spain and some other European countries, in the Far East and in South America . 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 .…”

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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“…Graphical illustrations use squares for the states and arrows for transitions between pairs of states. One example is the competing risks model (Figure A), which has become an important tool in observational pregnancy outcome analyses …”

Section: Methodsmentioning

confidence: 99%

“…Thus, event history techniques are indispensable . One well‐established tool is competing risks regression formulated for both left truncation and competing events . To additionally include time‐dependent exposures, we use a multistate perspective .…”

Section: Introductionmentioning

confidence: 99%

Multistate methodology improves risk assessment under time‐varying drug intake—a new view on pregnancy outcomes following coumarin exposure

Bluhmki¹,

Fietz

Stegherr³

et al. 2019

Pharmacoepidemiology and Drug

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Purpose Observational cohort studies are essential to evaluate the risk of adverse pregnancy outcomes associated with drug intake. Besides left truncation and competing events, it is crucial to account for the time‐dynamic pattern of drug exposure. In fact, potentially harmful medications are often discontinued, which might affect the outcome. Ignoring these challenges may lead to biased estimation of drug‐related risks highlighting the need for adequate statistical techniques. Methods We reanalyze updated data of a recently published study provided by the German Embryotox pharmacovigilance institute. The aim of the study was to quantify the effect of discontinuation of vitamin K antagonist phenprocoumon on the risk of spontaneous abortion. Results We outline multistate methodology as a powerful method removing bias in probability estimation inherent to commonly used crude proportions. We incorporate time‐dependent discontinuation and competing pregnancy outcomes as separate states in a multistate model, which enables the formulation of hazard‐based Cox proportional hazard models and the application of so‐called landmark techniques. Results show that early discontinuation of phenprocoumon substantially reduces the risk of spontaneous abortion, which is of great importance for both pregnant women and treating physicians. Conclusions An adequate handling of discontinuation times is essential when analyzing the risk of spontaneous abortion. The proposed concepts are not restricted to pregnancy outcome studies but have broad usage in other fields of epidemiology. Our nontechnical report may provide guidance for the design and analysis of future studies. Example code is provided.

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“…A Metamizol (noraminophenazon) alkalmazása diaphragma fejlődési rendellenességhez, illetve car dio vascu la ris anomáliák kialakulásához vezethet. FDA besorolást nem kapott, mivel az Egyesült Államokban nincs forgalomban [9].…”

Section: Fájdalomcsillapítókunclassified

Várandósság és gyógyszerek

et al. 2019

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A várandós páciensek fogászati kezelése néhány pontban eltér a nem várandósokétól. A fogorvos feladata az erre vonatkozó naprakész információk ismerete, melyek betartásával az anya és a magzat egészsége is megóvható. A várandós nőknek gyakrabban kell látogatniuk a fogorvosi szakrendelést, hiszen a megváltozott hormonális hatások fokozott rizikótjelentenek egyes fogászati kórképek kialakulására. Ezek felismerése és szakszerű ellátása kulcsfontosságú a terhesség során. Mind a kezelés menete, mind a szükséges gyógyszerelés nagyobb odafigyelést igényel a fogorvos részéről. A várandósok fogászati kezelését befolyásoló tényezőket és a magzati fejlődésre ható gyógyszereket számos tudományos kutatás célozza, ám a rendelkezésünkre álló információ még így is csekély. Cikkünkben a fogászati gyakorlatban használt gyógyszereket – antibiotikumok, fájdalomcsillapítók, helyi érzéstelenítők, gombaellenes készítmények, vírusellenes szerek, szorongáscsökkentők, szájfertőtlenítők és szájüregi ecsetelők – gyűjtöttük össze és összegeztük a várandósságban történő alkalmazhatóságukat az aktuális irányelvek alapján.

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Metamizole use during first trimester—A prospective observational cohort study on pregnancy outcome

Abstract: Metamizole exposure in the first trimester does not seem to bear a substantial teratogenic risk. Our study results support reassurance in those instances where metamizole has been used during an unrecognized pregnancy or where its use appears indispensable.

Cited by 15 publications

References 24 publications

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

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

Multistate methodology improves risk assessment under time‐varying drug intake—a new view on pregnancy outcomes following coumarin exposure

Várandósság és gyógyszerek

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