Metamizole Utilization and Expenditure During 6-Year Period: Serbia vs. Croatia

Abstract

Background: Metamizole is a medication with analgesic, antipyretic, spasmolytic, and weak anti-inflammatory effects. The aim of our study was to evaluate a six-year trend in the utilization and expenditure of metamizole in comparison to other group of licensed non-opioid analgesics in Serbia and Croatia, in order to rationalize its use and prescribing in these countries.Methods: The data of metamizole vs. all other non-opioid analgesics utilization and expenditure in Serbia and Croatia was analyzed according to the WHO methodology and expressed as defined daily doses per 1,000 inhabitants per day (DDD/1,000 inhabitants/per day) and total costs, respectively, during the 6-year period from 2010 to 2015.Results: In the observed period, utilization of metamizole was 3.31 fold higher in Serbia than in Croatia (median in Serbia was 2.238 vs. 0.675 in Croatia DDD/1,000 inhabitants/per day/per year). Expenditure of metamizole in the same period was 5.29-fold higher in Serbia than in Croatia (median in Serbia was 1,738,192.51 €/per year vs. 328,355.03 €/per year in Croatia).Conclusion: Utilization and expenditure of non-opioid analgesics, including metamizole, in Serbia was significantly higher comparing with Croatia.Further research is needed to determine whether the current analgesic consumption in Serbia meets the needs of the patient. The benefits of metamizole should be weighed against the risk of metamizole-induced adverse effects. Until then, its prescribing should be based on indications and the appropriate duration of therapy.

Regional Differences in Prescribing Patterns of Metamizole in Germany Based on Data from 70 Million Persons

“…Internationally, Germany plays a special role in the high market relevance of metamizole [24,25,28,29]. This is partially due to the ban of metamizole preparations in some countries [5,25].…”

“…In Croatia and Serbia in 2015, 1.3 and 4.0 500 mg tablets per inhabitant were distributed, respectively. In both countries, a decrease in usage was recorded between 2010 and 2015 [29]. In Switzerland, metamizole also plays a minor role compared to other analgesics, but similar to Germany, prescription volume has increased markedly over the last decade [24].…”

Metamizole: Current status of the safety and efficacy

“…It is interesting to note that the fi rst bone marrow transplantation in the former Yugoslavia was performed in the patient with agranulocytosis as ADR of metamizole [32].…”

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

“…1,2 Due to its chemical structure belonging to the class of pyrazolones and its analgesic, antipyretic, and (however weak) antiphlogistic effects, metamizole is classified as a nonsteroidal anti-inflammatory drug (NSAID). [3][4][5] Compared to the other agents of this heterogeneous group, metamizole also offers additional spasmolytic properties. 6,7 In combination with its mostly favorable gastrointestinal tolerability, this profile led to an extensive clinical application of metamizole during the initial period after its market introduction.…”

“…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.…”