Metamizole may be an acceptable alternative to NSAIDs
Metamizole should be considered in patients with contraindications to NSAIDs.
HealthDay News — Metamizole seems to be safer than other nonsteroidal anti-inflammatory drugs (NSAIDs) and causes fewer gastric and duodenal ulcers in postoperative pain management, according to a review published online June 27 in Pain Practice.
Noting that use of metamizole has been discouraged because of the risk for agranulocytosis, Jorieke Konijnenbelt-Peters, MD, PhD, from Canisius Wilhelmina Ziekenhuis in Nijmegen, Netherlands, and colleagues conducted a systematic literature review to examine whether metamizole could be an alternative to classical NSAIDs in postoperative pain management.
The researchers found that there were fewer gastric and duodenal ulcers with metamizole versus other nonselective NSAIDs, with a limited risk of bleeding. It was unknown whether metamizole was safer than a nonselective NSAID together with a proton pump inhibitor. In healthy volunteers, the drug appeared to be safe for renal function, but data were lacking for high-risk patients (such as those with heart or renal failure). The incidence of metamizole-induced agranulocytosis was controversial, but in this selected group of patients, the risk was likely limited to short-term postoperative use.
"Although firm evidence is lacking, metamizole may be safer for the upper intestinal tract and kidneys than other NSAIDs, and could alternatively be used in patients with an increased risk for stomach or renal problems," the authors write. "The risk for metamizole-induced agranulocytosis is judged to be acceptable."
- Konijnenbelt-Peters J, van der Heijden C, Ekhart C, et al. Metamizole (Dipyrone) as an alternative agent in postoperative analgesia in patients with contraindications for nonsteroidal anti-inflammatory drugs. Pain Practice. 2016; doi: 10.1111/papr.12467