E-drug: dipyrone (summary of replies)
Dear Madam/Sir:
Few days ago, I wrote to E-Drugs members about Dipyrone ( Metamizol). This
is a abstracts of answer I received. Many thanks to you.
" Australia does not allow dipyrone, in fact very few medical practitioners
have heard of it. Information about Australian 'Therapeutic Guidelines:
Analgesic' are available from mhemming@medeserv.com.au "
Beverley Snell [ International Health Unit, Macfarlane Burnet Centre, Box
254 FAIRFIELD 3078 AUSTRALIA]
" Dipyrone is not available in Canada"
Joel Lexchin, Canada [joel.lexchin@utoronto.ca (Joel Lexchin)]
" Yes, dipyrone is available in South Africa. It is available in combination
with hyoscine-N-butyl bromide (10 mg) and dipyrone (250 mg). The product is
called Buscopan Co and is manufactured/ marketed by Boehringer Ingelheim.
It is one of many products which should be reviewed by our Regulatory Authority"
Leesette Turner
" The German Drug Regulatory Agency (BGA), the home country of
Boehringer Ingelheim, banned all combinations of dipyrone/metamizol with
spasmolytic drugs 10 years ago after clinical studies cold not show any
benefit of the dipyrone combinations over dipyrone alone. Due to the
popularity of these combinations, doctors often did not realize these
combinations contained dipyrone. This was enough reason for Germany to ban
the combnations.
Most European countries followed suit, and banned dipyrone(metamizol)
combinations as well. The brandnames were so popular, that sometimes the
company kept the 'old' combination brandname for the single product!"
Wilbert Bannenberg
E-drug moderator
" Strangely enough the combination preparation (injectable) was NOT
banned because of suspected bone marrow toxicity, but because of the
risk of anaphylactic shock. This measure was actually taken by the
German BGA after the chairman of the drug committee of the German
Medical Association died after such an injection "
Leo Offerhaus MD PhD
E-mail LO@EURONET.NL, CompuServe 71530,15
" Yes, dipyrone is available in Argentina"
Daniel Domosbian [e-mail: colfar@satlink.com]
" Metamizol/dipyrone/analgin/noraminophenazonum etc. was recently
registered in Sweden (kind of reintroduction as it formerly existed at
least in one preparation called Palerol comp. from Sandoz and which
was used for treatment of biliary colic and colic caused by kidney
stones as far as I remember).
The drug now registered, Novalgin from Hoechst, comes in tablets and
as injection. Indications: Short-term treatment of acute moderate to
severe pain caused by tissue damage, e.g. after surgical procedures
and colic, e.g. biliary and urinary.
With Sweden being a EU-member, it is to be expected that metamizole
will reappear in more European countries.
Metamizole is extensively used in East Europe. In Mongolia, which I
visited recently, in addition to commerially available preparations,
the pharmacies were producing Analgin solutions in large quantities
and selling it without prescription. Metamizole has also been part of
drug donations by e.g. MSF, Spain. They claim to use it as an
alternative to opiates which cannot be included in donations (or so
they say)"
Ms Kirsten Myhr,
[E-mail: myhr@online.no or (w): kirsten.myhr@helsetilsynet.dep.telemax.no]
" A number of years ago, HAI and one of its members, BUKO Pharma-Kampagne in
Germany, wrote a report on the drug and its dangerous side effects. While
the report is now a few years old, it does include some good background
information about the drug and its use."
Elizabeth Hayes
Health Action International Europe
Jacob van Lennepkade 334 T, 1053 NJ Amsterdam, Netherlands
tel: +31 20 6833684, fax: +31 20 6855002
France:
" Dipyrone is marketed in France in many drugs. 2 tradenames contain only
dipyrone and 2 are combnations with cafeine and 2 others with antispamodic
and 1 with codeine".
Cameroon:
" Dipyrone was also present in Cameroon up to 1994 when I left the country,
but there is no doubt that the same drugs are still present. It was very
much used mainly as antipyretic. A retrospective survey carried out in 1993
on outpatient records of a district hospital found that 48% of prescriptions
contained dipyrone . The October-December 1992 issue of the Precriber's
bulletin (independent drug bulletin, no longer published) contained two
pages of review on dipyrone. The main messages were: fatal side effects
exists altough rare, and dipyrone shoudl not be used as first line
antipyretic or analgesic. This bulletin was sent to all prescribers
(doctors, nurses, midwives and pharmacists). The survey mentionned above
found that in the same hospital prescription at the outpatient department
dropped to 9% in 1993. (Steinhausen KF. The effect of a drug bulletin on
rational prescribing in hospitals of Fako division in South West province,
Cameroon. University of Heidelberg, 1993)".
Jerome Sclafer [e-mail: jeromejet@easynet.fr]
" Dipyrone is effective as an analgesic and antipyretic. However,
its use carries with it a high risk of agranulocytosis. If a person
requires effective pain relief not achieved with an NSAID, then I
would use a narcotic. Dipryone might be considered for someone
with a life-threatening fever that can't be treated otherwise"
Randy Trinkle, BScPharm, BA [mailto://rtrinkle@pris.bc.ca]
Once again, Thanks for help me,
Arturo Marti-Carvajal
Venezuela
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