E-drug: Re: Dipyrone
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The data we offered about dipyrone and % of agranulocytosis due to this drug
were given in a Lecture by Dr Joan-Ramon Laporte in December 1996, in
Institut Catala de Farmacologia. This Centre is the coordinator for
Barcelona in the Boston Study.
I would like to know which analgesics are more effective, harmless and
cheaper than dipyrone with exception of ibuprofen, which is currently known
as the NSAID with better relation benefit/risk.
We must remember that Hartl (Excerpta Medica Monogr,147,1976) established in
1964 that the incidence of agranulocytosis type I was 0,8% for USA, but this
conclusion was made from Huguley's data (JAMA, 1964, 188:817, JAMA
1964,189:938-41) and Discombe (BMJ, 1952,1:1270-73) At the same time
Discombe cited data from other authors which used mainly aminopyrine. This
data have been widely applied to Dipyrone and USA population.
In a monograph by Prof. Geraldo Halfeld, a Brazilian academic, mortality is
analysed, as well as per capita use of dipyrone in 1976; it was observed the
mean mortality of countries that use dipyrone is 0,61 x 100 000 inhabitants
and in countries which DO NOT USE dipyrone is 0,68 x 100 000. Sweden and
Australia reintroduced it after having banned it, and agranulocytosis
incidence kept the same.
Even though the Boston Study has been critized, I don't know of another
reliable study. In this study the incidence for agranulocytosis due to
dipyrone is 0.0002% related to all analgesics, which is considered very low.
We do not deny dipyrone produces agranulocytosis, but we do say it's not in
an elevated degree as to banish its use and deprive the population of a drug
with so good ratio benefit/risk. We quietly accept high incidence of
gastrointestinal bleeding by ASA, with a letality of 10 - 20 %
(BMJ1973;3:655), though less mortality has been reported, but not for this
reason has been banished.
The data offered by Dr Pablo Adolfo Elios are very interesting, in Buenos
Aires population, which seems to have a great incidence of agranulocytosis
and is in agreement with other authors such as Larrinaga (Medicina, B. Aires
1994, 54:13-6). Probably the Argentine population has increased sensitivity
for suffering agranulocytosis, which might be due to more use of dipyrone or
geographical risk variations (Levy,M Agent Actions suppl 1988,25:21-31)
I consider the exchange of ideas has been very valuable
Best regards to all participants
CENTRO PARA EL DESARROLLO DE LA FARMACOEPIDEMIOLOGIA
Dr Juan A Furones, Senior Lecturer on Pharmacology, MD
Rogelio Fernandez, Pharmacist, PhD
Frank Debesa, Pharmacist B Sc
Pharmacoepidemiology Development Center
44 No 502 esq 5a Ave
Miramar, Playa
Havana, Cuba
CP 11300
E-mail; cdf@infomed.sld.cu
FAX: (537)24-7227 Phone(537) 24-0924
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