Metamizole
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Metamizole
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| Systematic (IUPAC) name | |
| Sodium [(2,3-dihydro-1,5-dimethyl-3-oxo-2-phenyl- 1H-pyrazol-4-yl)methylamino] methanesulfonate |
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| Identifiers | |
| CAS number | |
| ATC code | N02 |
| PubChem | |
| Chemical data | |
| Formula | C13H16N3NaO4S |
| Mol. mass | 311.358 g/mol |
| Pharmacokinetic data | |
| Bioavailability | ? |
| Metabolism | ? |
| Half life | ? |
| Excretion | ? |
| Therapeutic considerations | |
| Pregnancy cat. |
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| Legal status | |
| Routes | ? |
Metamizole sodium is a non-steroidal anti-inflammatory drug (NSAID), commonly used in the past as a powerful painkiller and fever reducer. It is better known under the names Dipyrone, Analgin and Novalgin.
Metamizole was first synthesized by the German company Hoechst AG in 1920, and its mass production started in 1922. It remained freely available worldwide until the 1970s, when it was discovered that the drug carries a small risk of causing agranulocytosis - a very dangerous and potentially fatal condition. Recent studies estimate that the incidence rate of metamizole-induced agranulocytosis is between 0.2 and 2 cases per million person days of use, with approximately 7% of all cases fatal (provided that all patients have access to urgent medical care). In other words, one should expect 50 to 500 deaths annually due to metamizole in a country of 300 million, assuming that every citizen takes the drug once a month. This is not a very high rate, especially compared to other drugs - for example, the prescription drug clozapine is known to be at least 50 times more likely to trigger agranulocytosis. However, at the time the risk was assumed to be much greater [1] and, as such, excessive for an over-the-counter analgesic, especially considering the existence of safer alternatives (aspirin and ibuprofen).
Metamizole was banned in Sweden in 1974, in the United States in 1977; more than 30 countries, including Japan, Australia, Iran, and part of the European Union, have followed suit. In these countries, metamizole is still occasionally used as a veterinary drug. In Germany it became a prescription drug. Some European pharmaceutical companies, notably Hoechst and Merck, continue to develop metamizole-containing drugs and market them in some countries. In Sweden, the ban was lifted in 1995 and re-introduced in 1999.
In the rest of the world (esp. in Spain, Mexico, India, Brazil, Russia, Bulgaria and Third World countries) metamizole is still freely available over-the-counter, remains one of the most popular analgesics, and plays an important role in self-medication. For example, metamizole and metamizole-containing drugs account for 80% of OTC analgesic market in Russia, whereas ibuprofen accounts for 2.5%.
Metamizole received brief period of attention by American media in 2001[2], when a Latino immigrant boy was admitted into a Salt Lake City clinic with symptoms of agranulocytosis. It was discovered that the drug remained freely available in Latino shops and highly popular among Mexican immigrants, despite the ban. The ongoing "LATIN" Study, a multicenter international case-control study, is examining the incidence of agranulocytosis in Latin America and the role of metamizole.
[edit] Brand names
- Mexico: Neo-Melubrina
- Brazil: Novalgina
- Germany: Novalgin, Analgin, Berlosin, Metalgin, Metamizol-Puren, Novaminsulfon.
- Hungary: Algopyrin
- Romania: Algocalmin, Novocalmin, Algozone, Nevralgin
- Spain: Nolotil
- Russia/Bulgaria: Tempalgin (combination drug; metamizole is one of its components)
- Israel: Optalgin
- Finland: Litalgin
- Bulgaria: Proalgin
[edit] References
- ^ WHO Pharmaceuticals Newsletter No. 1, 2002, p.15
- ^ Metamizole Use by Latino Immigrants: A Common and Potentially Harmful Home Remedy
[edit] External links
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| Opioids | Bezitramide, Buprenorphine, Butorphanol, Dextromoramide, Dextropropoxyphene, Diamorphine, Dihydrocodeine, Fentanyl, Hydromorphone, Ketobemidone, Methadone, Morphine, Nalbufine, Nicomorphine, Opium, Oxycodone, Papaveretum, Pethidine, Piritramide, Tramadol (see also longer list) |
| Salicylic acid and derivatives | Aspirin (Acetylsalicylic Acid), Diflunisal, Ethenzamide -- See also: NSAIDs |
| Pyrazolones | Aminophenazone, Metamizole, Phenazone |
| Anilides | Paracetamol (acetaminophen), Phenacetin |
| Others | Ziconotide, Tetrahydrocannabinol, Ibuprofen, Ketoprofen, Mefenamic Acid, Naproxen, Diclofenac, Flurbiprofen, Diflunisal, Fenoprofen, Indomethacin, Ketorolac, Meclofenamate, Meloxicam, Piroxicam, Tolmetin |
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