title: Who gets dipyrone (metamizole) in Germany? Prescribing by age, sex and region.
abstract: OBJECTIVE
  Metamizole (dipyrone) is an analgesic that has been the focus of considerable controversy regarding its safety. Because of potentially life-threatening blood disorders such as agranulocytosis, it has been withdrawn in many countries but not in Germany, where prescribing even increased over recent years. We aimed to evaluate prescribing of metamizole in Germany with respect to age, sex and regional variations.
  
  
  METHODS
  Using data of a statutory health insurance, we analysed a cohort of 1·7 million persons who were insured at least 1 day in each quarter of 2009. Outcome of interest was the outpatient prescription prevalence, for example the proportion of persons receiving at least one prescription of metamizole.
  
  
  CONCLUSIONS
  A total of 6·8% received metamizole with a higher prescribing prevalence in females (7·8% vs. 6·0%). The prevalence increased with age up to 26·7% in persons ≥85 years (men: 21·1%; and women: 30·4%). We found large regional variations with higher prevalences in the northern part of Germany. Most of the prescriptions were issued by general practitioners (78·9%). 58·3% were liquid oral formulations with considerable regional variations ranging between 32·3% in Mecklenburg-West Pomerania and 67·3% in North Rhine-Westphalia. Overall, liquid oral forms are much more often prescribed in the western than in the eastern part of Germany.
  
  
  CONCLUSIONS
  Metamizole - a drug with a relatively narrow indication - is often prescribed in Germany with relevant differences by age, sex and region. Qualitative studies should clarify reasons for this. Further quantitative research should investigate small-area variations, indications and treatment durations.
authors.affiliation: Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hoffmann
authors.forename: P
authors.initials: P
authors.lastname: Meinecke
authors.forename: M H
authors.initials: MH
authors.lastname: Freitag
authors.forename: G
authors.initials: G
authors.lastname: Glaeske
authors.forename: J
authors.initials: J
authors.lastname: Schulze
authors.forename: G
authors.initials: G
authors.lastname: Schmiemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004177:Dipyrone / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004177:Dipyrone
keywords: Germany; analgesics; dipyrone; health services research; outpatient