title: Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti-Inflammatory Drugs.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) play an important role in multimodal pain management. In patients with a contraindication for NSAIDs, pain management is challenging. A recent Dutch anesthesiology guideline propagates the use of metamizole (dipyrone) in these patients. Metamizole is a controversial drug, its use being previously discouraged because of the risk for agranulocytosis. We discuss whether metamizole could be an alternative to classical NSAIDs and opioids in postoperative pain management despite this drawback.
  
  
  
  Literature review and pharmacovigilance research based on World Health Organization adverse effect registrations.
  
  
  
  Metamizole causes fewer gastric and duodenal ulcers than other nonselective NSAIDs, and the risk for bleeding is limited. It is unknown whether it is safer than a nonselective NSAID combined with a proton pump inhibitor. Although the drug appears to be safe for renal function in healthy volunteers, data in high-risk patients (eg, those with heart or renal failure) are lacking. The incidence of metamizole-induced agranulocytosis is controversial, but the risk is likely to be limited with short-term postoperative use in this selected group of patients.
  
  
  
  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. Hereby, improved postoperative pain relief can potentially be achieved. The risk for metamizole-induced agranulocytosis is judged to be acceptable.
authors.affiliation: Department of Internal Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.
authors.forename: Jorieke
authors.initials: J
authors.lastname: Konijnenbelt-Peters
authors.affiliation: Department of Internal Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: van der Heijden
authors.affiliation: Netherlands Pharmacovigilance Centre Lareb, 'sHertogenbosch, the Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: Ekhart
authors.affiliation: Department of Clinical Pharmacy, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Bos
authors.affiliation: Department of Anaesthesiology, Radboud UMC, Nijmegen, the Netherlands.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Bruhn
authors.affiliation: Department of Clinical Pharmacy, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands.|Department of Internal Medicine, Radboud UMC, Nijmegen, the Netherlands.|Department of Pharmacology-Toxicology, Radboud UMC, Nijmegen, the Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Kramers
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000139:chemically induced / Q000517:prevention & control; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D004177:Dipyrone / Q000009:adverse effects / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D060735:Pharmacovigilance; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D004177:Dipyrone
keywords: analgesia; anti-inflammatory agents; metamizole; nonsteroidal; opioids; pain; postoperative