Metamizole

Metamizole is a powerful drug (active ingredient) for pain, cramps and fever. Due to its mechanism of action and possible side effects, it does not only require pharmacy but also prescription.

What is metamizole?

Metamizole is a drug for severe and moderate pain. It not only alleviates pain itself, but also has a spasmolytic (antispasmodic) and antipyretic (fever-lowering) effect in higher doses and is counted among the so-called pyrazolones.

These also include drugs with the active ingredients phenazone, aminophenazone, propyphenazone and phenylbutazone. With the exception of metamizole, all of these drugs are NSAIDs.

An analgesic is a medicine that works against pain. Antipyretics have an antipyretic effect. In addition, metamizole has the property that - but only in higher doses - it also has an antispasmodic effect, i.e. it is also an antispasmodic.

Pharmacological effect

What is the mechanism of action of Metamizole, mainly known as Novalgin® in the drug trade, there is still no general agreement in medical research.

On the one hand, it inhibits cyclooxygenases and thus prostaglandin synthesis. Prostaglandins are pain messengers. In addition, it was researched that metamizole also has a central effect on neurons, which are located in the thalamus and hypothalamus. This should have an impact on the general processing of pain, i.e. pain perception, as well as on the regulation of body temperature. For this reason, metamizole is used as the strongest pain reliever that does not count among the opioids and opiate derivatives, for example as a combined medication with tramadol for analgesia of wound pain after operations.

A combination with tilidine is also conceivable. The reason why it is often combined with opiates is the fact that, according to a study by the University of Münster in 2008, like opiates, metamizole works on the NMDA receptor. This in turn increases the effect of morphine in combination with metamizole but with a reduced actual opiate requirement.

For patients who have to be treated with a metamizole-opiate combination over a longer period of time, this results in the significant advantage that the time until the opiate becomes tolerant is postponed, since less of the opiate is actually consumed than it would be necessary without the metamizole to achieve substantial pain relief or absolute freedom from pain.

Medical application & use

As already described above, is Metamizole much more than just a simple analgesic. It can do a lot more than just relieve severe pain. It is used for chronic pain, whereby a regular blood control is necessary here.

It is also used in acute pain, for example in colic of any origin, as it has an analgesic effect as well as a spasmolytic effect. In the case of kidney, biliary or intestinal colic, metamizole is usually given preference in the emergency services and in medical practices, as worsening of the symptoms has often been observed with the use of opiates.

However, if the pain is not colicky, but injury or burn pain, metamizole is usually administered intravenously, possibly in combination with morphine, depending on the pain intensity and genesis. Another important area of ​​application for metamizole is when fever cannot be controlled with other common antipyretics from the group of NSAIDs such as ASA, paracetamol, ibuprofen, etc.

There are patients who generally do not respond to these drugs, or who cannot be treated with them due to an intolerance to them, but who still need lowering of the fever. The fever is rarely alone here, but is accompanied by severe pain in various parts of the body.

With Metamizol you kill two birds with one stone: high fever is reduced, which cannot be reduced with other common medications, and the patient is relieved of the accompanying pain.

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Risks & side effects

Metamizole, also known under the trade names Novalgin®, Metamizol Hexal®, Berlosin® etc., is basically a miracle drug in medicine.

It can help reduce the need for opiates. It is a strong pain reliever, relieves cramps, and helps lower fever. However, like any other drug, it has the ability to produce effects that are undesirable. In asthma sufferers, it can trigger threatening asthma attacks known as "analgesic asthma". Anaphylactic reactions are also possible, such as shortness of breath, hives, etc. It can also cause dizziness and circulatory collapse by lowering blood pressure.

The dreaded drop in blood pressure was mainly observed when the intravenous injection was too rapid, whereby the administering physician should always ensure that it does not inject too quickly. If metamizole is used in the treatment of chronic pain, a reliable blood test must be carried out at regular intervals, since so-called leukopenia can occur with long-term use.

This is a dangerous reduction in the white blood cells, also called leukocytes, which are necessary for the immune system. If it is necessary to take metamizole, the rule of thumb also applies here: as much as necessary, as little as possible, in order to reduce the risks and side effects to a minimum.