metamizole / Generic mfg. - LARVOL DELTA

Hematological parameters in patients with chronic pain on long-term dipyrone therapy followed in a tertiary hospital: a retrospective cohort study. (PubMed, Clinics (Sao Paulo)) - "In this large cohort of chronic pain patients on long-term dipyrone therapy, only mild and clinically insignificant variations in hematological parameters were observed, and no cases of agranulocytosis were identified. However, the absence of an unexposed control group of chronic pain patients and the lack of systematic data on concomitant medications preclude attributing these observed changes to dipyrone alone."

Journal • Retrospective data • Agranulocytosis • Granulocytopenia • Hematological Disorders • Pain

Prevalence and clinical characterization of headache in patients with cranial bone defects: a single-center retrospective study. (PubMed, Acta Neurol Belg) - "Headache affects most patients with cranial bone defects, presenting as a moderate-to-severe, defect-site-predominant syndrome with pressure-mediated features and a rich neurological accompaniment. Systematic headache assessment and evidence-based analgesic protocols are warranted in this population pending cranioplasty."

Journal • Retrospective data • Neuralgia • Otorhinolaryngology • Pain • Vertigo

Status of perioperative pain therapy in thoracic surgery in Germany - A survey by the AG Perioperative Medicine in Thoracic Surgery (APMT) (DGT 2026) - "The survey shows a broad implementation of in-house standards and systematic pain assessment in thoracic surgery in Germany.At the same time, there are differences in perioperative pain therapy in the integration of ERAS concepts and in the choice of regional anesthesiological procedures depending on the extent of the operation.Greater standardization in the sense of evidence-based, perioperative concepts could contribute to further optimization of pain therapy in thoracic surgery."

Surgery • Addiction (Opioid and Alcohol) • Pain

Efficacy and safety of a fixed-dose oral tramadol-dipyrone combination for postoperative analgesia in dogs undergoing ovariohysterectomy and unilateral mastectomy: a randomized clinical trial. (PubMed, Front Vet Sci) - "At the end of surgery, all dogs received meloxicam and the first intravenous dose of the assigned treatment...Rescue analgesia with intravenous morphine was administered when predefined thresholds were reached...The tramadol-dipyrone combination improved early postoperative pain control in dogs undergoing ovariohysterectomy and unilateral mastectomy while maintaining favorable tolerability. These findings support its clinical use as part of a multimodal postoperative analgesic protocol, particularly during the early postoperative period."

Clinical • Journal • Gynecology • Pain

SCORTEN in Contrast: Two Cases of SJS/TEN Overlap With Divergent Outcomes Highlighting the Role of Renal Dysfunction. (PubMed, Clin Case Rep) - "Case 1 involved a previously healthy 18-year-old male who developed SJS/TEN overlap with 20% total body surface area (TBSA) involvement following exposure to amoxicillin, diclofenac, and levofloxacin...Case 2 involved a 32-year-old female with stage G5 chronic kidney disease (CKD) not on dialysis who developed SJS/TEN overlap with 30% TBSA involvement after metamizole and acetaminophen exposure...Furthermore, they suggest that cutaneous improvement with corticosteroids does not necessarily translate into survival when underlying organ vulnerability exists. Individualized clinical assessment beyond prognostic scores remains essential, particularly in resource-limited settings."

Journal • Chronic Kidney Disease • Critical care • Dermatology • Nephrology • Renal Disease • Steven-Johnson Syndrome

Analgesic combinations to reduce the stress/pain responses in ewes submitted to non-surgical embryo recovery: butorphanol associated with meloxicam or with dipyrone/hyoscine. (PubMed, Anim Reprod) - "No significant effects were detected for the remaining parameters. Under the tested conditions, neither analgesic protocol significantly reduced physiological indicators of stress."

Journal • Anesthesia • Pain

Evaluating the analgesic effect of metamizole in the mouse model for DSS-induced acute colitis. (PubMed, Front Physiol) - "However, metamizole did not reduce disease severity or pain in this mouse model. Therefore, other refinement strategies should be explored in future studies."

Journal • Preclinical • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Pain • Ulcerative Colitis

Pain-related facial expressions, heart rate variability and operator-assessed procedural ease during transvaginal follicular aspiration in mares: effect of procedure, sedation and butylscopolamine bromide - metamizole. (PubMed, Vet J) - "Follicular puncture did not appear to increase pain beyond ovarian manipulation. These findings support the use of behavioral parameters to evaluate pain and highlight the need to refine analgesic protocols to improve animal welfare during OPU."

Journal • Anesthesia • Pain

Agranulocytosis associated with metamizole among EudraVigilance reports involving methotrexate for rheumatoid arthritis. (PubMed, Naunyn Schmiedebergs Arch Pharmacol) - "Our study supports regulatory warnings that a concurrent administration of metamizole can increase the haematotoxic effect of MTX and should therefore be avoided. A sufficient RA therapy might decrease the need for analgesics and should be aimed at also in older RA patients."

Journal • Agranulocytosis • Granulocytopenia • Immunology • Inflammatory Arthritis • Pain • Rheumatoid Arthritis • Rheumatology

Maternal Dipyrone Exposure and Risk of Major Congenital Malformations, Adverse Perinatal and Postnatal Outcomes: A Population-Based Cohort Study. (PubMed, Clin Pharmacol Ther) - "Sensitivity Analysis for over-the-counter use indicated minimal possible misclassification bias. This study provides evidence supporting maternal dipyrone use in early or late pregnancy is not associated with MCMs, adverse perinatal outcomes, or early neonatal complications."

Journal • Agranulocytosis • Granulocytopenia • Pain • Renal Disease

Clinical Characteristics and Prognostic Factors of Patients with Acute Poisoning: A Retrospective Observational Cohort Study of Diquat, Single-Drug and Mixed-Drug Exposures. (PubMed, Risk Manag Healthc Policy) - "Diquat poisoning is increasingly reported where paraquat use has been restricted, whereas metamizole exposure remains relevant in regions where dipyrone remains clinically available...Diquat poisoning carried the greatest mortality and multi-organ injury, whereas mixed-drug poisoning showed intermediate severity. Early haemoperfusion was associated with improved outcomes in diquat poisoning, but causal interpretation is limited by the retrospective design; prospective multicentre validation is needed."

Biomarker • Journal • Observational data • Retrospective data • Hepatology • Hypotension • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease

Challenges in the HPLC analysis of hydrolytically unstable compounds: Metamizole and 4-methylaminoantipyrin case study. (PubMed, J Pharm Biomed Anal) - "Critical verification parameters demonstrated full compliance with International Council for Harmonisation guidelines. The practical utility of the procedure was confirmed through the analysis of two production batches of metamizole."

Journal

Efficacy of Non-opioid Drugs in Addition to Opioid Therapy for Cancer Pain Management (clinicaltrials.gov) - P3 | N=318 | Not yet recruiting | Sponsor: University Hospital, Basel, Switzerland

New P3 trial • Oncology • Pain • Palliative care

Metamizole-induced agranulocytosis: utilisation trends, pharmacovigilance signals and regulatory risk-minimisation in Switzerland. (PubMed, Swiss Med Wkly) - "Regulatory assessments by EMA and Swissmedic concluded that the benefits of metamizole continue to outweigh the risks, provided the drug is used appropriately, action is taken promptly at first symptoms and concomitant methotrexate is avoided. However, the number of reported cases of agranulocytosis underscores the known risk in the context of widespread use. Spontaneous reports reflect reporting intensity, not incidence; ongoing monitoring of risk-minimisation effectiveness is warranted."

Adverse events • Journal • Agranulocytosis • Granulocytopenia • Pain

Comparative Evaluation of Glidants for Enhancing the Flowability of Poorly Flowing Powdered Materials with Varying Particle Sizes and Morphologies. (PubMed, Pharmaceutics) - " Binary mixtures were prepared using one of four model substances (ibuprofen, metamizole sodium, mefenamic acid, or sunflower lecithin) combined with a glidant (colloidal silica, precipitated silica, or tricalcium phosphate). Very fine or cohesive powders, such as mefenamic acid and sunflower lecithin, showed limited response to silica-based glidants, whereas tribasic calcium phosphate proved more effective and additionally increased bulk density. Overall, no universal glidant strategy was identified; effective flow enhancement requires a tailored approach based on specific powder characteristics."

Journal

Acute Kidney Injury Secondary to Severe Hemolysis in Evans Syndrome: case reportIn this case is presented Evans syndrome which is a rare cause of AKI. (ERA 2026) - "Second-line therapy includes rituximab, cyclosporine, mycophenolate mofetil, and splenectomy...On September 16, 2024, she developed acute lumbar pain and received an intramuscular combination of dexamethasone, diclofenac, vitamin B12, and metamizole...Why this case is exeptional Evans syndrome remains a challenging diagnosis due to the absence of pathognomonic features and its heterogeneous clinical presentation. Delay in recognition may contribute to serious complications, including severe bleeding, thrombotic events, infections related to immunosuppression, and, as demonstrated in this case, acute kidney injury from intravascular hemolysis.This case emphasizes the importance of considering Evans syndrome in patients presenting with hemolysis, thrombocytopenia, and AKI, particularly when thrombotic microangiopathy has been excluded."

Case report • Clinical • Acute Kidney Injury • Atopic Dermatitis • Atypical Hemolytic Uremic Syndrome • Autoimmune Hemolytic Anemia • Dermatitis • Hematological Disorders • Immune Thrombocytopenic Purpura • Immunology • Infectious Disease • Nephrology • Pneumococcal Infections • Pneumonia • Renal Disease • Thrombocytopenia • Thrombocytopenic Purpura • HP

Incidence of drug-induced liver injury in the urban primary care setting. (PubMed, Clin Gastroenterol Hepatol) - "DILI represents a relevant cause of liver enzyme abnormalities in the primary care setting and is typically associated with favourable outcomes. ALT ≥5×ULN is the most reliable alert criterion, and analgesics, statins, and supplements are the leading culprits. Laboratory-linked alert systems may enhance early DILI detection in community practice."

Journal • Hepatology • Liver Failure • Pain

Pharmacological pitfalls in inpatient lung transplant care and management of medication risks. (PubMed, Front Pharmacol) - "Tacrolimus was the most commonly commented on drug, often due to interactions with metamizole/dipyrone, resulting in fluctuating tacrolimus levels. Other frequent issues included QTc-prolonging combinations (e.g., domperidone with escitalopram or amiodarone in addition to itraconazole) and reduced levothyroxine absorption due to divalent cations. Only five comments reflected actual adverse outcomes, indicating overall high drug safety. These findings are consistent with the literature describing the importance of systematic pharmacological review and interdisciplinary collaboration to improve medication safety and standardise care in lung transplant recipients."

Journal • Transplantation

SUNCT after traumatic brain injury initially misdiagnosed as trigeminal neuralgia (AHS 2026) - "She initially used dipyrone without relief and presented with severe episodes associated with tearing, conjunctival hyperemia, nasal obstruction, facial edema, and flushing...A neurologist prescribed venlafaxine 37.5 mg, carbamazepine 1400 mg, and lamotrigine 100 mg, reducing episodes to about 30 daily... This case contributes to the literature by highlighting the importance of recognizing SUNCT in unusual contexts, such as post-TBI. Unlike trigeminal neuralgia, SUNCT is characterized by prominent ipsilateral autonomic signs, which are crucial for differential diagnosis. Correct identification not only guides more effective pharmacological treatment but also reduces the functional impact of recurrent pain, broadening discussion on possible pathophysiological mechanisms."

CNS Disorders • Neuralgia • Pain • Vascular Neurology

Increasing metamizole prescription in high risk groups of methotrexate-treated patients with inflammatory rheumatic diseases: nationwide German claims data from 2006 to 2024 (EULAR 2026) - "Hospitalisations for agranulocytosis after overlapping use of MTX and metamizole were markedly increased in patients 70 years and older. Adequate DMARD therapy in the elderly and interdisciplinary information about the risk of agranulocytosis is needed to reach all groups of physicians involved in the care of patients with iRMD."

Clinical • Addiction (Opioid and Alcohol) • Agranulocytosis • Ankylosing Spondylitis • Giant Cell Arteritis • Granulocytopenia • Hepatology • Musculoskeletal Pain • Osteoarthritis • Psoriatic Arthritis • Rheumatoid Arthritis • Rheumatology • Seronegative Spondyloarthropathies • Spondylarthritis • Vasculitis

PANAMA: Fixed-dose Combination of 1000 mg Dipyrone Monohydrate + 60 mg Caffeine + 4 mg Chlorpheniramine Maleate in Improving Symptoms of the Common Cold and Flu in Adults (clinicaltrials.gov) - P3 | N=620 | Recruiting | Sponsor: Brainfarma Industria Química e Farmacêutica S/A

Head-to-Head • New P3 trial • Respiratory Diseases

Rechallenge after a DILI episode: importance of the pattern and the medication class (EASL 2026) - "Two of the 3 cases were reported after exposure to the same drug: Irinotecan/oxaliplatin, latency time 1 month, hepatocellular pattern; co-trimoxazole, latency 6 months, cholestatic. The third occurred after switching within the analgesic class (metamizole to ibuprofen, cholestatic pattern, latency 1 month)). Rechallenge after a DILI episode is not infrequent in clinical practice, and the rate of relapse is relatively low, especially among oncohematological and lipid-lowering drugs."

Cardiovascular • Diabetes • Dyslipidemia • Hepatitis C • Hepatology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Pulmonary Arterial Hypertension • Respiratory Diseases • Tuberculosis

Anesthetic Management in Metabolic and Bariatric Surgery Among Anesthesiologists: Survey-Based Study in Poland. (PubMed, J Clin Med) - "Multimodal analgesia components were commonly used, with paracetamol (95.8%), dexamethasone (91.5%), metamizole (90.1%), and lignocaine (84.5%) being the most frequently administered drugs. Reported practices among surveyed anesthesiologists for MBS in Poland are generally consistent with international recommendations, particularly regarding the use of PEEP. However, variability remains in airway management strategies and the use of videolaryngoscopy, highlighting the need for continued education and broader implementation of evidence-based perioperative protocols."

Journal • Anesthesia • Cardiovascular • Genetic Disorders • Hypertension • Hypotension • Obesity

Population-Based Assessment of Phenoconversion Potential in Switzerland: A Claims Data Study of Key Drug-Metabolizing Enzymes and Transporters. (PubMed, Pharmgenomics Pers Med) - "Quetiapine ranked first in the number of involved drug pairs, with quetiapine - metamizole being the predominant drug pair. These findings quantify real-world phenoconversion potential at the population level and underscore the need for outcome- and genotype-linked studies to determine clinical relevance. As this study was not designed to assess clinical outcomes, future genotype- and outcome-linked investigations are required to determine the actual impact on adverse drug reactions or treatment effectiveness."

Journal • Cardiovascular • CYP3A4

Leveraging large language models to audit perioperative total laryngectomy care: anesthetic, nutritional, and complication profiles in a real‑world cohort. (PubMed, Otolaryngol Pol) - "Multimodal anal‑ gesia based on intravenous paracetamol (60%), ketoprofen (47%), and metamizole (40%) was routinely employed, while strong opioids were used in only 5% of pa‑ tients...CRP peaked on postoperative day 3 (mean 114 mg/L). Pharmacologic VTE prophylaxis was admi‑ nistered in 65% of patients.</p><p><strong></strong> In TL patients, enteral feeding forms the backbone of nutritional sup‑port, and multimodal analgesia provides effective pain control, whereas VTE pro‑phylaxis and other modifiable elements of perioperative care warrant optimization within prehabilitation and ERAS-based protocols.</p><p>&nbsp;</p&gt."

Journal • Real-world evidence • Retrospective data • Anesthesia • Head and Neck Cancer • Laryngeal Cancer • Oncology • Pain • Solid Tumor