ReviewSchmerz (Berlin, Germany)2017
[Dipyrone (metamizole) : Considerations on monitoring for early detection of agranulocytosis].
Review in Schmerz (Berlin, Germany), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Guideline
- [Recommendations for the perioperative use of dipyrone : Expert recommendation of the working group on acute pain of the German Pain Society, the scientific working group on pain medicine of the German Society for Anesthesiology and Intensive Care Medicine and the surgical working group on acute pain of the German Society for Surgery with participation of representatives of the Drug Commission of the German Medical Association].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2019Guideline
- Febuxostat-Induced Agranulocytosis: An Illustrative Case Report and Comprehensive Literature Review.Clinical case reports · 2025Article
- A probable case of metamizole-induced neutropaenia presenting 10 days after drug discontinuation.SAGE open medical case reports · 2025Article
- Case Report: Simultaneously Induced Neutropenia and Hemolysis After a Single Metamizole Dose.Drugs in R&D · 2023Article
- Article
- [The challenges of managing thoracic pain in cystic fibrosis (CF)].Schmerz (Berlin, Germany) · 2022Review
- [Perioperative analgesia with nonopioid analgesics : Joint interdisciplinary consensus-based recommendations of the German Pain Society, the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery].Schmerz (Berlin, Germany) · 2021Review
- Review
- [Perioperative analgesia with nonopioid analgesics : Joint interdisciplinary consensus-based recommendations of the German Pain Society, the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2021Review
- Drug-Induced Idiosyncratic Agranulocytosis - Infrequent but Dangerous.Frontiers in pharmacology · 2021Review
- Regional Differences in Prescribing Patterns of Metamizole in Germany Based on Data from 70 Million Persons.International journal of environmental research and public health · 2020Article
- [Treatment of pain in people with dementia].Zeitschrift fur Gerontologie und Geriatrie · 2019Article
- [Considerations concerning the perioperative use of metamizole].Der Anaesthesist · 2019Review
- Review
- [Palliative care of patients receiving opioid substitution therapy].Schmerz (Berlin, Germany) · 2019Article
- [Pharmacology of non-opioid analgesics].Schmerz (Berlin, Germany) · 2019Article
- [Perioperative use of metamizole and other nonopioid analgesics in children : Results of a survey].Der Anaesthesist · 2019Article
- Pharmacological treatment of knee osteoarthritis: Special considerations of the new German guideline.Orthopedic reviews · 2018Article
- [Side effects of pain therapy : Sufficient analgesia without unnecessary complications].Der Urologe. Ausg. A · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice.
objectivesWhich recommendations can be derived from the published literature for evaluating blood cell counts during treatment with metamizole and which other options for monitoring exist?
methodsData from recent epidemiological studies, reviews, and spontaneously reported cases were evaluated.
resultsAgranulocytosis can emerge at highly variable intervals ranging from the first day of metamizole treatment to months after treatment has begun. As a result, there is no conclusive, evidence-based recommendation for the time intervals at which blood cell counts should be tested. Therefore, the onset of clinical symptoms should be used as trigger for monitoring blood cell counts to enable early diagnosis and avoid agranulocytosis-related complications. In addition to general symptoms like fever, sore throat, fatigue, and muscle pain, mucosal ulcerations, severe angina, and systemic infections leading to sepsis are typical of agranulocytosis.
conclusionsProviding patients and medical staff with better information about early symptoms of agranulocytosis could be a sensible way to prevent complications. Any suspicion of agranulocytosis should immediately lead to a differential blood count and to the withdrawal of all drugs possibly associated with agranulocytosis. Patients should be monitored and treated according to the severity of their symptoms.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.