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Metamizole-associated adverse events: a systematic review and meta-analysis

Thomas Kötter1, Bruno R da Costa2, Margrit Fässler3

  • 1Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany; Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Plos One
|April 16, 2015
PubMed
Abstract

Insights

Metamizole is a safe option for short-term pain relief compared to other analgesics, with fewer adverse events than opioids. Further research is needed for long-term safety assessments.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Evidence-Based Medicine

Background:

  • Metamizole is a widely used analgesic globally.
  • Existing data on metamizole's safety profile is limited and lacks a comprehensive summary.
  • This study addresses the need for a conclusive evaluation of metamizole's clinical safety.

Purpose of the Study:

  • To systematically evaluate the clinical safety of metamizole in comparison to placebo and other common analgesics.
  • To synthesize evidence from randomized controlled trials regarding metamizole's adverse event profile.

Main Methods:

  • Conducted a systematic literature search across major databases (CENTRAL, MEDLINE, EMBASE, CINAHL) and trial registries.
  • Included randomized controlled trials (RCTs) comparing metamizole with placebo or other analgesics in adults.
  • Performed meta-analyses to assess adverse events (AEs), serious adverse events (SAEs), and dropouts, calculating risk ratios (RRs).

Main Results:

  • Analyzed 79 RCTs involving nearly 4000 patients for short-term metamizole use (less than two weeks).
  • Metamizole showed fewer adverse events compared to opioids (RR = 0.79; 95% CI, 0.79-0.96).
  • No significant differences in AEs were observed between metamizole, placebo, paracetamol, or NSAIDs; few SAEs were reported with no significant differences.

Conclusions:

  • Metamizole appears to be a safe analgesic for short-term hospital use when compared to other common pain relievers.
  • High-quality trials are necessary to thoroughly assess the intermediate- and long-term safety of metamizole.
  • The overall quality of included reports was mediocre, highlighting a need for improved trial reporting standards.

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