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Metamizole-induced agranulocytosis from a German intensive care perspective

Laura Hille1,2, Martin J Hug2, Tobias Wengenmayer1

  • 1Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Frontiers in Medicine
|April 17, 2026
PubMed
Abstract

Insights

Metamizole (dipyrone) can cause severe agranulocytosis, a dangerous drop in white blood cells, even in healthy individuals. This study highlights the critical need for careful monitoring and risk assessment when using this common pain reliever.

Area of Science:

  • Pharmacovigilance
  • Hematology
  • Intensive Care Medicine

Background:

  • Metamizole (dipyrone) use has surged in Germany, but it carries a risk of agranulocytosis.
  • Agranulocytosis is a severe adverse reaction to metamizole, potentially fatal and independent of dose.

Purpose of the Study:

  • To describe severe cases of metamizole-induced agranulocytosis requiring intensive care.
  • To contextualize these severe cases with current metamizole consumption data.

Main Methods:

  • Retrospective analysis of patients admitted to intensive care units for metamizole-associated agranulocytosis.
  • Data collected included demographics, clinical and laboratory findings, bone marrow exams, microbiology, treatments, and outcomes.

Main Results:

  • Seven patients required intensive care for metamizole-induced agranulocytosis, presenting with neutropenia and severe infections.
  • Two patients died; survivors faced prolonged ICU stays (11-60 days) with complications like septic shock and organ failure.
  • No patients had prior hematologic issues or immunosuppression.

Conclusions:

  • Metamizole-induced agranulocytosis is rare but can be life-threatening.
  • Despite low incidence, severe complications necessitate awareness and careful benefit-risk assessment.
  • Consideration of alternative analgesics is crucial for rational metamizole use.
Keywords:
Germanyagranulocytosisdipyroneintensive care unitmetamizole sodiumprescription statistics

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