Metamizole-induced agranulocytosis (MIA): a mini review
Abstract Metamizole is an analgesic, antipyretic, and spasmolytic drug in Germany only approved for the treatment of severe pain or high fever that does not respond to other measures. In recent years, an increased use has been described among both adults and children, often against the approved indi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-08-01
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| Series: | Molecular and Cellular Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40348-023-00160-8 |
| _version_ | 1797559100403351552 |
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| author | Markos K. Tomidis Chatzimanouil Ines Goppelt Yvonne Zeissig Ulrich J. Sachs Martin W. Laass |
| author_facet | Markos K. Tomidis Chatzimanouil Ines Goppelt Yvonne Zeissig Ulrich J. Sachs Martin W. Laass |
| author_sort | Markos K. Tomidis Chatzimanouil |
| collection | DOAJ |
| description | Abstract Metamizole is an analgesic, antipyretic, and spasmolytic drug in Germany only approved for the treatment of severe pain or high fever that does not respond to other measures. In recent years, an increased use has been described among both adults and children, often against the approved indication. The most important side effect of metamizole is the development of agranulocytosis (neutrophil count < 500/µL). Incidence of metamizole-induced agranulocytosis (MIA) ranges depending on the study from 0.96 cases per million per year to 1:1602 per patient and metamizole prescription. The risk of agranulocytosis in children remains unclear, but is probably lower than in adults. Female gender and older age are associated with higher incidence, reflecting prescription distribution. MIA is dose-independent and risk seems to increase with duration of intake. In patients with past exposure, re-exposure may lead to rapid onset. MIA is believed to be induced either through immunologic or toxic mechanisms. MIA presents with fever, sore throat, fatigue, and mucosal inflammation, up to ulceration. Even in the case of suspected MIA, treatment with metamizole should be immediately paused and an examination of the blood cell count is required. In case of local or systemic infections, empirical therapy with broad-spectrum antibiotics should be administered. G-CSF therapy should be limited to patients with poor prognostic factors. The patient should be monitored closely until the neutrophil count returns to normal. Re-exposure to metamizole must be avoided. |
| first_indexed | 2024-03-10T17:40:49Z |
| format | Article |
| id | doaj.art-6dc9b22e935f43c0928d663c55156736 |
| institution | Directory Open Access Journal |
| issn | 2194-7791 |
| language | English |
| last_indexed | 2024-03-10T17:40:49Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Molecular and Cellular Pediatrics |
| spelling | doaj.art-6dc9b22e935f43c0928d663c551567362023-11-20T09:41:59ZengSpringerOpenMolecular and Cellular Pediatrics2194-77912023-08-011011710.1186/s40348-023-00160-8Metamizole-induced agranulocytosis (MIA): a mini reviewMarkos K. Tomidis Chatzimanouil0Ines Goppelt1Yvonne Zeissig2Ulrich J. Sachs3Martin W. Laass4Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität DresdenDepartment of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität DresdenDepartment of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität DresdenInstitute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University GiessenDepartment of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität DresdenAbstract Metamizole is an analgesic, antipyretic, and spasmolytic drug in Germany only approved for the treatment of severe pain or high fever that does not respond to other measures. In recent years, an increased use has been described among both adults and children, often against the approved indication. The most important side effect of metamizole is the development of agranulocytosis (neutrophil count < 500/µL). Incidence of metamizole-induced agranulocytosis (MIA) ranges depending on the study from 0.96 cases per million per year to 1:1602 per patient and metamizole prescription. The risk of agranulocytosis in children remains unclear, but is probably lower than in adults. Female gender and older age are associated with higher incidence, reflecting prescription distribution. MIA is dose-independent and risk seems to increase with duration of intake. In patients with past exposure, re-exposure may lead to rapid onset. MIA is believed to be induced either through immunologic or toxic mechanisms. MIA presents with fever, sore throat, fatigue, and mucosal inflammation, up to ulceration. Even in the case of suspected MIA, treatment with metamizole should be immediately paused and an examination of the blood cell count is required. In case of local or systemic infections, empirical therapy with broad-spectrum antibiotics should be administered. G-CSF therapy should be limited to patients with poor prognostic factors. The patient should be monitored closely until the neutrophil count returns to normal. Re-exposure to metamizole must be avoided.https://doi.org/10.1186/s40348-023-00160-8Metamizole-induced agranulocytosisMetamizoleAgranulocytosisAnalgesicsAntibodies against granulocytes |
| spellingShingle | Markos K. Tomidis Chatzimanouil Ines Goppelt Yvonne Zeissig Ulrich J. Sachs Martin W. Laass Metamizole-induced agranulocytosis (MIA): a mini review Molecular and Cellular Pediatrics Metamizole-induced agranulocytosis Metamizole Agranulocytosis Analgesics Antibodies against granulocytes |
| title | Metamizole-induced agranulocytosis (MIA): a mini review |
| title_full | Metamizole-induced agranulocytosis (MIA): a mini review |
| title_fullStr | Metamizole-induced agranulocytosis (MIA): a mini review |
| title_full_unstemmed | Metamizole-induced agranulocytosis (MIA): a mini review |
| title_short | Metamizole-induced agranulocytosis (MIA): a mini review |
| title_sort | metamizole induced agranulocytosis mia a mini review |
| topic | Metamizole-induced agranulocytosis Metamizole Agranulocytosis Analgesics Antibodies against granulocytes |
| url | https://doi.org/10.1186/s40348-023-00160-8 |
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