Dipyrone

Dipyrone or metamizole is a non-opioid analgesic and antipyretic drug, primarily used to treat pain and fever. It is a derivative of pyrazolone and was first synthesized by the German company Hoechst AG in 1922. Despite its effectiveness, the use of dipyrone has been subject to controversy due to its association with agranulocytosis, a potentially life-threatening condition characterized by a severe reduction in the number of white blood cells.

Pharmacology

Dipyrone acts as an analgesic through its metabolites, which inhibit the cyclooxygenase enzymes COX-1 and COX-2, leading to a decrease in the production of prostaglandins. Prostaglandins are substances in the body that mediate pain and inflammation. By reducing their levels, dipyrone effectively alleviates pain and reduces fever. Unlike other nonsteroidal anti-inflammatory drugs (NSAIDs), dipyrone does not significantly affect platelet function or cause gastrointestinal bleeding, which makes it a preferred choice in certain clinical situations.

Indications

Dipyrone is indicated for the treatment of various types of pain, including acute, chronic, and post-operative pain, as well as for the reduction of fever that does not respond to other treatments. It is particularly useful in cases where NSAIDs are contraindicated or when patients have a history of gastrointestinal issues.

Side Effects

The most serious side effect associated with dipyrone is agranulocytosis, a condition that can lead to severe infections due to a decreased number of white blood cells. Other side effects may include allergic reactions, hypotension, and, less commonly, renal and liver impairment. Due to the risk of agranulocytosis, dipyrone is banned or its use is restricted in several countries, including the United States and some European nations.

Administration

Dipyrone can be administered orally, rectally, or via intravenous or intramuscular injection. The route of administration depends on the clinical situation and the severity of symptoms. Intravenous administration is typically reserved for hospital settings and for cases requiring rapid onset of analgesia.

Regulatory Status

The regulatory status of dipyrone varies globally. In countries where it is available, it may be sold under various brand names, including Novalgin, Analgin, and Neo-Melubrina. In jurisdictions where dipyrone is banned or restricted, alternative analgesics and antipyretics are used.

Conclusion

Dipyrone remains a valuable analgesic and antipyretic agent in countries where it is approved for use. Its efficacy in treating pain and fever, combined with a favorable gastrointestinal safety profile compared to other NSAIDs, makes it a useful option in specific patient populations. However, the potential for severe side effects necessitates careful patient selection and monitoring.