Wednesday , December 2 2020

A drug forbidden out there but available in Portugal?



A few days ago there was a big controversy with the medicine – nolotil – used in medicine for decades The fun is that people go out of medication and do not follow the medicine simply because they heard or saw the news …

Let's break the controversy from credible sources!
(Who can consult)

nolotil, agranulocytosis

The reason is that nolotil has magnesium methamizole as active ingredient. A substance marketed in Portugal also in other brands. Especially Dolocalma as in Cinnamon Metamizole and Metamizol Sandoz, the latter two generic drugs.

Metamizole is a prodrug that spontaneously disintegrates in compounds structurally related to pyrazolone. In short, it is a popular analgesic drug, do not do it opioid!

Magnesium metamizole has pain relievers (against pain), antiinflammatory (treatment of inflammation) and antipyretic (fever). Particularly acute pain in postoperative or posttraumatic period. Spasmodic pains. High fever that does not respond to other antipyretic therapies. Tumor pain.

Analgesic roast (by the World Health Organization):

The use of drugs for pain control is based on the principle of using a three-stage analgesic ladder based on:

nolotil, agranulocytosis

  1. Non-steroidal anti-inflammatory analgesics and other analgesics (paracetamol and metamizole)
  2. Opioids denoted as weak (codine or tramadol),
  3. Opioids called as strong (morphine, buprenorphine or fentanyl)

To any of these steps may be added adjuvants, such as anti-depressants,
anti-convulsants and others.

This ladder aims to prevent overuse of opioids, which can induce tolerance and additive phenomena.

Although it is considered to be a pain reliever on the proven effect, metamizole, like most drugs, has negative effects!

However, it is up to healthcare professionals, namely, a physician prescribing the blood parameters to be analyzed (blood count) and balancing the risk benefit.

Therefore, its use depends on a careful evaluation of the risk / benefit ratio with regard to available options.

Well, metamizole was withdrawn from the market in the US and several European countries after reports of lethal agranulocytosis among users! However, it is available in many countries in Europe, South America and Asia

But what is agranulocytosis after all? What caused death?

Agranulocytosis is the medical term for the reduction of granulocyte (immune) leukocyte cells, such as neutrophils.

These cells are responsible for "initial combat" against foreign agents or pathogenic particles. With that said, these cells decrease the risk of fatal infectious disease.

In short, this led to death and consequently the withdrawal of the drug in other countries!

Why is it still in Portugal?

nolotil, agranulocytosis

According to Infarmed, "The use of drugs containing this substance may cause side effects – agranulocytosis – which, although difficult, is very rare"

"In Portugal, a total of 11 cases of agranulocytosis were associated with the use of metamizole to the pharmacovigilance system between 2008 and 2018, with a frequency of 1 to 2 cases per year (which is within the expected frequency of a very rare reaction)."

To avoid such reactions, Infarmed recommends using "limited to a short period of time" within a maximum of seven days.

If usage is longer than this, it is advisable to monitor the values ​​of the homogram, a study that evaluates and counts the patient's blood cells.

"These medicines should not be used in patients with hematologic reactions prior to metamizole, during treatment with immunosuppressants or other medicinal products that may cause agranulocytosis": "Special attention should be paid to prescription medications for elderly patients," he warned.

Despite this warning, Infarmed warns that "patients who have been prescribed metamizole should not stop treatment": "It is only necessary to contact your doctor immediately if there are signs and symptoms of blood dyscrasia such as general disease, infection, persistent fever, bruising, bleeding or pallets ".

In conclusion, there is a risky population – people at risk of infections and related problems!

However, you are always free to ask your doctor not to prescribe this medicine and to replace it with another alternative for the same therapeutic purpose. (Try everything to not cost!)


But also read:

Sources: 1, 2, 3, 4, 5


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