Monday , March 20 2023

A drug banned there but available in Portugal?


A few days ago there was a big controversy with the drug – nolotil – used in medicine for decades. The funny thing is that people take a medication balance and do not follow the medication simply because they heard or saw the news …

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

nolotil, agranulocytosis

In principle, nolotil has as active ingredient magnesium metamizole. A substance marketed in Portugal and other brands. In particular, Dolocalma like in Cinnamon Cinnamon and Metamizol Sandoz, the last two generic drugs.

Metamizole is a prodrug that breaks down spontaneously into structurally related compounds of pyrazolone. In short, it is a popular analgesic drug, not opioid!

Metamizole Magnesium has analgesics (against pain), anti-inflammatory (treatment of inflammation) and antipyretic (for fever). Especially acute pain in the postoperative or post-traumatic period. Spastic Pain. Large fever that does not respond to other antipyretic therapies. Tumor pain.

Analgesic scale (by the World Health Organization):

The use of pain control medications 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 designated as weak (codeine or tramadol),
  3. Opioids designated as potent (morphine, buprenorphine or fentanyl)

At any of these steps, adjuvants, such as antidepressants,
anti-convulsants and others.

This scale is intended to prevent excessive consumption of opioids, which can induce tolerance and addition phenomena.

Despite the fact that it is considered an analgesic of demonstrated efficacy, metamizol has, like most drugs, side effects!

However, it is the health professionals, namely doctors prescribing to analyze blood parameters (blood count) and balance the risk and benefits.

Therefore, its use depends on a careful risk / benefit assessment taking into account the available alternatives.

Well, metamizol has been withdrawn from the market in the United States and in several European countries after reports of fatal agranulocytosis among users!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 reducing granulocyte leukocyte cells (immune system), such as neutrophils.

These cells are responsible for the "initial struggle" against foreign agents or pathogens. That being said, lowering these cells increases the risk of contracting a fatal infectious disease.

In short, it has led to death and, consequently, to withdrawal of medicine in other countries!

Why is it still marketed in Portugal?

nolotil, agranulocytosis

Fit Infarmed, "The use of drugs containing this substance can cause an adverse reaction – agranulocytosis – which, although severe, is very rare"

"In Portugal, 11 cases of agranulocytosis potentially associated with the use of metamizole were reported in the pharmacovigilance system between 2008 and 2018, with a frequency of 1 to 2 cases per year (which is in 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 use is longer than this, it is recommended to monitor homogram values, an exam that evaluates and counts a patient's blood cells.

These medicines should not be used in patients with haematological reactions before metamizole, in the treatment of immunosuppressants or other medicines that can cause agranulocytosis. "" Particular attention should be paid to prescribing these medicines to elderly patients, "he warned.

Despite this warning, Infarmed warns that "patients who have been prescribed metamizole should not stop treatment": "You will need to consult your doctor immediately if there are signs and symptoms of blood discordance, persistent fever, bruising, bleeding or paleness ".

In conclusion, there is a population at risk – people at risk of infection and / or associated problems!

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

However, read also:

Sources: 1, 2, 3, 4, 5

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