Nolotil has been in the spotlight for a few weeks. The lawsuit by a patient association against the Government of Spain for prescribing it has opened the debate on whether the active ingredient of this medication, metamizole, is safe. The case is the following: according to the Association of People Affected by Drugs (ADAF), who has filed the complaint, in our country it is prescribed with 'joy' even to British tourists. And here comes the crux of the matter, in recent years, 45 of them have died because, they say, of its side effects. In addition, there are 125 more affected. In all of them, it seems, they had been prescribed this medication while they were here, either on vacation or on longer stays, when it is prohibited in the United Kingdom.
So with this on the table, many people have begun to wonder if it really is a safe treatment. This pain reliever is one of the most consumed in our country. In 2020, no less than 22 million boxes were sold. And it is indicated to treat pain. It is also used as “antipyretic, but only in some cases where the fever has not responded to other medications or in people with certain allergies,” says Juan del Arco, president of the Pharmacy section of the Bilbao Academy of Medical Sciences.
The amount
22
million boxes
of Nolotil were sold last year in Spain. It is the most consumed painkiller in the world.
It has been used for more than half a century in our country and until now there is no data that invites us to distrust it. «Of course it has side effects, like everyone. Paracetamol also has them,” Del Arco continues. But he invites calm: if we use it well there would be no problem. «First, it is not dispensed without a doctor's prescription. And second, the sheet indicates two important things: it should not be used for long-term treatments. And if it is done, it is necessary to follow up with the patient,” he adds.
This means that a doctor can prescribe Nolotil to take for 7 days without problem. If it is necessary to extend the time period, then we will be scheduled to perform more tests, including a blood test with which we could see if the metamizole is really harming us or not.
Because what happens in the case of the British is that in most cases they have suffered from a disease called agranulocytosis, which, roughly explained, implies a sudden drop in defenses that makes the individual more prone to infections. «This is an adverse reaction to this medication considered very rare; “It occurs in less than one case per 10,000 patients treated,” says José Manuel Paredero, president of the Spanish Society of Primary Care Pharmacists (SEFAP). And in our country, the incidence rate of this ailment is even lower, emphasizes Del Arco.
«Metamizole should not be used for long-term treatments. And if it is done, the patient must be followed up.”
John of the Arc
President of the Pharmacy section of the Bilbao Academy of Medical Sciences
Paredero also delves into the message that the risk profile of the drug has not changed. This is confirmed by the Spanish Medicines Agency (AEMPS): “There are no new findings.” In 2018, this institution already launched a note for health professionals talking about the topic. Then it recommended “not using metamizole in patients in whom it is not possible to perform controls, for example, floating population.”
And that, the follow-up, is the key to the story. If the treatment with metamizole is prolonged, the doctor who prescribed it must be attentive to us because, unfortunately, the symptoms of agranulocytosis are “nonspecific,” explains Del Arco: general malaise, infection, sores, bruises, paleness, bleeding… And be careful, because suffering from them does not mean that you have that condition.
Patient information
If metamizole is safe, the next question that has sparked controversy is why it has been banned in the United Kingdom. The explanation is “epidemiological”, the two experts agree. Just as in Spain cases of agranulocytosis are few, there they are more frequent and the decision has been made to restrict it. For this, another note has also been weighed that, they warn, must be interpreted with some caution: there are studies that point to the involvement of genetic factors that could influence the predisposition of British people to this disease.
«The most adverse reaction to Nolotil is agranulocytosis, which occurs in less than one case per 10,000 patients treated»
José Manuel Paredero,
President of the Spanish Society of Primary Care Pharmacists (SEFAP)
Now, not only is it prohibited there, it is also not prescribed in the United States, Australia, Sweden and India. However, the list of countries where it is still among the medical resources to treat certain patients is longer (Belgium, Austria, Finland, Germany, the Netherlands…), they conclude from the health area. “The most important thing is to stick to what is indicated in the technical sheet in terms of dose and duration of treatment and, above all, warn the patient when and how they should interrupt the treatment,” concludes Paredero.
Be careful with saving medication or increasing the dose
Metamizole in Spain is only sold with a prescription. A citizen cannot go to the pharmacy and buy it without first being prescribed by a doctor. Therefore, it is more difficult to self-medicate with it and put yourself at risk. But it also happens that many people save leftover medication from other treatments. “This does not have to be done, it has to be taken to the recycling point of the nearest pharmacy,” asks Del Arco. «Be careful about taking the extra when you have another health problem because it may have nothing to do with it. For example, if your throat hurts, maybe it was due to a bacterial infection and now the one you have is of viral origin. he explains.
Self-medicating can only bring us problems. «And another important thing, it doesn't matter if we are talking about metamizole or another analgesic, it should be used at the lowest dose at which it is effective: taking more will not take away the pain sooner, nor will taking twice as much make you more effect. The dose-analgesia relationship is not linear. What is, even exponential, is the dose-adverse effects relationship.
#safe #Nolotil #banned