in pictures and a few words
What it is and why it matters
Metamizole is a medicine for pain. It is considered a strong one.
- Its other names are analgin and dipyrone
- Sold on prescription
Relieves acute pain well
In acute pain, metamizole helps well.
- Most people who took it had their pain at least halved
- Much more often than after a dummy pill
Tested in people. Tested in people: in a summary of several studies in acute pain.
Why people trust it
Metamizole’s reputation as a strong medicine is not baseless. In Germany it is prescribed to millions.
- In Germany it has been on prescription since 1987
- It is available in Italy too — on prescription
How to take it
Metamizole is a prescription medicine: a doctor prescribes it.
- Treat it more strictly than a painkiller sold without a prescription
- Don’t take it on your own for a long time
- Learn in advance the signs that mean stopping at once
A rare but dangerous reaction
Very rarely, metamizole causes agranulocytosis: the number of blood cells that protect against bacterial infections drops sharply.
- Untreated, this condition is life-threatening
- The reaction can’t be predicted in advance
- It can start at any point during treatment and shortly after it
You are the main guard
The German regulator dropped scheduled blood tests during treatment: the reaction develops too fast to be caught by a scheduled test.
- It can be caught by the person themselves, if they know the signs
A trap with fever
If metamizole is taken for fever or together with antibiotics, the signs of the reaction may go unnoticed.
- A person takes a pill for fever — and fever as a warning signal gets lost
Who should see a doctor first
With any of these signs, stop taking it at once and see a doctor the same day: a full blood count with differential is needed.
- Fever and chills with no clear cause
- Sore throat
- Painful changes in the mouth, nose, throat, on the genitals or around the anus
Important. Don’t restart it until the test result is in. If the diagnosis is confirmed, never restart it.
In one sentence
Metamizole relieves acute pain well, but it is a prescription medicine: know the signs that mean stopping it at once, and don’t take it on your own for a long time.
Key points
Metamizole (dipyrone) is a painkiller that German doctors prescribe often, on prescription since 1987. The table shows what is known about it in people.
| Where | How it helps | What human studies showed |
|---|---|---|
| Acute pain | relieves pain; its reputation as a strong agent is not baseless | 2016 Cochrane review, 500 mg orally: at least half the pain relieved in over 70% of participants against 30% on placebo; NNT 2.4 (95% CI 1.8–3.1), moderate certainty; 5 studies, 288 participants, 143 on the 500 mg dose |
How it helps
Acute pain
The figures in «Key points» come from the 2016 Cochrane review, and they are good: metamizole is regarded as a good analgesic, and its reputation as a strong agent is not baseless.
Track record
In Germany metamizole is prescribed to millions — on prescription since 1987.
How to take it
Metamizole is a prescription drug: the prescribing stays with a doctor. The figures in «Key points» refer to the 500 mg oral dose.
- Treat it differently from an over-the-counter painkiller, and do not take it long-term on your own initiative.
- Know in advance the signs that mean stopping immediately — they are in «Who should see a doctor first».
Where it is sold
- Germany — prescription since 1987 (Novalgin, Novaminsulfon and generics).
- Italy — registered (Novalgina and others), all forms on prescription, paid entirely by the patient.
- France — not sold: no valid authorisation.
- United States — withdrawn from the market in 1977.
The drug is in the catalogue: Novalgina (metamizole) 500 mg. No price is shown — prescription medicines are ordered through the chat, and the administrator confirms availability and cost.
Who should see a doctor first
Agranulocytosis: what it is and how likely
Agranulocytosis is a sharp fall in neutrophils, the cells that defend against bacterial infection. A person becomes defenceless against ordinary flora, and untreated the condition is life-threatening.
The German label classes the frequency as «very rare» — up to one case in 10,000. That is rare, with two features that make it contentious: the reaction is unpredictable, and it can arise at any point during treatment and shortly after it ends.
What the regulator changed in December 2024
On 9 December 2024 the German regulator issued an official notice, agreed with the European agency, on measures to reduce the consequences of this risk.
The most interesting part is what many expected and did not get: routine blood monitoring during treatment was dropped. Instead, contraindications and warnings were tightened, and the main weight was placed on informing the patient. The logic is that the reaction develops too fast to be caught by scheduled tests; the only person who can catch it is the patient who knows the signs.
Signs that mean stopping immediately:
- fever and chills with no clear cause;
- sore throat;
- painful changes to the mucous membranes — mouth, nose, throat, and also the genital and anal area.
If any appear, stop the drug and see a doctor the same day: a full blood count with differential is required. Treatment is not resumed until the result is in. If the diagnosis is confirmed, it is never resumed.
A specific trap, named in the notice itself: when the drug is taken for fever, or alongside antibiotics, the symptoms can be masked. Someone takes it for a temperature — and temperature as a warning sign disappears into that.
Bottom line
Metamizole genuinely relieves pain well, and its reputation as a strong agent is not baseless.
It deserves different treatment from an over-the-counter painkiller: know the signs that mean stopping at once, and do not take it long-term on your own initiative.
Caveats
- Volume of data. The whole review covers eight studies and 809 participants; the NNT was calculated not on all of it, but on five studies and 288 participants, and the 500 mg oral dose itself accounts for 143 people. For comparison: etoricoxib has 798 participants on a single dose. Metamizole is the thinnest evidence base of the five.
- Withdrawn version. The review replaces a withdrawn 2010 version — the previous one was retracted.
- No comparison. The review contains no direct comparison of metamizole with other analgesics: the authors write that there were too few data for it, although comparator arms existed in the studies. So «stronger than ibuprofen» cannot be derived from this source in any form.
- Why the argument has run for fifty years. The reason for the divergence has one name: agranulocytosis (see «Who should see a doctor first»); regulators in different countries, looking at the same data, reached opposite decisions (see «Where it is sold»).
The prescribing stays with a doctor: this guide explains what is known about the drug, it does not replace a consultation.
Key facts
- NNT 2.4 (95% CI 1.8–3.1) for the 500 mg oral dose: over 70% got at least half their pain relieved, against 30% on placebo (2016 Cochrane review, moderate certainty; 5 studies, 288 participants).
- In Germany metamizole has been prescription-only since 1987 (Novalgin, Novaminsulfon and generics); in Italy it is registered (Novalgina and others), all forms on prescription; in France it is not sold.
- In the German label agranulocytosis is classed as «very rare» — up to 1 in 10,000.
- The regulator's notice of 09.12.2024 dropped routine blood monitoring, tightening contraindications and warnings instead; the main weight is on informing the patient.
- Fever and chills with no clear cause, sore throat, painful changes to the mucous membranes — stop the drug and see a doctor the same day: a full blood count with differential is needed.
