New aspects of the mode of action of dipyrone

He, Xiang; Neugebauer, Volker; Schaible, Hans‐Georg; Schmidt, Robert F.

doi:10.1007/978-3-0348-6387-2_1

Cited by 12 publications

(4 citation statements)

References 14 publications

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“…It is known that there is no relationship between the analgesic effect of metamizol and its ability to inhibit prostaglandins (16). It is also known that metamizol acts in two main ways: in the periphery, turning nociceptor insensitive to pain activation (17), and centrally, acting on periaquedutal grey substance, activating the pain inhibitory pathways (18). An interesting finding arising from the present study is that metamizol action was more than analgesic: it produced significant relief of phono‐, photophobia, nausea and aura.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Metamizol (Dipyrone) in Acute Migraine Treatment and in Episodic Tension-Type Headache–A Placebo-Controlled Study

Bigal¹,

Bordini²

2001

Cephalalgia

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Acute headache is a very frequent symptom, responsible for significant demand at primary care units and emergency rooms. In such sets in Brazil, metamizol is easily found but, on the other hand, neither ergotics nor triptans are available. The aim of this study is to compare intravenous metamizol with placebo in the acute treatment of migraine with aura, migraine without aura and episodic tension-type headache. Fifty-four migraine with aura patients, 95 migraine without aura patients and 30 tension-type headache patients were treated with metamizol. Ninety patients (30 migraine with aura, 30 migraine without aura and 30 tension-type headache patients) received placebo. Pain intensity, nausea, aura, photo- and phonophobia were investigated at 30 min and 60 min after the administration of the drug. Significant improvement of pain after 30 min and 60 min post-dosage was achieved from metamizol groups compared with placebo groups. Significant improvement of all other symptoms was achieved after 60 min post-dosage. Side-effects were mild and with small incidence. Metamizol is an effective, safe and low price drug. It may be regarded as a good alternative drug for the treatment of common acute primary headaches.

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Section: Discussionmentioning

confidence: 99%

“…The action of metamizol on the aura makes possible some speculation. There is evidence suggesting that migraine might be due to a cannalopathy (18, 19). Neuronal P-type calcium channels regulate 5-hydroxytryptophan (5-HT) liberation.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Metamizol (Dipyrone) in Acute Migraine Treatment and in Episodic Tension-Type Headache–A Placebo-Controlled Study

Bigal¹,

Bordini²

2001

Cephalalgia

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“…It may act in two ways, peripherally and centrally. The turning off of nociceptors sensitive to pain activation is the potential site for peripheral action whereas the effect on the periaqueductal gray matter (PAG) and the activation of pain inhibitory pathways may be the central mechanism 26,27 . Regarding the beneficial effects of dipyrone in nausea and photophobia, its action on the PAG and on medial rostrobulbar areas, as well as on the interaction between the trigeminal and visual pathways may explain why dipyrone was effective in relieving these associated symptoms 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Lysine clonixinate versus dipyrone (metamizole) for the acute treatment of severe migraine attacks: a single-blind, randomized study

Krymchantowski¹,

Carneiro

Barbosa³

et al. 2008

Arq. Neuro-Psiquiatr.

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-Background and Objective: Nonsteroidal anti-inflammatory drugs (NSAID) are effective to treat migraine attacks. Lysine clonixinate (LC) and dipyrone (metamizol) have been proven effective to treat acute migraine. The aim of this study was to evaluate the efficacy and tolerability of the intravenous formulations of LC and dipyrone in the treatment of severe migraine attacks. Method: Thirty patients (28 women, 2 men), aged 18 to 48 years with migraine according the International Headache Society (IHS) (2004) were studied. The patients were randomized into 2 groups when presenting to an emergency department with a severe migraine attack. The study was single-blind. Headache intensity, nausea, photophobia and side effects were evaluated at 0, 30, 60 and 90 minutes after the drug administration. Rectal indomethacin as rescue medication (RM) was available after 2 hours and its use compared between groups. Results: All patients completed the study. At 30 minutes, 0% of the dipyrone group 13% of the LC group were pain free (p=0.46). At 60 and 90 minutes, 2 (13%) and 5 (33%) patients from the dipyrone group and 11 (73%) and 13 (86.7%) patients from the LC group were pain free (p<0.001). At 60 minutes, significantly more patients from the LC group were nausea-free (p<0.001). Regarding photophobia, there were no differences between groups at 60 minutes (p=0.11). The use of RM at 2 hours did not differ among groups (p=0.50). Pain in the site of the injection was reported by more patients of the LC group compared to the dipyrone group (p<0.0001). Conclusion: LC is significantly superior to dipyrone in treating severe migraine attacks. LC promotes significantly more burning at the site of the injection.Key woRDS: lysine clonixinate, dipyrone (metamizole), migraine, severe attacks, acute treatment. Clonixinato de lisina versus dipirona (metamizol) para o tratamento agudo de uma crise intensa de enxaqueca: estudo monocego e randomizadoResumo -Contexto e Objetivo: Antiinflamatórios não esteroidais (AINe) são eficazes no tratamento de crises de enxaqueca. o objetivo deste estudo foi comparar a eficácia e a tolerabilidade das apresentações injetáveis do clonixinato de lisina (CL) e da dipirona no tratamento de crises intensas de enxaqueca. Método: Trinta pacientes (28 mulheres, 2 homens), com idades entre 18 e 48 anos e enxaqueca de acordo com a Classificação Internacional de Cefaléias (2004) foram estudados. os pacientes foram randomizados em 2 grupos ao se apresentarem em uma unidade de emergência, com uma crise intensa de enxaqueca. o desenho do estudo foi monocego. A intensidade da cefaléia, a presença de náusea e fotofobia e os efeitos colaterais foram avaliados e comparados na administração das drogas e após 30, 60 e 90 minutos. Indometacina retal foi disponibilizada como droga de resgate (DR) e seu uso comparado entre os grupos. Resultados: Todos os pacientes completaram o estudo. Após 30 minutos, 0% do grupo da dipirona e 13% do CL encontravam-se sem cefaléia (p=0,46). Após 60 e 90 minutos, 2 (13%) e 5 (33%) do g...

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“…The drug acts in two main ways: at the periphery, making nociceptors insensitive to pain activation (25), and centrally, acting on the periaqueductal gray matter and activating the pain inhibitory pathways (26). As the pathophysiology of tension-type headache seems to involve central hypersensitivity and peripheral triggers, we consider that dipyrone, both centrally activating the pain inhibitory system or acting on the nociceptors at the periphery, can have its mode of action explained.…”

Section: Discussionmentioning

confidence: 99%

Intravenous dipyrone for the acute treatment of episodic tension-type headache: A randomized, placebo-controlled, double-blind study

Bigal

Bordini

Speciali

2002

Braz J Med Biol Res

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Acute headaches are responsible for a significant percentage of the case load at primary care units and emergency rooms in Brazil. Dipyrone (metamizol) is easily available in these settings, being the most frequently used drug. We conducted a randomized, placebocontrolled, double-blind study to assess the effect of dipyrone in the acute treatment of episodic tension-type headache. Sixty patients were randomized to receive placebo (intravenous injection of 10 ml saline) or 1 g dipyrone in 10 ml saline. We used seven parameters of analgesic evaluation. The patients receiving dipyrone showed a statistically significant improvement (P<0.05) of pain compared to placebo up to 30 min after drug administration. The therapeutic gain was 30% in 30 min and 40% in 60 min. The number of patients needed to be treated for at least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There were statistically significant reductions in the recurrence (dipyrone = 25%, placebo = 50%) and use of rescue medication (dipyrone = 20%, placebo = 47.6%) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting.

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New aspects of the mode of action of dipyrone

Cited by 12 publications

References 14 publications

Intravenous Metamizol (Dipyrone) in Acute Migraine Treatment and in Episodic Tension-Type Headache–A Placebo-Controlled Study

Intravenous Metamizol (Dipyrone) in Acute Migraine Treatment and in Episodic Tension-Type Headache–A Placebo-Controlled Study

Lysine clonixinate versus dipyrone (metamizole) for the acute treatment of severe migraine attacks: a single-blind, randomized study

Intravenous dipyrone for the acute treatment of episodic tension-type headache: A randomized, placebo-controlled, double-blind study

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