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Seven patients with metamizole-induced agranulocytosis required ICU admission, resulting in two deaths and severe complicationsSeven patients needed ICU care for severe reactions to metamizole

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Key Takeaway
Consider careful benefit-risk assessment and alternative analgesics due to rare but life-threatening agranulocytosis risk.

This retrospective analysis focused on seven patients admitted to interdisciplinary medical intensive care units at a tertiary university hospital in southern Germany. The cohort consisted of individuals presenting with metamizole-induced agranulocytosis, a condition characterized by profound neutropenia and severe infections. The study described the clinical course, outcomes, and complications associated with this specific adverse reaction requiring intensive care.

The primary outcomes assessed included mortality, duration of ICU stay, and the occurrence of severe complications. Results indicated that two of the seven patients died, representing a mortality rate of 2/7. The cause of death was multiorgan failure. Survivors experienced prolonged ICU stays lasting between 11 and 60 days. Additionally, survivors faced severe complications, including septic shock, acute respiratory distress syndrome, and renal failure requiring dialysis.

Safety considerations highlighted the occurrence of agranulocytosis, profound neutropenia, and severe infections as adverse events. Serious adverse events included multiorgan failure and death. The study did not report data on drug discontinuations or general tolerability. Limitations of this descriptive analysis include its retrospective design, single-center setting, and lack of a control group for comparison.

The practice relevance of these findings underscores the necessity of awareness regarding the risk of life-threatening agranulocytosis. Despite the absolute incidence being low relative to the widespread use of metamizole, careful benefit-risk assessment and consideration of alternative analgesics remain essential for safe and rational use of the drug in clinical practice.

Researchers examined seven patients who were admitted to an interdisciplinary medical intensive care unit at a university hospital in southern Germany. All patients had been exposed to metamizole, a medication used for pain relief, before developing severe blood problems known as agranulocytosis.

The study found that two of the seven patients died from multiorgan failure. Among the five survivors, hospital stays were much longer than usual, ranging from 11 to 60 days. Survivors also experienced serious complications, including septic shock, acute respiratory distress syndrome, and kidney failure that required dialysis.

These findings highlight the potential severity of agranulocytosis caused by metamizole. However, because the study was a small, descriptive review of only seven cases at one hospital, it cannot tell us how often this happens in the general population. Readers should understand that while the risk is real and life-threatening, the absolute number of cases is low compared to how widely the drug is used. Careful benefit-risk assessment and considering alternative pain treatments remain essential for safe use.

What this means for you:
This small study shows severe, rare risks of metamizole requiring ICU care; careful use and alternatives are essential.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background/objectivesMetamizole (dipyrone) is a non-opioid analgesic and antipyretic widely used in Germany, with prescriptions having increased more than tenfold since 1997. Despite its popularity, metamizole remains controversial due to the risk of agranulocytosis–a potentially life-threatening adverse reaction that can occur independently of dose or duration of therapy. This study aimed to describe severe cases of metamizole-induced agranulocytosis requiring intensive care treatment and to contextualize them within current consumption data.MethodsA retrospective analysis was conducted of all patients admitted to the interdisciplinary medical intensive care units of a tertiary university hospital in southern Germany between April 2022 and April 2025 due to metamizole-associated agranulocytosis. Demographic, clinical, and laboratory data were collected. Bone marrow examinations, microbiological findings, treatment regimens, and outcomes were analyzed descriptively.ResultsSeven patients required intensive care for metamizole-induced agranulocytosis. All presented with profound neutropenia and severe infections. Two patients died from multiorgan failure despite maximal supportive care. The five survivors experienced prolonged ICU stays (11–60 days) with complications including septic shock, acute respiratory distress syndrome, and renal failure requiring dialysis. None of the patients had pre-existing hematologic disorders or immunosuppression.ConclusionMetamizole-induced agranulocytosis is a rare but potentially severe adverse reaction. Even though its absolute incidence is low relative to the widespread use of metamizole, affected patients may experience life-threatening complications. Awareness of this risk, combined with careful benefit–risk assessment and consideration of alternative analgesics, remains essential for safe and rational use of metamizole in clinical practice.
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