In the treatment of patients receiving cytotoxic drugs, as well as children under 5 years of treatment with metamizole sodium should only be carried out under the supervision of a doctor.
Anaphylactic / anaphylactoid reactions
When choosing the method of drug administration, it should be taken into account that parenteral administration is associated with a higher risk of anaphylactic / anaphylactoid reactions. An increased risk of hypersensitivity reactions metamizol sodium can be caused by the following states:
- analgesic bronchial asthma, especially with concomitant polyposis rhinosinusitis;
- chronic urticaria;
- alcohol intolerance (hypersensitivity to alcohol) against which even when taking a minorthe amount of some alcoholic beverages, patients have sneezing, lacrimation and pronounced reddening of the face. Alcohol intolerance may indicate a previously unidentified syndrome of aspirin asthma;
- intolerance or hypersensitivity to dyes (eg, tartrazine) or to preservatives (eg benzoate).
Before using metamizole sodium it is necessary to conduct a thorough questioning of the patient in order to find out anamnestic information.
If there is a risk of developing anaphylactic reactions, reception is only possible after a careful assessment of the relationship between the expected benefit and the possible risk of using the drug. In the case of sodium metamizole, these patients need strict medical supervision of their condition and need to have the means to provide them with emergency care in case of anaphylactic / anaphylactoid reactions.
In predisposed patients, anaphylactic shock can occur, so patients with asthma or atopy metamizol sodium should be administered with caution. Patients who have anaphylactoid reactions in response to metamizole sodium,are also at risk of developing them in response to the use of other non-narcotic analgesics / NSAIDs.
Patients who have anaphylactic or other immunocompromised reactions (eg, agranulocytosis) in response to metamizole sodium use are also at risk of developing them for the use of other pyrazolones and pyrazolidines.
Severe skin reactions
With the use of metamizole sodium, life-threatening skin reactions, such as Stevens-Johnson syndrome (SSD) and toxic epidermal necrolysis (TEN), have been described. If there are symptoms of SS and TENS, including progressive skin rash, often with blisters or mucosal lesions, treatment with metamizole sodium should be discontinued immediately, and then not be performed in this category of patients. Patients should be aware of the symptoms of these diseases. They should carefully monitor skin reactions, especially during the first days of treatment.
Agranulocytosis
With prolonged use (more than 7 days), you need to monitor the picture of peripheral blood. Against the background of taking metamizole sodium, the development of agranulocytosis is possible.It occurs very rarely, lasts at least a week, does not depend on the dose, can be severe, threaten life and, in some cases, lead to death. In connection with this, in the detection of symptoms such as unmotivated rise in temperature, chills, sore throat, difficulty swallowing, stomatitis, erosive-ulcerative oral lesions, vaginitis or proctitis, a decrease in the number of neutrophils in the peripheral blood is less than 1500 / mm3 it is necessary to immediately consult a doctor and cancel the drug.
Pancytopenia
In case of development of pancytopenia, treatment should be stopped immediately, it is necessary to monitor the indicators of the developed blood test up to their normalization.
All patients should be aware that pathological changes in the blood may be accompanied by the appearance of symptoms such as general malaise, infection, persistent fever, hematoma formation, bleeding, pallor, while taking metamizole sodium, which requires immediate medical attention.
Isolated hypotensive reactions
Metamizole sodium can cause isolated hypotensive reactions. These reactions can be dose-dependent.The risk of such reactions is also increased with: previous arterial hypotension, decreased circulating blood volume or dehydration, unstable hemodynamics or acute circulatory disturbance (eg, in patients with myocardial infarction or trauma), in patients with fever.
In this regard, these patients should be carried out detailed diagnostics and establish close monitoring. In order to reduce the risk of hypotensive reactions, preventive measures (stabilization of hemodynamics) may be required.
In patients in whom a reduction in blood pressure should be avoided at all costs (eg, in severe coronary heart disease or significant stenosis of the cerebral arteries), metamizol sodium It can only be used with careful monitoring of hemodynamic parameters.
Abdominal pain
It is inadmissible to use the drug to relieve acute pain in the abdomen (until finding out their cause).
Impaired liver and kidney function
In patients with impaired liver or kidney function, it is recommended that metamizole sodium should not be taken at high doses due to a decrease in the elimination rate of the drug.The drug contains sodium, which must be taken into account by individuals on a diet low in sodium.
Rules of drug administration
Intravenous administration should be carried out very slowly (no more than 1 ml per minute), so that at the first signs of anaphylactic / anaphylactoid reactions it would be possible to stop the administration, as well as to minimize the occurrence of individual hypotensive reactions. With intramuscular injection, a long needle should be used for intramuscular injection.