Metamizol sodium - instructions for use, dose, side effects, contraindications

Nonselective blockade of cyclooxygenase and a decrease in the synthesis of prostaglandins and their precursors from arachidonic acid. It prevents painful extra- and proprioceptive pulses along the Gaull and Burdach beams, raises the threshold of excitability of thalamic centers of pain sensitivity, increases heat transfer. Has analgesic, antipyretic and anti-inflammatory effects.

Pharmacokinetics:

Good and quickly absorbed in the gastrointestinal tract. In the intestinal wall it hydrolyzes to form an active metabolite (4-methyl-amino-antipyrine); unchanged metamizol sodium in the blood is absent (detected in plasma in a small amount only after intravenous administration). Penetrates into breast milk (in therapeutic doses). The association of the active metabolite with plasma proteins is 50-60%. Biotransformation in the liver. Displayed kidneys (in small amounts in the form of metabolites).

Indications:

· Arthralgia, rheumatism, chorea

· Headache, dental, menstrual pain

· Neuralgia, ischialgia, myalgia

· Renal, hepatic, intestinal colic.

· Pulmonary infarction, myocardial infarction, aortic dissection, thrombosis of major vessels.

· Inflammatory processes: pleurisy, pneumonia, lumbago, myocarditis.

· Injuries, burns, decompression sickness, shingles, swelling.

· Orchitis, pancreatitis, peritonitis, perforation of the esophagus, pneumothorax.

· Post-transfusion complications, priapism.

· Feverish syndrome with acute infectious, purulent and urological diseases, insect bites.

ICD-10

X.J00-J06 Acute respiratory infections of the upper respiratory tract

X.J10-J18.J11 Influenza, virus not identified

XVIII.R50-R69.R52.9 Pain, unspecified

XVIII.R50-R69.R52.0 Acute pain

XVIII.R50-R69.R52 Pain, not elsewhere classified

XVIII.R50-R69.R51 Headache

XVIII.R00-R09.R07.2 Pain in the region of the heart

XIII.M20-M25.M25.5 Pain in the joint

XVIII.R50-R69.R50 Fever of unknown origin

XIII.M30-M36.M35.3 Rheumatic polymyalgia

XIII.M50-M54.M54.3 Sciatica

XIII.M70-M79.M79.1 Myalgia

XIII.M70-M79.M79.2 Neuralgia and neuritis, unspecified

XIV.N20-N23.N23 Renal colic, unspecified

VI.G20-G26.G25.5 Other types of chorea

Contraindications:

Individual intolerance.

Inhibition of hematopoiesis (agranulocytosis, cytostatic or infectious neutropenia).

Hereditary hemolytic anemia associated with deficiency of glucose-6-phosphate dehydrogenase.

Anemia, leukopenia, hepatic and / or renal insufficiency.

Aspirin form of bronchial asthma.

Pregnancy (especially the first trimester and the last 6 weeks), breast-feeding.

Carefully:No data.

Pregnancy and lactation:The category of FDA recommendations is not defined. Do not use during pregnancy and during breastfeeding.

Dosing and Administration:

Intramuscularly or intravenously (with severe pain) - 1-2 ml 50% or 25% solution 2-3 times a day, the maximum daily dose of 2 g.

Inside, after meals, or rectally 250-500 mg 2-3 times a day, the maximum single dose - 1 g, daily - 3 g.

Side effects:

Urinary system: impaired renal function, oliguria, anuria, proteinuria, interstitial nephritis, urine staining in red.

Allergic reactions: urticaria (including conjunctiva and mucous membranes of the nasopharynx), angioedema, in rare cases - malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), bronchospastic syndrome, anaphylactic shock.

Blood: agranulocytosis (there is insufficient information to recommend the use of metamizole sodium for headache), leukopenia, thrombocytopenia.

Others: lowering blood pressure, nausea.

Local reactions: with intramuscular injection, the formation of infiltrates at the site of administration is possible.

When used intravenously - drowsiness, dry mouth.

Overdose:

When an overdose occurs, nausea, vomiting, gastralgia, oliguria, hypothermia, lowering of blood pressure, tachycardia, dyspnea, tinnitus, drowsiness, delirium, impaired consciousness, acute agranulocytosis, hemorrhagic syndrome, acute renal and / or hepatic insufficiency, convulsions, respiratory paralysis musculature.

For treatment appointed gastric lavage, saline laxatives, enterosorbents, forced diuresis, hemodialysis, with the development of convulsive syndrome - intravenous diazepam and high-speed barbiturates.

Interaction:

Allopurinol, non-narcotic analgesics, tricyclic antidepressants, hormonal contraceptives - increased toxicity.

Benzylpenicillin, colloidal blood substitutes and radiocontrast agents - not to be used during treatment with metamizole sodium.

Blockers H₂-receptors, codeine and propranolol (slows inactivation) - increased effectiveness.

Myelotoxic drugs - increased hematotoxicity of the drug.

Sugar-reducing drugs for oral administration, indirect anticoagulants, glucocorticoids, indomethacin - increase in their activity (metamizol sodium displaces them from the bond with the protein).

Sedative and anxiolytic drugs (tranquilizers) - an increase in the analgesic effect of metamizole sodium.

Thiamazole and cytotoxic drugs increase the risk of developing leukopenia.

Phenylbutazone, barbiturates and other hepatoinductors - with the simultaneous administration of reduced metamizole sodium.

Chlorpromazine or other derivatives of phenothiazine - the development of pronounced hyperthermia.

Ciclosporin - a decrease in its concentration in the blood.

Ethanol is the enhancement of the effect.

In one syringe with other drugs do not inject because of the high likelihood of developing pharmaceutical incompatibility.

Special instructions:

An increased risk of hypersensitivity reactions metamizol sodium is present in patients with bronchial asthma, especially with concomitant polyps in the nasal sinus; in patients with chronic urticaria; in patients with alcohol intolerance; in patients with intolerance to dyes (eg, tartrazine) or to preservatives (eg benzoate).

With prolonged use, it is necessary to monitor the picture of peripheral blood. It is inadmissible to use the drug to relieve acute pain in the abdomen (until finding out the cause).

Instructions

Metamizol sodium (Metamizolum natrium)