[e-drug] Banning the unbannable (2)

["Leo Offerhaus" <offerhausl@euronet.nl>]

E-DRUG: Banning the unbannable (2)
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Dear colleague,

The problem with metamizole (noramidopyrine) is that (a) it is cheap; 
(b) that it is easy to manufacture, (c) that it does not cause 
gastrointestinal problems, (d) that it is an effective analgesic and 
(e) its side effects are difficult to detect in an environment with 
deficient medical care. It will be almost impossible to stop its 
distribution because it is still made in massive amounts in Eastern 
Europe and in India. In stead of focusing on the regulation aspect I 
would try to educate the medical community on recognizing and 
properly diagnosing side effects once they occur. That means taking a 
proper drug history on any patient with acute severe pharyngitis, 
and/or unexplained massive infections and refer them as soon as 
possible for a blood count - if facilities are available. The other 
problem is anaphylaxis, which can take any form from angioneurotic 
oedema to laryngeal oedema with its inherent danger of acute 
suffocation. Any such case should be properly screened, especially 
when treatment has started 7-10 days before or when the drug has been 
taken repeatedly. This is exactly where your Network with its 
excellent bulletin may have a leading role.

Furazolidine is quite another matter, because it is unsafe because it 
is ineffective and might be given instead of proper treatment with 
ORS or antibiotics on indication. It is quite difficult to convince 
prescribers because the trial data are very old and good literature 
data are no longer available. The approach would be to ask the 
importer or the manufacturer for their best clinical data supporting 
their claims and then expose this rubbish in the Bulletin. 

I would not worry too much about co-proxamol (paracetamol/dextroproxaphene) in your country because the main  danger is the combination with alcohol.

So every "old" drug should be approached individually with the main 
emphasis on the medical side of the adverse reaction - teach doctors 
how to recognize medical symptoms which might be linked to drug use, 
and how to take a proper drug history.

Good luck,

Leo Offerhaus
The Netherlands
offerhausl@euronet.nl