Former nurse and now writer Claudia Jackson on the potential hazards of widely prescribed painkiller Nolotil for northern Europeans
It was about a year ago when I awoke with a mysterious pain on my right side. As a former nurse, my initial reaction was to do as most healthcare professionals do – ignore it and hope it would go away – but 600mg of ibuprofen later and the pain wasn’t going anywhere. It was getting worse. And it wasn’t kidding.
A short taxi ride to my local urgencias, several tests and a diagnosis (kidney stones) later and I found myself in bed in a generic, backless hospital gown as a nurse attached a small bag of fluid to the cannula in my arm. I eyed the bag suspiciously. (Medical professionals are notoriously the worst patients).
“¿Qué es eso?” I said
“Nolotil,” came the nurse’s reply. Alarm bells began ringing in my brain. Nolotil. I’d read something about that somewhere. And it wasn’t good. “Pero, Nolotil es muy peligroso para mi,” I continued in my lacklustre Spanish.
She frowned, “Por qué?” After listening dubiously to my feeble attempt at explaining, the nurse disappeared, giving me time to search my phone for evidence of the dangers of Nolotil. When she returned with a doctor, I was ready. The doctor peered at the article on my phone with a confused frown, before shrugging her shoulders and swapping the Nolotil infusion for paracetamol.
What Is Nolotil?
Nolotil, brand name Metamizole, is a painkiller, anti-inflammatory, anti-convulsant, and anti-fever medication commonly used around the world particularly in Spain, Portugal, and Latin America.
Side Effects of Nolotil
Possible side effects of Nolotil include skin reactions and hypotension although these are uncommon, occurring in 0.1-1% of patients. An even rarer side effect is agranulocytosis, which drastically lowers the patient’s white blood cell count thus reducing the body’s ability to fight infection. Symptoms of agranulocytosis include weakness, fever, inflammatory mucosal changes (sore/ bleeding mouth and gums), mouth ulcers, and sore throat. If left untreated, agranulocytosis can lead to sepsis, a serious infection of the blood which can be fatal.
Is Nolotil dangerous for Northern Europeans?
While studies have shown an increased risk of developing agranulocytosis in the elderly and those with pre-existing health conditions, no concrete link has been established between the development of adverse effects and those of Northern European descent, and the evidence remains anecdotal. Some reports, however, including one by the Internal Medicine Unit of the Costa del Sol Hospital have concluded that cases of agranulocytosis secondary to Nolotil were higher in British patients than in Spanish ones.
In 2018, following a spate of deaths among Britons who had been prescribed Nolotil in Spain, the Spanish Agency of Medicines and Medical Devices (AEMPS) banned the sale of Nolotil without a prescription and recommended that it not be prescribed to people who are only in Spain for a limited time, as they could not be sufficiently monitored for side effects. Nolotil is currently banned in the UK, Ireland, Sweden, and the United States due to the risk of agranulocytosis.
Although there is currently no conclusive evidence that British and other Northern Europeans are more likely to develop serious side effects from taking Nolotil, it seems common sense to avoid the medication, especially when there are safer alternatives available. As in my own experience, many medical staff still seem to be unaware of the possible risks and Nolotil continues to be sold over the counter in some pharmacies. It is up to us then, as patients, to check what we are being prescribed and request an alternative, as well as to inform others, including healthcare professionals of the possible dangers of this controversial drug.