Novalgin for severe life threatening fever and cancer pain

Metamizole Sodium

Composition :

Novalgin tablets :
Active ingredient: Each tablet contains 500 mg metarnizole
Excipients: Maize starch, lactose monohydrate, sodium bicarbonate, talc and magnesium stearate.
Oblong Novalgin film coated tablets :
Active ingredient: Each film coated tablet contains 500 mg
metamizole sodium.
Excipients: Macrogol 4000, macrogol 8000, magnesium
stearate, saccharin, titanium dioxide, talc, hydroxypropylmethyl cellulose.
Novalgin suppositories for children :
Active ingredient: Each suppository contains 300 mg metamizole sodium.
Excipients: Soja lecithin and hard fat.
Pharmaceutical form
Tablets, Film coated tablets and Suppositories.

Pharmacological actions :

Metamizole is a non-narcotic pyrazolone derivative with analgesic, antipyretic and spasmolytic effects. The mechanism of actionis not completely investigated, someaata indicate that metamizole and its main metabolite (4-N-methylaminoantipyrine) might have a combined central and peripheral mode of action.

Pharmacokinetics :

After oral administration, metamizole is completely hydrolyzed to the pharmacologically active 4-N-methylaminoantipyrine (MM). The absolute bioavailability of MM is approx. 90% and is somewhat higher after oral compared to intravenous administration; the pharmacokinetics of MM does not change to any appreciable extent when rnetarnizole is taken together with food.

Indications :

– Severe life threatening fever.
– Cancer pain.
– Not used as a routine analgesic

Dosage and administration :

Generally, the dosage is based on the desired effect and patient’s
condition. The effect of Novalgin sets within 30 to 60 minutes and
lasts for approximately four hours. Unless otherwise directed, the
following dosage guidelines should be applied:
With oral and rectal applications, the SIngle dose for all age groups is
8 mg to 16 mg rnetarnizole per kilogram body weight. For children
with high temperature, a dose of 10 mg metamizoTe per kilogram
body weight is usually sufficient.Multiple aosing: Cf the effect of a single dose is inadequate or has subsided, the dose can usually be administered up to 4 times a day.
The lowest pain-and fever- controlling dose should be selected.
Generally speaking, in adult, 5 g metamizole per day or 70 mg
metamizole per kilogram body weight in 24 hours should not be
exceeded unless special dinical circumstances make this necessary.
Dosing in patients with renal or hepatic impairment As the elimination rate is reduced in impaired kidney or liver functions,
high doses and long term use should be avoided. For only short-term use, it is not necessary to reduce the dose. No data is available on the dosage for long-term use. Consideration must be given to the possibility of such Impairment in elderly patients and patients whose general state of health is poor.Duration of use: The duration of use depends on the nature and severity of the disorder. In reCatively long-term treatment with Novalgin, regular monitoring of the blood pjdure induding differential blood count is required.
Method of administration: For oral forms, it is best to swallow the.,
tablet whole with sufficient amount of liquid (about 1/2 to 1 glass).

Contraindications :

Novalgin must not be used in patients with:

– Allergv to metamizole or to other pyrazolones (e.g. phenazone,
propyphenazone) or to pyrazolidines (e.g. phenylbutazone,
oxyphenbutazone) including, for example, previously experienced agranulocytosis to one of these substances.
– trnpaired bone marrow function (e.g. following cytostatic
treatment) or diseases of the haematopoietic system.

– Patients known to develop bronchospasm or other anaphylactoid
reactions (e.g. urticaria, rhinitis, angioedema) to analgesics such as: salicylates, paracetamol, didofenac, ibuprofen, indomethacin, naproxen.
– Allergv to any of the excipients of Novalgin.
– Acute intermittent hepatic porphyria (risk of induction of porphyria attacks).
– Congenital glucose 6 phosphate dehydrogenase deficiency (risk of haemolysis).
– lnfants under 3 months of age or 5 kg body weight.
– ln infants between 3 and 11 months of age, Novalgin must not be injected by the intravenous route.
– Novalgin must not be given parenterally in patients with hypotension or unstable hemodynamic.

Side Effects :

Anaphylactidanaphyladoid reactions:

In rare instances, metamizole may cause anaphylactic / anaphylactoid reactions, which in very cases may be severe and life-threatening. They may occur even after NovaCgin has
previously been used on many occasions without complications.
Applies only to tablets: Such drug reactions may develop Immediately after administration of metamizole or hours later;
however, the usual pattern is for them to occur within the first hour alter administration.
Applies to all formulations: Typically, milder anaphylactic / anaphylactoid reactions mani est themseCves in cutaneous and
mucosal symptoms (such as itching, burning, reddening,  urticaria, swelhngs), dvspnea and less frequently gastrointestinal complaints. Milder reactions may progress to severe forms with generalized urticaria, severe angio-oederna (even involving the larynx), severe bronchospasm, cardiac arrhythmias, drop in (sometimes preceded by a rise in blood pressure ) and circulatory shock in analgesic intolerant patients asthma syndrome, these reactions typically appear in the form of asthma attacks.
Other cutaneous and mucosal reactions: Aside from thecutaneous and mucosal manifestations of anaphylactic! anaphylactoid reactions mentioned above, fixed drug eruptions may occur occasionally, rash may occur rarely, as may Stevens-Johnson syndrome or Lyell’s syndrome in isolated cases.
Haematological reactions:
Rarely, leucopenia and, in very rare cases, agranulocytosis or
thrombocytopenia may develop. These reactions are regarded to
be immunological in nature. They may occur even after Novalgin
has previously been used on many occasions without complications.
Agranulocytosis may be life-threatening, and could be fatal. Typical signs of agranulocytosis include inftammatory mucosal lesions (e.g. oropharyngeal, anorectal, genital), sore throat, and fever (even unexpectedly persistent or recurring fever). However, in patients receiving antibiotic therapy typical signs of agranulocytosis may be minimal. Erythrocyte sedimentation rate is greatly increased,
whereas enlargement of lymph nodes is typically slight or absent.
Typical signs of thrombocytopenia include an increased tendency
to bleeding and petechiae on the skin and mucous membranes.
Isolated hypotensive reactions:
Applies only to tablets: Occasionally, isolated transitory hypotensive reactions (possibly pharmacologically mediated and not
accompanied by other signs of an anaphylactic! anaphylactoid
reaction) may occur after administration; in rare cases, this reaction takes the form of a critical drop in blood pressure.
Other reactions: In very rare instances, especially in patients with a history of renal disease, acute worsening of renal function (acute renal failure), in some cases with oliguria, anuria or proteinuria may occur. Acute interstitial nephritis may occur in isolated cases. Pain and local reactions may occur at the injection site. These may sometimes include phlebitis. A red coloration has been sometimes observed in the urine, which may be due to a metabolite present at a low concentratio.n:..rubazonic.acid.

Drug Interactions :

When cyclosporine is given concomitantly, a fall in the cyclosporine serum level may occur therefore, the cyclosporine level must be monitored.

Pregnancy :

Metamizole crosses the placenta. There is no evidence that the
drug is harmful to the fetus: metamizole did not show teratogenic
eftects in rats and rabbits, and fetotoxicity was observed only at
high dose levels those were maternally toxic. There is, however,
insufficient clinical data on the use of Novalgin during pregnancy.
Therefore, it is recommended that Novalgin IS not used during the
first three months of pregnancy, and that it is used in the following three months only after careful weighing of potential benefit and risk by a physician. Novalgin must, however, not be used during the last three months of pregnancy. This is because, although metamizole is only a week inhibitor of prostaglandin synthesis, the possibility of premature ductus arteriosus closure and perinatal complications due to impairment of both maternal and neonatal platelet aggregability cannot be ruled out.

Lactation :

Metamizole metabolites are excreted into the breast milk. Breast feeding mustbe avoided during and for 48 hours after adminisuation of Novalgin.

Precautions and warnings :

Anaphylactic/anaphylactoid reactions: The following patients are
at special risk for possibly severe anaphylactoid reactions to
metamizole (see contraindications).
-Patients with bronchial asthma, particularly those with concomitant rhinosinusitis polyposa.
-Patients with chronic urticaria.
-Patients with alcohol intolerance, i.e. patients reacting to even
minor quantities of certain alcoholic beverages with symftoms such as sneezing, lacrimation and pronounced redness 0 the face. Alcohol intolerance may be indicative of a previously undiagnosed analgesic asthma syndrome.
-Patients with intolerance to dyes (e.g. tartrazine) or to preservatives (e.g. benzoates).
-Before Novalgin is administered, the patient must be questioned
specifically, in patients found to be at special risk for anaphylactoid
reactions, Novalgin must only be used after carefully weighing the
possible risks against the expected benefit. If Novalgin is to be
administered in such circumstances, close medical supervision is
required and the facilities for immediate emergency treatment
must be available.
Isolated hypotensive reactions: Administration of metamizole may cause isolated hypotensive reactions (see side effects). These
reactions are possibly dose-dependent and are more likely to occur following parenteral administration. In order to avoid severe
hypotensive reactions of this kind:
-The intravenous injectron should be given slowly.
-Reverse hemodynamic in patients with pre-existing hypotension,
with volume depletion or dehydration, or with circulatory instability or with incipient circulatory failure.
-Care should be taken in patients with high fever.
In such patients, the indication for metamizole must be established
with particular care and, if Novalgin is to be administered in such
circumstances, close medical supervision is required. Prevention
measures (hemodynamic stabilization) may be necessary to reduce the risk of a hypotensive reaction. Concerning patients with hypotension or unstable circulation see contra indications. Metamizole must only be used under close hemodynamic monitoring in patients in whom lowering of blood pressure must be avoided, such as in patients with severe coronary heart disease or stenosis of blood vessels supplying the brain. In patients with renal or hepatic impairment, It is recommended that high. metamizole doses be avoided, smce Its rate of elimination is reduced in these patients.
Agranulocytosis induced by metamizole is an accident 0f immuno-allergic origin lasting for at least one week. These reactions are very rare, may be severe and life threatening, and could be fatal. They are not dose dependent and may occur at any time during treatment. All patients should be advised to stop medication and consulttheir physician immediately if anyof the following signs or symptoms possibly related to neutropenia occur: fever, chills, sore throat, ulcerations in oral cavity. In the event of neutropenia «1,500 neutrophils/mm3) treatment should be immediately discontinued and complete blood count should be urgently controlled and monitored until they retum to normal values.
It mav lead to reduction of number of white blood cells
Anaphylactic shock:These reactions occur principally In sensrtive
patients. Therefore, rnetamizole should be prescribed With caution
In asthmatic or atopic patients (see Contraindications).

Storage :

store below 30° C

Expiry date :

Do not use later than the date of expiry on the pack.

Presentation :

Novalgin tablets: Box of 10 blisters of 10 tablets.
Oblong Novalgin: Box of 10 film coated tablets.
Economy pack of 300 film coated tablets.
Novalgin suppositories: Box of 5 suppositories

Produced by :

sanofi-aventis egypt s.a.e.
Under license of sanofi-aventis / Germany

نوفالجين لعلاج درجة الحرارة المرتفعة و الالام السرطانية