Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice

Gaertner, Jan; Stamer, Ulrike; Remi, Constanze; Voltz, Raymond; Bausewein, Claudia; Sabatowski, Rainer; Wirz, Stefan; Müller-Mundt, Gabriele; Simon, Steffen T; Pralong, Anne; Nauck, Friedemann; Follmann, Markus; Radbruch, Lukas; Meißner, Winfried (2017). Metamizole/dipyrone for the relief of cancer pain: A systematic review and evidence-based recommendations for clinical practice. Palliative medicine, 31(1), pp. 26-34. Sage 10.1177/0269216316655746

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BACKGROUND Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. AIM Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. DESIGN First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. DATA SOURCES The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. RESULTS Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. CONCLUSION Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Stamer, Ulrike


600 Technology > 610 Medicine & health








Jeannie Wurz

Date Deposited:

05 Sep 2016 11:06

Last Modified:

16 May 2018 16:44

Publisher DOI:


PubMed ID:


Additional Information:

Gaertner and Stamer contributed equally as first author

Uncontrolled Keywords:

Dipyrone; neoplasms; non-steroidal anti-inflammatory agents; pain management; palliative care; review




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