Is Metamizole compatible with breastfeeding? Do we have alternatives for Metamizole?

Metamizole

June 9, 2018 (Low Risk)

An analgesic and non-steroidal anti-inflammatory drug derived from pyrazolone. Oral, rectal, intramuscular or intravenous administration every 6 to 8 hours.
Authorized and widely used in childbirth and puerperium in almost all of Europe and America (Bordini 2016, Chaves 2009, Sabo 2001, DUP 1992). This has not been the case in the USA and UK since the 1970s due to the risk of exanthemas, anaphylaxis and agranulocytosis (<2 per million), which is actually lower than other medicines (Bordini 2016).

It is excreted in breastmilk in amounts that could be significant (Zylber 1986, Rizzoni 1984). It has been detected in plasma or urine of infants whose mothers were taking it (Rizzoni 1984).
No side effects have been reported in infants of mothers who take it except for a cyanotic crisis (Rizzoni 1984).
Increased risk of acute lymphocytic leukemia has been found in children whose mothers took metamizole during pregnancy and breastfeeding (Couto 2015).

American Academy of Pediatrics: medication which is usually compatible with breastfeeding (AAP 2001).

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable (Bar-Oz 2003), especially during the neonatal period and in case of prematurity.

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Dipyrone
  • Metamizole Sodium
  • Sulpyrine

Writings

  • Μεταμιζόλη (Greek)
  • ميتاميزول صوديوم (Arabic)
  • Метамизол Натрий (Cyrillic)
  • 安乃近 (Chinese)
  • ジピロン; スルピリン (Japanese)
  • C13 H16 N3 NaO4 S, H2 O (Molecular formula)
  • Sodium N-(2,3-dimethyl-5-oxo-1-phenyl-3-pyrazolin-4-yl)-N-methylaminomethanesulphonate monohydrate (Chemical name)
  • N02BB02 (ATC Code/s)

References

  1. Bordini CA, Roesler C, Carvalho Dde S, Macedo DD, Piovesan É, Melhado EM, Dach F, Kowacs F, Silva Júnior HM, Souza JA, Maciel JA Jr, Carvalho JJ, Speciali JG, Barea LM, Queiroz LP, Ciciarelli MC, Valença MM, Lima MM, Vincent MB. Recommendations for the treatment of migraine attacks - a Brazilian consensus. Arq Neuropsiquiatr. 2016Abstract Full text (link to original source) Full text (in our servers)
  2. Couto AC, Ferreira JD, Pombo-de-Oliveira MS, Koifman S. Pregnancy, maternal exposure to analgesic medicines, and leukemia in Brazilian children below 2 years of age. Eur J Cancer Prev. 2015Abstract
  3. Chaves RG, Lamounier JA, César CC. Self-medication in nursing mothers and its influence on the duration of breastfeeding. J Pediatr (Rio J). 2009Abstract
  4. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003Abstract
  5. Sabo A, Stanulović M, Jakovljević V, Grujić Z. Collaborative study on drug use in pregnancy: the results of the follow-up 10 years after (Novi Sad Centre). Pharmacoepidemiol Drug Saf. 2001Abstract
  6. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  7. Levy M, Zylber-Katz E, Rosenkranz B. Clinical pharmacokinetics of dipyrone and its metabolites. Clin Pharmacokinet. 1995Abstract
  8. Grupo de Trabajo DUP España. [The DUP Working Group Spain]. Estudio multicéntrico sobre el uso de medicamentos durante el embarazo en España (IV). Los fármacos utilizados durante la lactancia. [A multicenter study of drug use during pregnancy in Spain (IV). The drugs used during lactation]. Med Clin (Barc). 1992Abstract
  9. Zylber-Katz E, Linder N, Granit L, Levy M. Excretion of dipyrone metabolites in human breast milk. Eur J Clin Pharmacol. 1986Abstract
  10. Rizzoni G, Furlanut M. Cyanotic crises in a breast-fed infant from mother taking dipyrone. Hum Toxicol. 1984Abstract