Metamizol-sf

Leaflet attached to the packaging: information for the user

Metamizol-SF, 500 mg/ml, solution for injection

Metamizolum natricum monohydricum

Metamizol-SF may cause a severely decreased number of white blood cells (agranulocytosis), which can lead to severe and life-threatening infections (see section 4).

You should stop taking the medicine and contact your doctor immediately if you experience any of the following symptoms: fever, chills, sore throat, painful mouth ulcers, or ulcers in the genital or anal area.

If the patient has ever had agranulocytosis while taking metamizole or similar medicines, they should never take this medicine again in the future (see section 2).

You should carefully read the contents of the leaflet before using the medicine, as it contains important information for the patient.

• You should keep this leaflet so that you can read it again if you need to.
• If you have any doubts, you should consult your doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
• If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is Metamizol-SF and what is it used for
• 2. Important information before taking Metamizol-SF
• 3. How to take Metamizol-SF
• 4. Possible side effects
• 5. How to store Metamizol-SF
• 6. Contents of the packaging and other information

1. What is Metamizol-SF and what is it used for

Metamizol-SF contains the active substance metamizole sodium monohydrate and is a pain-relieving and antipyretic medicine belonging to the group of medicines called pyrazolones.
Metamizol-SF is used to treat:

• severe pain after injuries or operations,
• colic (spasmodic abdominal pain),
• pain in cancer patients,
• other severe and prolonged pain, when other treatment methods are not indicated,
• high fever that does not respond to other treatment methods.

The solution for injection is used only when treatment with other pharmaceutical forms (tablets, oral solution, suppositories) is not possible.

2. Important information before taking Metamizol-SF

When not to take Metamizol-SF:

• if the patient has had a significant decrease in the number of white blood cells called granulocytes, caused by metamizole or other similar medicines called pyrazolones or pyrazolidines;
• if the patient has disorders of bone marrow function or a disease that affects the production or function of blood cells;
• if the patient is allergic to metamizole or other pyrazolones (e.g. propyphenazone, phenazone) or pyrazolidines (e.g. phenylbutazone, oxyphenbutazone); This also applies to patients who have had severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS)) after taking these substances (see "Warnings and precautions");
• if the patient is allergic to any of the excipients listed in section 6;
• if the patient has intolerance to painkillers (analgetic asthma syndrome or intolerance to painkillers, manifested by urticaria, angioedema); This applies to patients who react with sudden bronchospasm or other hypersensitivity reaction, such as urticaria with itching and blisters, rhinitis, angioedema;
• if the patient has a hereditary disease (congenital defect) with a risk of red blood cell breakdown (congenital glucose-6-phosphate dehydrogenase deficiency);
• if the patient has a hereditary disease characterized by disorders of hemoglobin synthesis (acute intermittent porphyria);
• if the patient has low blood pressure or circulatory disorders;
• if the patient is in the last three months of pregnancy (third trimester of pregnancy).

Warnings and precautions

Before starting treatment with Metamizol-SF, you should discuss it with your doctor.
Agranulocytosis (a severely decreased number of white blood cells)
Metamizol-SF may cause agranulocytosis, a severely decreased number of a certain type of white blood cell called granulocytes, which play an important role in fighting infections (see section 4).
You should stop taking metamizole and contact your doctor immediately if you experience any of the following symptoms, as they may indicate possible agranulocytosis: chills, fever, sore throat, and painful mouth ulcers, especially in the mouth, nose, and throat or in the genital or anal area. Your doctor will order a laboratory test to check your blood cell count.
If you are taking metamizole for fever, some symptoms of developing agranulocytosis may remain unnoticed. Similarly, symptoms may also be masked if you are taking antibiotics.
Agranulocytosis can develop at any time during treatment with Metamizol-SF, even after a short period of treatment.
Agranulocytosis can occur even if metamizole was previously administered without complications.
Metamizol-SF contains metamizole, which is associated with a rare but life-threatening risk of:

• sudden circulatory shock (circulatory collapse);
• agranulocytosis (a severe disorder caused by a significant decrease in the number of granulocytes, a type of white blood cell).

If the patient has experienced symptoms of a decrease in the number of all blood cells (pancytopenia), such as general malaise, infection, persistent fever, bruising, bleeding, pallor, or a decrease in platelet count (thrombocytopenia), such as increased bleeding tendency, small bleeding in the skin and mucous membranes, you should stop taking Metamizol-SF immediately and consult your doctor as soon as possible (see section 4 "Possible side effects").
If the patient has an allergic reaction to Metamizol-SF, they are also particularly at risk of a similar reaction to other painkillers.
If the patient has had an allergic reaction or other immune system reaction (e.g. agranulocytosis) to Metamizol-SF, they are also particularly at risk of a similar reaction to other pyrazolones and pyrazolidines (similar chemical substances), such as phenazone, propyphenazone, phenylbutazone, oxyphenbutazone.
If the patient has had an allergic reaction or other immune system reaction to other pyrazolones and pyrazolidines or other painkillers, there is a high risk of a similar reaction to Metamizol-SF (see section 2 "When not to take Metamizol-SF").
When choosing the method of administration, it should be taken into account that parenteral administration (intramuscular or intravenous) is associated with a higher risk of hypersensitivity reactions.
Severe hypersensitivity reactions
The risk of severe hypersensitivity reactions is higher during treatment with Metamizol-SF than during treatment with medicines containing metamizole in oral or suppository form.
If the patient has one of the following conditions, the risk of severe hypersensitivity reactions to Metamizol-SF is significantly increased:

• intolerance to painkillers and anti-rheumatic drugs, manifested by urticaria with itching and blisters or angioedema; In such cases, Metamizol-SF should not be used. More information can be found in section 2 "When not to take Metamizol-SF".
• breathlessness, e.g. associated with asthma, especially when accompanied by nasal polyps or sinusitis;
• chronic urticaria;
• hypersensitivity to certain dyes (e.g. tartrazine) or preservatives (e.g. benzoates);
• alcohol intolerance; If the patient reacts to even small amounts of alcohol with sneezing, tearing, and severe flushing of the face, it may indicate previously unrecognized intolerance to painkillers (see section 2 "When not to take Metamizol-SF").

Patient with an increased risk of hypersensitivity reactions can be given Metamizol-SF only after careful assessment of the benefit-risk ratio (see section 2 "When not to take Metamizol-SF"). In such cases, the patient must be under close medical supervision, with the possibility of providing assistance (rescue equipment) in case of an emergency.
Particularly in patients with allergies, anaphylactic shock may occur (see section 4 "Possible side effects"). Therefore, during treatment with this medicine, special caution is recommended in patients with asthma or a predisposition to hypersensitivity reactions.
Severe skin reactions
Severe skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported in association with metamizole treatment. If the patient experiences any of these symptoms of severe skin reactions listed in section 4, they should stop taking metamizole and seek medical attention immediately.
If the patient has ever had severe skin reactions, they should never be treated with Metamizol-SF again (see section 4 "Possible side effects").
Liver disorders
Metamizole has been associated with cases of liver inflammation, with symptoms appearing within a few days to a few months after starting treatment.
You should stop taking Metamizol-SF and contact your doctor if you experience any liver disorders, such as malaise (nausea or vomiting), fever, fatigue, loss of appetite, dark urine, pale stools, yellowing of the skin or whites of the eyes, itching, rash, or pain in the upper abdomen. Your doctor will check your liver function.
The patient should not take Metamizol-SF if they have previously taken any medicinal products containing metamizole and had liver disorders.
Decrease in blood pressure
Metamizol-SF may cause a decrease in blood pressure (see section 4 "Possible side effects"). This reaction occurs more frequently after intravenous injection than after oral administration.
The risk of such a reaction is higher:

• if the intravenous administration is too rapid;
• if the patient has low blood pressure, is severely dehydrated, has circulatory disorders, or is in the initial stage of circulatory failure (e.g. patients with myocardial infarction or severe injury);
• if the patient has a high fever.

In order to minimize the risk of a decrease in blood pressure, the use of Metamizol-SF must be carefully considered (see section 2 "When not to take Metamizol-SF") and closely monitored. Appropriate preventive measures (e.g. correction of circulatory disorders) may also be necessary.
Metamizol-SF can only be used if the patient's circulatory parameters are closely monitored, if the patient should avoid decreases in blood pressure, e.g.:

• if the patient has severe coronary artery disease;
• if the patient has significant narrowing of the cerebral vessels (limited blood flow in the cerebral vessels).

In order to minimize the risk of a severe decrease in blood pressure and to ensure that the administration of the medicine can be terminated at the first signs of a hypersensitivity reaction, the intravenous injection of Metamizol-SF should be very slow, i.e. no faster than 1 ml (500 mg metamizole) per minute.
Patient with impaired liver or kidney function
If the patient has impaired liver or kidney function, Metamizol-SF can only be administered after careful assessment of the benefit-risk ratio and with appropriate preventive measures (see section 3 "Patients with impaired renal or hepatic function").
Metamizol-SF should not be used with other medicines if the possibility of incompatibility has not been previously established.

Metamizol-SF and other medicines

You should tell your doctor or pharmacist about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take.
In particular, you should inform your doctor about the following medicines that may interact with Metamizol-SF and medicines that may be affected by Metamizol-SF:

• cyclosporin, a medicine used to suppress the immune system (immunosuppressant); In case of concomitant use, the doctor will monitor the cyclosporin blood level;
• methotrexate, a medicine used to treat cancer or rheumatic diseases; Concomitant use may increase the toxic effect of methotrexate on the hematopoietic system, especially in elderly patients. Therefore, it is recommended to avoid combining these medicines;
• acetylsalicylic acid, taken in small doses to protect the heart; Metamizole may reduce the effect of acetylsalicylic acid on platelet aggregation (clumping of blood cells and formation of a clot), if these medicines are used concomitantly. Therefore, caution should be exercised when using metamizole in patients taking acetylsalicylic acid;
• bupropion, a medicine used to treat depression or as an aid to smoking cessation; Concomitant use may decrease the bupropion blood level;
• efavirenz, a medicine used to treat HIV infection (AIDS);
• methadone, a medicine used to treat opioid dependence;
• valproate, a medicine used to treat epilepsy or bipolar disorder;
• tacrolimus, a medicine used to prevent organ rejection in patients after transplantation;
• sertraline, a medicine used to treat depression;
• chlorpromazine, a medicine used to treat psychiatric disorders; Concomitant use may lead to a severe drop in body temperature.

Active substances from the pyrazolone group (to which metamizole belongs) may interact with certain medicines:

• medicines that prevent blood clotting (oral anticoagulants),
• captopril, a medicine used to treat high blood pressure and certain heart diseases,
• lithium, a medicine used to treat psychiatric disorders,
• diuretics, used to increase the amount of urine excreted (e.g. triamterene),
• medicines used to treat high blood pressure (hypotensive agents).

The extent to which metamizole leads to such interactions is not known.
Effect on laboratory test results
Before performing any laboratory tests, you should inform your doctor that you are taking Metamizol-SF, as metamizole may affect the results of certain tests, e.g. determination of creatinine, triglycerides, HDL cholesterol, or uric acid levels in the blood.

Metamizol-SF with alcohol

You should not consume alcohol while taking Metamizol-SF.

Pregnancy, breastfeeding, and fertility

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, you should consult your doctor or pharmacist before taking this medicine.
Pregnancy
Available data on the use of metamizole during the first 3 months of pregnancy are limited, but do not indicate a harmful effect on the fetus. In selected cases, if there are no other treatment options, after consulting a doctor or pharmacist, a woman may take a single dose of metamizole during the first and second trimester, provided that the benefits and risks associated with taking the medicine are carefully weighed. Administration of metamizole during the first and second trimester is not recommended.
You should not take Metamizol-SF during the last three months of pregnancy due to the increased risk of complications in the mother and child (bleeding, premature closure of the fetal ductus arteriosus, which normally closes after birth).
Breastfeeding
Metamizole metabolites pass into breast milk in significant amounts, and the risk to the breastfed infant cannot be excluded. Therefore, repeated use of metamizole during breastfeeding should be avoided. In the case of a single administration of metamizole, mothers should be advised to discard breast milk for 48 hours after administration.

Driving and using machines

Within the recommended dose range, no impairment of concentration and reaction time has been observed. However, as a precaution, you should take into account the possibility of impaired concentration and reaction time, especially when taking higher doses, and avoid operating machinery, driving, or performing activities that involve risk. This is especially true when combining with alcohol.

Metamizol-SF contains sodium

The medicine contains 32.7 mg of sodium (a major component of table salt) per ml. This corresponds to 1.64% of the maximum recommended daily intake of sodium in the diet for adults.

3. How to take Metamizol-SF

The dose depends on the severity of the pain or fever and the individual's response to Metamizol-SF. Metamizol-SF will be administered by intravenous or intramuscular injection.
If a single dose is not sufficiently effective or if the analgesic effect weakens over time, your doctor may administer another dose, without exceeding the maximum daily dose specified below.
You should always use the smallest effective dose that allows you to control the pain and fever.
A noticeable effect of the medicine can be expected within 30 minutes of administration. Depending on the maximum daily dose, a single dose can be administered up to 4 times a day, at intervals of 6-8 hours.
Adults and adolescents aged 15 and over
Adults and adolescents aged 15 and over (with a body weight over 53 kg) can be given 1-2 ml intravenously or intramuscularly as a single dose; if necessary, the single dose can be increased to a maximum of 5 ml (corresponding to 2500 mg Metamizol-SF). The maximum daily dose is 8 ml; if necessary, the daily dose can be increased to a maximum of 10 ml (corresponding to 5000 mg Metamizol-SF).
Infants and children
You should follow the dosage schedule below for single intravenous or intramuscular doses:
Age range in children (body weight)
Single dose
Maximum daily dose
Infants aged 3-11 months (5-8 kg)
0.1 – 0.2 ml
0.4 – 0.8 ml
1-3 years (9-15 kg)
0.2 – 0.5 ml
0.8 – 2.0 ml
4-6 years (16-23 kg)
0.3 – 0.8 ml
1.2 – 3.2 ml
7-9 years (24-30 kg)
0.4 – 1.0 ml
1.6 – 4.0 ml
10-12 years (31-45 kg)
0.5 – 1.4 ml
2.0 – 5.6 ml
13-14 years (46-53 kg)
0.8 – 1.8 ml
3.2 – 7.2 ml
Special patient groups
Elderly patients and patients in poor general health or with renal impairment
In elderly patients, weakened patients, and patients with impaired renal function, the dose should be reduced due to the possibility of prolonged elimination of metamizole metabolites.
Patient with impaired renal or hepatic function
Due to the decreased elimination rate in patients with impaired renal or hepatic function, high doses should be avoided. In the case of short-term use, dose reduction is not required. There is a lack of data on long-term use.
Duration of treatment
The duration of treatment depends on the type and severity of the disease and will be determined by your doctor.
You should not take painkillers for more than 3 to 5 days, unless you have consulted your doctor or dentist.

Overdose of Metamizol-SF

Symptoms of overdose are:

• nausea, vomiting, abdominal pain;
• impairment of renal function up to acute renal failure;
• dizziness, drowsiness, loss of consciousness;
• seizures;
• decrease in blood pressure, potentially leading to circulatory shock;
• rapid heartbeat.

If you have taken more than the recommended dose, you should contact your doctor immediately to receive appropriate countermeasures.
Note: In the case of high doses, the excretion of a harmless metamizole metabolite may cause red discoloration of the urine.
If you have any further doubts about the use of this medicine, you should consult your doctor.

4. Possible side effects

Like all medicines, Metamizol-SF can cause side effects, although not everybody gets them.

Side effects that can be serious and require immediate discontinuation of Metamizol-SF and urgent medical attention.

If you experience any of the following side effects, you should contact your doctor immediately. Some side effects (e.g. severe hypersensitivity reactions, severe skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, agranulocytosis, pancytopenia) can be life-threatening. In no case should you take Metamizol-SF without medical supervision.
Stopping the treatment may be crucial.
If you experience symptoms of agranulocytosis, pancytopenia, or thrombocytopenia (see below and section 2 "Warnings and precautions"), you should stop taking Metamizol-SF immediately, and your doctor should order a blood test, including a blood smear. Treatment should be discontinued even before the laboratory test results are available.
You should stop taking Metamizol-SF and seek medical attention immediately if you experience any of the following symptoms:
Malaise (nausea or vomiting), fever, fatigue, loss of appetite, dark urine, pale stools, yellowing of the skin or whites of the eyes, itching, rash, or pain in the upper abdomen. These may be symptoms of liver damage. See also section 2 "Warnings and precautions".

Other side effects

Uncommon (may affect up to 1 in 100 people)

• purple to dark red rash, sometimes blistering (drug rash);
• decrease in blood pressure, which is likely to be caused by the direct effect of the medicine and is not accompanied by other symptoms of a hypersensitivity reaction. This reaction occurs only in rare cases and may lead to a significant decrease in blood pressure. Rapid intravenous injection increases the risk of a decrease in blood pressure. The risk of a decrease in blood pressure may be higher in patients with high fever. Typical symptoms of excessive hypotension include rapid heartbeat, pallor, tremors, dizziness, nausea, and loss of consciousness.

Rare (may affect up to 1 in 1,000 people)

• hypersensitivity reactions (anaphylactic or anaphylactoid reactions); Mild reactions include:
• burning sensation in the eyes,
• cough, runny nose, sneezing,
• feeling of compression in the chest,
• redness of the skin, especially on the face and head,
• urticaria and angioedema of the face,
• less frequently - nausea and abdominal cramps. Symptoms that require special attention are burning, itching, and a feeling of heat on the tongue and under it, as well as on the palms and soles. These mild reactions can progress to more severe forms, such as:
• severe urticaria,
• severe angioedema (swelling, including of the larynx),
• severe bronchospasm,
• rapid heartbeat, sometimes slow heartbeat, arrhythmia,
• decrease in blood pressure, sometimes preceded by an increase in blood pressure,
• loss of consciousness, circulatory shock. These reactions can occur especially after intravenous administration, can be severe or life-threatening, and in some cases may even be fatal. They can occur even if the medicine was previously taken without complications. In patients with analgetic asthma syndrome, hypersensitivity reactions are manifested by typical asthma attacks (see section 2 "When not to take Metamizol-SF").
• decrease in the number of white blood cells in the blood (leukopenia);
• skin rash (e.g. maculopapular).

Very rare (may affect up to 1 in 10,000 people)

• agranulocytosis (a significant decrease in the number of granulocytes, a type of white blood cell), including cases with a fatal outcome, decrease in platelet count (thrombocytopenia) (see section 2 "Warnings and precautions"). These reactions are likely to have an immunological basis. The above reactions can occur even if metamizole was previously administered without complications or even shortly after discontinuation of metamizole. Typical symptoms of agranulocytosis include fever, chills, sore throat, difficulty swallowing, inflammation in the mouth, nose, throat, genital or anal area. In patients taking antibiotics (medicines used to treat bacterial infections), these symptoms may be masked. Red blood cell count is significantly accelerated, while lymph nodes may remain unchanged or be only slightly enlarged.
  Typical symptoms of thrombocytopenia include increased bleeding and small bleeding in the skin and mucous membranes.

• asthma attacks;
• large areas of skin with blisters and peeling (Stevens-Johnson syndrome or toxic epidermal necrolysis);
• sudden worsening of kidney function, which in some cases may lead to oliguria or anuria, proteinuria, acute interstitial nephritis, or acute renal failure.

Frequency not known (frequency cannot be estimated from the available data)

• sudden circulatory shock due to a severe allergic reaction (anaphylactic shock);
• myocardial infarction due to an allergic reaction (Kounis syndrome);
• anemia occurring simultaneously with bone marrow disorders (aplastic anemia), decrease in the number of white and red blood cells and platelets (pancytopenia), including fatal cases; Symptoms of aplastic anemia and pancytopenia include general malaise, infection, persistent fever, bruising, bleeding, pallor.
• gastrointestinal bleeding;
• liver inflammation, yellowing of the skin or whites of the eyes, increased liver enzyme activity in the blood;
• severe skin reactions.

You should stop taking Metamizol-SF and seek medical attention immediately if you experience any of the following severe side effects:

• red, flat patches on the torso, target-like or round, often with blisters in the center, peeling of the skin, ulcers in the mouth, throat, nose, genitals, and eyes. The occurrence of such severe skin rashes may be preceded by fever and flu-like symptoms (Stevens-Johnson syndrome, toxic epidermal necrolysis);
• widespread rash, high fever, and swollen lymph nodes (DRESS syndrome or hypersensitivity syndrome).

Red discoloration of the urine may occur due to the excretion of a harmless metamizole metabolite.
Local reactions
At the injection site, pain and local reactions may occur, very rarely leading to phlebitis.

Reporting side effects

If you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety Monitoring of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Metamizol-SF

The medicine should be stored out of sight and reach of children.
There are no special storage instructions for the medicine. Do not store in the refrigerator or freeze.
Store the ampoule in the outer packaging to protect it from light.
The medicine should be used immediately after opening or dilution.
Do not use this medicine after the expiry date stated on the packaging after "EXP".
The expiry date refers to the last day of the month stated.
Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the packaging and other information

What Metamizol-SF contains

• The active substance of the medicine is metamizole sodium monohydrate. 1 ampoule (2 ml) of Metamizol-SF contains 1000 mg of metamizole sodium monohydrate. 1 ampoule (5 ml) of Metamizol-SF contains 2500 mg of metamizole sodium monohydrate.

1 ml of Metamizol-SF contains 500 mg of metamizole sodium monohydrate.

• Other ingredients: water for injections.

What Metamizol-SF looks like and contents of the packaging

Clear, colorless to yellowish solution for injection.
Metamizol-SF is available in ampoules made of orange glass type I with a break point (OPC), containing 2 or 5 ml of solution, in a cardboard box.
Pack sizes:
5 ampoules of 2 ml,
10 ampoules of 2 ml,
5 ampoules of 5 ml,
10 ampoules of 5 ml.
Not all pack sizes may be marketed.

Marketing authorization holder

SUN-FARM Sp. z o.o.
ul. Dolna 21
05-092 Łomianki
phone: +48 22 350 66 69

Manufacturer

mibe GmbH Arzneimittel
Münchener Straße 15
06796 Brehna
Germany

Date of last revision of the leaflet:

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Information intended for healthcare professionals only:

Dosage and administration

The dose of the medicine depends on the severity of the pain or fever and the individual's sensitivity to Metamizol-SF.
The choice of the smallest effective dose that allows control of pain and fever is crucial.
In children and adolescents under 14 years of age, metamizole can be administered in a single dose of 8 to 16 mg per kilogram of body weight. In the case of fever in children, a dose of 10 mg per kilogram of body weight is usually sufficient. Adults and adolescents over 15 years of age (body weight >53 kg) can be given a maximum of 1000 mg of metamizole as a single dose.
Depending on the maximum daily dose, a single dose can be administered up to 4 times a day, at intervals of 6-8 hours.
If necessary, the single dose can be increased to 5 ml (corresponding to 2500 mg of metamizole), and the daily dose can be increased to 10 ml (corresponding to 5000 mg of metamizole).
Since the decrease in blood pressure in response to the injection of the medicine may depend on the dose, the administration of a dose of Metamizol-SF greater than 2 ml (1000 mg of metamizole) must be strictly justified.
Method of administration and precautions
Metamizol-SF is administered intravenously or intramuscularly. Intramuscular injection should always be performed using a solution at body temperature.
Metamizol-SF can be diluted or mixed with a 0.9% sodium chloride solution. However, such a mixture has only limited stability, so it should be administered immediately.
Due to the possibility of incompatibility, it is not recommended to administer Metamizol-SF in the form of injections or infusions together with other medicines.
Parenteral administration of Metamizol-SF must be performed with the patient in a supine position and under close medical supervision.
In the event of symptoms of agranulocytosis, pancytopenia, thrombocytopenia, or severe skin reactions (see "Warnings and precautions" in section 2), you should stop taking Metamizol-SF immediately.
In order to minimize the risk of hypotensive reactions and to ensure that the administration of the medicine can be terminated at the first signs of a hypersensitivity reaction, the intravenous injection of Metamizol-SF should be very slow, i.e. no faster than 1 ml (500 mg of metamizole) per minute.