NOTORIOUS painkiller Nolotil was produced in 1922 in Germany under the brand name ‘Novalgin’.
Over 100 years later, the drug has been linked to the deaths of some 40 British and Irish people in Spain.
Nolotil, whose main ingredient is metamizole, is known to have severe adverse effects for northern European patients, including agranulocytosis, or low white blood cell count.
This can lead to sepsis, gangrene and organ failure among many other severe side effects.
Nonetheless the painkiller remains available in many countries across the globe, so where is Nolotil banned and where do you need to be careful if you fall ill while travelling?
Where is Nolotil banned?
The United Kingdom
Nolotil was never licensed for use in the UK and does not appear in the UK National Formulary, the British pharmaceutical reference book due to the risk of agranulocytosis (low white blood cell count). However as documented by the Olive Press, the drug continues to be prescribed to British and Irish people in Spain, often with serious consequences.
As Nolotil is not available in the UK, it is also banned in Gibraltar.
Citizens of the Rock should not be able to buy the drug over the counter or by prescription, according to a government spokesperson.
However, when investigated by the Gibraltar Broadcasting Corporation in 2018, reporters were able to buy the medication, copping 20 tablets for just £2.50.
The Republic of Ireland
According to the Irish Health Products Regulatory Authority (HPRA), Nolotil has never been authorised for use in Ireland.
In a statement to the Irish Independent, they said: “Metamizole is authorised in the above countries for the treatment of moderate or severe acute pain and high fever not responding to general therapeutic measures.
“It is known to be associated with a risk of blood disorders, including agranulocytosis (low white cell count).”
The Federal Drug Association banned the drug, known as Dipyrone, in 1979 due the high incidence of agranulocytosis.
However, some studies have indicated that the drug is commonly used by Latino populations and can still be purchased in the USA.
Down under Nolotil is classed under ‘schedule 10’, the highest danger level for drugs. Medications on this level are ‘substances of such danger to health as to warrant prohibition of sale, supply and use.’
According to a government webpage: “Metamizole for human use was withdrawn from the Canadian market in the 1960’s due to the risk of agranulocytosis.”
However, like in many other countries, the drug is available for veterinary use.
In 1999, Swedish regulators estimated the risk of arganulocytosis to be one in 2,000 prescriptions, with a mortality rate of 26%.
They concluded that the benefit-risk profile was unfavourable and banned the drug.
Other countries where Nolotil is prohibited include: Japan, Denmark and France.
Where is Nolotil still available?
Despite being banned in many countries Nolotil is still available in some 40 nations worldwide, including:
Its birthplace, Nolotil was first sold in Germany under the brand name, ‘Novalgin’.
Today, it is one of the country’s most popular painkillers, where it is produced by pharmaceutical giant, Boehringer Ingelheim.
In 2018, Portugal’s pharmaceutical watchdog, Infarmed issued a bulletin urging ‘caution’ with the use of Nolotil.
It followed Spain’s advisory note recommending the drug only be given with a ‘thorough consideration’ of the patient’s background.
The drug is still available in Spain’s neighbouring nation, under the brand names Nolotil, Dolocalma and Metamizol Cinfa.
The watchdog also claimed that between 2011-2018 only 11 cases of agranulocytosis had been recorded as a result of taking Nolotil, saying this is the expected rate of a ‘very rare’ side effect to the painkiller.
Nolotil can be bought and prescribed in Russia, where the drug reportedly makes up some 80% of the country’s painkiller market.
The country banned metamizole in 2013, where it is under the brand name Analgin, but the restriction was soon lifted in 2014.
Many newspapers report the drug is still banned in India, but the Olive Press was unable to find any information to support this and found many Indian websites selling the drug today.
In Brazil, Nolotil is one of the country’s most popular medicines, with 215 million doses given out in 2022 alone. This follows a trend in Latin America, where the medication is reportedly very popular.
Despite the danger it poses to northern Europeans, Nolotil is still available in many countries in Europe and beyond, these include: Belgium, Finland, the Netherlands, Italy, Austria, Luxembourg, Croatia, Slovakia, the Czech Republic, Bulgaria, Indonesia, Mexico and Brazil.
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- ‘Our Nolotil hell’: British expats recall their terrifying ordeals after taking the ‘lethal’ painkiller in Spain – including one who ‘momentarily died’ before having to learn to walk again
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