Carmine Murrell

The Spanish Health Ministry has issued a warning regarding the misuse of metamizole, a painkiller whose most popular brand name in Spain is Nolotil.

Following reports of British citizens who died after being prescribed the medication in Spain, the country’s health authorities are reminding users about the risk of a dangerous and unpredictable side effect known as agranulocytosis, which drastically lowers the patient’s white cell count and can even lead to death.

Vicente Faus, Costa del Sol Hospital

On October 30, the Spanish Medication and Health Products Agency (AEMPS) issued a reminder that metamizole can only be purchased with a doctor’s prescription, even though many Spanish pharmacies continue to sell it over the counter.

Last weekend, British news outlets reported that a dozen UK citizens had died after taking metamizole in Spain. It is one of the most commonly prescribed anti-inflammatory medications in Spain and Latin America, although it is banned in several European countries, including Sweden, the UK and Ireland.

“The AEMPS has reviewed the situation in Spain due to recent reports of agranulocytosis filed with the Spanish Pharmaceutical Monitoring System, particularly in patients of British origin,” said the note. “While there has been a years-long debate around a greater sensitivity among the population of northern Europe, and certain genetic factors have been studied, available information does not allow us to either rule out or confirm a greater risk for groups with specific ethnic characteristics.”

But the AEMPS insists that the drug should only be taken for “short-term treatments, seven days at the most.” If a longer course is necessary, the agency encourages periodic blood tests to monitor the patients’ white cell count, and recommends “not using metamizole on patients when it is not possible to conduct these checks,” such as tourists.

The warning also calls for “special precaution with patients of advanced age” because they tend to have lower defenses than the general population.

The agency notes that there has been a rise in reports of adverse effects running parallel to a spike in metamizole consumption in Spain. “The use of metamizole in Spain, based on prescription information from the National Healthcare System, has doubled in the last 10 years, with the biggest rise observed in the last five years,” says the statement.

The people most at risk of agranulocytosis are the elderly and those with depressed immune systems. “It occurs randomly, meaning that it does not depend on dosage, and each person can react differently to it,” explains Pedro J. Ibor, coordinator of the Pain Management Working Group at the Spanish Society of Primary Care Physicians (Semergen).

AEMPS

And while there are no conclusive studies to prove it, many health specialists suspect that people from northern Europe may be more sensitive to metamizole than Spaniards.

For over a decade, the scientific literature has been describing cases of agranulocytosis in tourists from northern Europe who took the medication in Spain or Latin America. The oldest case that this newspaper has had access to dates back to 2002 and analyzes the adverse effects suffered by Swedish patients who were prescribed metamizole in Brazil. The drug was banned in Sweden in 1974.

In Spain, health professionals at Costa del Sol Hospital in Marbella published a study on the subject in 2009. Nearly 30% of the hospital’s activity involves patients from northern Europe who are either visiting the area or are residents.

“We ran into this randomly,” explains Vicente Faus, who co-wrote the study when he was head of pharmacology at the health center. “The hospital had a computer system that allowed us to explore the agranalucytosis cases we had seen. We analyzed the connection with metamizole, and found to our surprise that the rate was nearly three times higher among foreigners than among Spaniards,” he recalls.

Failure to return the form will result in the court sending a County Court bailiff to issue the form by hand. If you fail to return the form after that and the court believes you have received the form, a warrant of arrest could be issued against you.

A bailiff will be sent to collect you and may take you to the court to fill in the form or explain why you have not provided the information asked of you.

You must attend this hearing. If you don’t the court can issue a warrant for your arrest and attendance at court, or they can even send you to prison for up to 14 days.

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The offer will take into consideration how much you need to live on i.e. food, rent/mortgage, essentials and bills. If you are a low wage earner, it might be that an AEO is rejected.

Once you have paid the debt in full you can ask for the attachment to be suspended.

If you think too much money would be taken from your wages, you can inform the court that you disagree with the amount asked for by the creditor. You can do this within 14 days of the order being made. A hearing will be set and a judge may decide to make a different order.

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If granted, the court will divide the money up from your wages and give this to the relevant people with CCJs against you. This may be a beneficial option if:

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There will be no hearing and there is a timeframe of 14 days for your creditors to object to the new order. The option to consolidate the orders is usually granted, and details of the new order will be sent across to you once agreed.

If a creditor knows your employer’s contact information, which they may do from previous financial details given to them, this information can be given straight to the court.

The court can then go to your employer and ask for details of your earnings in cases where you don’t return the N56 form to the court.

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You will have to go to court and swear an oath that the financial information you are giving is accurate.

This can be a serious situation in some jobs and there may be grounds for dismissal or disciplinary action, if your employer finds out you have an AEO.

You should check your contract of employment if you receive an N56 form. This is particularly the case in jobs that demand a lot of trust and where an employer may have a policy for dismissing employees who have a court order made against them. For example:

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You can ask for the AEO not to be granted by filling out the N56 form and you would explain the reason for not wanting this is because you would lose your job, and it will then be up to the court to decide what to do.

If they decide not to enforce the AEO you will receive a Suspended Attachment of Earnings and will need to come to a new agreement with your creditor to pay them directly.

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