Evidence mapPaperPMID 40289271Full record

Observational studyBritish journal of clinical pharmacology2025

Metamizole induces voriconazole metabolism and results in subtherapeutic voriconazole concentrations.

Simone D Baan, Daan J Touw, Marjolijn N Lub-de Hooge, Thijs H Oude Munnink

Abstract readObservational Study
In one paragraph

Observational study in British journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Simone D BaanDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands.
Daan J TouwDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands.
Marjolijn N Lub-de HoogeDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands.
Thijs H Oude MunninkDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Groningen, Netherlands.ORCID https://orcid.org/0000-0001-8392-5858

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsVoriconazole is extensively metabolized via cytochrome P450 (CYP) enzymes, predominantly CYP2C19 and CYP3A4. Drugs influencing the activity or expression of CYP enzymes can cause clinically relevant changes in the metabolism and voriconazole exposure. Metamizole is known to induce CYP3A4 and CYP2C19. This study aimed to investigate the pharmacokinetic drug-drug interaction between metamizole and voriconazole.

methodsIn this single-centre retrospective observational cohort study, we compared voriconazole serum trough concentrations before, during and after metamizole treatment.

resultsIn the 9 included patients, the median voriconazole trough concentration decreased by 71% during metamizole treatment (P = .028) compared to before start of metamizole. The concentration/dose ratio similarly decreased by 81% during metamizole treatment (P = .018). Additionally, the metabolic ratio (voriconazole-n-oxide/voriconazole) increased from 0.9 to 2.4 (P = .028) during metamizole treatment. Subtherapeutic voriconazole trough concentrations were more frequent when combined with metamizole (before 14%, during 70%, after 17%).

conclusionsMetamizole increases voriconazole metabolism and decreases voriconazole trough concentrations, probably through a CYP3A4 and CYP2C19 inducing effect. It is recommended to avoid concurrent use of metamizole and voriconazole or to closely monitor voriconazole trough concentrations during metamizole treatment and up to 2 weeks after discontinuation of metamizole.

Indexed as

Antifungal AgentsAnti-Inflammatory Agents, Non-SteroidalCytochrome P-450 CYP3A InducersDipyroneVoriconazoleAdultAgedCytochrome P-450 CYP2C19Cytochrome P-450 CYP3ADrug InteractionsFemaleHumansMaleMiddle AgedRetrospective StudiesAntifungal AgentsAnti-Inflammatory Agents, Non-SteroidalCYP2C19 protein, humanCYP3A4 protein, humanCytochrome P-450 CYP2C19Cytochrome P-450 CYP3ACytochrome P-450 CYP3A InducersDipyroneVoriconazoleaspergillusdipyronedrug interactionmetamizolepharmacokineticstherapeutic drug monitoringvoriconazole

Identifiers

PMID40289271
PMCPMC12381621

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.