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HEALTH

Nolotil: The activist warning foreigners in Spain about a dangerous painkiller

The Local speaks to Cristina García Del Campo, a medical translator turned researcher who for years has fought to get Spain to ban a popular painkiller with potentially lethal side effects for Britons and other Northern Europeans in particular.

cristina research nolotil spain 1
Cristina advises people to register, in writing, at hospitals and healthcare centres their wish not to be given Nolotil/Metamizol. Photo: Cristina Research Information

What is Nolotil? 

Nolotil is a painkiller, the go-to painkiller and most sold medicine in Spain. In fact, in Spanish hospitals and healthcare centres the rule is: “if in pain, give Nolotil”.

It is a different type of painkiller, it is not an anti-inflammatory or an opioid and it is not like Paracetamol. It is a pyrazolone. Its active ingredient is Metamizole and it is sold under different names, but Nolotil is the most popular one in Spain.

When it was first introduced in Spain, it was considered to be so toxic that it was only given in hospitals and under very strict supervision. Why did it go from that to being the most sold medicine in the country?

Why is Nolotil controversial?

Nolotil became very controversial when, in the 1970s, it was discovered that it could cause agranulocytosis, a severe reduction in the number of white cells which can be fatal. It was known that it could cause a lot of side effects, but agranulocytosis was its most feared side effect and, even though it was considered to be very rare, the fact that it could cause death was enough for many countries to decide to get it banned.

Nowadays, Nolotil is prohibited in around 40 countries, included the UK, the United States, Japan , Australia and many countries in Europe. In Sweden, the ban was lifted in 1995 and re-introduced in 1999 only to be taken off the market again just a few years later because of cases of agranulocytosis.

What has your research into Nolotil involved and why did you choose to embark on this mission?

One of my clients, who I translated for, suddenly became very ill and died in December 2017. His name was James and he was Irish.

Before he died, I spent hours at the hospital with him. Fournier’s Gangrene and sepsis were mentioned. At the time, I remember thinking that was not the first time I had heard the word sepsis and James was not the first British or Irish patient to have died suddenly.

I started to wonder why this was happening and, one Saturday evening, on 9th Dec 2017,  I sat at my dining-room table at home and started going through some medical reports I had from patients. It was then when I realised they all had one thing in common: they had all taken Nolotil.

I then remembered that a British friend of mine had told me Nolotil was banned in the UK and I decided to look for more possible cases on the internet. I found three more cases of British or Irish people who had either died or been severely affected by this drug.

I was taking Nolotil for a toothache at the time so I quickly went to get my box of Nolotil and started reading the patient information leaflet. And there it was! Sepsis, Fournier’s Gangrene, necrotising fasciitis, agranulocytosis…

I was shocked and nervous and started printing all the information. Until then, I had always been a great believer in Nolotil, like most Spanish people. Nolotil is part of our culture, something you are always supposed to have at home and you cannot live without. It is imprinted in our brains as a necessary thing and a lifesaver and, since I had never heard anything negative about it before, I was in shock. I kept thinking: “surely doctors must know about this… but if they did, why would they give it to people?” First thing on Monday morning, I turned up at the hospital and said: “I think we have a public health problem caused by Nolotil”.

What have been your primary findings?

When James became so ill, during the hours I spent at the hospital with him, I used to think that getting a sudden infection and dying or nearly dying did not seem an uncommon thing. I started thinking about other cases: a client, and friend, of mine had very suddenly died of an infection four years before and that was also a shock, as all this man had was gallstones and was waiting for an operation. He was prescribed Nolotil while he waited for his operation and never made it to the operation. He developed a terrible infection two days before he was due for surgery, went into septic shock and died on the day his surgery was due.

I also had a friend/ client who had had an operation and a few weeks later, he developed a very high temperature for no apparent reason. I remember talking to his wife about his temperature and thinking: “I must watch out for Steve, from previous experience with other patients, I know that when people get a temperature, for no apparent reason, within a month of having surgery, it may be sepsis”. I had this feeling that we could not wait and made his wife get him out of bed in the middle of the night to take him to the Emergency Department… He had sepsis and I was told had we waited until the next morning, he would not have made it…. When I looked in his notes, I also found he had been taking Nolotil after his operation.

Just around the time when James died, I also remember a friend of mine telling me there was a man in hospital dying of sepsis. This happened just as I was starting to research so I quickly asked her if this man had been taking Nolotil and the reply was he had taken Nolotil following a shoulder operation. This man spent two months in a coma in intensive care, fighting for his life, and one month in a different hospital learning to walk again.

Little by little, I realised all these cases had several things in common: they were all British or Irish, they had all taken Nolotil for pain before or after surgery and they had all become very ill very suddenly. Little did I know this was only the beginning of a huge campaign.

What have you achieved so far and what are your future goals?

I started joining Expats Groups on Facebook, as I thought there had to be more cases out there and I just did not know how to reach out to these people. As cases started to come in, I decided to create my own Facebook page, solely for this purpose, which I called Cristina Research Information.

Once I had collected 100 cases, I spoke to the AEMPS (Spanish Agency of Medicines and Medical Products) and told them I wanted to come and see them in Madrid with all my cases. I took the train to Madrid and had my first meeting with them on 6th July 2018. They were shocked when they saw all my cases, backed up by medical reports stating “agranulocytosis due to Nolotil / Metamizole”, and said: “We’ve got to stop giving Nolotil to these population groups!”.

I submitted cases to them throughout the summer, often going to bed between 4:00 and 6:00 am and then having to work the following day, but, following my work, the directors from the AEMPS decided to invite me to a Drug Safety Committee Meeting in Madrid on 26th Sept 2018, where I spoke in front of a large number of doctors.

As a result, the AEMPS issued a directive on 30/10/2018, banning Nolotil for tourists and tightening guidelines.

Unfortunately, these guidelines were not enough, as we have continued to get Nolotil cases but the AEMPS has done nothing else about it.

I know for a fact that many lives have been saved due to me raising awareness through my Facebook page and my campaign.

People who were in hospital dying have been saved because someone had heard about my Nolotil campaign and told the doctor who was giving Nolotil to the patient, the doctor stopped giving the patient Nolotil and the patient recovered, in some cases after a month.

This has happened to an awful lot of people and not just in Spain, but also in Germany and other countries, as my campaign has raised awareness worldwide. I now have over 350 cases, most of them British, but 63 of them are Spanish, which would indicate that, due to a genetic component, the British are more at risk, but other nationalities are not immune to its deadly effects.

I am now officially registered as a “researcher” and, in April 2021, I wrote an article with a team of medical experts and it was published in medical journals. The reason for this article was to highlight the inadequacy of the measures taken by the AEMPS

Over the last four years, I have notified hundreds of Nolotil cases to the AEMPS and I have asked them on numerous occasions to take tougher measures. Not only have they not replied to any of my messages, but they also decided to include Nolotil on the list of essential medicines during Covid.

I know the only reason why many people have managed to avoid taking it, or have survived its effects, is because of my campaign, not because of the AEMPS.

Doctors keep prescribing or giving Nolotil to people against their will, which means they are violating patients’ rights.

For this reason, as it is obvious that the prescription of Nolotil cannot be controlled and it continues to affect people, I have asked for Nolotil to be banned, at least for people from countries where it is already banned, and for tougher guidelines for the rest.

Cristina’s hard work and activism have not only helped save lives, but led to wider coverage in the Spanish press about the potential side effects of Nolotil. Screenshot: Google

I have also filed a formal complaint with the Ombudsman against the AEMPS and the Ministry of Health because of their lack of action, resulting in patients’ rights being violated and people’s lives being put at risk.

After studying all the information I submitted, the Ombudsman decided to accept my complaint and launched an investigation asking the AEMPS to provide a full report. The AEMPS has been given 15 days to submit this report and I am currently waiting to hear from the Ombudsman, who will be taking it to Parliament if the AEMPS does not submit the report they are obliged to.

What advice would you like to give foreigners (and Spaniards) in Spain regarding Nolotil?

A lot of people ask not to be given Nolotil and, despite this, doctors give it or prescribe it to them against their will. I would advise people to register, in writing, at hospitals and healthcare centres their wish not to be given Nolotil/Metamizol, stating that should they be given it against their will, they will hold the doctor responsible for any consequences.

I would also advise people to ask for a blood test to check their white cell count if they are given Nolotil/Metamizol. But be aware, the effects of Nolotil are unpredictable. According to the datasheet and the cases I have compiled through my research, Nolotil can affect anybody anytime, regardless of whether they have taken one capsule or seven, even if they have taken it before without a problem.

As well as the potentially fatal agranulocytosis, it can also cause many other side effects, such us liver or kidney damage, anaphylactic shock, hypotension, etc.

Member comments

  1. Although I have faith in the Medical Profession generally, I never take any medecine perscribed without looking it up on the Internet. My doctor in Spain presribed Nolotil when I had cracked/slipped a disc and I looked on the internet and never even had the prescription filled. A friend offered me some immediately after the accident with my back – she keeps it at home, like you might do with paracetamol – uses it for period pain, headaches anything. Parecetamol is not without harmful factors, but not as bad as this drug.

  2. My husband was prescribed Nolotil (Irish ancestry) in October/November 2017 for a very bad tooth infection. Because I was unfamiliar with Nolotil and he has had reactions to some painkillers, I did a quick google search and saw exactly what Cristina has found: that it was potentially lethal for people of Northern European descent. I spoke to the dentist, who had never heard of this, but was kind and took my word for it, so he recommended a different painkiller. So this risk has been documented, but thank you Cristina for following up and doing something about it.

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HEALTH

What is the average waiting time across Spain to see a doctor?

Find out the average amount of time you'll have to wait to see your GP, a specialist and get a non-urgent surgery in your region of Spain.

What is the average waiting time across Spain to see a doctor?

Where you live in Spain greatly affects the amount of time you’ll have to wait, from the first appointment with your family doctor to seeing a specialist and even through to an operation, if you need one. 

Two and half years after the beginning of the Covid-19 pandemic, which almost brought the country’s clinics and hospitals to breaking point, how is the situation now?

Here are the average waiting times in each region of the country, with data published by the regional health authorities. 

Andalusia
In Andalusia, the average wait time to see a doctor is four days. To see a specialist such as a dermatologist or a cardiologist, however, you will be waiting three months. Wait times for non-urgent surgeries vary depending on what you need. 

Aragón
Those living in Aragón will typically be able to get a doctor’s appointment within three days, but to see a specialist, it is one of the worst regions in the country, with an average waiting time of four months.

Asturias
The latest waiting times to see a doctor or a specialist in Asturias have not yet been published, but if you need a special test such as an MRI, you will be waiting more than three months.

Balearic Islands
In the Balearics, the average waiting time for an appointment to see your GP is one week, while if you need to see a specialist, you will be waiting around two months. For a non-urgent surgery, you will be on the waiting list for an average of four and a half months. The Balearic Islands are one of the worst places if you need a diagnostic test though with an average wait of more than six months. 

Basque Country
Data from the Basque Country has so far not been made available. 

Canary Islands
Like in Aragón, the Canary Islands is one of the worst places to live if you need to see a specialist with the longest waiting time of more than four months.

Cantabria
Cantabria has so far not updated its data on waiting times to see a specialist, but if you need a non-urgent surgery it has one of the longest waiting times at six months.

Castilla-La-Mancha
Those in Castilla-La-Mancha have one of the shortest wait times to see a GP, being able to book an appointment within just 48 hours. They’ll have to wait longer to see a specialist, however, with an average wait of two months. Those waiting for non-urgent surgery will be waiting another four months.

Castilla y León
In Castilla y León you’ll wait an average of six days before being given an appointment and two months to see a specialist.

Catalonia
Residents of Spain’s northeastern region wait an average of five days in order to get a doctor’s appointment. For diagnostic tests, the wait time depends on what you need. You will be on the list for five months on average for a colonoscopy and two months for an MRI.

If you need to see a specialist again it will completely depend on what type of specialist you need to see. For example, if you need to see a urologist you’ll have to wait five months, but if you need to see a neurologist you’ll be able to get an appointment in less than three months. If your doctor thinks you require non-urgent surgery, you will need to wait another four and half months.

Extremadura
In Extremadura, you’ll have to wait an average of four days for an appointment, while the waiting time to see a specialist will be around two months. Like Cantabria, Extremadura is one of the worst places to live if you need non-urgent surgery, as you’ll be waiting around half a year.

Galicia
Those in Galicia will be able to see a doctor in just three days, however, they have not published recent data on the wait time to see a specialist. They have however published data for non-urgent surgery which is an average wait of three months.

Madrid
Like in Galicia, in Madrid the waiting time for an appointment is just three days, but two months to see a specialist. For a test like an ultrasound or a CT scan, you will be waiting two months. If you need a non-urgent surgery, you’ll be on the waitlist for a further three months.

Murcia
The average wait time to see your GP has not been made available yet, but like in Andalusia, you’ll be waiting more than three months if you need to see a specialist. It’s one of the best regions for wait times for diagnostic tests though as you will be waiting less than one month. 

Navarre
Navarre has one of the shortest wait times for an appointment, available in just 48 hours. If you need to see a specialist, you’ll be waiting a further two months. Those waiting for a non-urgent surgery will have to wait an average of three months.  

La Rioja
Along with Castilla-La Mancha and Navarre, La Rioja has the shortest wait time to get a doctor’s appointment. Here, you’ll be able to see your GP in just 48 hours. This region is also the best to live in if you need to see a specialist or get a specialised test, with a wait of less than one month. If you need non-urgent surgery though it’s not so good, as you’ll be waiting an average of four months.

Valencia
Those living in Valencia have the longest wait out of all the regions for an appointment, where you’ll wait more than a month just to see a GP. When it comes to seeing a specialist you’ll need to wait another three months. And if you need surgery, you will have to wait four and half months on top of that.

The types of non-urgent surgeries the data refers to are hip and knee replacements. For other types of surgeries, it will depend on how urgent it is and what type of surgery it is. At the beginning of the year, there were more than 706,000 people waiting for an operation in Spain, according to data from the Ministry of Health.

You should be aware, however, that official data doesn’t always represent reality. Some readers have told us that currently, they are having to wait a month to see their GP in Catalonia and seven months to see a specialist.

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