A COMPARATIVE ANALYSIS OF THE RISKS OF AGRANULOCYTOSIS: DIPYRONE VERSUS PARACETAMOL IN ANESTHETIC PRACTICE

Abstract

Dipyrone and paracetamol are widely used in anesthetic practice due to their analgesic efficacy, but they have different safety profiles. Agranulocytosis is a rare but potentially fatal adverse reaction associated with the use of these drugs. This study aims to comparatively analyze the risks of agranulocytosis related to dipyrone and paracetamol, highlighting their clinical implications and risk factors. An integrative review was carried out on the PubMed, Scopus and Scielo databases, covering publications between 2018 and 2024. Original studies, systematic reviews and meta-analyses addressing the hematological risks of dipyrone and paracetamol in the context of anesthesia were included.  Dipyrone showed a higher risk of agranulocytosis, with an incidence ranging from 0.46 to 1.63 cases per million weekly users, being higher in European and Latin American populations.

The pathophysiology involves immune-mediated and metabolic mechanisms. Paracetamol has shown rare hematological events that are generally associated with toxic doses or specific conditions. In the perioperative context, dipyrone has shown superior efficacy in analgesia, but with a greater need for hematological monitoring. Although effective, dipyrone is associated with a higher risk of agranulocytosis, especially with prolonged use or in predisposed populations. Paracetamol, although safe, is less potent for analgesia. The choice between the two should consider factors such as the patient's risk profile, clinical context and need for analgesic efficacy. Strategies for monitoring and reporting adverse events are fundamental to promoting the safe use of these drugs. Future studies are recommended to deepen the mechanisms and optimize strategies to prevent agranulocytosis.