Lorraine Williamson
For many British and Northern European residents, Spain’s healthcare system feels modern and efficient. Yet one medication — sold under the name Nolotil — has cast a long and troubling shadow. Known generically as metamizole or dipyrone, the painkiller has been banned in the UK and more than thirty other countries for over forty years.
Despite this, it remains one of the most frequently prescribed drugs in Spain, routinely given for dental pain, post-surgery discomfort, and high fever.
Growing evidence now links Nolotil to a rare but devastating condition called agranulocytosis, which destroys white blood cells and leaves the body defenceless against infection. While the reaction is uncommon, its consequences can be fatal — and it appears to affect Northern Europeans far more often than Spaniards.
Why are some people more vulnerable?
Spanish doctors have prescribed metamizole for decades with relatively few local cases of agranulocytosis. However, hospital data from the Costa del Sol and Valencia suggest that foreign patients are several times more likely to experience severe complications. Researchers believe genetics may play a part, although other factors — such as differences in metabolism, pre-existing conditions, or even concurrent medications — could also increase the risk.
A series of investigations by The Guardian and El País has linked the deaths of dozens of British and Irish nationals in Spain to the use of Nolotil. Some victims were long-term residents; others were holidaymakers given the drug after surgery or minor injury. Families describe a near-identical pattern: sudden fever, collapse, sepsis, and death within days.
How is it still being prescribed?
In theory, Nolotil should only be used under close medical supervision for short-term pain relief — typically no longer than a week. In practice, the rules are often ignored. Pharmacies have been known to supply it over the counter, and hospitals frequently administer it intravenously without explaining that it’s banned elsewhere.
Spain’s AEMPS (Medicines Agency) has warned doctors to avoid prescribing it to short-term visitors and to inform foreign patients of the risks. But critics argue that these recommendations are poorly enforced and that communication in hospital settings — particularly when language barriers exist — remains dangerously inconsistent.
Protecting yourself in Spain
Avoiding Nolotil starts with awareness. Anyone living in or travelling to Spain should make their medical preferences clear before treatment. Patients are entitled to refuse medication containing metamizole or dipirona and to request safer alternatives such as paracetamol or ibuprofen. It helps to carry a written note — in Spanish if possible — stating: “No metamizol/dipirona, por favor.”
If you suspect you’ve already been given Nolotil, stay alert for early symptoms of agranulocytosis: sudden fever, sore throat, mouth ulcers, or unusual fatigue. Seek immediate medical help and request a blood test to check white-cell levels. Residents can also ask their GP to record a “Do Not Prescribe Metamizole” note in their digital health file, ensuring the warning appears on all future prescriptions.
Why the issue persists
The European Medicines Agency is reviewing metamizole use across the EU in an effort to harmonise safety standards. In the meantime, Spain continues to authorise it, insisting that with proper monitoring, the benefits outweigh the risks. Campaigners disagree. Groups such as ADAF Spain (Asociación de Afectados por Fármacos) argue that foreign patients remain inadequately protected and that the simplest safeguard would be to restrict the drug altogether for non-Spanish nationals.
The debate highlights a wider problem: inconsistent drug regulation across Europe and the assumption that what’s safe for one population must be safe for all. Until clearer guidance is issued, British and Northern European residents are advised to be proactive — ask questions, read labels, and never assume a familiar-sounding medication is harmless.
Awareness saves lives
Spain’s health system is among the best in the world, but cultural and regulatory differences can create unseen hazards for newcomers. Nolotil’s risks in Spain are a powerful reminder that vigilance matters as much as trust. Knowing the drug’s alternative names — metamizole or dipyrone — and politely declining it could prevent a tragedy.
Sources:
This article is based on investigations by The Guardian (January 2024), which reported multiple British deaths linked to Nolotil; El País English Edition (November 2018), detailing Spain’s official warning to foreign patients; and statements from the European Medicines Agency on minimising metamizole-related risks. Further context was drawn from Pharmaceutical Technology (2024) and clinical data published by Drugs.com and the National Center for Biotechnology Information (NCBI/PMC). Additional testimonies were provided by ADAF Spain, the patients’ association campaigning for tighter regulation, and general reference material was verified via Wikipedia’s Metamizole entry.