Spain has been accused of “playing Russian roulette” with expats’ lives by continuing to prescribe a painkiller alleged to be behind the deaths of at least 37 British and Irish expats.

A campaign to have metamizole, sold under the brand name Nolotil, banned as it is in Britain, the US and Australia has prompted the public prosecutor in Spain’s national court to investigate why the deadly drug is still widely available.

Nolotil is Spain’s top-selling drug, with 27.8 million pills or blisters sold in 2022. However, it has been withdrawn in around 30 countries because it can lower a person’s immune system to such an extent that otherwise routine infections cause life-threatening illnesses or even death, a condition known as agranulocytosis.

People from certain countries are believed to be more susceptible to the drug’s side effects, although it is not clear why.
Campaigners have compiled a dossier of 400 such cases in Spain, mostly among the country’s significant English-speaking expat community. Of 47 deaths documented, 37 were British and Irish.

Isolation bubble

Beckie Harris was one of the lucky ones. The 60-year-old from Cambridgeshire nearly died in Spain in 2014 after taking Nolotil for two months for arthritis-related back pain.

She developed acute agranulocytosis and only survived by being kept in an isolation bubble in a hospital in Almería, southern Spain.

But ever since, Ms Harris has suffered from extreme fatigue, serious skin rashes, fibromyalgia and allergies to dozens of everyday substances. She recently had a rare thymus tumour.

“I try to think I am lucky not to have died but it has been 10 years of torture since then, if I’m honest. I wake up each day and I don’t know what’s going to be next,” she told The Telegraph.

“It is if they are playing Russian roulette with patients. I am absolutely disgusted they are still prescribing it to people.”

Spain’s AEMPS medicines agency told The Telegraph the risk of agranulocytosis among patients on metamizole was “very low, in the range of 1 to 10 cases per million users”.

It said it had advised doctors to check on patients’ health records to look for agranulocytosis risk factors and not to prescribe it to the “floating population” of British and other northern European expats.

Nolotil’s Germany-based manufacturer, Boehringer Ingelheim, did not respond to a request for comment.

Last year it told The Guardian that “metamizole has been used by patients for almost 100 years, with an established and well-known safety profile.

“Agranulocytosis is described as a very rare frequency adverse reaction in the current prescribing information. The side effect of agranulocytosis is addressed in the current product information.”

The effect of the drug

The campaign to have Nolotil banned is being led by Cristina García del Campo, a translator and language teacher who began to study the effects of the drug on Spain’s English-speaking expat community after the sudden death of an Irish friend.