Metamizole, a potent analgesic and antipyretic, has been effective in treating pain and fever but faces scrutiny due to its association with agranulocytosis, a serious reduction in white blood cells. Although the exact mechanism behind this adverse effect is unclear, genetic factors seem to contribute. Recent research suggests that metamizole has good renal tolerance, making it a potential alternative for patients with heart failure or chronic renal insufficiency, who are at risk with NSAIDs. Despite its benefits, severe side effects like agranulocytosis and acute renal failure highlight the need for cautious patient selection and monitoring. Overall, further research and careful clinical use are essential to maximize metamizole's therapeutic potential while minimizing risks.