The Spaniard crashed heavily in third practice and missed qualifying while he underwent checks at Chemnitz hospital.

He had been declared fit to take part in Sunday morning’s warm-up session, but did not appear after suffering from continued dizziness.

He has now been ruled out of the race due to low blood pressure, joining title rival Jorge Lorenzo on the sidelines.

Pedrosa had won the previous three races at the Sachsenring.

His Honda team-mate Marc Marquez could now take the lead of the championship if he wins the race.

Marquez starts from pole ahead of Cal Crutchlow and Valentino Rossi.