Paracetamol
Paracetamol is the most widely used and prescribed drug in the United Kingdom. It is a good all-round pain reliever and also helps to lower a high temperature (antipyretic). It is used to relieve the symptoms of many common healthcare complaints such as headaches, colds and flu, sore throat, muscular pain, dental pain and period pain.
The National Institute for Health and Clinical Excellence (NICE) which gives guidance to healthcare professionals recommends paracetamol as the first line treatment for osteoarthritis, chronic back pain and migraine as well as treatment for mild to moderate pain.
Paracetamol has been on the market for well over 50 years. In 2009, there were 197 million packs of over-the-counter paracetamol sold (two thirds of the total painkiller market).
When used as directed paracetamol is a very safe drug. Its lack of side effects and serious interactions with other medicines means that, unlike many other types of painkiller, there are very few groups of people that it is unsuitable for.
Dosage
The recommended adult dose of paracetamol is two 500mg tablets or capsules, with four hours between doses, and no more than eight tablets in 24 hours.
Paracetamol is also in some other over-the-counter products, such as cold remedies, in sachet form which usually contain 1000mg of paracetamol (equivalent to two tablets).
When using a paracetamol product it is important to not take any other paracetamol containing products.
Paracetamol use in children
Paracetamol can be given to children aged over two months to relieve pain and reduce fever, with liquid paracetamol products available for babies and younger children.
Always follow the dosage instructions very carefully to ensure that you give the right amount for the child’s age and use any measuring device that has been provided.
In 2011, the dosages on children’s paracetamol products were updated. The revised dosages include more age bands e.g. 2 to 4 years, 4 to 6 years rather than 1 year to 6 years, to ensure the optimum dose is given for the child’s age.
Pregnancy
Paracetamol is generally regarded as the only painkiller that is safe to use in pregnancy. However, before taking any medicine when you’re pregnant, you should get advice from your midwife or GP. As with any medicine taken during pregnancy, paracetamol should be used at the lowest effective dose for the shortest possible time.
Overdose
used as directed paracetamol is a very safe drug. However, overdosing on paracetamol can cause permanent liver damage and can be fatal if not treated urgently.
It is therefore very important to stick to the recommended dose and not take more than one medicine containing paracetamol at the same time e.g. a pain relief product and a cough and cold product that also contains paracetamol.
In the UK, research over many years has shown that paracetamol overdose resulting in a fatality is almost all the result of deliberate overdose, with the drug being taken for purpose of self harm or suicide.1
In rare cases paracetamol overdoses have been caused by people taking more medicine because they have tried the recommended amount and they are still in pain. In these cases an overdose has been taken knowingly in an attempt to increase efficacy but with no intention of self harm.2 Either the consequences of the overdose were not understood, or they were ignored.
Such cases are sometimes referred to as ‘accidental overdoses’, but this is not an accurate way to describe them, as the fact that the recommended dosage has been exceeded is usually acknowledged, it is the consequences of doing so that is misunderstood.
Although such cases constitute a very small proportion of the total number of overdose cases, they are important because any strategy to reduce their incidence needs to be completely different to that considered for reducing deliberate self harm.
Sales restrictions
Packs of paracetamol on general sale in retail outlets such as supermarkets and convenience stores have been legally restricted to 16 tablets since 1998.
Larger packs can only be sold under the supervision of a pharmacist and the sale or supply of more than 100 tablets at any one time is restricted to prescription control.
The Medicines and Healthcare products Regulatory Agency (MHRA) reviewed paracetamol in 2009 and published updated guidance to retailers on the sale of painkillers (analgesics). The best practice advice is:
- Sales of medicines for pain relief should be restricted to a maximum of two packs in any one tranaction.
- Promotional offers on medicines for pain relief should not directly encourage the purchase of more than one pack e.g. 'buy one get one free' offers should not be used for painkillers.
These measures have proven to be successful in striking a reasonable balance between meeting a customer's immediate need for pain relief while helping to minimise stockpiling and accidental or impulsive overdose.
Pack warnings
Products are clearly labelled to say they contain paracetamol on the front of pack.
Packs also show prominent warnings about not taking the product with any other paracetamol-containing products and to seek immediate medical advice in the event of an overdose.
Asthma
Paracetamol is the preferred painkiller for asthma sufferers, because aspirin and ibuprofen are much more likely to trigger asthma attacks and are to be avoided.
Over the past few years there have been several studies that make a link between paracetamol use and an increased risk of developing asthma.3 However, these studies have had limitations and while they suggest an association, there is currently no evidence to prove that paracetamol was the cause.
The Medicines and Healthcare products Regulatory Agency (MHRA) continually monitors the safety of medicines in light of emerging evidence and its guidance on paracetamol use remains the same.
1 Keith Hawton, Michael Goldacre – Br.J. Psych; 1982; 141; 166-170
2 L F Prescott - Paracetamol. A Critical Bibliographic Review; Taylor & Francis 1996; pp401-473.
3 NHS Choices website: Paracetamol and asthma and Paracetamol asthma link 'uncertain'