Side Effects Of Paracetamol – A Medical Dissection Of Paracetamol

Paracetamol tablets

How many of you remember those nights, when your brain was hurting as though someone opened it and was pricking on it, piece by piece. A hangover so bad, that you couldn’t cure with your grandma’s black coffee.

A lot of these incidents start with pain or ailment in some part of the body, especially with the head.

We all had one savior in our medicine cabinet, easily available, the over the counter standard for any ailment of your body.

What is Paracetamol?

For many decades Acetaminophen also commonly known as Paracetamol, has been the pharmaceutical holy grail, these small white pills were considered to cure every disease known to man.

Paracetamol Tablets
Image:ShutterStock

The easy availability and the added advantage of not needing a prescription made them a viable option, creating a false impression that they are completely risk-free.  

Sadly, that is not the case.

FDA, The food and drug administration in America recently issued a warning to all practicing physicians about painkiller medications with more than 325 milligrams of paracetamol.  Sustained use of these drugs proved to have significant damage to the liver.

In the United Kingdom, around 22.5 million prescriptions were written for it by general physicians. Around 200 million packets of the drug were sold annually, accounting to almost two-thirds of the market relying on this cheap and ‘effective’ over the counter drug(1).  

These numbers are substantial proof that showed an exponential rise however is this drug safe and effective?  

It is a well-known fact that paracetamol has potentially fatal consequences, however, the widespread belief is that the drug is safe if used mildly and in an effective dosage.

The scientific community for a long time has kept questioning the potency of this ‘wonder drug’, who have concluded after extensive research that paracetamol has side effects that may be fatal, with prolonged usage of this drug.

That still might seem like a risk that you can take however in the recent light of events, new research has surfaced stating that drug has lost its potency and may not work or may only work on a small group of people.

A Brief History of Paracetamol

Paracetamol is an established antipyretic and an anti-inflammatory drug that is used for pain ranging from mild to moderate.

Though used by Von Mering in 1893, It hadn’t appeared onto store shelves up until the 1950s due to raising concerns caused by the toxicity of non-prescription analgesics such as aspirin and ibuprofen as they were known to cause gastric ulcers and other serious side effects.

During these dark times, Paracetamol performed well and proved to have a consistently safe profile.

Its exemplary record was tarnished by the discovery in 1966, where a major dosage was proven to show complications in the health and fatal to the liver.  

Risks Associated With Using Paracetamol

Dr. John Dickson, a retired surgeon/physician from North Yorkshire puts it in the simplest way

“Paracetamol can be an extremely fatal drug, It can cause kidney and liver problems and also causes gastrointestinal bleeding as much as the other NSAIDS” (2)

Non-steroidal-Anti-Inflammatory-Drugs, such as ibuprofen, aspirin were proven to have a side effect of internal bleeding.

Belonging to the same class of drugs, it was presumed that paracetamol presented the same side effect, it was a mixed review until recently.  

In 2011 a study was conducted at Nottingham University

Professor Michael Doherty, a rheumatologist who conducted and published a study on 900 patients aged 40 years and above who took paracetamol, ibuprofen or a combination of these both drugs for chronic knee pain.

After an extensive observation over the period of 13 weeks, he compared the patients who took paracetamol and ibuprofen.

The ones on ibuprofen showed one in five suffered from internal bleeding and lost about a unit of blood however surprisingly it was the same results for people who used paracetamol(3).

In 2013, FDA issued warnings in regards to the usage of paracetamol, as to how in some rare instances it could cause potentially fatal skin diseases such as Stevens-Johnson syndrome, toxic epidermal necrolysis that cause the fascia (top layer of the skin) peel of the body.

The major risk associated with paracetamol is that liver damage, the Liver is the site of break down for any material entering the body.

As this drug enters the bloodstream it is taken to the liver for a breakdown, overloading the liver with this would cause liver failure.

[Also Read: Home Remedies for Liver Cancer]

This overdosage is actually a thing that can happen easily to anyone.

Every cough syrup, painkiller, suppository has paracetamol, a couple of pills for a headache and cold and your way above the recommended limit of the dosage, putting you at a risk.

Paracetamol Uses, Dose, Overdose And Everything In Between!

Paracetamol tablets on floor
Image:ShutterStock

There is never a safe level of dosage for any drug in the pharmaceutical world.

All of them carry risks, A safe dosage merely means that the drug in that dosage carries more effective benefits than risks.

Hence dosage of every drug should be taken into account very particularly before using them.

Adults and children have different kinds of dosages, of course, due to the change in body sizes and metabolic rates.

It is recommended that for a working adult a maximum single dose of 1000 milligrams with a maximum dosage for the day is 4000 milligrams.

However, it should be taken into consideration that this for the healthy adult, for people with a damaged liver or liver failure the numbers are way too lower.

Such people should take the advice of the doctor before even considering this drug as an option.

Also, people who drink alcohol and also take this drug should be very careful, as their recommended dosage is the half of a healthy adult that is 2000 milligrams.

Also according to recent studies conducted by several reputed healthcare universities, even caffeine has the effect of increasing the levels of paracetamol-induced liver toxins.

According to a report made by FDA, in 2009 recommends to reduce the total maximum dosage to be reduced to 650 milligrams for a single dose and that the 4000 milligrams of everyday dosage be reduced as well (albeit the report doesn’t suggest by how much)

Each individual has different levels of reactions to the overdosage of this drug, some may have adverse reactions to even the lowest of the dosage.

However, it is been widely accepted that one strip of paracetamol can be more than harmful to any individual and could also be fatal in some cases.

Even though the dosage may not be harmful to some individuals it may cause irreparable liver damage.

A person who has overdosed on paracetamol for whatever reason it maybe could be fine for a day or two, as there might not be immediate implications.

However, his/her liver may be on the verge of overloading itself with toxins and may soon enter into a horrifying phase of unbearable pain, which would progressively degrade the liver and bring upon death to the individual.

Note: If paracetamol overdose is suspected in you/your friend or anyone even if the person feels well immediate medical attention is to be sought.

Breaking Myths About Paracetamol

  • A Lot Different From A ‘spoonful Of Sugar’

Many of us might have heard to this phrase, ‘a spoonful of sugar’, in several occasions in a household situation this drug has been compared to sugar which is equally as harmful as this drug (Banning this phrase is the only way to go!)

Children can be administered with pediatric paracetamol, to fight pain or fever but as a responsible parent, it always falls on them to read the label properly avoid any confusion in regards to the dosage errors.

If you look clearly on the bottle you will find a ‘directions’ section that outlines how that drug is to be administered and in what dosage.

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If you’re unsure DON’T TAKE THE RISK.  

Take advice from your pediatrician/ physician as to the directions of use of this drug.

The FDA also recommends using the measuring tool given with the medicine; NEVER the kitchen spoon.

  • They are better ways to cure your HANGOVER!

women hangover
Image:ShutterStock

Every single one of us has had one of those nights, where we have had one too many and woke up the next day with a splitting headache and incessant need for a painkiller some coffee.

Experts and a lot of studies suggest that one should be very carefully considering which medicine to use to cure your hangover, especially if you are a chronic drinker.
Alcohol compounds the effect of paracetamol, even when taken in small quantities it increases the risk of liver damage and kidney failure.  

According to the National Institutes of Health, glutathione is one enzyme that is required by the liver to metabolize paracetamol.

However, due to heavy drinking glutathione levels are severely decreased causing the paracetamol to be metabolized to a toxic by-product in the liver.

Another study shows that taking the recommended dose of paracetamol with little to moderate amount of alcohol increases the chances of liver damage by 123% FDA says that you may not experience liver failure immediately but in due course of time your body gives you signs such as loss of appetite, nausea, dizziness.

These should be taken seriously and one should immediately seek medical help.  

  • It is easy to OVERDOSE! Easier than you KNOW!

The daily recommended paracetamol dosage is about 4000 milligrams and it is very easy to reach this upper limit.

Just one Panadol tablet consists of 500 milligrams of paracetamol. It is conventional knowledge to arbitrarily take one tablet every six hours, at this rate you would already be reaching half the limit of your daily dosage.

This is not including the possibility of using a cold cure, decongestants and any other suppositories.  

  • It doesn’t actually help with MUSCLE PAIN!

man with muscle pain
Image:ShutterStock

Yes, you read that right. The painkiller doesn’t work on muscle pains, there is a lot of medical jargon associated with this but let’s try to break it down into simpler terms.

Paracetamol is a non-opioid analgesic, which is used to treat mild to moderate pain.

Non-opioid analgesics work by blocking cyclooxygenase (COX) enzyme, which produces a lipid compound called prostaglandins that cause pain in your muscles.

According to John Hopkins Health care center,  most non-opioid analgesics work in the peripheral nervous system, that is the nerves that are not present in the brain and the spinal cord.  

However, paracetamol works on the central nervous system and blocks a different kind of enzyme called COX3, which means that this drug can help you fight those headaches and minor aches but not a muscle ache.

[Read: Home Remedies for Headache]

A Devil’s Drug!

If you look at asthma, diabetes or any other kind of disease, all these are managed well by the patient, they take care of their blood glucose levels, or have an inhaler handy or anything to combat what the disease throws at them.

However self-pain management is not a concept that most patients are aware of, not only that even the doctors have had the same approach.

How many times have you heard to this phrase, “No you shouldn’t have any pain, I’ll give you something to deal with it”

This kind of attitude from the physicians and health practitioners has helped trivialize the usage of pain meds leading to the point of abuse.

Uprooting it at the preliminary stage is an important step to be taken.

Dickinson agrees and says that “ What we have to get across to people is that pain itself isn’t doing any harm, it’s not something you can cure and sometimes it makes sense not to take anything. We have to learn to manage pain more proportionately.”

It is an elemental concept of using painkillers for pain, but as it doesn’t cause any harm apart from of course!

Causing pain one should effectively manage pain, to eliminate this cultural medical phenomenon.

“My view is that no one would be using paracetamol in the next five years if properly tackle it,” says Dickinson

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