Paracetamol, a humble and simple analgesic, was first used clinically in 1893, but was not commercialized in Australia until 19561Also known as acetaminophen in North America and Japan, it is the most commonly used analgesic, partly because of its low cost and availability without a doctor’s prescription. It is best used to reduce fever and it also has pain relief properties. This is the medicine that most people have used since childhood. However, the danger of paracetamol, like all medicines, can cause harm. The serious nature of paracetamol is often overlooked or even forgotten.
There are poisonings, overdose and deaths related to paracetamol in Australia every year2. Worryingly, the numbers are rising. Between 2007-08 and 2016-17, the number of hospitalizations related to paracetamol in Australia increased by 44%2. Nearly three-quarters of the cases are women. During the same period, the age group with the largest increase in the number of poisonings was children aged 10-14, an increase of 133%2. A good reason to return any old or unwanted medications to your pharmacy for disposal. This will prevent children and pets from accidentally ingesting drugs that are distributed at home (especially cats that are highly toxic to paracetamol because they lack the enzymes needed for metabolism)3). Remember, do not pour medicine into the drain, sink, toilet, or general trash.
The availability of paracetamol and the ability to buy in large quantities lead to paracetamol poisoning. In addition, people may inadvertently double up on the same type of medicine without knowing its therapeutic ingredients. This is part of the call for ingredients to be placed on all medication packaging to help people in the community identify and understand the medications they are taking. If you follow the instructions on the back of the package, you can safely take 4 grams of paracetamol in excess of the recommended daily dose to avoid potential liver damage or other potential hazards. Unfortunately, many people take paracetamol on a regular basis to treat chronic pain syndrome, but do not know that long-term use, even in moderate doses, can also cause chronic liver damage, fatty liver and cirrhosis.Acetaminophen may also be unsafe for pregnant women, leading to developmental disorders, including neurogenic genitourinary system and reproductive system diseases4.
There is good news. Paracetamol can effectively control certain pain conditions. A recent literature review investigated the efficacy of paracetamol in 44 pain conditions.The review found that paracetamol can relieve knee or hip osteoarthritis, tension-type headaches (may be painless within 2 hours), perineal pain after childbirth, etc.5However, high-quality evidence found that paracetamol is not effective in relieving acute low back pain, and there is no or inconclusive evidence that paracetamol is beneficial in the treatment of chronic low back pain, endodontic pain, rheumatoid arthritis and some sequelae. Surgery pain conditions (eg thyroidectomy, spinal surgery)5If used properly, paracetamol rarely causes serious side effects, occurs at a similar frequency compared to placebo, and is generally widely tolerated5.
1. Prescott LF. Paracetamol: past, present and future. American Journal of Therapeutics. 2000;7(2):143-7.
2. Keynes R et al. Number of hospitalizations and deaths related to paracetamol poisoning in Australia from 2004 to 2017. Australian Medical Journal. 2019;211(5):218-23.
3. Bates N et al. Common problems in veterinary toxicology. Small Animal Practice Journal. 2015;56(5):298-306.
4. Bauer AZ et al. Use of paracetamol during pregnancy-call for precautions. Nature Reviews Endocrinology. 2021.doi: 10.1038/s41574-021-00553-7. The electronic version before printing.
5. Abdul Shahid C et al. The effectiveness and safety of paracetamol in pain relief: an overview of systematic reviews. Australian Medical Journal. 2021;214:324-31.
Dr. Stephanie Mathieson is a researcher at the Institute of Musculoskeletal Health, University of Sydney.