You have a headache after a glass of wine too many. Your back aches from another day hunched over a keyboard. That old shoulder injury is playing up again. What do you do? There is a good chance that you will reach for the unglamorous white pills lurking in your medicine cabinet.
Paracetamol is the workhorse painkiller. GPs wrote 22.5m prescriptions for it in 2013. Around 200m packets of it are sold annually, accounting for two-thirds of the UK market for over-the-counter painkillers. It is widely viewed as cheap, safe and effective.
At around 2p per 500mg tablet, it certainly is cheap. But safe and effective? Although the potentially fatal consequences of taking a paracetamol overdose are well known, the widespread belief has been that the drug is mild and relatively safe if taken at the recommended dose. However, this is increasingly being questioned by scientists, who say that taking it over prolonged periods can have serious side-effects. That might seem a risk worth taking if it were not for recent research that suggests the drug either doesn’t work, or has only a very small effect for most people.
Paracetamol rose to prominence during the 1960s in the wake of fears that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen could cause gastric bleeding, ulcers and other serious side-effects. Some concerns were raised about the possibility that long-term use of paracetamol could also cause internal bleeding, but the evidence for that was mixed for many years.
However, in 2011, Professor Michael Doherty, a rheumatologist at Nottingham University, published a study looking at almost 900 patients aged 40 and older who took paracetamol, ibuprofen or a combination of both for chronic knee pain. When he compared the participants after 13 weeks, it came as no surprise that one in five on ibuprofen lost the equivalent of a unit of blood through internal bleeding. What was surprising was that so, too, had the same proportion of patients who were taking paracetamol
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“Paracetamol can actually be a very dangerous drug,” says Dr John Dickson, who retired from general practice in Northallerton, North Yorkshire, last year. “It can cause kidney and liver problems, and causes as much gastrointestinal bleeding as the NSAIDs.”
In 2013, the US Food and Drugs Administration (FDA) even issued warnings that taking paracetamol can, in some rare instances, cause potentially fatal skin conditions called Stevens-Johnson Syndrome, toxic epidermal necrolysis and acute generalised exanthematous pustulosis, which can cause the top layer of skin to become detached.
The maximum 24-hour dose of paracetamol is 4g, but as little as 5g can cause liver complications, and it can be easy to overdose accidentally by taking more than one product containing it at the same time. “I have a headache, so I’ll take some paracetamol, and I’ve got a cold so I’ll take a cold product such as Lemsip,” says Professor Andrew Moore, a leading pain researcher at Oxford University. “People don’t necessarily look at the small print.”
Last year, the FDA reduced the maximum dose of paracetamol (called acetaminophen in the US) in tablets or capsules to 325mg to reduce the risk of accidental overdoses.
In the UK, in draft guidelines issued in 2013, the National Institute for Health and Care Excellence (Nice) advised GPs that they should no longer prescribe paracetamol for osteoarthritis, suggesting it had “limited benefit” and highlighting links of higher doses to cardiovascular, gastrointestinal and renal problems. Doctors, though, were quick to criticise the new advice on the grounds that it would leave them either telling patients to simply endure their pain or lead to greater use of stronger, potentially more harmful opiate-based alternatives such as tramadol and diamorphine.
In its final recommendation last year, Nice performed a U-turn, reinstating its previous backing of paracetamol, pending the outcome of a broad review of over-the-counter painkillers by the Medicines and Healthcare Products Regulatory Agency, the results of which are due later this year.
Of course, most medicines have some side-effects, and taking
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http://www.theguardian.com/lifeandstyle/2015/may/25/does-paracetamol-do-you-more-harm-than-good?CMP=fb_gu