Paracetamol is one of the most widely used drug available over the counter (OTC) which is persistently and heavily promoted by the catchy advertisements all around us. Surprisingly, it is one of the most common drugs for suicide as well. Shockingly, paracetamol causes hepatotoxicity even at therapeutic doses, which has led some national formularies to recommend dose reductions. This article aims to highlight the aspects which are not in the limelight of this widely available OTC medication. In addition to creating awareness, we also suggest implementation of laws to reduce the risks of deliberate and accidental overdose.
Mangus BC, Miller MG. Pharmacology application in athletic training. FA. Davis Co; vol. 86; 2005. pp. 460–461.
Sharma CV, Mehta V. Paracetamol: mechanisms and updates. Cont Educ Anaesth Crit Care Pain Med 2014;14:153–158. DOI: 10.1093/bjaceaccp/mkt049.
WHO Model List of Essential Medicines (19th List). World Health Organization. Available at https://www.who.int/medicines/publications/essentialmedicines/en/, (accessed on 9 February 2019).
Kaur A, Thanasan S, Ng CG, Zainal NZ. P03-295 – Paracetamol as the major contributing factor in parasuicides in a single centre in Malaysia. Eur Psychiatry 2010;25:1363. DOI: 10.1016/S0924-9338(10)71349-3.
Gazzard BG, Davis M, Spooner J, Williams R. Why do people use paracetamol for suicide? Br Med J 1976;1:212–213. DOI: 10.1136/bmj.1.6003.212.
University of Oxford Centre of Suicide Research. Use of paracetamol for suicide and non-fatal self-poisoning, and evaluation of the effects of legislation on paracetamol and aspirin pack sizes; Available from http://cebmh.warne.ox.ac.uk/csr//resparacet.html, (accessed on 9 February 2019).
Fall in paracetamol deaths ‘linked to pack limits’. Available from https://www.bbc.com/news/health-21370910, (accessed on 9 February 2019).
Gulhati CM. Don't pop that pill: Here's why you must avoid paracetamol for back pain. Available at https://www.indiatoday.in/lifestyle/health/story/paracetamol-for-back-pain-heres-why-you-must-avoid-it-282264-2015-07-14, (accessed on 9 February 2019).
Tan SF, Chong CP, Chooi W-T. An Evaluation of Practices, Perceptions and Understanding About Use of Acetaminophen (Paracetamol) Among Malaysian Consumers: A Qualitative Study. Mali J Pharm Sci 2015;13:25–41.
Moriarty C, Carroll W. Paracetamol: pharmacology, prescribing and controversies. Arch Dis Child Educ Pract Ed 2016;101:331–334. DOI: 10.1136/archdischild-2014-307287.
Foxhall K. FDA May Restrict Acetaminophen. WebMD. Available at https://www.webmd.com/pain-management/news/20090701/fda-may-restrict-acetaminophen#1, (accessed on 9 February 2019).
FDA Drug Safety Communication: Prescription Acetaminophen Products to be Limited to 325 mg Per Dosage Unit; Boxed Warning Will Highlight Potential for Severe Liver Failure. U.S. Department of Health and Human Services, U.S. Food & Drug Administration. Available at https://www.fda.gov/Drugs/DrugSafety/ucm239821.htm, (accessed on 9 February 2019).
Liquid Paracetamol for Children: revised UK dosing instructions have been introduced. Mhra.gov.uk. 2011. [document on the Internet]. Available from https://web.archive.org/web/20111114224356/http://www.mhra.gov.uk/home/groups/comms-ic/documents/websiteresources/con134921.pdf (accessed 9th February 2019).