Paracetamol, known as acetaminophen in the United States, may have more risks than originally thought, particularly when it is taken at the higher end of standard therapeutic doses, according to a new systematic review
“Paracetamol is the most widely used over-the-counter and prescription analgesic worldwide. It is the first step on the [World Health Organization] pain ladder and is currently recommended as first-line pharmacological therapy by a variety of international guidelines for a multitude of acute and chronic painful conditions,”
Both studies that examined mortality risk among adults who took paracetamol and those who did not found an elevation in overall risk.
Of four studies that reported cardiovascular adverse events, all found a dose-response.
Four studies reported adverse events; of those, three found a dose-response, with one that reported an odds ratio of 30% or more decrease in estimated glomerular filtration rate
“Because this literature review was based on long-term observational data, there are many potential biases that could influence the results, so it cannot be called ‘hard’ data at all,”
Clinicians should ask themselves whether a patient needs medication in the first place
First they should assess if paracetamol is needed for a given patient. It might not add much to people also taking other pain killers such as [nonsteroidal anti-inflammatory drugs] or opioids
Second, they should ask their patients about all their pain killers, including over-the-counter pills, to get a complete picture of analgesic use
Thirdly, they should be conscious that people using moderate to high doses of paracetamol over long periods of time may be more prone to certain side effects that they need to look out for,”
[T]here is a massive need for pain control with ageing communities, increased levels of back pain and osteoarthritic joint pain, and lots of people can’t tolerate aspirin and ibuprofen,”
He also noted that it is worth reassessing every so often whether the drug is still helping the patient. “That might mean stopping it for a couple of days and seeing if it makes much difference to their pain.
. A recent study in Lancet suggested paracetamol wasn’t effective for treating acute lower back pain, although its safety was good over the 4-week period of that study,”