by Dr Deborah Lee, Dr Fox Online Pharmacy
https://pixabay.com/photos/pill-medication-drug-paracetamol-4159141/
At this time of year with so many colds, flu and COVID, we are all reaching for the paracetamol.
It’s a salient point that 227 people die every year in the UK, from overdosing on paracetamol.
Around 100,000 people visit A&E every year after taking too much paracetamol. A sizeable proportion of these are people who did not realise they had taken more than the recommended dose.
The paracetamol problem
Paracetamol is a common ingredient in many cold and flu remedies. If you don’t know what you are taking and take paracetamol at the same time, it’s easy to exceed the maximum dose. You only need to take a few extra tablets to cause serious harm.
How to take paracetamol safely
The adult dose is 2 x 500 mg tablets, 4 times a day – maximum 8 in 24 hours. These should be taken 4-6 hours apart. Babies and children have specific dosing regimes. Always read the package insert and the label, and measure this out carefully using a proper medicine spoon or the designated syringe.
Which cold and flu remedies contain paracetamol?
Never take flu and cold remedies at the same time as paracetamol. Even taking just a small extra amount can be serious.
Commonly used cold and flu remedies or migraine tablets that contain paracetamol include Beecham’s cold and flu remedies, Benilyn products, Boots decongestant remedies, Lemsip, Migraleve, Night Nurse, Solpadol, and Sudafed preparations.
This list is not exhaustive. You can find a full list at https://www.medicines.org.uk/. If you are unsure always ask your pharmacist, or GP.
Why is paracetamol harmful?
Taken correctly paracetamol is a safe drug which can be taken for years without any issues.
However, paracetamol is broken down in the liver to a toxic chemical called n-acetyl-p-benzoquinone imine, or NAPQI. This is then detoxified by glutathione – a peptide which has an integral role in liver detoxification processes.
When too much paracetamol has been taken, the stores of glutathione are quickly used up, leaving the liver susceptible to the toxic effects of NAPQI. This results in liver failure and death. Symptoms usually occur within a few days of the overdose and death occurs 4 – 18 days later.
Liver failure causes jaundice, confusion, nausea and vomiting. Kidney failure and pancreatitis may follow. Treatment of a paracetamol overdose is with N-acetyl cysteine, but in severe cases, the only possible option is a liver transplant.
Who is at risk of a paracetamol overdose?
Sometimes people take too much paracetamol deliberately as a deliberate attempt at suicide. But other cases of paracetamol overdose can occur in those who weigh less than 50 kg, those taking enzyme-inducing drugs, and those who take it along with proprietary cold and flu medicines as explained above. Those with low body weight often have low stores of glutathione. Enzyme-inducing drugs include carbamazepine, phenytoin, rifabutin, ketoconazole and griseofulvin, for example.
More tips on how to take paracetamol
Paracetamol is a good option for pain relief for mild to moderate pain and to help bring down a fever.
Adults can take ibuprofen at the same time as paracetamol but there are special recommendations about ibuprofen for children. Always check with your GP or pharmacist before giving ibuprofen or any other non-steroidal anti-inflammatory (NSAID) to babies or children. Aspirin is not permitted for children under age 16.
Paracetamol is suitable for pregnant and breastfeeding women.
It is not likely to be appropriate for anyone who weighs less than 50 Kg, is malnourished, or has chronic liver or kidney disease.
What to do if you have taken too many paracetamol
If you have taken more than 8 x 500 mg paracetamol tablets in 24 hours (4g), get help immediately – don’t delay.
- Go to A&E immediately – advises the British Liver Trust.
- Depending on how many you have taken, if you are unsure and feel well, you could start by phoning NHS 111.
The level of paracetamol in your blood will be tested. If elevated, they will offer you appropriate treatment which will include activated charcoal and/or N-acetyl cysteine given intravenously as a drip.
The sooner you are properly assessed the more likely this will have a good outcome.
Final thoughts
Paracetamol is a safe effective drug if taken correctly. Don’t risk your health by not following the instructions with care. Never mix taking paracetamol with cold and flu medicines. Stay safe this winter.
For more information
- NHS – Paracetamol
