Table of Content

• What is paracetamol?

• Why does paracetamol get so popular?

• What are the storage conditions for paracetamol?

• When to use paracetamol?

• What is the bioavailability of paracetamol?

• How does paracetamol work?

• Different forms and doses of paracetamol

• Safety advice

• Interactions of paracetamol

• Paracetamol Contraindications or Precautions of paracetamol use

• General uses of Paracetamol

• Effects of paracetamol

• What are the side effects of paracetamol?

• Long term effects of paracetamol

• How are we going to overcome the overdose effects of paracetamol?

• New advances and studies on the effects of paracetamol

• Take home points

• FAQ for paracetamol uses and side effects

Introduction

• Acetaminophen, also known as paracetamol, is used as an analgesic and antipyretic. Acetaminophen is formed from the degradation of acetanilide and phenacetin.

• Paracetamol is used in reducing body temperature by its thermoregulatory action on the brain. By raising the pain threshold of the body, paracetamol helps us to relieve pain. 

• Paracetamol inhibits the chemicals like prostaglandins in the central nervous system but fails to exhibit an anti-inflammatory effect in the peripheral nervous system. Paracetamol does not have any sedative action. So, paracetamol is a non-steroidal anti-inflammatory drug.

• The effects of paracetamol depend on the dose administered. Even the lowest dose can help to reduce body temperature, acute migraine headaches.

In this blog, we are going to learn more about- paracetamol uses and side effects.

What is paracetamol?

• Paracetamol is the common name of acetaminophen. Acetaminophen is a derivative of p-aminophenol that is widely known for its analgesic and antipyretic property.

• Paracetamol is a non-prescription medicine or over-the-counter drug that helps to relieve pain and fever. 

• Paracetamol is also found in combination with other over-the-counter medications such as sleep medications, cold medications, pain killers, allergy medications, and other drugs. 

• Paracetamol use in lower doses - provides the best therapeutic effect in the reduction of fever, cold and flu symptoms, pains but when taken in high doses paracetamol uses can lead to toxicity effects. 

Why does paracetamol get so popular?

The first question I got in mind while writing this blog is, why is paracetamol so popular? Why is it a solution for every problem? You got a fever, you take paracetamol; you got cold, you take paracetamol, for the pain you take paracetamol. Recently due to covid occurrence paracetamol has become a perfect go-to medicine for any causative symptom.

Paracetamol has become like a monarch - one solution for many problems. But, why? Here it is the most awaited answer-

• Paracetamol is used so widely for its safety and efficacy. 

• With fewer paracetamol side effects, many doses and dosage forms serve every purpose.

• Paracetamol is made available in syrups, tablets, injections to suit each age group.

• Cheap and easily available as an over-the-counter drug without a prescription.

• Can be even purchased from the general stores.

Now let’s know about the perfect storage conditions for paracetamol uses:

What are the storage conditions for paracetamol?

To avoid the cause of side effects of paracetamol you should follow the below storage practice:

• Always store the paracetamol under 25oC in a dry place. Keep away from sunlight. These storage conditions are for tablet forms.

• For liquids, store them at room temperature in the same amber glass container. 

• Close the lid tightly to avoid exposure to air and for better paracetamol uses.

• Never store at lower temperatures and in the fridge.

When to use paracetamol?

For efficient use of paracetamol take paracetamol after food, avoid taking it on an empty stomach even though it is ok. Taking paracetamol on an empty stomach may cause gastric irritation or may reduce the effects of paracetamol uses due to decreased bioavailability. 

What is the bioavailability of paracetamol?

The bioavailability of paracetamol is dose-dependent. Paracetamol is metabolized in the liver and excreted in the urine. 2-5% of the paracetamol is eliminated without any change. 25-35% of the drug is converted to sulfonic molecules. 

And the next pathway involves 1-2% of paracetamol which contributes to paracetamol uses and answers the question -

How does paracetamol work?

The most important minor pathway converts the paracetamol into p-aminophenol. 1-2% of paracetamol is converted to this form and is then moved to the barn and metabolized to AM404 by fatty acid amide hydrolase. This AM404 is responsible for the analgesic action of paracetamol.

Different forms and doses of paracetamol

Paracetamol is available in different forms like:

• tablets

• syrup

• suppository

and different doses ranging from 250 mg to 1000 mg based on the need and requirement.

As mentioned above there are different forms and doses for infants, children, and adults.

The requirement of the paracetamol dose varies depending on age, weight, and disease condition. So, it becomes important to understand the dosage forms and requirements before paracetamol use.

Here are some dosage forms and doses for paracetamol use in infants, children, and adults.

Paracetamol dose for infants and children under 3 years

• Infants are prescribed with the solution form of a drug like syrup or suspension.

• You can give paracetamol syrup to babies from 2 months. Instead of syrup, you can also use paracetamol suppositories for babies from 2 months of age. 

• Paracetamol use is restricted in babies under 2 months unless it is prescribed. 

• Mostly injection form is preferred over syrup for babies up to 3 months of age.

• An amount of 1.25ml to 3.75 ml is given per dose, without exceeding 4 doses in 24 hrs.

Paracetamol dose for children above 3 years and 12 years below

• You are allowed to give tablets, syrups, or suppositories to this age group of kids.

• You can get these medications without a prescription at any medical store.

• If you are not sure of your child’s condition or dosage you can ask for a doctor’s advice. 

• The junior syrup is available for children under 6 years of age. The syrup contains 120mg of paracetamol in 5ml of solution and for children above 6 years, the dose is doubled i.e., 250mg per 5ml. 

• If your child refuses to take syrups, you can try giving a tablet directly or diluting it in the water (use a half tablet of 250mg dose). The dilution does not change the uses of paracetamol or cause any side effects of paracetamol.

• Maintain a gap of 4 to 6hrs between each paracetamol use without more than 4 doses a day.

Paracetamol dose for children under 16 years

The paracetamol tablet dose ranges from 250mg to 750 mg. You can break the tablets in an emergency to give a smaller dose. 

Depending on the severity of symptoms and disease condition you can give up to 4 doses to obtain relief. Be cautious about overdosing on the drug unnecessarily.

Paracetamol dose for adults above 18 years

The usual dose of 500mg can be taken every 4 to 6 hrs as required. For effective use of paracetamol take immediately after you experience pain or fever. 

You can use paracetamol up to 4000mg only, do not take more than 4000mg as it may lead to toxicity or overdose leading to side effects of paracetamol.

Consult a physician if symptoms persist.

Safety advice

• If your child took an extra dose of medication unintentionally wait for 24hrs to give the next dose.

• Consult a physician if your child accidentally took more than two doses of medicine.

• Never self-inject the I.V without doctors’ supervision.

• Avoid giving the liquid medication without measurement.

• Consider visiting a doctor if you are taking other medicines for other disease conditions like epilepsy.

For the best and most effective use of paracetamol practice the above advice.

Interactions of paracetamol

Using paracetamol with other medicines and food can cause drug interactions. So, it is advised to look for the interactions of paracetamol to avoid the side effects of paracetamol.

Here below are the interactions of paracetamol that cause paracetamol side effects:

Effects of paracetamol in Food interactions

• Paracetamol use interacts with alcohol and worsens liver issues.

• Consumption of paracetamol with tea, coffee, milk, or any other beverages is prohibited as it causes paracetamol side effects.

Effects of paracetamol in Drug interactions

• The paracetamol is increased or the bioavailability of the paracetamol is enhanced by the interaction of prokinetic agents like metoclopramide (a drug that prevents nausea and vomiting).

• The availability of paracetamol is decreased by the drugs like propantheline and morphine leading to a decrease in paracetamol uses in the body.

• Ranitidine, cisapride, and nizatidine are all these drugs that decrease the bioavailability of paracetamol in the body.

• Paracetamol use increases ethinylestradiol plasma concentrations during the therapy.

• Avoid taking paracetamol along with warfarin as it may increase the anticoagulant effect of warfarin.

Paracetamol use will lead to some drug-drug interactions in combination with other drugs during postpartum. The paracetamol use causes interactions that have uses and adverse effects of paracetamol. These are as follows

Paracetamol uses in combination with other drugs

Paracetamol use in combination with opioids, ibuprofen and dipyrone causes the following benefits in postpartum: 

Paracetamol use helps in the prevention of following harmful effects of postoperative pain which include:

• Increased risk of atelectasis (Collapsed lung) and pneumonia

• Increased risk of deep venous thrombosis

• Delay in feeding outset

• Psychological sequels

• Affect the interaction of mother-fetus connection

Side effects of paracetamol in combination with other drugs

In combination with opioids, ibuprofen and dipyrone paracetamol causes adverse effects in postpartum: 

• Behavioral problems to mother

• Neurodevelopment fetal problems

• Interferes in sexual, thyroid hormones, metabolism

Effects of paracetamol in Disease interactions:

• The paracetamol tablet interacts with the liver functions of chronic alcohol patients leading to liver damage. 

• Use of paracetamol interrupts lung function when taken during asthma.

• Use of paracetamol causes adverse effects by intrusion if given during kidney, pancreatitis, heart issues, and IBD (Inflammatory bowel disease).

Effects of paracetamol in lab tests:

• The paracetamol gives a positive result in the 5-HIAA (5-Hydroxyindoleacetic acid) urine test. 

• So, you have to inform your doctor about the prescribed medicines like paracetamol tablets before you get tested.

Paracetamol Contraindications or Precautions of paracetamol use

Avoid paracetamol use during the following situations to minimize the paracetamol side effects.

• Liver failure/Liver cirrhosis

Patients with liver damage should inform the doctor about the condition and the prescribed medicines to prevent further occurrence of paracetamol side effects caused by paracetamol use.

• Alcohol consumption

To avoid the adverse effects of paracetamol use do not take alcohol. Paracetamol use can also be fatal when taken along with alcohol.

• Pregnant Women

Pregnant women should take paracetamol under the supervision of a physician. 

• During Breastfeeding/lactation

The use of paracetamol does not affect the baby if you are breastfeeding. The paracetamol composition does not pass-through breastmilk so it is ok to use paracetamol on the advice of a physician.

• Kidney failure

All patients with kidney impairment should give detailed information on the prescribed medicines to the doctor to avoid the damage caused by the paracetamol side effects.

• Hypersensitivity

Do not take paracetamol when you have any allergies to paracetamol or drugs in combination with it.

Check with the doctor if you experience any of the above adverse effects or side effects for paracetamol for more than a day.

General uses of Paracetamol

Paracetamol uses as antipyretic

Paracetamol is generally used as an antipyretic by most of us. The antipyretic effect of paracetamol helps to reduce body temperature during an illness.

• Paracetamol uses in fever

We can use paracetamol to regulate body temperature during fever, flu, colds, chills, or any fever symptom associated with other diseases.

A retrospective study of paracetamol found that the enteral paracetamol helps in reducing the body temperature by 0.3oC which occurred due to systemic inflammatory response syndrome.

The effect of intravenous paracetamol use in temperature reduction during traumatic brain-injured patients is still under study.

Fever caused due to vaccination can also be treated with paracetamol use. Vaccination causes fever, swelling, and pain at the site of injection which can be treated with 2 or 3 doses of paracetamol a day.

Paracetamol uses as analgesic

Paracetamol is proven analgesia for its strong effect on pain relief. Paracetamol uses as analgesia are vast, paracetamol helps to reduce mild to moderate pains, and here below is the list of paracetamol effects on different kinds of pains.

Paracetamol uses on body pains

Paracetamol is used to relieve body aches and pains caused due to sprains, flu and dysmenorrhea. Paracetamol is used to treat headaches, toothaches, period pains, muscle and joint pains.

• Paracetamol use on headache

Headaches are caused due to stress, anxiety and disease symptoms associated with cold, migraine, or flu. Headache can be treated with some rest, medications, coffee, relaxation exercises, or meditation. 

Paracetamol use is the first line of choice for the treatment of headaches in teens and adults. 

• Paracetamol use on toothache

Toothache can be due to injury, illness, or caused by food. It may include swelling, pain, and redness around the tooth. 

Paracetamol use helps to reduce pain in the initial stages. You can visit a doctor to know the cause and if the pain is more or worse even after paracetamol use. Paracetamol cannot treat severe cases of toothache.

• Paracetamol use in muscle pain

Muscle pains are due to nutritional deficit, sprains, and strains, infections, diseases, dehydration, sleep deficiencies, or too much physical activity. 

Physical rest, ice pack treatment, warm Epsom salt bath, and medication can help to treat muscle pains. 

Paracetamol is known for its analgesic activity in reducing pain caused to muscle.

Paracetamol in combination with other drugs will help you cure if you have high-intensity pain.

• Paracetamol uses in period pain

Paracetamol is useful for reducing muscle cramps and period pains. Menstrual pain is common in women before, during, and after the periods. Period pain may include mild low back pain, leg pains, abdominal pain, and cramping pain.

Paracetamol use helps to relieve you from all these pains.

• Paracetamol uses on joint pains

Joint pains cause damage to the knees and may lead to injury if not treated well. Paracetamol can be used to relieve discomfort in joints and to reduce pain.

Osteoarthritis in the knee and hip can lead to physical disability and death in severe conditions. Paracetamol is used in milder cases of osteoarthritis and as an emergency pain killer. 

Despite its low efficacy in such conditions, paracetamol is preferred over other drugs due to its relative safety and tolerance.

Paracetamol uses in inflammation

Inflammation is caused due to the response of WBC against the toxins, infections, and injuries in the attempt of healing. 

Paracetamol is a very less effective anti-inflammatory drug, but the side effects of paracetamol are often less compared to NSAIDs.

It is good to try paracetamol before consuming NSAIDs for inflammation reduction. If you have a higher risk of inflammation consult a doctor for better treatment and medication. 

Paracetamol uses in neurological injury

Acute brain injury is usually associated with an increase in body temperature. Neurological conditions like stroke and traumatic brain injury will cause fever, which leads to adverse outcomes that can include mortality, hospitalization due to increased stroke index.

Effects of paracetamol on fever during such conditions may reduce body temperature, but can cause hypotension (decreased blood pressure).

Studies are conducted on the effects of paracetamol in Neuro-Intensive Care Unit (NICU) patients suffering from fever. The studies showed effective results in the reduction of body temperatures but onset hypotension as a paracetamol side effect. 

To reduce these adverse effects of paracetamol we should monitor the hypotension episodes and treat them to prevent further brain damage.

• Paracetamol uses in sepsis

Sepsis is a fatal condition where your body shows excessive reaction to damage caused by infections (1st stage). The immune system starts fighting leading to increased body temperatures and poor organ function (2nd stage). This may sometimes follow to the 3rd stage i.e., septic shock.

Hypothermia is a more common sign of sepsis than hyperthermia. When administered with paracetamol, the body temperature is controlled.

However, studies on paracetamol use, to decrease the body temperature during sepsis have not shown any significant effect. With or without paracetamol use the sepsis caused death in ICU patients in case of febrile infection.

So, it is better to avoid paracetamol during febrile fevers even though it helps to reduce body temperature.

Apart from the paracetamol uses that are expected, some unexpected effects of paracetamol are found through investigation. Have a look about those new paracetamol effects: 

Effects of paracetamol

Paracetamol has uses beyond fever and pain that can affect various aspects in the body. Some of the effects of paracetamol are mentioned below:

Effects of paracetamol on blood glucose levels

Paracetamol’s effects on the body include the decrease of glucose levels in the blood. When taken in low doses acetaminophen can help to reduce blood glucose levels.

Paracetamol use helps in the maintenance of pancreatic insulin synthesis. Paracetamol acts by reducing the hyperglycaemic conditions of the blood. Along with glucose control, paracetamol is also useful for the restoration of fasting insulin levels, and improves glucose tolerance.

The use of paracetamol is believed to improve pancreatic insulin synthesis or secretion at the early stages of diabetics or prediabetics, however further studies are required to know the precise mechanism behind paracetamol effects.

Effects of paracetamol on skeletal muscle

Studies have found that paracetamol use helps to increase muscle metabolism (increases muscle protein synthesis, a mechanism through which new protein is added to muscle). 

The study reports that there is a substantial intramuscular change, enhancing the metabolic response to resistance exercise promoting the body to add new muscle protein.

Paracetamol use can decrease aging of myocyte and myocyte apoptosis, increase myocyte size by reducing oxidative and nitrosative stress.

Effects of paracetamol on heart

Paracetamol has exhibited cardioprotective action by showing the antioxidant property. A study on the cardioprotective action of paracetamol has found the following facts:

For the proper systolic and diastolic phases of the cardiac cycle, we need cardiac functional and structural proteins. The Troponin complex (cardiac protein) has a physiological role in a healthy heart and helps in the diagnosis of myocardial infarction. 

Matrix metalloproteinases (MMP) damage this troponin complex and disrupt its physiological activity. Paracetamol use helps to inhibit the damage and protects the cardiac muscles. Also, the paracetamol kept the cardiac striations and mitochondria healthier during ischemia (heart stroke).

Effects of paracetamol on nervous system

Another experiment was done on the study of the effects of paracetamol on the brain.

Anesthetized rats were blocked in both carotid arteries and bled in both femoral arteries exposing them to oxidative stress. This was done in both the presence and absence of paracetamol. After that, the shed blood was reperfused (reoxygenation) for 120 min and the brain is separated to test the efficacy of paracetamol. 

The outcomes with paracetamol use exhibited a reduction in cerebral apoptosis (neural cell death), cerebral infarctions (brain stroke), and risk of brain damage.

The study found that paracetamol use helps to protect the neurons from inflammation and oxygen stress preventing neuronal death.

Effects of paracetamol on ovarian cancer

A study was conducted by Athens University on 4,405 women about the effects of paracetamol on ovarian cancer. The results predicted that regular use of paracetamol has reduced the risk of cancer by 30 percent. 

The benefits are estimated to be due to i) induction of reproductive atrophy because of similar sex-steroid phenolic structure ii) inhibition of macrophage migration inhibitory factor reduction of glutathione pools.

The risks caused by long-term use may overweigh the beneficial effects of paracetamol in ovarian cancer.

Effects of paracetamol on infections

Infections are mostly due to the invasion of a foreign particle or chemical substance into our body. Studies were conducted on the effects of paracetamol on different infections and here are the results below:

Effects of paracetamol on viral infections

Flu and cold are the most common viral infections we experience. Recently the pandemic introduced us to a new viral infection i.e., coronavirus. The flu is caused by the influenza virus and cold is caused by a group of rhinoviruses. Both these are associated with fever, pain, weakness, and difficulty in breathing. And acetaminophen is the one drug that we all trust to provide relief during these conditions. 

But does paracetamol cure the viral infection? 

New Zealand researchers have done a study to find this and the results showed a different fact.

A double-blind, randomized controlled trial was conducted on the effects of paracetamol. The study was done on children suffering from viral fever and has found that paracetamol has not shown any significant difference when given alone. With the manual antipyresis along with paracetamol, the fever reduction is rapid. 

Paracetamol is not designed to cure viral infections; it is intended to decrease the symptoms associated with it like fever or mild pain. For the cure of viral infections, you need antiviral drugs and not paracetamol. 

Effects of paracetamol on bacterial infections

Bacterial infections are caused due to the entry of bacteria into your body. The immune system of your body responds and starts fighting against the bacteria increasing the body temperature. This sometimes may also lead to fatigue and pains due to low body strength.

When you use paracetamol, it helps to decrease these symptoms which you may assume that it cures the bacterial infection. But certainly not, the mechanism required to shut the bacterial multiplication is absent in paracetamol. You will need antibiotics to treat the bacterial infection.

But constant dependency on antibiotics is not good as it may lead to resistance in bacteria. Use paracetamol for relief and let the infection get cured without antibiotics.

Effects of paracetamol on malaria

Paracetamol is used to regulate body temperatures during fever. The use of paracetamol in the treatment of malaria has not shown any significant change. The study of paracetamol’s effects on children suffering from malaria has not found any difference when compared to mechanical antipyresis. However, the paracetamol use increased the parasite clearance time (time required to decline parasite level in blood after treatment) and is believed to be due to a decrease in TNF (a most important factor of the immune system) and oxygen radical production.

Apart from the uses and benefits paracetamol has side effects that can range from normal treatable to fatal toxic effects. The reason for side effects, precautions for safety, and treatment of toxicity are discussed below:

What are the side effects of paracetamol?

At higher doses, the paracetamol forms a quinone metabolite that causes harmful toxicity reactions leading to the side effects of paracetamol.

What are the side effects of paracetamol use in resistant people?

Paracetamol use will lead to paracetamol adverse effects in people who are intolerant to paracetamol.

5 main paracetamol side effects as allergic reactions

Allergic reactions to paracetamol use are mostly due to intolerance or any interactions in the body.

1. Skin rashes

The allergic reaction to paracetamol is rare but can be possible if you are not tolerant to acetaminophen. The reaction causes itching, swelling, rash, and redness to your skin. 

If you have any allergic reactions to paracetamol use stop taking the medicine immediately and consult a doctor.

2. Hives

The medical term for hives is urticaria. The hives will appear as red bumps on the surface of the skin which may burn or sting in severe cases. This can be caused when something you eat or take that is not tolerant like foods or medicine like paracetamol. Stress and exposure to the sun will increase skin rash.

3. Swelling

Swelling of the tongue, face, lips, and throat is another allergic reaction caused by the use of paracetamol.

4. Nausea and vomiting

Nausea and vomiting are common side effects of paracetamol that are due to gastrointestinal changes.

5. Difficulty in breathing

Paracetamol use may cause breathing problems and dizziness.

Other side effects of paracetamol

Sometimes, the use of paracetamol may cause any of the below-mentioned symptoms. The adverse effects of paracetamol are:

• Drowsiness

• Abdominal pain

• Yellow eyes or skin

• Dark clay-colored stools

• Diarrhea

• Bloody and cloudy urine

• Stomach discomfort

Long term effects of paracetamol

Long-term use of any drug in medicine will have its contribution in the cause of toxicity and overdose. Toxicity is the effect of paracetamol caused due to overdose. Overdose is the intake of excessive amounts of paracetamol accidentally or intentionally during administration.

Long term side effects for paracetamol in Hematology

Hematology is the study of blood and blood disorders. Paracetamol absorption into the blood causes some disorders in long-term use. Some of them are described below:

• Anemia (less RBC)

• Leukopenia (decreased white blood cells)

• Thrombocytopenia (decreased platelet count)

• Neutropenia (destruction of neutrophils)

• Pancytopenia (decrease in all blood cells)

Long term side effects for paracetamol in platelet aggregation

Paracetamol dose-dependently inhibits platelet aggregation by the influence of arachidonic acid, ADP, or epinephrine. The platelet aggregation will help to stop bleeding, so paracetamol may cause a risk of bleeding when given during surgeries.

Side effects of paracetamol impair the function of platelets at all doses when triggered by arachidonic acid.

Long term side effects of paracetamol on Liver

Liver necrosis and toxicity can cause liver damage or death. Paracetamol can cause liver toxicity due to the release of quinone metabolite.

Hepatotoxicity/ hepatitis

There is a connection between paracetamol side effects and hepatotoxicity. The people with liver failure when administered with paracetamol, the side effects of paracetamol cause worsening of the situation. 

Alcohol consumption may further lead to liver damage and fatal conditions. Febrile illness, nutritional deficiency are other concerns in hepatotoxicity due to paracetamol use.

Long term side effects for paracetamol on heart

The long term use of paracetamol will lead to fluctuations in the blood pressure and cause heart diseases.

Cardiovascular diseases

Paracetamol use was found to cause an increase in blood pressure (hypertension) when used in higher doses or regularly. 

It is observed there is an increase in the systolic and diastolic ambulatory B.P. The increase in B.P will lead to an increased risk of cardiovascular diseases.

The paracetamol when taken more frequently will cause the high occurrence of vascular events.

Long term side effects for paracetamol on respiratory system

Paracetamol use can affect your respiratory system when used on a long term. Paracetamol use will cause complications in asthma.

Asthma

Due to increased B.P, there has been an indication of common symptoms that contribute to asthma in asthmatic patients- like recurrent symptomatic respiratory infections, glutathione depletion, febrile illness, atopic disease.

Paracetamol adverse effects cause an imbalance in lipoxygenase activity resulting in increased leukotriene and decreased PGE2 production.

The evidence may be not clear but it is not safe to give paracetamol when you are facing asthma or asthmatic problems.

Long term side effects for paracetamol on the gastrointestinal system

The use of paracetamol effects on the gastrointestinal tract is the focused concern as it may cause the following disorder.

GI bleeding

One of the serious side effects of paracetamol use is GI bleeding. Paracetamol use for longer periods will cause a potential risk of GI bleeding. When taken more than 2 -3 gms of paracetamol a day, will cause ulcers in the layers of the stomach due to acidity. 

When you take these doses regularly, the paracetamol adverse effects will increase.

Long term side effects for paracetamol on renal system

The generation of quinone metabolite from paracetamol is believed to be the reason for the renal effects. Even the administration of acetylcysteine does not control the adverse effects of paracetamol indicating that quinone is not the only cause of renal failure.

Long term side effects for paracetamol on nervous system

Nervous system is the main site of action for paracetamol. Use of paracetamol for long term effects the nervous system leading to brain injury and damage. Some of the paracetamol adverse effects are-

• Paracetamol effects in seizures:

Seizures are the result of a high dose of paracetamol in cases of febrile fever. Paracetamol is ineffective in decreasing seizures.

• Paracetamol effects in coma

Overdoses of paracetamol can also cause coma and death due to decreased blood pressure and breathing inability.

How are we going to overcome the overdose effects of paracetamol?

Fortunately, paracetamol overdose can be treated with medicines and by taking some precautions to prevent the side effects of paracetamol.

Treatment of overdose of paracetamol use

The medical care for an overdose of paracetamol depends on the dose, dosage form, frequency, age, and disease condition.

If you visit the nearest clinic, you are given basic emergency treatment to prevent paracetamol adverse effects. 

• Before that, the doctors perform a blood test along with physical and psychological observation.

• You will be given an antidote like activated charcoal, to remove the drug from the body.

• Acetylcysteine is the first choice of antidote given during the paracetamol overdose. An antidote within 12 hrs will be very effective.

• If required you will be asked to admit to the hospital for further observation of the paracetamol adverse effects.

 What would be the self-care if you are away from a physician?

It is important to be aware of self-care during such emergency conditions to prevent further damage to the body.

• Connect to a doctor or health care professional and ask for advice.

• Follow the instructions of the doctor.

• Drink plenty of water to dilute the drug dose.

Prevention of overdose to inhibit the paracetamol side effects

The precautions to be followed to prevent the overdose of paracetamol and its side effects are:

• Never take any medicine before reading the label.

• Always read the prescription for the administration of the prescribed dose.

• If you miss a dose, never take it if it is almost time for the next dose.

• Do not self-medicate without a doctor’s prescription.

• Never use an expired medicine or medicine without expiry on it.

• Always purchase medicine with an expiry label.

• Keep the medicines away from children in a safe lock.

• Store the medicine at the temperature as labeled.

• Beware of the interactions when taking two medicines.

New advances and studies on the effects of paracetamol

Studies on the paracetamol adverse effects have been going on to determine its safety and efficacy. Some of the recent advances and the results are given below:

Metabolic and electrolyte

Long-term use of paracetamol may cause changes in the metabolism and changes the electrolyte composition in the body.

Paracetamol adverse effects include-

• Hyperammonemia

• Hyperchloremia

• Hyperuricemia

• Decreased serum bicarbonate

• Decreased concentration of sodium and calcium

• Increased serum glucose 

• Increased bilirubin and alkaline phosphatase

Carcinogenesis

Paracetamol use has shown carcinogenic action in female rats with a high incidence of mononuclear cell leukemia at 0.8 times higher doses than human doses. But there are no adverse effects of paracetamol in the female rats, the study was unclear so needs further investigation.

Mutagenesis

In some studies, paracetamol use has shown mutagenic effects disrupting the chromosomes and bacterial reverse mutation when administered with a high dose. The clinical relevance is unknown in humans but paracetamol can exhibit mutagenic effects at overdose.

Pregnancy

Administration of paracetamol during pregnancy will cause some of the following disorders:

• Neurodevelopmental effects

• Asthma

• Endocrine and reproductive toxicity

• Effects on serum concentrations

Even though it is said that paracetamol does not cross the placenta there are side effects for paracetamol in the embryo-fetal and neonates. When exposed to paracetamol effects for more than 2 weeks during the 2nd trimester, it causes reproductive toxicity like cryptorchidism.

All these effects of paracetamol are dependent on dose, duration of exposure, and trimester exposure. 

The studies performed still need more evidence to understand the actual mechanism and reason behind the cause. What’s more convincing is the GI bleeding and blood pressure as they are evident in many cases.

When taken in small doses and symptomatic base the adverse effects of paracetamol are very less and have shown good therapeutic benefit.

Take home points

• Paracetamol use in low doses helps to relieve pain and reduce the fever with no paracetamol adverse effects.

• Daily use of paracetamol will cause toxicity of liver and kidney leading to death.

• Always follow the prescribed dose and treat the overdose immediately.

• Do not use paracetamol for febrile seizures.

• Avoid alcohol consumption during paracetamol use.

References

• NCBI

• NCBI

• NCBI

• Paracetamol in critical illness