Is paracetamol really safe?
Paracetamol ( called Acetaminophen- in the USA) is the most common medicine for fever or pain used in worldwide. Almost every household has it and almost everyone would have taken it at some point of their life . It is being so commonly used that people take it for granted that it is always safe & they sometimes give indiscriminately.
But remember that Paracetamol is dangerous when given wrongly .Paracetamol poisoning remains the most common cause of accidental & suicidal poisoning . It is the most common cause of acute liver failure the USA & the UK . Paracetamol-induced liver disease among children is common in India also according to a recent study .
After over dose , parents or caregivers may not suspect it all as the child appears normal in the first few hours. The initial symptoms of paracetamol poisoning are nausea , vomiting ,sweating & then pain right upper abdomen. Late symptoms are drowsiness, unresponsiveness, jaundice, bleeding and finally it may result in death.
Causes of Paracetamol poisoning :
Wrong dosing: This is the most common cause . This could be due to mistakes in the type of medication used .Drops have more concentration of paracetamol (100 mg /1 ml). Syrups have 120 mg/5 ml or 240 mg /5ml or 250 mg/5ml or 500 mg /5 ml . Since there are so many preparations and so many companies producing paracetamol , there is high chance of error . Parents often confuse drops with syrup and give the same ml . So if a child needs 2.5 ml sryup of 125/5ml ( total 62.5mg) , if they accidentally give 2.5 ml of drops100 mg/ml ( total 250 mg ), the child would get 4 times the required amount & this easily leads to paracetamol poisoning.
Sometimes pharmacist advises them wrongly .Some times out of their anxiety , they give more frequently to decrease the fever ASAP & reduce the chance of febrile seizures but inadvertently harm the child in the process.
There is difference in the strengths & efficacy of brands also . There are hundreds of brands of paracetamol like Crocin,Calpol,Dolo , Paracip , Fepanil etc. This creates more confusion
Multiple medicines: sometimes dose may be right but the parents may be giving combination drugs which have paracetamol in them and also plain paracetamol simultaneously
Accidental intake: kids may accidentally consume for the taste even when not indicated . So parents must make sure all the medicines are out of reach of children
Coexisting illnesses: pre-existing liver disease or if the patient is on other medications which can cause liver damage, even normal dose of paracetamol can cause problems.
Alcohol intake: in adults , if they consume alcohol , then toxicity of the paracetamol is more. For example , if an adult consumes paracetamol for alcohol induced headache as in a hangover ,then he is at more risk of liver damage.
Suicidal: sometimes adolescents & adults may take it for suicide
The right dosage of Paracetamol :
Children and adolescents <60 kg: 10-15 mg/kg/dose every 6 hours ; not to exceed 15 mg/kg/dose
Adults: 500 mg four times a day for most cases. 650 mg four times a day for slightly higher dose or a bit over weight adults . Max is 1000 mg , four times a day when its really needed - when using under Doctor's advice .Adults cannot take more than 8 tablets of 500 mg or 6 tablets of 650 mg per 24 hours .
No difference in efficacy taken by mouth or inserted in anus ( rectal suppository )
If the fever does not come down with the above dose , do NOT increase the frequency or the dose.
The aim of giving paracetamol is to lower the fever( Eg from 102 to 101 ) , to provide some pain relief and NOT to bring it down to completely normal temperature( Eg 102 to 98 ). Most of the common fevers are viral & are self limiting. Treatment with paracetamol has not been proven conclusively to decrease the incidence of febrile seizures . So there is no point in panicking and give too many doses of paracetamol.
Once fever is controlled , decrease the number of doses . No need to give it like an antibiotic course for 5 days etc . Stop it when not needed . Very simple.
Bottom line : Do NOT take paracetamol lightly . Stick to the dose of paracetamol as advised by the doctor.
Please go through the articles which came out in major newspapers of India . You will realise how dangerous paracetamol can be.
https://www.indiatoday.in/health/story/paracetamol-tablets-excessive-dose-drug-liver-failure-toxicity-2588568-2024-08-27
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