Paracetamol

Overview

Paracetamol (also known as acetaminophen) is a widely used analgesic (pain reliever) and antipyretic (fever reducer). It belongs to the class of miscellaneous analgesics/antipyretics and is available over-the-counter in many forms, including tablets, capsules, liquids, and suppositories.

How Paracetamol works

Although not fully understood, paracetamol is thought to work mainly in the brain by inhibiting cyclooxygenase (COX) enzymes, particularly COX-2. This reduces the production of prostaglandins, chemicals that promote pain and fever. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), it has little effect on inflammation because it doesn’t act in the rest of the body. It may also influence serotonin pathways to enhance pain relief.

Uses

• Relief of mild to moderate pain such as headache, toothache, menstrual cramps, backache, muscle aches, and sore throat
• Reduction of fever
• Management of osteoarthritis pain
• Often used in combination with other analgesics for more severe pain (e.g., with codeine or tramadol)

Side effects

• At recommended doses, side effects are rare but may include nausea, vomiting, or allergic skin reactions like rash
• Serious adverse effects requiring urgent medical attention:
• Liver damage (particularly with overdose; symptoms include abdominal pain, yellowing of skin/eyes, dark urine)
• Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) – seek help if you develop a rash, blisters, or peeling skin
• Blood disorders (e.g., thrombocytopenia, leukopenia) – signs may include unusual bruising or bleeding, sore throat, fever
• Anaphylaxis – difficulty breathing, swelling of face/throat

Precautions

• Do not exceed the recommended dose (usually maximum 4 grams per day for adults; lower for certain individuals). Overdose can cause fatal liver damage.
• Use with caution in patients with liver disease, chronic alcohol use, or malnutrition. Paracetamol is contraindicated in severe hepatic impairment.
• Check other medications for paracetamol content to avoid unintentional overdose (e.g., many cold and flu remedies contain paracetamol).
• Prolonged high-dose use may increase the effect of warfarin and other anticoagulants; monitor INR if taken together regularly.
• Not recommended for children under 2 months of age unless prescribed by a doctor.
• Avoid alcohol while taking paracetamol as it increases the risk of liver damage.