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Paracetamol: patients need to be more aware of the harms

In France, 20% of patients seem to be unaware that paracetamol is toxic at high doses, especially to the liver, and around 30% are unaware that alcohol aggravates this toxicity.

Paracetamol is the first-choice analgesic drug for mild to moderate pain. Its adverse effects are mainly related to overdoses that expose people to severe liver damage and kidney failure. It is marketed alone or in combination with other substances under numerous trade names. This exposes the patient to unknowingly taking several drugs containing paracetamol, especially when the trade name distracts attention from the composition of the drug, as in the case of "umbrella" product lines.

A study on the general public’s knowledge of paracetamol was conducted among 819 patients in France in 2015-16. It emerged that fewer than one in five patients had sufficient overall knowledge of paracetamol. Only one in seven patients knew the hepatic risk of paracetamol, while 37% of patients did not make the link between an overdose and serious and irreversible health consequences; 34% did not know that alcohol increased paracetamol’s hepatic toxicity.

About 20% of patients gave answers that showed that they were not immune from involuntary overdose due to their lack of knowledge of paracetamol’s toxicity at high doses. 

Patients should be well informed of the hepatic toxicity of paracetamol and the importance of not exceeding the dose, and of abiding by the intervals between doses: in general, in adults and children over 50 kg, the dosage is 500 mg to 1 gramme per dose, every 4 to 6 hours, not to exceed 4 grammes per 24 hours. In some patients, particularly in cases of liver damage, heavy alcohol consumption or malnutrition, the maximum dose of paracetamol should not exceed 3 grammes per day in an adult.

©Prescrire 1 October 2019

"Paracetamol: patients are not sufficiently aware of the harms" Prescrire Int 2019; 28 (208): 249-250. (Pdf, subscribers only).

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