For years, it has been hailed as a reliable painkiller, but now the most popular analgesic is under review.
Acetaminophen, known as paracetamol in many parts of the world, has been a go-to pain reliever for decades. With its origins dating back to 1878 when H. N. Morse first prepared it, this versatile analgesic has become a staple in medicine cabinets worldwide. While it gained popularity and was eventually marketed as Triagesic in 1950, it is commonly recognized today by its trade names Tylenol and Panadol, though it is also widely available as a generic drug.
Despite its widespread use, the exact mechanism of action of acetaminophen/paracetamol remains a mystery. Numerous studies have been conducted to understand its effectiveness as a pain reliever, but its mode of action continues to elude scientists. Although theories emerged in the 1970s and later in the 2000s, neither of them stood up to rigorous scrutiny. This knowledge gap is particularly significant due to the well-known liver toxicity associated with acetaminophen, making it crucial to comprehend how it operates within the body.
In an enlightening article published in The Conversation, Kelly Grindrod, Associate Professor at the University of Waterloo School of Pharmacy, Eric Yoshida, Professor of Medicine at the University of British Columbia, and Trana Hussaini, Clinical Associate Professor at the University of British Columbia School of Pharmaceutical Sciences, shed light on the potential dangers of paracetamol abuse. They provide compelling evidence that misuse and overuse of this commonly used pain reliever can lead to severe liver damage, posing a serious threat to human life.
Understanding the intricacies of acetaminophen/paracetamol and its impact on liver health is crucial in ensuring the safe and effective use of this widely accessible medication.
People often make a common mistake when they combine over-the-counter and/or prescription drugs containing acetaminophen. In a survey conducted in 2020, they discovered that over half of the respondents were unaware that extra strength products contain up to twice the amount of acetaminophen compared to regular strength ones.
Recently, the shortage of children’s pain and fever products has raised concerns about the potential for accidental overdose in children. Some parents and guardians have resorted to using adult products for their children, posing a significant risk.
This risk is particularly heightened for individuals who regularly consume three or more alcoholic drinks per day, as well as those who are malnourished or fasting. For them, even normal doses of acetaminophen can lead to an overdose. (For example, the maximum recommended 24-hour dose for adults is up to 4,000 milligrams, and it is lower for children).
Understanding the Primary Cause of Acute Liver Failure
When it comes to acetaminophen usage, lower doses are generally considered safe for the liver, as the organ efficiently breaks it down and eliminates it through urine. However, the liver has its limits when it comes to processing acetaminophen.
Exceeding the recommended dosage within a 24-hour period overwhelms the liver’s capacity to metabolize the drug effectively. Consequently, the surplus acetaminophen bypasses the usual breakdown pathway and enters an alternate route within the liver, leading to the production of a toxic byproduct. The toxicity levels escalate with the amount of acetaminophen taken in a single instance.
During the initial 24 hours following an overdose, symptoms may be relatively mild, including nausea and vomiting, or some individuals may not experience any symptoms at all.
After one to two days, liver damage sets in, accompanied by symptoms such as abdominal pain, dark-colored urine, and the development of yellowing of the eyes and skin. As time progresses to three days, severe symptoms such as bleeding, bruising, confusion, and low blood sugar emerge, signaling liver failure, which can be fatal.
Although the liver possesses the ability to self-heal, approximately six percent of individuals hospitalized due to acetaminophen overdose experience liver failure.
Urgent and timely treatment is of utmost importance. An antidote called N-acetylcysteine, administered intravenously, is available and proves most effective when given within 24 hours of the overdose. In certain cases, a liver transplant may be necessary, particularly if treatment is delayed, but unfortunately, many individuals succumb while awaiting a suitable liver donor or as a result of complications post-transplantation.
Safely Utilizing Paracetamol: Best Practices for Pain Relief
Considering that acetaminophen remains a widely-used medication for pain and fever management, it is crucial for individuals to adopt precautionary measures to minimize the risk of liver damage.
To begin with, it is imperative to carefully read all medication labels. Refrain from consuming multiple products containing acetaminophen simultaneously. Exercise caution when using medications for conditions such as arthritis, cold and flu, sleep disorders, menstrual pain, and back pain. Don’t hesitate to seek assistance from a pharmacist if needed.
Always check the packaging of acetaminophen for the recommended maximum single dose and the 24-hour dose limit. If you ingest your first dose of acetaminophen at noon, ensure that the 24-hour period concludes at noon the following day. Adjust the dosage if you regularly consume three or more alcoholic beverages per day or encounter difficulties with regular eating patterns, such as in the case of an eating disorder, frailty in older age, or during episodes of nausea or vomiting.
When purchasing acetaminophen for common ailments like headaches or arthritis pain, opt for the regular strength variant. Extra strength products elevate the risk of unintentional overdose.
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