Paracetamol is one of the most used drugs in the world. It serves as an analgesic, anti-inflammatory, antipyretic and even as a placebo. So far, it has been argued that the paracetamol It is an innocuous, low-cost and low-risk analgesic, however, its abusive use or in its proper measure but continuously over time can cause severe liver damagebeing this one of the most common causes of acute liver failure and of organ transplant. This is stated by doctors Aldo Rodrigo Jiménez Vega and Alejandro Yared Meraz Muñoz in the podcast of Medscapethe prestigious space for scientific studies for doctors and health professionals.
In this way, they warn, while in the United States paracetamol is the most frequent clinical manifestation of liver damage induced by chemical products, in Europe they account for more than 60% of cases of liver injury either due to a high or unpredictable dose consumed, regardless of the quantity –the maximum dose per day is three grams in adults and from four it could already produce some toxicity effects–. However, although it must be clarified that in Spain the most frequent liver damage is due to hepatitis viruses (A, B and C), due to genetic liver diseases or due to abusive use of alcohol, Alicia Lázaro, a pharmacist at the Hospital de Guadalajara and liver disease coordinator of the Spanish Society of Hospital Pharmacy, warns in THE OBJECTIVE that they are observing a certain hepatotoxicity or even severe liver damage such as cirrhosis “in certain population groups – chronic alcoholics or patients with malnutrition or prolonged fasting – as a consequence of misuse or abusive use of paracetamol”.
Paracetamol unseats ibuprofen
For the first time in history, this year, paracetamol has superseded ibuprofen to become the first choice of many people to treat fever and moderate pain, according to data collected by the IQVIA consultancy, which ensures that its consumption has skyrocketed by 37% in the last year. A change in trend that begins in March 2020, coinciding with the start of the pandemic and is maximized in the months where the largest number of vaccines have been dispensed, whose main mild side effects have been pain and fever. And it is that in 2020, the Ministry of Health recommended, among other measures, in its guide on how to act in case of having symptoms of covid-19, the use of paracetamol for the symptomatic treatment of fever. Such has been the consumption of this analgesic, that at the beginning of the year it began to be scarce in pharmacies in its form of effervescent tablets, as we have already reported in this newspaper.
“Using high or even normal doses for prolonged periods increases the risk of liver damage, which would increase if consumed together with alcohol,” he also warns. THE OBJECTIVE Cristina Fernández, coordinator of the Drug Information Center of the Official Council of Pharmacists, who assures that many people with the flu or colds tend to take paracetamol when they are already taking anti-flu drugs, something that “can increase the risk of toxicity” because many anti-flu drugs already contain this analgesic. In this way, to avoid abusive consumption of the drug in a single dose, since 2019 a medical prescription is necessary to acquire one gram of paracetamol. «Science saw that people directly took one gram of paracetamol when on many occasions one of 650 would be enough and the effect we are looking for can be achieved. The more we raise the dose, the more risk of intoxication or adverse reaction, “says Fernández.
In the first quarter, 8.3 million paracetamol dispensed
In March 2022, the sale of non-reimbursed painkillers grew by 24.4% with a total of 23.5 million euros invoiced in that month, according to IQVIA. On the other hand, from January to March 2022, 16.9 million units of non-reimbursed medicines have been dispensed to treat mild or moderate pain and fever, from Spanish pharmacies, of which 3.2 million have been units of ibuprofen, 8.3 million paracetamol and the rest are shared among other molecules.
In this way, the experts agree that, although paracetamol –synthesized for the first time in 1878– is «very good pain reliever», it must be taken with the «minimum effective dose for the shortest time and frequency possible», since used indiscriminately it has the potential to cause effects adverse because it is metabolized in the liver, however, although its compounds are eliminated in the urine, with paracetamol intoxication these pathways can be saturated and, therefore, cause inflammation, mitochondrial dysfunction and necrosis.
Thus, the experts conclude that, for example, when faced with a headache or fever that does not go away with a safe dose of paracetamol -from 500 to 650 mg- in three or four days, “the recommendation is to go to the doctor and not continue self-medicating”, they conclude.
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