Warning: avoid the excessive use of paracetamol

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Extract from the article: These days, when faced with a simple headache, slight fatigue or aches and pains, the reflex is often quick: turn to paracetamol. This medicine has become a staple in our family pharmacies. It effectively relieves mild to moderate pain and lowers fev

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These days, when faced with a simple headache, slight fatigue or aches and pains, the reflex is often quick: turn to paracetamol. This medicine has become a staple in our family pharmacies. It effectively relieves mild to moderate pain and lowers fever. The fact that it is so readily available and perceived as a safe drug masks a real danger, not only in the event of overdose, but also sometimes at usual doses.

Paracetamol is mainly administered orally, in the form of tablets, capsules, sachets, suppositories or syrups for the very young. Its effectiveness is based on its ability to inhibit the production of prostaglandins in the brain. These substances are involved in the sensation of pain and the increase in body temperature. Paracetamol therefore acts as an analgesic against pain and an antipyretic against fever.

The usual dosage for an adult varies from 500 mg to 1 g per dose, repeated every 4 to 6 hours, without exceeding 4 grams per day. It is available in different dosages, and it is crucial to adapt the dose to your age and weight, following medical and package insert recommendations.

Serious liver damage

An overdose of paracetamol can cause severe liver damage.Prolonged use at high doses can also cause progressive damage.Liver cells damaged in this way severely disrupt its function.This is a medical emergency, which may manifest itself as jaundice and coagulation disorders. Other symptoms may include fatigue, stomach pains or disturbed digestion.Most alarmingly, there may be no symptoms at all in the early stages.

Kidney damage

Under normal conditions, paracetamol has no harmful effect on the kidneys. Kidney damage is a serious complication of overdose, especially in cases of serious liver damage.Toxic substances produced in the liver can reach the kidneys and impair their function.

Kidney function tests may reveal abnormal creatinine levels and a reduction in glomerular filtration. Renal failure complicates the elimination of paracetamol and reduces the effectiveness of the antidote.

Misleading initial symptoms

The first signs of paracetamol poisoning are often vague: nausea, vomiting, fatigue and widespread abdominal pain.They appear within 24 hours of excessive ingestion.These non-specific symptoms or lack of immediate warning signs can delay medical consultation, reducing the chances of effective treatment.

Blood coagulation problems

Excess paracetamol can also alter the liver's production of clotting factors, leading to coagulation problems and internal bleeding.

Risk of coma

If left untreated, liver failure can lead to brain damage caused by accumulated toxins. This accumulation of toxins in the brain causes serious neurological disorders, ranging from confusion to convulsions and coma, with a high risk of death.

Cardiovascular risks

Taking paracetamol for long periods could increase blood pressure and the risk of heart problems.A warning from a group of Scottish researchers at the University of Edinburgh has been published in the scientific journal Circulation.Taking paracetamol regularly can increase blood pressure in hypertensive patients. According to the study ‘Paracetamol: not as safe as we thought? A systematic literature review of observational studies’ published by the British journal “Annals of The Rheumatic Diseases”, paracetamol is likely to increase the risk of cardiovascular disease, heart attack or stroke by 20%. 

Gastrointestinal problems

Regular consumption of paracetamol can lead to digestive bleeding and ulceration.Although the exact mechanism remains to be determined, paracetamol may alter the protection of the intestinal wall, promoting inflammation or lesions. Paracetamol, taken in large quantities or for a prolonged period, can cause irritation of the stomach and intestines. This can lead to increased nausea, vomiting and diarrhoea.

Death

In the most serious cases of untreated overdose, neurological disorders such as confusion, drowsiness and coma may occur.Mortality can be as high as 50% without prompt treatment.Renal damage, although less frequent, may also occur.

Danger to pregnancy

When pregnant, self-medication is strongly discouraged. Even in the case of medicines perceived as harmless, such as paracetamol. These are the findings of an international study published in the journal Nature Reviews Endocrinology.According to its 91 authors, experts in a range of specialities, paracetamol consumption during pregnancy ‘may alter foetal development, which could increase the risk of certain neurodevelopmental, reproductive and urogenital disorders’.  Research by the University of Bristol has established a link between taking paracetamol between the 18th and 32nd week of pregnancy and behavioural problems such as hyperactivity and attention disorders in young children.

It is important to follow the instructions on the package leaflet or those of your health professional. Pay attention to your body's reactions when taking any medication.If in doubt or if symptoms persist, consult a health professional or go back to the prescriber.Caution is advised when taking this common medicine.

William O. & Esther KOLANI

Article validated by Dr Jean-Claude Bakpatina, general practitioner at the Floréal clinic in Lomé.