Paracetamol: Underestimated Danger

Larissa Melville completed her traineeship in the editorial team of . After studying biology at Ludwig Maximilians University and the Technical University of Munich, she first got to know digital media online at Focus and then decided to learn medical journalism from scratch.

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Paracetamol is one of the most commonly used pain relievers in the world. But taking it too carelessly harbors dangers: The drug can damage the heart, kidneys and gastrointestinal tract, among other things - and the more the higher the dose, the more so.

Paracetamol is a common and popular substance - be it for headaches, toothaches or joint problems. For some time, however, the use of paracetamol has been linked to some undesirable side effects. Dr. Emmert Roberts from Maudsley Hospital in London and his team took a closer look at the risk of damage to internal organs.

Fatal side effects

The team analyzed eight studies that looked at the risks of taking paracetamol. The researchers were particularly interested in the risk of heart attacks, strokes, high blood pressure, bleeding in the gastrointestinal tract and kidney problems and their impact on life expectancy. In all studies, the subjects had taken 0.5 to one gram of paracetamol every four to six hours, i.e. they were within the recommended dose. Four grams per day is the maximum limit. The respective comparison groups had not taken any paracetamol.

It showed that patients who had used paracetamol for more than a year had a 20 to 70 percent higher risk of so-called cardiovascular incidents such as a stroke or a heart attack. The risk of side effects in the digestive tract - especially internal bleeding - was about 10 to 50 percent greater. They also suffered increased kidney damage - up to twice as often.

The risk increases with the dose

In addition, there was a dose-dependent effect - the more paracetamol a patient took, the more likely they were to struggle with complications.One of the studies even came to the result: Small doses of paracetamol every now and then did not increase the risk of dying earlier, but larger amounts over a longer period of time did.

Use only when necessary

Even if the researchers admit weaknesses in their analysis - for example the small number of studies - they believe that the risk of undesirable effects from paracetamol is higher than currently assumed. "Paracetamol is still safer than non-steroidal anti-inflammatory drugs (NSAIDs), but the potential side effects are worrying," Professor Philip Conaghan of the Leeds Institute of Rheumatic and Musculoskeletal Medicine told "Doctors should always weigh up whether a patient really needs paracetamol." Every person reacts differently to paracetamol, which is why using it in the recommended dose range can also cause damage no side effects, ”says Conaghan.

Level 1 pain relievers

The maximum daily dose of 4000 milligrams of paracetamol is usually only used for a few days - for example for stubborn toothache. Patients who need such a large amount for longer should discuss with their doctor what more effective alternatives are available. Another pain reliever or accompanying treatments such as physiotherapy may help you better.

According to the definition of the World Health Organization (WHO), paracetamol belongs to stage 1 of the three-stage scheme for pain therapy. It is the world's best-selling drug for the treatment of a wide variety of acute and chronic pain, as well as fever. In the central nervous system, it inhibits the enzyme COX-3, which in turn regulates the production of an inflammatory messenger substance. It also affects two systems that also have analgesic and calming effects: the endocannabinoid and the serotonin system.

Source:

Roberts E. et al .: Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the Rheumatic Diseases. doi: 10.1136 / annrheumdis-2014-206914

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