Big rise in cases of liver failure from ‘safe’ paracetamol

Paracetamol is the world’s top painkiller—and it’s considered a safe remedy, available in pharmacies without a doctor’s prescription.

But exceed the recommended dose, and it becomes a dangerous poison, causing liver failure and even death, say health regulators in Switzerland, which has seen a 40 percent rise in cases of poisoning after more powerful doses of the drug started to be sold in pharmacies.

The sudden increase happened in the first three years after 1000 mg (1 g) doses were available over-the-counter. People have been taking too many of the tablets every day, and probably exceeding the maximum daily dose of 4g.

“Paracetamol is not effective for all patients or against all forms of pain. If the drug doesn’t help to ease someone’s symptoms, they may be tempted to increase the dosage,” said Andrea Burden at ETH Zurich.

Cases of poisoning were almost non-existent when only the 500 mg tablets were available without a prescription, she said, but this started to change when the 1000 mg dose was introduced in 2003 in Switzerland. Today, sales of the more powerful paracetamol are ten times greater than the weaker version.

Burden recommends that fewer tablets are included in the 1000mg packs, and people also need to be told that the drugs are not suitable for chronic pain management. It’s only for short-term pain relief, she added.

(Source: JAMA Network Open, 2020; 3: e2022897)

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