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What is Paracetamol?
Paracetamol, also called acetaminophen, is a medication that is used for the management of pain and fever. It was discovered in the late 19th Century, and became widely used since the mid-20th Century. Among its group of painkillers, called aniline analgesics, it is the only one still in use. This is because paracetamol is good in the management of fever and mild to moderate pain, despite being largely underrated and taken for granted.
Under the World Health Organisation (WHO) Pain Management Guidelines, paracetamol is the cornerstone in the management of mild pain, with or without adjuvant therapy. This should already partly answer the question, “is paracetamol good?”
Paracetamol is thought to exert its activities by altering some chemicals in the nervous system, that are responsible for producing pain and fever. It therefore interrupts the messages and brings relief from these distressing symptoms. It however does not cure the underlying cause of pain or fever, which has to be investigated by Health Professionals and dealt with definitively.
Is Paracetamol an Anti-inflammatory?
Paracetamol does have a little or minimal anti-inflammatory activity. But it does not have activity against the enzyme called cyclo-oxygenase (“COX”). As a result, it is not considered to be one of the Non-Steroidal Anti-inflammatory Drugs (NSAIDs).
Paracetamol and nonsteroidal anti inflammatory agents (including aspirin or ASA) are recommended as the agents of choice in the WHO analgesic ladder, for the management of mild pain.
* Links to quality, affordable paracetamol products are provided here, for the Reader’s convenience:
In What Form Is Paracetamol Available?
Paracetamol is available in several different forms, for use in many different situations and age groups.
1. There is a syrup which is used for children. It can be useful for adults who for any reason are unable to swallow solids.
Most of the available preparations are of two strengths:
- 120mg per 5ml
- 250mg per 5ml
2. Paracetamol is also available as a powder, which can be used for children. The powder may also be available in combination with other painkillers such as aspirin, with or without other medications. These powdered combinations are for use in adults
3. There are tablets of 500mg (occasionally capsules)
These are usually white, thick and scored tablets (to aid breaking into half). These tablets have a little bit of a bitter taste especially if kept for a long time in the mouth.
4. There are suppositories which are inserted into the rear passage (rectum). The suppositories are very useful for patients who are unable to take medications by mouth, such as those with a decreased level of concentration, those with nausea or vomiting, or those not eating in the peri-operative period.
Suppositories are available for children and for adults.
5. Paracetamol injection, which is administered into the veins (intravenously) is available but fairly expensive.
Like suppositories, intravenous paracetamol is useful for patients who cannot take by mouth, and acts fast and efficiently.
(6. Paracetamol is also available in combination with other drugs. These formulations are discussed below, under Precautions.)
What Is The Dose of Paracetamol?
* For both children and adults, paracetamol is taken in divided daily doses, with intervals of 4 – 6 hours. The total daily dose should never be exceeded, and the interval should not be less than 4 hours.
To adequately manage significant (e.g. chronic) mild to moderate pain, it is important that paracetamol is taken REGULARLY rather than episodically or “when needed”.
The dose is based on the child’s weight. This has to be observed strictly.
The dose is 10 – 15mg per kg of body weight.
For example, a child of 10kg (average 1 year old) is given 100 – 150mg of paracetamol.
Most paracetamol syrup preparations are conveniently labelled to show how many millilitres of the medication should be given to children of what weight or age range.
It is important to use the correct and adequate dose of paracetamol in order to achieve good results. In many instances, paracetamol is criticised as being weak or ineffective, when it is not being taken correctly.
- The dose is 500 – 1000mg (0.5 – 1g) four to six times daily.
- The maximum total daily dose is 4g (4000mg).
- The dose is decreased in the elderly (over 70 years old).
Advantages of Paracetamol Over Other Painkillers
Compared to other painkillers, paracetamol tends to be the safest, with very few adverse effects. This is why it is the preferred agent for mild pain in most instances.
Paracetamol does not cause upper GIT bleeding (bleeding from the stomach and first part of the small intestines) or peptic ulceration. These adverse events occur commonly with the nonsteroidal anti inflammatory agents, especially in the elderly and people with predisposing factors. Pain in the elderly (patients over 70 years of age) should by all means, be managed with paracetamol, even for conditions like osteoarthritis.
Ibuprofen, a nonsteroidal anti inflammatory agent, has been found to cause a worse outcome in patients with COVID-19, caused by the novel Coronavirus. Paracetamol is the preferred and well tolerated agent in these cases.
Paracetamol does not cause dependence (addiction), which is a big problem with the opioid painkillers, causing a serious epidemic in many countries.
Opiates also frequently cause constipation as a side effect. This can be obviated by using paracetamol, if the pain is not of severe intensity. However, in chronic use or abuse, paracetamol, like other painkillers, can cause constipation by making the bowel sluggish (paralytic ileus).
Paracetamol is very good for the symptomatic management of viral illnesses like coryza, bronchiolitis or chicken pox in children. It effectively reduces fever and pain, and makes the child comfortable.
Although paracetamol is relatively safe compared to other painkillers, it must be handled with utmost caution. This is because paracetamol overdose is very dangerous and potentially lethal. Paracetamol can badly damage the liver, even in mild overdose. It is one of the commonest causes of death from drug overdose globally.
Particular care should be taken with cough and cold medications, as many contain paracetamol. Inadvertent overdose does occur when these preparations are taken with additional paracetamol for management of fever and pain.
Paracetamol is also found in combination with other painkillers, such as aspirin, ibuprofen, diclofenac, or codeine. Inadvertent paracetamol overdosing, such as occurs with cough and cold medications, can and does occur with combination painkillers, if the presence of paracetamol is not noted when top-up paracetamol is taken. The other danger of combination analgesics, popular as they are, is that they have a higher potential to damage the kidneys and cause “analgesic nephropathy”, than single agents.
Paracetamol is a good, safe and very useful medication for the treatment of fever and pain, which can be used for paediatric, adult and elderly patients in many clinical situations. If WHO Pain Management Guidelines are followed properly, the majority of patients with mild to moderate pain can be managed safely and successfully starting first with paracetamol and then stepping up as needed.