Paracetamol (Acetaminophen)

Paracetamol, also known as acetaminophen, is a widely used non-opioid analgesic (pain reliever) and antipyretic (fever reducer). It is commonly employed in treating mild-to-moderate pain and fever¹².

Mechanism of Action

While extensively used, its exact mechanism of action remains somewhat unclear. Paracetamol is believed to inhibit the enzyme cyclooxygenase (COX), particularly COX-2, in the brain. This leads to a reduction in the synthesis of prostaglandins, which are compounds involved in pain and inflammation³⁴.

Efficacy

Paracetamol has been shown to be effective in various types of pain, including musculoskeletal pain, osteoarthritis, and headaches. It is commonly used as a first or second-line treatment, especially for patients who may not tolerate NSAIDs due to gastrointestinal or cardiovascular concerns⁵⁶.

Safety and Side Effects

Paracetamol generally has a favorable safety profile when used at recommended doses. However, it can cause severe liver damage when taken in excessive amounts. This risk is heightened in people with pre-existing liver conditions or those who consume excessive alcohol⁷⁸.

Other potential risks include:

• Gastrointestinal bleeding
• Small increases in systolic blood pressure
• Rarely, nephrotoxicity and asthma exacerbation⁵⁶.

Drug Interactions

Paracetamol can interact with other medications and herbal supplements. For instance:

• Combining paracetamol with alcohol increases the risk of liver damage.
• Concomitant use with other drugs metabolized by the liver can also heighten the risk of hepatotoxicity⁹¹⁰.

Certain herbal supplements, like those containing ginkgo or Echinacea, may also increase the risk of bleeding or liver toxicity when taken with paracetamol⁹.

Conclusion

Despite being a staple in pain and fever management, paracetamol's long-term use comes with considerations of efficacy and safety. Health professionals often recommend it within multimodal treatment plans to minimize risks while managing pain effectively.

Footnotes

1. Ulderico Freo. "Paracetamol: A Review of Guideline Recommendations," Journal of Clinical Medicine, 2021. ↩

2. Valerie Gerriets. "Acetaminophen - StatPearls," NCBI Bookshelf. ↩

3. Samir S Ayoub. "Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action," PubMed Central, 2021. ↩

4. J. C. McCrae. "Long‐term adverse effects of paracetamol – a review," British Journal of Clinical Pharmacology, 2020. ↩

5. Ulderico Freo. "Paracetamol: A Review of Guideline Recommendations," Journal of Clinical Medicine, 2021. ↩ ↩²

6. Samir S Ayoub. "Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action," PubMed Central, 2021. ↩ ↩²

7. J. C. McCrae. "Long‐term adverse effects of paracetamol – a review," British Journal of Clinical Pharmacology, 2020. ↩

8. Ulderico Freo. "Paracetamol: A Review of Guideline Recommendations," Journal of Clinical Medicine, 2021. ↩

9. W Abebe. "Herbal medication: potential for adverse interactions with analgesic drugs," PubMed, 2024. ↩ ↩²

10. Ausama Ayob Jaccob. "Vitamin C, omega-3 and paracetamol pharmacokinetic interactions using saliva specimens as determiners," PubMed, 2019. ↩