The active ingredient paracetamol can help reduce fever and relieve symptoms. It is also used in pain of various origins. What are the side effects after taking it? We asked Artur Fałek, a doctor and expert at the Rafał Piotr Janiszewski Consulting Office for an explanation.
Anna Tłustochowicz: What are side effects and how do they differ from side effects. Or is it the same?
Artur Fałek:These are synonyms in common understanding. We should think about side effects in the context of definitions in pharmaceutical law. It literally goes like this: "An undesirable effect of a medicinal product is any adverse and unintended effect of a medicinal product." What does it mean? The word"unfavorable" obviously refers to the patient's he alth,and"unintentional" means that this is not our goal.In the case of paracetamol, which is an analgesic and antipyretic drug, any action that is not analgesic or antipyretic but has a different effect is an undesirable effect. The drug is used to achieve the declared effect of this drug. We care about the antipyretic effect, and not about e.g. urinating more.
Sure, what about the side effects? This is the same as a side effect only colloquially?
If we wanted to discuss the etymology of both phrases, sometimes something is a side effect, right? If paracetamol is metabolized in the liver, an increase in liver enzymes may be a side effect in this case. Only that it is permanently related to the effect of the drug, so it is not an adverse effect, but one that is tolerated to some extent, because we are interested in the indication, purpose.
The integerI would not put an equal sign between the side effect and the side effect , these are synonyms.
During our previous interview, the doctor indicated that information on side effects should be found in the leaflet.
That's right. I always say that it is of utmost importance for patientto read the leaflet . And in the subject of today's conversation, it is all the more important, because we are talkingabout paracetamol, which is a drug widely available on the market.
Very popular, right?
Very! Preparing for our interview, I downloaded the latest data from the Register of Medicinal Products and was surprised myself! We have757 paracetamol preparations.
757?!
Yes! There are 757 paracetamol-containing medicinal products legally authorized on our market. And I am talking now only about those that are approved for humans, because this drug can also be used in veterinary applications. If we enter, for example, "pig" as the target species, we will find out that for pigs products with paracetamol on our market are allowed 13, and for the target species homo sapiens - 757. Of coursethis is the total number of preparations that are in our market . I would like to point out a very important thing at this point! There is a tremendous amount of paracetamol combinations with other substances!
Only pure paracetamol products that have one active ingredient are 364.
More than twice as many are mixtures?
Yes. Paracetamolis found in many combinations , which use the properties of both its and other active substances.
And now let's note: most of these 757 medicinal products in total have the OTC availability category that we talked about in a previous interview, sothese are over-the-counter medications!Medicines, which everyone can buy without any problems, be it in a pharmacy or a pharmacy, but also in non-pharmacy sales: shops, kiosks, shopping centers, gas stations. Remember that paracetamol was registered in the 1950s, so it is adrug that has been present in the world for over sixty years !
Was it invented in America?
The first drugs appeared in the United States, but they became popular in the world very quickly because they are effective.Paracetamol has a very practical range of indications: sore throats, headaches, migraines, toothaches, bone pain and spine, i.e. this drug helps with all joint and muscle histories, as well as painful menstruation and fights fever.These preparations can also be used in children, for example in the case of fever, during teething or earache . The use of paracetamol is therefore indicated in conditions when we have a fever, in conditions associated with colds - flu-like. And if we look at its current, very practical use, then if we have a fever with COVID-19, then paracetamol is absolutely necessary.can be used to lower body temperature.
In one of the advertisements I heard that paracetamol is also most often used in hospital treatment. Is it true?
In this case, we will also talk about infusion products intended for use in inpatient medicine.Oral paracetamol is commonly used in hospital wardsas a moderate pain reliever. The indications are pains of moderate intensity and, of course, fighting fever. For both of these indications, paracetamol is used in hospitals.
Let's go back to the side effects. If we take paracetamol in the morning, and we should do it after eating, I don't know if that's just an example, are we risking something?
There is no great risk in this case, but you've found:it is generally known that the whole group of anti-inflammatory and analgesic drugs should be taken after eatingbecause it protects the gastric mucosa . However, specifically in the case of paracetamol, I do not see such an obvious indication.
And drug interactions?
Important thing! When it comes to precautionary measures, first of all, we must remember that paracetamol is metabolized in the liver.Diseases of the liver and kidneys should be the circumstances in which we use these drugs after consulting a doctor , because severe liver or kidney failure and alcoholism are a contraindication, or certainly an indication for the use of special precautions for the use of paracetamol due to the risk of liver damage.
We also have an overdose risk here!You have to be careful about itas you do with all other medications.
Since we know that paracetamol can be overdosed, what do we need to do first?Check if paracetamol is also one of the active substances in other medications we take!Multiple preparations on the market and the presence of paracetamol in combination drugs mean that the dose may accumulate in the body and cause toxic effects.
Poisoning?
Yes. The toxic effect we fear most about this substance is liver damage.
The doctor now draws attention to a very important issue!
This is all the more important as the toxic dose is slightly higher than the recommended dose! The average dose for an adult is2 times 500 mg, and the maximum daily dose is 8 tablets, i.e. 4,000mg . Exceeding this dose twice may result in toxic effects (toxic effects were noted even at a dose of 5,000 mg).
This is not a drug that you can eat a lot without fear and will have no side effects.
In the previous interview you said that "drugs are not candies".
Exactly and just as you need to be careful with any other medications. It's not just paracetamol! You asked about interactions with other medications. Of coursedrugs always interact with each other!They can be of a different nature: they can be debilitating or counteracting the effect, but also interactions can increase the effect of the drug, including the occurrence of toxic reactions about which I was talking.Paracetamol may enhance the effects of anticoagulantssuch as coumarin derivatives which are known to have a risk of bleeding. On the other hand, drugs that increase the metabolism of the liver, such as sleeping pills and antiepileptic drugs, can lead to liver damage when combined with paracetamol. Somedications must be carefully selected!Adopt the principle that if we have nothing else, and we have moderate pain, we can buy this drug and apply it, but if it does not work after 3 days, we should absolutely stop using it and see a doctor.
What are the other side effects of paracetamol?
Taking paracetamol and other anti-inflammatory and analgesic drugs may increase the risk of kidney problems.
I repeat: not only paracetamol, but also all other drugs should be handled with care. This is golden, generally valid.
The drug we are discussing todayhas been in the global market for over sixty yearsand is generally well tolerated by patients. Let's imagine how many people in their lives have taken a paracetamol preparation at least once! I am sure several times. Your editor, probably too?
Yes.
And I haven't said yet that it can be used during pregnancy! And since it can be used in pregnancy and in children, remember that teething is a matter of the first year of life! This means that we are talking about a really safe drug, of course, assuming a properly selected dose.This is the drug of first choice when it comes to lowering fever in children!Paracetamol is definitely a drug that is very needed and useful in … you would even say "daily use", but if someone uses paracetamol every day that something is wrong.
It is a commonly used drugused.
Yes. Intended for ad hoc use!It is an effective and safe drug.Of course, ending the answer to the question about side effects, the summary of this medicinal product also describes side effects that occur rarely or very rarely, once every ten thousand casesThis is thrombocytopenia, which is a reduction in the number of platelets, these are hypersensitivity reactions including anaphylactic reactions as well as rashes and swellings, as well as other skin reactions that may arise.Among the side effects bronchospasms are also found. Paracetamol can cause cross-effects with acetylsalicylic acid, so if someone is hypersensitive to this acid, then be careful with paracetamol! We have already talked about liver dysfunction, including toxic liver damage.
You have to remember that you can overdose the drug unknowingly!
With the multitude of preparations on the market, if someone does not pay attention to the composition, and you have to look not only at the trade name, but also the one given below: international - an overdose of the product may occur.Nausea, vomiting, excessive sweating, drowsiness, weakness may occur in overdose.And then you need to be alert! These symptoms may go away, but you still need to go to the hospital for treatment.
So, after an overdose, you can go to toxicology.
Of course, if we find out that someone has taken too much of the drug, we can act temporarily at home: induce vomiting. You should give activated charcoal, preferably in liquid form, i.e.take 60-100 grams of charcoal and dissolve it in water.In the past, there was always activated charcoal in home medicine kits! Now less often.
What a pity.
Too bad. However, anyway, you have to go to the hospital to determine the level of the drug in the blood serum and possibly start treatment in a hospital setting. As I said before, the difference between the maximum allowable dose and the toxic dose is very small here.
We already talked about it in the previous interview, but let us remind you that information on adverse drug reactions is collected by the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, and recently we can also report side effects ourselves: patients!
Yes. The reporting of adverse reactions is the patient's right and the responsibility of medical professionals.
Dr. Artur Fałek, doctor
He is an expert of the Rafał Piotr Janiszewski Advisory OfficeHe is an expert in the field of reimbursement and drug management in the field of the organization and operation of the he alth care system, the activities of the state administration, and legislation in the field of he alth care. He worked in the Ministry of He alth as the Director of the Department of Drug Policy and Pharmacy (2007-2015), previously as the Deputy Director (2007), in the National He alth Fund Headquarters as the Director of the Drug Management Department.
From 2005 he was a member and from November 2007 the Chairman of the Drug Management Team. He is the author, co-author of many organizational solutions and legislation in the field of pharmacy and drugs, he was a Deputy Member of the Management Board at the European Medicines Agency; Senior Project Officer in the "Transparency of the National He alth System Drug Reimbursement Decisions" project (2007-2008); was a representative of Poland in the work of working groups at the European level.
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