Is paracetamol safe? Increasing worries over the side-effects of our most popular pain killer

Keeping a packet of paracetamol handy in the cabinet might seem the safest and most convenient way to tackle pain.

After all, it’s free from the stomach damaging side-effects of other painkillers, such as aspirin and ibuprofen.

However, evidence is mounting to show that not only does paracetamol cause this kind of damage after all, but the ‘everyday’ drug may also harm us in many other serious ways.

Indeed, far from being the risk-free panacea so many of us believe it to be, a growing weight of evidence from studies conducted across the world links the drug to a number of very serious side-effects.

These include asthma and developmental defects, such as attention-deficit hyperactivity disorder (ADHD) in children, as well as potentially lethal heart and kidney problems in adults, and even a risk of death from rare, but excruciating, skin reactions.

The evidence has prompted drug watchdogs in Britain and America to warn doctors against routinely prescribing paracetamol.

But this has ignited a row with medical professionals who feel that without it in their medicine bags, they will have nothing with which to treat millions of patients.

Meanwhile, there are also suggestions that for some ailments, the drug is, in fact, no better than a placebo.

A PLACEBO WORKED JUST AS WELL FOR BACK PAIN

Paracetamol has, until now, been regarded as especially helpful for those who cannot take painkilling non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

They may be allergic to NSAIDs or be on medication that interacts dangerously with them, such as blood pressure pills or steroids.

Other patients may have stomach ulcers or bleeding disorders, which can be worsened by NSAIDs.

The latest question over paracetamol was raised by a study published in The Lancet last month, which found that the drug is no better than a placebo for lower back pain.

Researchers at the University of Sydney looked at more than 1,650 people who had suffered back pain, for a variety of reasons, for six weeks or less.

One third received daily doses of paracetamol, another third took the drug as needed, while the remainder were given a dummy placebo pill. All three groups took 17 days to recover, on average.

Dr Christopher Williams, who led the study, says: ‘The results suggest that we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment for back pain.’

However, that is precisely the way paracetamol is used by the NHS to treat back pain, among other forms of pain.

In 2012 alone there were 72 million prescriptions for paracetamol, plus another 78 million for paracetamol combined with codeine, according to the Government’s Health and Social Care Information Centre.

RISK OF OVERDOSE

The best known danger of paracetamol is an overdose – intentional or otherwise.

Excess paracetamol can overwhelm the liver’s processing abilities and cause damage, resulting in acute liver failure. This can prove fatal.

Concern over this led the Government in 1998 to rule that shops can sell only packs of 16 paracetamol tablets. Pharmacies can sell packs of 32 tablets.

But the danger remains, not least because of ‘staggered overdosing’ – this is where taking just a little more paracetamol than the recommended dose over the course of several days or weeks leads to a dangerous build-up in the liver.

The concern is that people can unwittingly overdose by also taking other over-the-counter products without realising these contain paracetamol.

Staggered overdosing is just as risky as taking one large overdose, according to a study from the Royal Infirmary of Edinburgh, published in 2012 in the British Journal of Clinical Pharmacology.

Professor Donald Singer, a fellow of the British Pharmacological Society, warns: ‘Paracetamol is present in a range of over-the-counter medicines for coughs and colds. But two out of five people who take such remedies don’t realise this.

‘It is a useful drug when used in the right way, but it is a powerful drug with powerful side-effects when taken excessively.

‘Doctors should take a good patient history to ensure that people are not already taking it through such products.

‘They should also ensure that patients are taking paracetamol at the lowest possible dose that can give relief.’

Dr Dickson believes it is time to question our use of paracetamol as the first drug treatment of choice.

‘An important alternative for using paracetamol for such conditions as chronic back pain is for GPs to give lifestyle advice, such as getting sufferers to exercise more and avoid bed rest,’ he said.

‘But it is very difficult to get GPs to do that, not least because they are short of time.’

He thinks it will take ‘between five and ten years for GPs and the public to finally grasp that taking paracetamol for such problems is simply unacceptable’.

The question is whether that’s soon enough, if the new evidence is to be believed.

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