Paracetamol - not so innocent after all?

Ah Paracetamol - considered one of the safest drugs around.  After all, we give it to babies as syrup, you can buy it over the counter and it's been around for practically forever.

However, a medical review of eight studies has recently thrown light on the possible dangers of long term Paracetamol use.  Paracetamol has been available since the 1950s and I think it's accurate to say that most of us have used it at some point or another.  But this recent review suggests that long term use may cause more harm than good.  Please note, this study is notreferring to the occasional pill, it's referring to sustained use.

As a medical doctor, I have sadly seen patients die as a result of liver and kidney failure after (usually deliberately) overdosing on Paracetamol.  We already know that Paracetamol in large quantities can irreparably damage the liver and kidneys and is a medical emergency. But what we didn't know up until now is that taking small amounts i.e. within the recommended daily amounts over a long period of time can also have significant effects on our organs too.

Many patients take Paracetamol every single day to help them cope with aches and pains, particularly those of arthritis and low back pain. But this recent report suggests that doing this can affect your heart and kidney function as well as cause gastrointestinal issues such as bleeding.  Also, it has been suggested that the degree of pain relief offered is often not sufficient enough to justify taking it in the first place.

For doctors, paracetamol is usually the first line drug suggestion for pain relief.  It's easy to buy from almost anywhere and is so cheap we don't even prescribe it much anymore as the cost of buying it over the counter is less than the cost of paying the prescription charge.  We often optimize treatment by suggesting patients take the full recommended daily dosage if once or twice a day isn't doing the trick.  We also suggest taking paracetamol when taking NSAIDS (Non Steroidal Anti Inflammatory Drugs) like Ibuprofen because the two together have a synergistic effect meaning they should offer better pain relief.

Of course, all these suggestions are not made out of misinformation; they're made because this is what we know and think is best at the time - it's standard clinical practice.  However, as more and more research is done on different  medications and practices, we continue to learn and update our knowledge.  We know so much more now than we did even last year, let alone a decade ago and I'm sure in the next decade we will look back and think - 'Wow! If only we knew then what we know now!'. 

But what this research does clearly illustrate is that even medication we think is safe and have no reason to think otherwise of, should only be used when really needed, for the shortest length of time and at the lowest effective dose.  If you are in pain, do not suffer but also do not ignore the underlying lifestyle issues which may be having a detrimental effect on the quality of your life in the first place.  Live proactively, doing what you can to keep yourself as healthy as possible for as long as possible so you will hopefully have no need for Paracetamol or other such drugs in the future.  There really are no side effects to living a healthier lifestyle and I'm pretty sure none will be found in 10 years time either!