Delivered without a prescription, paracetamol is one of the best-selling painkillers in France. However, improperly used or consumed in high doses, this drug is a danger for the liver. Indications, side effects, precautions to take it without risk … Advice from Professor Patrick Marcellin, hepatologist.
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SUMMARY
- Indications
- Examples of drugs
- Dosage
- Adult
- Person at risk
- Child
- Side effects
- Contraindications
- Precautions
- Overdose: the risks
- Overdose: symptoms
- What to do in case of overdose?
- Expired paracetamol: effective?
Doliprane ®, Dafalgan®, Efferalgan®, Fervex®, Prontalgine® … Nearly 200 drugs containing paracetamol , alone or combined with other substances, are available in pharmacies in France. Most are available without a medical prescription. Used occasionally, over a short period of time and respecting its dosage, paracetamol is a harmless analgesic . But when taken in too much or for too long, it is toxic to the liver and can have serious consequences. What are the indications for paracetamol? The dosage in an adult, child or adolescent weighing less than 50 kg? Symptoms and risks in case of overdose? Explanations from Prof. Patrick Marcellin, hepatologist.
Indications: in which case to take paracetamol?
Paracetamol is an analgesic (or level 1 analgesic ) sold in the form of tablets, effervesents, syrups or suppositories. It prevents or decreases the sensation of mild to moderate pain . This pain reliever is commonly used to treat headaches, sore throats, flu-like conditions , toothache , body aches , menstrual pain before or during menstruation, or fever in the case of a cold. Pregnant women, children and the elderly can take paracetamol from time to time and according to the dosage (see below).
Examples of drugs that contain paracetamol
Almost 200 medicines contain paracetamol, alone or in combination with other substances, and are currently available in pharmacies (including online pharmacies) with or without a medical prescription . For example :
Between each dose, an interval of at least 4 hours must be observed, or even 6 hours ideally.
- Doliprane®
- Dafalgan®
- Efferalgan®
- Actifed Cold®
- Antarene®
- Daflon®
- Dolirhume®
- Fervex® …
Dosage: how much is it safe to take?
” Paracetamol is the least dangerous analgesic if you follow the dosage. It can be used occasionally to treat mild to moderate pain. However, treatment with paracetamol when taken by self-medication should last as short as possible . Paracetamol should in no case be taken as a basic treatment “, insists the hepatologist. Taking it therefore requires compliance with the recommended duration of treatment, the dosage and the contraindications listed in the instructions. If symptoms last more than 3 days, it is important to see a doctor .
► Dosage in adults: maximum 4 g per day for an adult over 50 kg (approximately from 15 years old), i.e. the equivalent of 4 tablets of 1 g or 8 tablets of 500 mg maximum per day while respecting an interval of at least 4 hours between each dose, or even 6 hours ideally.
► Dosage in people at risk : maximum 3 g per day for an adult over 50 kg with risk factors such as:
- mild to moderate hepatic” Paracetamol is metabolized by the liver and eliminated by the kidneys in the urine. A liver that does not function very well (in the event of hepatic insufficiency for example), can no longer properly metabolize the toxic part contained in paracetamol, this which can lead to an accumulation of toxic substances and therefore intoxication. It is therefore necessary to ease off as soon as the symptoms improve and consult a doctor if they do not improve “ , explains Professor Marcellin.
- a renal failure severe,
- regular alcohol consumption(more than four units per day for a man, more than 3 units per day for a woman)
- a prolonged state of fasting. ” When one is on an empty stomach, the toxic concentration of the drug increases and the metabolism of the drug is slowed down. The risk of overdose is therefore higher “, explains the hepatologist.
People with these risk factors should seek medical advice before taking paracetamol. Between each intake of paracatemol, it is necessary to respect a period of at least 4 hours , even 6 hours ideally.
► Dosage in children (- 50 kg) : maximum 10 to 15 mg per kilogram of body weight, four times a day at most (example: if the child weighs 30 kg, the maximum dose is 450 mg per dose and this, no more than 4 times a day). Note that some paracetamol-based drugs are contraindicated for children under 27 kg, look at the instructions carefully. Between each dose, a period of at least 4 hours must be observed, or even 6 hours ideally.
>> Beware of unintentional overdose. If you or your child is taking several medicines containing paracetamol , take this into account and make sure that the maximum dose is not exceeded, all medicines combined. You can sometimes exceed the maximum dose without knowing it : for example, repeated intake of Toplexil® in combination with Dafalgan® can lead to an overdose. To avoid this type of accident, always consult the leaflets of a medication to check whether or not it contains paracetamol.
What are the side effects of paracetamol?
When its consumption is well supervised, it is rare for paracetamol to cause adverse effects. But like all medicines, treatments with paracetamol can cause side effects, which are not systematic. In rare cases, a rash , redness of the skin or an allergic reaction may occur, which may manifest as sudden swelling of the face and neck or sudden discomfort with a drop in blood pressure.. In this case, you must immediately stop the treatment, notify your doctor and do not resume drugs containing paracetamol. Very exceptionally, biological changes requiring a check of the blood test have been observed: functioning disorders of the liver, abnormally low level of certain white blood cells or certain blood cells such as platelets which can result in nosebleeds or gums. . In this case, consult a doctor.
Contraindications to paracetamol?
Paracetamol medicines should not be taken if you are allergic to paracetamol or any of the other ingredients in these medicines and if you have severe liver disease. If in doubt, seek the advice of your doctor or pharmacist.
Precautions before use?
Before starting treatment with paracetamol:
► Check that you are not taking other medicines containing paracetamol to avoid unintentional overdose. If possible, avoid self-medication without the advice of a doctor or pharmacist.
► Tell your doctor or pharmacist in the event of liver or kidney disease, or alcohol consumption,
► Tell your doctor or pharmacist if you are taking other medicines containing paracetamol,
► Avoid self-medication as far as possible without the advice of a doctor or pharmacist.
Overdose: what are the dangers for the liver?
It is a safe and effective drug under normal conditions of use
Paracetamol is a substance rather well tolerated if one respects the dosage, the duration of treatment and the contraindications. It is ” a safe and effective drug under normal conditions of use, ” said the Medicines Agency (ANSM) in a press release dated August 20, 2018 . But improper use (overdose, combination of several products containing paracetamol, non-compliance with the dosage) can lead to serious damage to the liver (and more rarely, the kidneys) which are in some cases irreversible .
” In case of overdose, the toxic part contained in paracetamol can destroy liver cells , which can lead todrug-induced hepatitis . This destruction of liver cells can sometimes be asymptomatic and go unnoticed, but not always. If the number of killed liver cells is very high, hepatic failure may develop . We then have a liver which is no longer fully functional and which can no longer properly destroy certain substances (present in drugs, alcohol, etc.) “, explains Prof. Marcellin.
