An internal medicine expert explains how we may unconsciously be overdosing ourselves
Paracetamol, the fever pill that features in each of our first aid boxes, has become our go-to solution for everything, from fever of all kinds to body aches, headaches, sinus, cold, vaccine-induced discomfort and any kind of pain. It is like our everyday shield that has become a silent addiction. Except it is not safe if popped at will.
That’s why the tweet by US-based gastroenterologist Dr Palaniappan Manickam, popularly known as Dr Pal, that “Indians take Dolo 650 like it’s Cadbury Gems,” has raised a viral storm. Dolo 650 is a brand name for paracetamol. “Just like any other drug that comes with its own caveat, paracetamol too comes with advisories. Except that we ignore them and have the pill unsupervised, almost like taking a vitamin and mineral supplement. We do not even feel the need to ask a doctor about dosage since it is available easily over the counter. Fact is overuse can be toxic for key organs like the liver and kidneys and can lead to serious health complications,” says Dr Rakesh Gupta, senior consultant, internal medicine, Indraprastha Apollo Hospital, New Delhi.
What’s the ideal way to take paracetamol?
It is absolutely safe when you take it as your doctor prescribes it, do not self-medicate or take the pharmacist’s word for it, the last being very common in India. Paracetamol is used to reduce fever and pain but is not an anti-inflammatory drug. It comes as tablets of 500 mg, 650 mg and even as 1000 mg injectables. The maximum dose that a person can have per day is 4 g or 4000 mg.
So if you have been prescribed 500 mg, you can have up to eight tablets in 24 hours with about four-hour gaps in between to see if the condition improves. The tablet can take up to an hour to work.
Do not take paracetamol with other medicines containing paracetamol because there is a risk of an overdose.
Most importantly, paracetamol is safe to take during pregnancy and breastfeeding as recommended by your doctor.
What does an overdose of paracetamol do?
An overdose of paracetamol can severely damage the liver, potentially leading to acute liver failure. The liver processes paracetamol but during an overdose, it gets overwhelmed and releases toxic byproducts. These then bind to liver cells, causing damage and potentially leading to liver cell death (necrosis). In one to two per cent of users with above-normal dosage, these toxins that the liver cannot neutralise lead to renal toxicity and damage the kidney’s filtering capacity. Sometimes even bleeding can happen.
In 2021, 227 deaths were recorded in England and Wales due to paracetamol overdose. In 2022, that number rose to 261.
If your liver and kidney are already compromised or if you are a regular drinker, having more than 14 units of alcohol a week, the effects could be more severe.
How long should one use paracetamol on one’s own?
Not more than two days. If the fever and pain have not subsided, it means that there are some other underlying infection or conditions that need to be investigated and treated with other medicines. Temporary relief could be suppressing a condition instead of treating it as fast as needed.(IE)
