How popular painkiller paracetamol may be injurious to your liver

Paracetamol is considered to be one of the workhorse painkillers.

These tablets provide hassle-free, quick relief with more than 50 years of proven efficacy.

Anything in excess, though, might be detrimental to your health.

Experts have warned anyone who takes paracetamol frequently about the serious health risks involved.

Let’s take a closer look.

The link between paracetamol and liver damage

Researchers at the University of Edinburgh observed the effects of taking paracetamol on mice and concluded that it is the leading cause of liver damage.

Their findings published in the journal Scientific Reports showed that, under certain circumstances, paracetamol can damage the liver by interfering with the structural junctions that are essential for the proper functioning of neighbouring cells in the liver.

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“Scientists at the University of Edinburgh studied the impact of paracetamol on liver cells in human and mouse tissue, and tests showed that in certain settings, paracetamol can damage the liver by harming vital structural connections between adjacent cells in the organ,” the study said.

“When these cell wall connections – known as tight junctions – are disrupted, the liver tissue structure is damaged, cells are unable to function properly and they may die,” it added.

Four grammes of paracetamol a day is a normal dose for patients with chronic pain.

Notably, this is the first study to connect liver damage from paracetamol toxicity to illnesses like cancer, cirrhosis, and hepatitis. Researchers from the Scottish National Blood Transfusion Service and the Universities of Edinburgh and Oslo participated in the study.

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The team’s current goal is to create a reliable method for employing human liver cells in place of animal research. Subsequently, they will examine the effects of varying paracetamol dosages and times of liver toxicity and pinpoint possible targets for new drugs.

Is paracetamol safe?

According to The Guardian, paracetamol gained popularity during the 1960s when people thought aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen might trigger gastric bleeding, ulcers, and other serious side effects. For many years, there was conflicting data on the likelihood that prolonged use of paracetamol could result in internal bleeding.

The US Food and Drug Administration (FDA) warned in 2013 that taking paracetamol may at times result in toxic epidermal necrolysis, acute generalised exanthematous pstulosis, and Stevens-Johnson Syndrome, which are skin conditions that can be fatal and cause the top layer of skin to peel off.

The National Institute for Health and Care Excellence in the UK recommended general practitioners not to prescribe paracetamol for osteoarthritis in draft guidelines released that same year. The guidelines suggested that paracetamol had “limited benefit” and linked higher doses to cardiovascular, gastrointestinal, and renal. But after medical professionals rejected the recommendation, Nice made a U-turn and resumed supporting paracetamol, as per a report by The Guardian published in 2015.

Though paracetamol is the treatment of choice recommended by the UK-based National Health Service, the evidence says that the drug is of little help for those with chronic pain, cancer, post-operative, period and paediatric pain, rheumatoid and osteoarthritis.

According to a study published in BMJ in 2015, paracetamol was ineffective for acute lower back pain and that compared with placebo, it had only a “small, clinically irrelevant” effect on pain and disability for osteoarthritis suffers. It also highlighted evidence that those taking it regularly were almost four times more likely to have abnormal liver function test results.

Researchers at the University of Bristol published a study in 2019 associating paracetamol intake during pregnancy with potential adverse behavioural and cognitive outcomes during childhood, such as hyperactivity and attention problems.

“Our findings add to a series of results concerning evidence of the possible adverse effects of taking paracetamol during pregnancy such as issues with asthma or behavior in the offspring. It reinforces the advice that women should be cautious when taking medication during pregnancy and to seek medical advice where necessary,” lead author Jean Golding said, according to News Medical Life Sciences.

A 2022 study by the University of Edinburgh also links between paracetamol and high blood pressure

The study published in BMJ last year also warned against the use of medicines like paracetamol, ibuprofen, and codeine, especially for lower back pain. The researchers found side effects like nausea, dyspepsia, vomiting, and diarrhoea in the gastrointestinal system; and discomforts like drowsiness, dizziness, and headaches to the nervous system.

According to research published in the journal Pediatric Research this year, increased usage of acetaminophen or paracetamol by pregnant women, particularly in the third trimester, was linked to smaller vocabularies and shorter utterances in two-year-olds.

Each use of the drug was linked to a two-word reduction in vocabulary in two-year-olds, raising concerns about its impact on foetal brain development, the University of Illinois study said.

Notably, the medicine is known to cause liver failure in overdoses, but the latest findings highlight the need for caution even in standard doses for pain relief.

Recommended dosage

Paracetamol comes in tablets, capsules, syrup, powder, and a suppository. They come in different strengths, such as a tablet of 500 mg or one gramme, while syrup (oral solution) comes in 120 mg, 250 mg or 500 mg in five ml.

The maximum 24-hour dose of paracetamol is four grammes, but as little as five grammes can cause liver complications, and it can be easy to overdose accidentally by taking more than one product containing it at the same time.

According to the NHS, the usual dose for adults is either 500 mg or one gramme. And if one weighs less than 50 kilogrammes, it is recommended to consult a doctor or pharmacist before consuming it.

Adults can take two, 500-mg tablets, 4 times in 24 hours. You must wait at least 4 hours between doses.

With inputs from agencies