Some risks with using paracetamol

THE EDITOR: With the serious situation existing in TT as a result of dengue, the advice being given by Ministry of Health officials and healthcare professionals is that those afflicted by the disease should use paracetamol for relieving pain and fever.

I continue to be perplexed as to why mention is rarely if ever made of combating the virus by strengthening our very sophisticated immune systems using, for example, clinically proven vitamin C.

Regarding paracetamol, this is one of the most commonly used over-the-counter drugs around the world. It was discovered more than 100 years ago and was introduced in the market in the 1950s. Despite its widespread use and because it is being recommended for use in the face of the dengue challenge, there are some safety issues with the drug about which the public should be aware.

In a 2014 paper in a journal published by the Polish Pharmaceutical Society (https://www.ptfarm.pl/pub/File/Acta_Poloniae/2014/1/011.pdf), researchers at a medical university in Poland discussed the drug, its mechanism of action and related safety concerns.

They reported that “Paracetamol is a well tolerated drug and produces few side effects from the gastrointestinal tract. However, despite that, every year has seen a steadily increasing number of registered cases of paracetamol-induced liver intoxication all over the world.”

They note that the drug “is not a panacea devoid of side effects, and indeed, especially when taken regularly and in large doses (more than 4g/day), there is a risk of serious side effects.”

In the paper the authors elaborate on the various side effects and state that while the drug is safe when used in therapeutic doses, “paracetamol overuse or application, even at therapeutic doses in some situations, like improper slimming, smoking, alcohol abuse or ingestion of other medicines, may cause severe (liver) damage or death.”

As a result, they caution that “it is very important for the patient to be warned by doctors or pharmacists about the risk connected with the ingestion and particularly with the overuse of the drug.”

I do not know if this is regularly done here in TT.

In another paper published in 2020 in the World Journal of Hepatology examining liver injury induced by paracetamol use (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336293/pdf/WJH-12-125.pdf), medical researchers from Rutgers New Jersey Medical School in the US state that paracetamol “has long been established to cause liver toxicity once above therapeutic levels.”

They indicate that liver-induced toxicity from paracetamol “is the most common cause of drug-induced liver injury in the United States and remains a global issue.” It contributes to “over half of all acute liver failure cases in the United States.”

They go on in the paper to discuss treatment options for this condition.

Finally, the British Liver Trust, an organisation whose vision is “A world without liver disease,” states on its website that in the UK the most common cause of acute liver failure is an overdose of paracetamol.

It is clear therefore that while citizens are being advised to take this drug in order to address the effects of dengue fever, due caution should be exercised in the quantity taken and the duration of use, especially given its over-the-counter availability.

STEPHAN GIFT

via e-mail