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The risks associated with paracetamol are greater than “currently perceived in the clinical community”, according to a recent meta-analysis.

For instance, two studies compared mortality in people using paracetamol and non-users. The study found a dose-related increase in relative mortality rate ranging from 0.95 to 1.63. All four studies reporting cardiovascular adverse events showed dose-related increases ranging from 19 to 68 per cent, while one study reported a dose-related increase in gastrointestinal adverse events or bleeds of between 11 and 49 per cent.

Three of four studies reported an increase in renal adverse events and one reported a dose-related increase in the risk of a 30 per cent or more decrease in estimated glomerular filtration rate from 1.40 to 2.19.

The authors remark that, “the dose-response seen for most end points suggests a considerable degree of paracetamol toxicity especially at the upper end of standard analgesic doses”. A systematic review should assess paracetamol’s efficacy and tolerability in individual conditions.

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