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5.2 Acetaminophen (paracetamol)Acetaminophen was first used in 1883 but gained widespread acceptance only after 1948. Itpossesses a wide safety profile. The WHO has recommended it to be used as the first linemedication for mild, moderate, or severe pain and to add opioids and other analgesics as thepain remains persistent or increases. This multimodal approach has been adopted in theEuropean Union and has effectively resulted in a 33% decrease in opioids use and theiradverse effects.Although paracetamol is acceptably safe in usual dosages, there have been some reports thatin patients with significant hepatic dysfunction or those taking substances that inducehepatic enzymes even common doses may aggravate liver dysfunction, sometimes to thepoint of causing hepatic failure. Stable mild chronic liver disease does not seem to be acontraindication.22Paracetamol is one of the most commonly ingested medications in deliberate self-poisoningand accidental ingestion by children. The problem of overdosage is substantial. Fulminanthepatic failure occurs in 1-5% of cases of paracetamol overdosage 3-6 days after ingestion23with frequent deaths in people who take 20-25g. There is noly a narrow margin betwwn thenormal maxium 24-hour dosage and that which can cause liver damage and acute hepaticfailure.Available in oral, rectal and intravenous administration (most of the countries)
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