5.2 Acetaminophen (paracetamol)
Acetaminophen was first used in 1883 but gained widespread acceptance only after 1948. It
possesses a wide safety profile. The WHO has recommended it to be used as the first line
medication for mild, moderate, or severe pain and to add opioids and other analgesics as the
pain remains persistent or increases. This multimodal approach has been adopted in the
European Union and has effectively resulted in a 33% decrease in opioids use and their
adverse effects.
Although paracetamol is acceptably safe in usual dosages, there have been some reports that
in patients with significant hepatic dysfunction or those taking substances that induce
hepatic enzymes even common doses may aggravate liver dysfunction, sometimes to the
point of causing hepatic failure. Stable mild chronic liver disease does not seem to be a
contraindication.22
Paracetamol is one of the most commonly ingested medications in deliberate self-poisoning
and accidental ingestion by children. The problem of overdosage is substantial. Fulminant
hepatic failure occurs in 1-5% of cases of paracetamol overdosage 3-6 days after ingestion23
with frequent deaths in people who take 20-25g. There is noly a narrow margin betwwn the
normal maxium 24-hour dosage and that which can cause liver damage and acute hepatic
failure.
Available in oral, rectal and intravenous administration (most of the countries)