Letters Paracetamol

And just how do you define narrow therapeutic ratio?

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d625 (Published 01 February 2011) Cite this as: BMJ 2011;342:d625
  1. J R Hoffman, professor1
  1. 1University of South Carolina School of Medicine, Columbia, SC 29208, USA
  1. jrh{at}ucla.edu

It is discouraging that the BMJ published a “lesson of the week” warning us of “chronic toxicity” from paracetamol (N-acetyl-p-aminophenol; APAP) without a counter argument.1 Although paracetamol can be life threatening after intentional overdose, when taken in anything less than extremely large doses it is one of the safest drugs ever created. Fear mongering about paracetamol will surely lead to the substitution of far more dangerous alternatives.

Before N-acetylcysteine became available, acute liver failure …

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