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BMJ 2006; 333 doi: (Published 13 July 2006) Cite this as: BMJ 2006;333:141
  1. Alison Tonks, associate editor (

    Normal doses of paracetamol can derange liver enzymes in healthy adults

    Therapeutic doses of paracetamol (acetaminophen) are normally considered safe. But in a recent experiment, healthy young volunteers taking therapeutic doses of the drug developed abnormal liver function after only a few days.

    Credit: JAMA

    The 145 volunteers took4gaday of paracetamol with or without an opioid (morphine, hydromorphone, or oxycodone), or a placebo. More than a third of the volunteers taking paracetamol had serum concentrations of alanine aminotransferase over three times the upper limit of normal at some point during the 14 day experiment. More than a fifth experienced peak concentrations over five times the upper limit of normal. The opioids seemed to make no difference either to peak concentrations of alanine aminotransferase or to the timing of the abnormal results, which persisted for 1-11 days after treatment was stopped and long after serum concentrations of paracetamol had fallen to subtherapeutic levels. Overall, peak values for alanine aminotransferase were two to three times higher in the paracetamol groups than the placebo group.

    Credit: JAMA

    The researchers aren't sure why no one has noticed such a marked effect before and suggest that further work be done to find out who is most vulnerable. In this study, Hispanic volunteers seemed more likely than non-Hispanic Americans to develop abnormally high serum concentrations of alanine aminotransferase (relative risk 1.9; 95% CI 1.1 to 3.3).

    Acupuncture and sham acupuncture both ease the pain of arthritis

    In Germany, acupuncture is a popular treatment for chronic pain caused by osteoarthritis of the knee. Faced with a patchy and inconsistent evidence base, a consortium of social healthcare insurance organisations funded a large and well designed trial to find out if acupuncture adds anything to standard treatments based on anti-inflammatory drugs and physiotherapy.

    All 1007 participants had up to six sessions of physiotherapy and anti-inflammatory drugs as required (rofecoxib or diclofenac). They also had either 10 consultations with a doctor, …

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