Paracetamol use in adultsBMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2022-070753 (Published 16 November 2023) Cite this as: BMJ 2023;383:e070753
- Thomas M Caparrotta, registrar in clinical pharmacology and general internal medicine1,
- Emma Carduff, patient representative2,
- James W Dear, professor of clinical pharmacology1
- 1Pharmacology, Therapeutics and Toxicology Unit, Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, UK
- 2Patient author
- Correspondence to J W Dear
What you need to know
Short term use of paracetamol can be effective for acute pain, but is unlikely to offer relief for chronic pain
Consider adjusting dose or dose frequency for patients with low body weight, who consume alcohol regularly, have liver disease, or who are frail
Overdose resulting in liver damage can occur in patients who accidentally take too much paracetamol or multiple paracetamol-containing products
Practical Prescribing is a series producedin conjunction with the Drug and Therapeutics Bulletin to highlight important issues for prescribers to consider and prompts for shared decision making between prescribers, patients, and their carers. Targeted at all medical and non-medical prescribers, particularly doctors in training, the series covers medicines commonly prescribed in primary and secondary care.
A 75 year old woman has knee pain owing to severe osteoarthritis. She is using topical ibuprofen gel and is taking indapamide and ramipril as antihypertensive medicines. She weighs 49 kg. She has asked whether she should be taking paracetamol regularly.
How often is paracetamol prescribed and how does it work?
Paracetamol is widely available over the counter as a single agent and in multiple combination products with other analgesics such as codeine, tramadol, and ibuprofen. Despite its over-the-counter availability, it is the most commonly prescribed analgesic worldwide. In England, 16 million prescriptions were dispensed from April 2022 to March 2023,1 and in Scotland more than 500 000 patients received three or more primary care prescriptions for medications that contained paracetamol in 2018.2 Typical licensed indications for paracetamol in adults include treatment of most painful and febrile conditions, including headache, neuralgia, sore throat, and rheumatic pain.3
Paracetamol inhibits the enzyme cyclooxygenase (COX), which produces pro-inflammatory prostaglandins and thromboxanes (fig 1).4 Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen have a similar mechanism of action. Uncertainty exists as to whether paracetamol should be classified as different to NSAIDs because …