Paracetamol is a very good pain reliever and anti-fever medicine. It is one of the world’s best-selling medicines. It is known as Acetaminophen in the United States, Canada, and Japan. This medicine is widely available and is even endorsed by movie stars.
Did you know that Paracetamol can be dangerous too?
It is important to know more about it. It is important to know what you can and cannot take with it.
PARACETAMOL IS NOT AS SAFE AS YOU THINK
Paracetamol can cause liver failure
Although Paracetamol has been considered safe, it has toxins which can damage the liver. In fact, this drug has been one of the leading causes of liver failure in the United States and United Kingdom. In the US alone, 1,500 deaths have been reported in the past 10 years due to it.
The difference between a toxic dose and a therapeutic dose may be smaller than previously thought. Last January 2014, the United States Food and Drug Administration (USFDA) have urged healthcare providers to reduce their paracetamol dosage to 325mg to avoid such toxicities. Precaution must be specially taken if you or your loved one has a liver problem.
Paracetamol can cause fatal skin problems
Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TENS), and Acute Generalized Exanthematous Pustulosis (AGEP) are skin problems which have been documented to occur with Paracetamol use. Both SJS and TENS are potentially fatal. Unfortunately, no one knows what causes SJS. As for TENS, a bacterial infection makes things worse. AGEP on the other hand has been shown to improve once Paracetamol is stopped.
PARACETAMOL AND ALCOHOL: A NO-NO COMBINATION
Just in case you develop headache after an alcoholic drinking spree, Paracetamol is a bad choice to use to relieve the headache. Like Paracetamol, Alcohol too can damage the liver. When taken together, their liver damaging effects are multiplied. Separating the intake time of Paracetamol and Alcohol doesn’t matter. The danger still exists, and probably isn’t worth taking.
FOR PARACETAMOL: “C” STANDS FOR CONTROVERSY
Many people takes loads of Vitamin C when they feel sick. Vitamin C has been touted as a sort of “wonder vitamin” to improve healing. Taking Paracetamol to relieve flu like symptoms with vitamin C may sounds like a good duo, but maybe it isn’t.
Vitamin C slows down the excretion of Paracetamol from the blood. This causes Paracetamol to stay longer in the blood. This lengthens the time your liver is exposed to Paracetamol’s toxins. The danger to your liver is even higher if you take high doses of Paracetamol in succession. This can happen during persistent fever.
Some studies on the other hand suggest that certain forms of vitamin C might just do the opposite – Protect the liver.
I recommend that to stay safe though, do not take more than 500mg of vitamin C with your paracetamol.
Vitamin C is richly found in some fruits and vegetables, as well as tablet forms.
HERBS AND MEDS REACT TO PARACETAMOL TOO
Certain herbs, or herbal preparations have been shown to affect Paracetamol metabolism. These herbs may either increase or decrease Paracetamol’s toxicity, or affect how effective Paracetamol will work on your body.
AN HERB WHICH MAY CAUSE MORE TOXICITY:
Echinea is often used as an immune booster. However, some individuals may experience an inflamed liver when they take echinea with paracetamol.
AN HERB WHICH MAY MAKE PARACETAMOL LESS EFFECTIVE
Large amounts of garlic inhibits Paracetamol metabolism in animal studies. This means that it is possible to reduce the effectiveness of Paracetamol when taken with large doses of garlic. But don’t worry, the dose is higher than the garlic an average asian diet provides.
HERBS/SUPLEMENTS THAT MAY REDUCE PARACETAMOL TOXICITY
Methionine is an essential amino acid needed by the body in processing other nutrients. Methionine appears to reduce Paracetamol’s toxic effects. Methionine is found in dairy products, fish, and meat. It is also found in sunflower seeds, pumpkin seeds, sesame seeds, lentils, and egg yolk. Your normal intestinal bacteria may also produce significant amounts.
Methionine production is a highlight of maintaining a healthy intestinal bacterial population. Things that can disrupt this include use of antibiotics, exposure to germs that can make you sick, and poor nutrition.
Silymarine found in milk thistle appears to also be protective of the liver. It prevents glutathione depletion and lipid peroxidation. Although it sounds promising, the amount of silymarine which reaches your body’s tissues (bioavailability) has been noted to be low when taken orally.
SAMe (S-adynosylmethionine) is another nutrient which can reduce paracetamol toxicity. It is found in most food in significant amounts. However, SAMe can be depleted if one lacks other nutrients such as methionine, folate, and vitamin B12. So it’s very important to stay well-nourished with these nutrients while you are sick.
N-Acetylcysteine is known to us as a drug which helps remove phlegm when we are sick. It is a food supplement in some countries.
N-Acetylcysteine was shown to reduce Paracetamol-related morbidity and mortality in research done in the US. Acetylcysteine appears to improve glutathione production which may help reduce Paracetamol’s toxicity. For this reason, acetylcysteine was regarded as an antidote for paracetamol overdose.
PARACETAMOL CAN CAUSE THIS MEDICINE TO BECOME LESS EFFECTIVE
Glucosamine sulfate is becoming a favorite for osteoarthritis. When taken together, Paracetamol consumes the sulfate glucosamine sulfate provides, thus making the glucosamine less effective. Other forms of glucosamine such as glucosamine hydrochloride appear to be unaffected by this reaction. However, whether these forms are as effective as glucosamine sulfate has yet to be seen.
PARACETAMOL MIGHT REDUCE SIDE EFFECTS OF THIS NUTRIENT
Niacin (Vitamin B3) is often used for burns, pregnancies, anxiety disorders, diabetes, high cholesterol levels, smoking cessation, and other things. It is richly found in liver, chicken, meat, fish, eggs, peanuts, brewer’s yeast, and rice bran. This wonderful nutrient can however, cause your skin to turn red and give burning or tingling sensations. Preliminary studies have shown that Paracetamol might be able to reduce these symptoms.
KNOW YOUR MEDICINES WELL
Paracetamol is found in a variety of medicines. These include popular cough, colds, and flu preparations. Many pain relievers combine Paracetamol with other drugs. Be careful when you take these medicines with your Paracetamol tablets. This is to avoid over dosage of Paracetamol. It is important to read the labels of your favorite medicines before you decide to take them. In many countries, the active ingredients are not displayed in a bold boxed letters like here in the Philippines. You may need to read the fine print carefully to know what you are really taking. Even better, seek a consultation with your doctor or healthcare provider before taking them.
ALLERGY TO PARACETAMOL? IT MIGHT JUST BE THE COLOR
Many Paracetmol tablets in the Philippines are colored orange-pink. I have encountered a good number of patients who seem to be allergic to this coloring. Having them use white colored paracetamol tablets may removes this allergy. However, if their allergy persists, they may be allergic to another component. This which may include the Paracetamol powder itself.
AVOID CONFUSION: PARACETAMOL IS KNOWN AS ACETAMINOPHEN IN THE USA
In case you are taking medicines from abroad, Paracetamol is known as Acetominophen in the United States, Canada, and Japan. Many drugs with similar sounding names have common mechanisms of actions. Changing the name of Paracetamol to Acetominophen, distances itself from similar-sounding non-related drugs such as Salbutamol. This change has advantages but can lead to some confusion too. This is very important in case your loved ones abroad send you medicines. This is very important too if you are travelling. Take note that different countries label their medications differently. The regular “usual” dose in different countries may differ too. These differences can lead you to overdose if you simply take your usual number of tablets and frequency without knowing the exact dose per tablet.
TAKE CARE OF YOUR LIVER
We only have one liver. Let’s keep it healthy for the well-being of our body. Liver diseases such as fatty liver disease and liver cancer have become the focus of many discussions lately. Toxins such as those found in medicines or food might be the culprit. It is a good idea to keep our exposure to these toxins as low as possible.
ASK YOUR DOCTOR
I seriously recommend that you consult with your physician before you take any medication. A good understanding of how medicines, vitamins, and nutrients interacts with each other is very important. Your family physician is always ready to help you sort them out. This too is part of the focus of a new specialty known as Interventional Wellness. By knowing your substances well, you can effectively reduce medicine intake. This translates to savings, safety, and better well being.
This article was written by Charles Florendo
is a certified family physician with training in interventional wellness. He is probably the first hyperventilation and dysfunctional breathing specialist in Southeast Asia. He has taught breathing retraining to patients and healthcare workers in Africa, United States, and the Philippines. He holds an advanced certificate in Buteyko from the Buteyko Breathing Association (UK). He is presently the medical adviser of the at Buteyko Clinic International and a consultant at Mary Chiles General Hospital (Philippines) and the Clinica Salutare (Philippines) and the Biobalance Wellness Center (Philippines). He lives in Manila, Philippines
Disclaimer: This article is based on the personal opinion of the author and does not constitute medical advice. Trademarks and copyright of names and logos of organizations, corporations, or products belong to their respective owners. The mention of any particular product or service does not constitute their endorsement by any particular entity. The author is not affiliated with the Global Initiative for Asthma,nor the British Thoracic Society.
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