How safe is paracetamol?

Abstract

Paracetamol is the most widely used medicine in children, in hospital and in the community. In most countries it is available over the counter and as a prescribed medicine. It is used as an analgesic and an antipyretic. Pain has historically been undertreated in children, especially in preverbal children. In contrast, fever is overtreated, especially in high-income countries. Concerns have been raised regarding the safety of paraceta-mol in relation to the development of liver toxicity and possible long-term effects in the development of asthma. Exposure to paracetamol in pregnancy or infancy has been linked with an increased risk of developing asthma. The meta-analysis by Cheelo et al 1 however suggests that this is likely to be due to the effect of respiratory infections, rather than the paracetamol itself. The OR of developing asthma after exposure to para-cetamol in infancy, after adjusting for respiratory infections was only 1.06. This suggests that the effect of paracetamol is likely to be minimal. We do however, need to be aware that every medicine has side effects and that medicines should only be given when appropriate. There have been isolated case reports of infants and preschool children developing liver toxicity following therapeutic doses of paracetamol. We know that young children are less likely to develop acute liver failure than adolescents following an overdose of paracetamol. This is thought to be due to the altered drug metabolism in young children , notably enhanced sulfation and increased glutathione production. We also know from numerous pharmacovigilance studies that deaths from paracetamol in preschool children are extremely rare. Rajanayagam et al have highlighted the high number of children that developed acute liver failure following medication errors with paracetamol. 2 As paracetamol is the most widely used medicine in young children and is also available in so many different formulations, it is not surprising that medication errors occur. What is of concern, however, is the significant number of young children who developed acute liver failure in Australasia following medication errors with paracetamol. While we are learning more about medication errors by health professionals, in hospital and the community, very little is known about medication errors by parents of young children. Because the study by Rajanayagam et al was a retrospective study, we do not have information as to why the parents committed the medication errors. Doctors will rarely take a full history of medicines that includes over-the-counter medicines and exact …

DOI: 10.1136/archdischild-2014-307431

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