Paracetamol (Acetaminophen): Uses, Dosage & Side Effects
A widely used over-the-counter analgesic and antipyretic for the relief of mild to moderate pain and fever reduction
Paracetamol (known as acetaminophen in the United States) is one of the most widely used medications in the world. It provides effective relief from mild to moderate pain and reduces fever. Available over the counter in most countries, paracetamol is recommended by the WHO as a first-line analgesic and is on the WHO Model List of Essential Medicines. While generally safe when used correctly, overdose can cause severe liver damage and requires immediate medical attention.
Quick Facts: Paracetamol
Key Takeaways
- Paracetamol is the recommended first-line treatment for mild to moderate pain and fever in adults and children, endorsed by WHO, NICE, and major medical guidelines worldwide.
- The maximum daily dose for healthy adults is 4,000 mg (4 g); exceeding this dose can cause severe, potentially fatal liver damage even if you feel well initially.
- Unlike NSAIDs such as ibuprofen, paracetamol is generally safe for people with stomach ulcers, bleeding disorders, or aspirin sensitivity, as it has minimal anti-inflammatory or antiplatelet activity.
- Always check ingredient labels of other medications you are taking, as many combination cold, flu, and pain products contain paracetamol, which can lead to accidental overdose.
- If overdose is suspected, seek immediate emergency medical attention; the antidote N-acetylcysteine (NAC) is most effective when administered within 8 hours.
What Is Paracetamol and What Is It Used For?
Paracetamol, known as acetaminophen in the United States, Canada, and Japan, is one of the most widely used over-the-counter medications globally. First introduced for clinical use in the 1950s, it has since become a cornerstone of pain management and fever reduction recommended by the World Health Organization (WHO), the National Institute for Health and Care Excellence (NICE), and virtually every major medical guideline worldwide.
The medication works primarily by inhibiting cyclooxygenase (COX) enzymes in the central nervous system, which reduces the production of prostaglandins involved in pain signaling and thermoregulation. Unlike non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, paracetamol has very limited anti-inflammatory activity and does not significantly affect peripheral prostaglandin synthesis. This makes it particularly suitable for patients who cannot tolerate NSAIDs due to gastrointestinal problems, bleeding disorders, or aspirin sensitivity.
Paracetamol is indicated for the treatment of a wide range of mild to moderate pain conditions, including headache, toothache, menstrual pain (dysmenorrhea), muscle and joint aches, back pain, and post-surgical pain. It is also highly effective as a fever reducer (antipyretic) in conditions such as the common cold, influenza, and other febrile illnesses in both adults and children. In the WHO analgesic ladder for cancer pain, paracetamol forms the foundation of Step 1 treatment.
Available in multiple formulations including standard tablets, effervescent (soluble) tablets, oral liquid solutions, suppositories, and intravenous infusion solutions, paracetamol can be administered through various routes depending on the clinical situation and patient needs. The most common oral tablet strengths are 500 mg and 1,000 mg (1 g). Liquid formulations (typically 24 mg/ml or 120 mg/5 ml) are widely used for children. The intravenous form (10 mg/ml) is reserved for hospital use when oral or rectal administration is not possible.
One of the key advantages of paracetamol is its favorable safety profile when used at recommended doses. It can be used by people with sensitive stomachs or peptic ulcers, those with increased bleeding tendency, and patients taking anticoagulant medications (with appropriate monitoring). However, it is essential to recognize that exceeding the maximum recommended dose can lead to severe hepatotoxicity (liver damage), which is the leading cause of acute liver failure in many developed countries.
What Should You Know Before Taking Paracetamol?
Contraindications
There are specific situations where paracetamol must not be used. Understanding these contraindications is essential for safe medication use. You should not take paracetamol if you have a known allergy (hypersensitivity) to paracetamol or any of the inactive ingredients in the specific formulation you intend to use, or if you have severe hepatic impairment (severely reduced liver function) or active liver disease. Patients with known severe hepatocellular insufficiency should avoid paracetamol entirely, as even therapeutic doses may precipitate further liver damage.
Warnings and Precautions
Never exceed the recommended dose. Higher doses do not provide better pain relief but do carry a risk of very serious liver damage. Symptoms of liver damage may not appear for 24 to 72 hours after ingestion. Seek immediate medical attention if you suspect an overdose, even if you feel well.
Paracetamol requires careful use and medical consultation in several circumstances. If you are taking other pain-relieving or cold and flu medications, always check the ingredient list, as many combination products contain paracetamol. Taking multiple products containing paracetamol simultaneously is a common cause of accidental overdose and can lead to life-threatening liver damage.
You should consult your doctor or pharmacist before taking paracetamol if you have any of the following conditions:
- Impaired liver function: Including chronic liver disease, hepatitis, or cirrhosis. The liver is responsible for metabolizing paracetamol, and impaired function increases the risk of toxicity.
- Impaired kidney function: Severe renal impairment may affect the elimination of paracetamol and its metabolites, requiring dose adjustment.
- Chronic alcohol use or alcohol use disorder: Regular alcohol consumption induces liver enzymes that increase the production of the toxic metabolite NAPQI, lowering the threshold for liver damage.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency: This inherited enzyme deficiency may increase the risk of hemolytic anemia with paracetamol use.
- Malnourishment or low body weight: Glutathione stores may be depleted, reducing the body's ability to neutralize the toxic metabolite NAPQI.
- Severe infection (sepsis): Serious infections may increase the risk of metabolic acidosis when paracetamol is used.
- Gilbert's syndrome: This common benign condition affecting bilirubin metabolism may alter paracetamol clearance, potentially requiring dose reduction.
- Asthma with aspirin sensitivity: While rare, some individuals with aspirin-sensitive asthma may also react to paracetamol, particularly at higher doses.
High anion gap metabolic acidosis has been reported in patients with severe underlying conditions such as sepsis, severe renal impairment, malnutrition, or chronic alcoholism, particularly when paracetamol is used at recommended doses for prolonged periods or in combination with flucloxacillin. Symptoms include deep, rapid, labored breathing; nausea and vomiting; and loss of appetite. Seek immediate medical attention if you experience a combination of these symptoms.
Pregnancy and Breastfeeding
Paracetamol is generally considered the safest analgesic and antipyretic option during pregnancy and has been widely used for decades. Major medical organizations, including the WHO, NICE, the American College of Obstetricians and Gynecologists (ACOG), and the European Medicines Agency (EMA), continue to recommend paracetamol as the first-line treatment for pain and fever during pregnancy.
If you are pregnant, you should use the lowest effective dose for the shortest possible duration. Contact your doctor or midwife if pain or fever does not improve, or if you need to take the medication more frequently. While some observational studies have raised questions about potential long-term effects of prolonged prenatal paracetamol exposure, systematic reviews and regulatory bodies have concluded that the current evidence does not support restricting paracetamol use during pregnancy when clinically indicated.
Paracetamol passes into breast milk in small amounts, but at therapeutic doses it is unlikely to affect a nursing infant. The amount transferred to the infant through breast milk is considerably less than the dose that would normally be given to an infant. However, if you are breastfeeding and using paracetamol regularly for more than occasional use, it is advisable to consult your doctor.
Driving and Operating Machinery
Paracetamol does not affect your ability to drive or operate machinery at recommended doses. Unlike opioid-containing combination products, pure paracetamol formulations do not cause drowsiness, sedation, or impaired reaction time. Note that some combination products that include paracetamol together with codeine, tramadol, or antihistamines may impair driving ability; always check the specific product labeling.
How Does Paracetamol Interact with Other Drugs?
Although paracetamol has a relatively favorable drug interaction profile compared to NSAIDs, it can interact with several medications in clinically significant ways. Understanding these interactions is important for safe use. Always inform your doctor, pharmacist, or nurse about all medications, herbal remedies, and supplements you are taking before using paracetamol.
Major Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Warfarin and other coumarins | Regular use of paracetamol (more than 2 g/day for several days) may enhance the anticoagulant effect of warfarin, increasing INR and bleeding risk | Occasional use is generally safe. If regular use is needed, limit to 2 g/day for max 5 days and monitor INR closely. Consult your doctor. |
| Flucloxacillin | Concurrent use may increase the risk of high anion gap metabolic acidosis, particularly in patients with sepsis, renal impairment, or malnutrition | Use with caution. Seek immediate medical attention if you develop rapid, labored breathing, nausea, or loss of appetite. |
| Carbamazepine, Phenytoin, Phenobarbital | These enzyme-inducing antiepileptic drugs increase the hepatic metabolism of paracetamol, potentially increasing the production of the hepatotoxic metabolite NAPQI | May lower the threshold for paracetamol hepatotoxicity. Use the lowest effective dose and consult your doctor. |
| Rifampicin | Potent enzyme inducer that significantly increases paracetamol metabolism and NAPQI production, while potentially reducing analgesic efficacy | Use reduced doses of paracetamol and monitor for both hepatotoxicity and reduced efficacy. Medical supervision recommended. |
Minor Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Probenecid | Reduces the clearance of paracetamol by inhibiting glucuronide conjugation, potentially increasing paracetamol blood levels | Consider reducing paracetamol dose by half or extending dosing intervals when taking probenecid. |
| Cholestyramine | Reduces absorption of paracetamol from the gastrointestinal tract if taken simultaneously | Take paracetamol at least 1 hour before or 4 hours after cholestyramine. |
| Chloramphenicol (IV) | Paracetamol may increase chloramphenicol blood levels by inhibiting its metabolism | Monitor chloramphenicol levels if concurrent use is necessary. Topical eye chloramphenicol is unaffected. |
| St. John's Wort | May increase paracetamol metabolism through enzyme induction, potentially reducing efficacy and increasing hepatotoxic metabolite production | Inform your doctor if you use St. John's Wort supplements. |
| Metoclopramide / Domperidone | Increases the rate of paracetamol absorption by accelerating gastric emptying | Generally beneficial; may lead to faster onset of pain relief. No dose adjustment typically needed. |
Avoid using paracetamol together with alcohol. Chronic alcohol consumption induces the CYP2E1 enzyme, which increases the production of NAPQI, the hepatotoxic metabolite of paracetamol. This means that people who drink alcohol regularly may experience liver damage at lower doses than those recommended for the general population. Note that paracetamol does not enhance the intoxicating effects of alcohol.
What Is the Correct Dosage of Paracetamol?
Paracetamol dosing depends on the patient's age, body weight, and underlying health conditions. The fundamental principle is to use the lowest effective dose for the shortest duration necessary to control symptoms. Never exceed the maximum daily dose, as even a modest overdose can lead to serious liver damage.
Adults and Adolescents (Over 50 kg Body Weight)
Standard Oral Dosing
Single dose: 500 mg to 1,000 mg (1 to 2 standard 500 mg tablets)
Dosing interval: Every 4 to 6 hours as needed
Maximum daily dose: 4,000 mg (4 g) in any 24-hour period
Maximum single dose: 1,000 mg (1 g)
Important: Many current guidelines recommend limiting intake to 3,000 mg per day for the general population and even lower doses for at-risk groups.
Children (Under 50 kg Body Weight)
Weight-Based Pediatric Dosing
Single dose: 10–15 mg per kg of body weight
Dosing interval: Every 4 to 6 hours as needed
Maximum daily dose: 60 mg/kg/day (not to exceed 2,000 mg in children under 50 kg)
Note: Always use age-appropriate formulations (liquid suspension for infants and young children). Use the measuring device provided with the product. Do not give paracetamol to infants under 2 months of age without medical advice.
Paracetamol is available in various formulations suitable for different age groups. Liquid suspensions (typically 120 mg/5 ml or 250 mg/5 ml) are used for infants and young children who cannot swallow tablets. Suppositories are available for situations when oral administration is not possible, such as during vomiting. The intravenous formulation is used in hospital settings for patients who cannot take oral or rectal medications.
Elderly Patients
Older adults may be more susceptible to the adverse effects of paracetamol due to reduced hepatic and renal function that accompanies aging. While no specific dose reduction is required solely on the basis of age, many clinical guidelines recommend that adults over 65 years or those weighing less than 50 kg should limit their daily intake to a maximum of 3,000 mg (3 g). This precautionary dose reduction helps to account for the gradual decline in liver and kidney function that is common in older adults. If you have any concerns about the appropriate dose, consult your doctor or pharmacist.
Hepatic and Renal Impairment
Patients with hepatic (liver) impairment require careful consideration of paracetamol dosing. In mild to moderate liver disease, paracetamol may be used at reduced doses under medical supervision. The typical recommendation is to reduce the maximum daily dose to 2,000 mg (2 g) and to extend the minimum dosing interval to every 6 to 8 hours. In severe liver disease or decompensated cirrhosis, paracetamol should generally be avoided. Similarly, patients with severe renal impairment (creatinine clearance less than 30 ml/min) should extend dosing intervals to every 6 to 8 hours.
Missed Dose
Since paracetamol is typically taken on an as-needed basis for pain or fever, a missed dose is generally not a concern. If you are taking paracetamol at regular intervals, take the missed dose as soon as you remember, provided at least 4 hours have passed since your last dose. Do not take a double dose to compensate for a missed one. If it is nearly time for your next scheduled dose, skip the missed dose and continue with your regular schedule.
Overdose
Paracetamol overdose is a medical emergency. Contact your local emergency services or poison control center immediately if you suspect an overdose, even if you feel well. Early treatment dramatically improves outcomes.
Paracetamol overdose is one of the most common causes of acute liver failure in many Western countries and can be fatal without timely treatment. Hepatotoxicity may occur after a single acute ingestion of more than 150 mg/kg (approximately 7.5 g in a 50 kg person or 10 g in an average-weight adult) or after repeated supratherapeutic doses (staggered overdose).
The mechanism of toxicity involves the accumulation of NAPQI (N-acetyl-p-benzoquinone imine), a toxic metabolite that is normally neutralized by glutathione in the liver. When paracetamol is taken in excess, glutathione stores are depleted, and NAPQI binds to liver cell proteins, causing hepatocellular necrosis (liver cell death).
Symptoms of overdose typically progress through four phases. In the first 24 hours, symptoms may be absent or limited to nausea, vomiting, and general malaise. Between 24 and 72 hours, liver damage begins to manifest with right upper abdominal pain, elevated liver enzymes, and abnormal coagulation parameters. At 72 to 96 hours, peak liver damage occurs, with potential jaundice, hepatic encephalopathy, renal failure, and multi-organ dysfunction. After 96 hours, if the patient survives, liver regeneration begins, and recovery may take several weeks.
The primary antidote for paracetamol overdose is N-acetylcysteine (NAC), which replenishes glutathione stores and directly neutralizes NAPQI. NAC is most effective when administered within 8 hours of overdose, but may still provide benefit up to 24 hours or later. The treatment protocol involves an intravenous infusion given over approximately 21 hours, though oral NAC regimens are also used in some settings.
What Are the Side Effects of Paracetamol?
When used at recommended doses, paracetamol has an excellent safety profile and most people experience no side effects. It is considered one of the safest analgesics available, which is why it remains the first-line recommendation for pain and fever across all age groups. However, like all medications, paracetamol can occasionally cause adverse effects. The following section classifies potential side effects by frequency, based on international pharmacovigilance data.
Rare
- Angioedema: Swelling of the face, tongue, or throat; difficulty swallowing
- Allergic skin reactions: Hives (urticaria), rash, itching
- Bronchospasm: Wheezing or difficulty breathing, particularly in aspirin-sensitive individuals
- Hepatotoxicity: Liver damage presenting as fatigue, nausea, vomiting, abdominal discomfort, and loss of appetite (primarily associated with overdose or prolonged supratherapeutic doses)
Very Rare
- Thrombocytopenia: Reduced platelet count causing unusual bleeding or bruising
- Leukopenia / Agranulocytosis: Reduced white blood cells causing increased susceptibility to infections, sore throat, and fever
- Hemolytic anemia: Destruction of red blood cells causing pallor, fatigue, and jaundice
- Severe skin reactions: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in extremely rare cases
- Anaphylaxis: Severe whole-body allergic reaction with potential drop in blood pressure and difficulty breathing
- Renal adverse effects: Kidney damage with prolonged use at high doses
Frequency Not Known
- Metabolic acidosis: Reported in patients with severe underlying conditions (sepsis, severe renal impairment, malnutrition) using paracetamol at recommended doses, especially with concurrent flucloxacillin use
Stop taking paracetamol and call emergency services immediately if you experience any of the following: swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe skin rash with blistering or peeling; unexplained bleeding or bruising; yellowing of the skin or eyes (jaundice); dark urine or pale stools.
It is important to distinguish between side effects of paracetamol itself (which are rare at therapeutic doses) and the effects of paracetamol overdose. The vast majority of serious adverse events associated with paracetamol, particularly liver damage, occur in the context of overdose (either acute or cumulative) rather than appropriate therapeutic use. This underscores the importance of adhering to recommended dosing guidelines and being aware of paracetamol content in other medications you may be taking.
If you experience any unexpected symptoms while taking paracetamol, even if they are not listed here, report them to your doctor or pharmacist. You can also report suspected side effects directly to your national pharmacovigilance authority (for example, the MHRA Yellow Card scheme in the UK, the FDA MedWatch program in the US, or the EMA EudraVigilance system in Europe). Reporting side effects contributes to the ongoing monitoring of the benefit-risk balance of medications.
How Should You Store Paracetamol?
Proper storage of paracetamol is important to maintain its effectiveness and safety. The following guidelines apply to all formulations unless the product packaging specifies otherwise:
- Temperature: Store at room temperature, generally below 25°C (77°F). Do not freeze liquid formulations. Avoid storing in excessively hot or humid environments such as bathrooms or near stoves.
- Packaging: Keep tablets and effervescent tablets in their original blister packs or containers with the cap tightly closed after each use. This protects them from moisture and maintains their potency. Effervescent tablets are particularly sensitive to humidity.
- Light protection: Some liquid formulations should be protected from direct sunlight. Store in a cool, dark place when possible.
- Child safety: Keep all medicines securely out of the sight and reach of children and adolescents. Consider using child-resistant packaging and storing medicines in a locked cabinet. Paracetamol overdose in children is a medical emergency.
- Expiry date: Do not use paracetamol after the expiry date stated on the packaging. The expiry date refers to the last day of that month.
- Disposal: Do not dispose of medications via household waste or down drains. Return unused or expired medicines to your pharmacy for safe disposal. Proper disposal helps protect the environment.
For opened oral liquid formulations (syrups and solutions), check the product labeling for the recommended use-by period after first opening. Most liquid paracetamol products remain stable for 6 months after opening, but this may vary by manufacturer. Mark the date of opening on the bottle for reference.
What Does Paracetamol Contain?
All paracetamol formulations contain paracetamol as the active pharmaceutical ingredient. The inactive ingredients (excipients) vary depending on the dosage form, manufacturer, and brand. These excipients do not have therapeutic activity but serve important functions in drug delivery, such as binding the tablet together, aiding disintegration, improving taste, and extending shelf life.
Common Formulations
Standard tablets (500 mg, 1 g): Typically contain excipients such as maize starch, pregelatinized starch, povidone, stearic acid, talc, and sometimes a film coating (hypromellose, titanium dioxide, macrogol).
Effervescent tablets (500 mg, 1 g): Contain sodium bicarbonate and citric acid (which produce effervescence when dissolved in water), along with povidone, saccharin sodium (sweetener), sodium chloride, sodium lauryl sulfate, and flavorings (often citrus).
Effervescent paracetamol tablets contain a significant amount of sodium (approximately 400–500 mg per tablet depending on the brand). This should be taken into account by patients on sodium-restricted diets, such as those with high blood pressure, heart failure, or impaired kidney function. Standard non-effervescent tablets contain negligible sodium.
Oral liquid / suspension (24 mg/ml, 120 mg/5 ml): Typically contain purified water, glycerol, sorbitol, methyl parahydroxybenzoate, propyl parahydroxybenzoate, xanthan gum, citric acid, and flavoring agents (strawberry, orange, or banana). Some formulations are sugar-free and suitable for diabetic patients.
Suppositories (125 mg, 250 mg, 500 mg, 1 g): Contain hard fat as the base material alongside the active ingredient. Suppositories are free from most common allergens and are suitable for patients with allergies to excipients found in oral formulations.
Intravenous infusion (10 mg/ml): A sterile solution containing paracetamol, mannitol, cysteine hydrochloride, disodium phosphate dihydrate, sodium hydroxide, hydrochloric acid, and water for injections. This formulation is used exclusively in hospital settings.
If you have known allergies to any specific excipients (such as certain food colorings, preservatives, or sweeteners), always check the full ingredient list on the product packaging or patient information leaflet before taking any paracetamol product. Your pharmacist can help you identify suitable formulations.
Frequently Asked Questions About Paracetamol
Yes, paracetamol and acetaminophen are the same drug with the same chemical structure and identical effects. The name "paracetamol" (derived from para-acetylaminophenol) is used in Europe, Australia, Africa, and most of Asia, while "acetaminophen" (derived from N-acetyl-para-aminophenol) is the name used primarily in the United States, Canada, and Japan. The International Nonproprietary Name (INN) designated by the WHO is "paracetamol," while the United States Adopted Name (USAN) is "acetaminophen." Regardless of the name, the medication is chemically identical worldwide.
The traditional maximum recommended daily dose for healthy adults weighing over 50 kg is 4,000 mg (4 grams). However, many healthcare authorities and guidelines now suggest limiting daily intake to 3,000 mg to provide a wider safety margin, especially for older adults. For adults weighing less than 50 kg, those with liver disease, regular alcohol users, or malnourished individuals, the maximum should be further reduced as advised by a healthcare professional. It is crucial to include paracetamol from all sources (including combination products for cold, flu, or pain) in your daily total.
Paracetamol is widely regarded as the safest pain reliever and fever reducer during all trimesters of pregnancy when used at the lowest effective dose for the shortest necessary duration. Major medical organizations including the WHO, NICE, ACOG, and EMA continue to recommend it as the first-line analgesic for pregnant women. Unlike NSAIDs (ibuprofen, aspirin), which carry specific risks during pregnancy particularly in the third trimester, paracetamol does not affect uterine contractions or fetal cardiovascular function. Always consult your midwife or doctor if you need regular pain relief during pregnancy.
Paracetamol overdose can cause severe, potentially fatal liver damage (hepatotoxicity). The toxic mechanism involves depletion of liver glutathione and accumulation of a harmful metabolite called NAPQI. Critically, symptoms of liver damage may not appear for 24 to 72 hours, even while serious damage is occurring. Early symptoms may include nausea, vomiting, and abdominal pain. If left untreated, this can progress to liver failure, multi-organ dysfunction, and death. The antidote, N-acetylcysteine (NAC), is highly effective when given early, ideally within 8 hours of overdose. This is why it is vital to seek emergency medical care immediately after any suspected overdose, even if you feel well.
Yes, paracetamol and ibuprofen can be taken together or alternated for improved pain and fever control. Since they work through different pharmacological mechanisms, the combination can provide superior analgesia compared to either drug alone. This approach is commonly recommended by healthcare professionals and supported by clinical evidence. You should take each drug according to its own dosing schedule and not exceed the maximum daily dose of either. Alternating the two medications every 2 to 3 hours (so that each individual drug is taken every 4 to 6 hours) is a commonly used strategy, particularly for managing fever in children.
The onset of action depends on the formulation. Standard oral tablets typically begin to relieve pain within 30 to 60 minutes, reaching peak effect at approximately 1 to 2 hours. Effervescent (soluble) tablets and liquid formulations are absorbed more rapidly and may begin working within 15 to 30 minutes. Suppositories have the slowest onset, taking 1 to 2 hours or longer. Intravenous paracetamol has the fastest onset at 5 to 10 minutes. The analgesic and antipyretic effects typically last 4 to 6 hours regardless of formulation.
References
This article is based on current international medical guidelines, regulatory documents, and peer-reviewed research. All sources meet evidence level 1A standards.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023. Paracetamol is listed as an essential medicine for pain and palliative care.
- European Medicines Agency (EMA). Paracetamol – Summary of Product Characteristics. EMA/CHMP; 2024. Comprehensive regulatory document covering indications, dosing, contraindications, and safety data.
- U.S. Food and Drug Administration (FDA). Acetaminophen Prescribing Information and Drug Safety Communication. FDA; 2023. Includes maximum dose recommendations and liver toxicity warnings.
- Joint Formulary Committee. British National Formulary (BNF) – Paracetamol Monograph. London: BMJ Group and Pharmaceutical Press; 2024. Evidence-based prescribing reference for UK healthcare professionals.
- National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Analgesia – Mild-to-Moderate Pain. NICE; 2023. Recommends paracetamol as first-line treatment for mild-to-moderate pain.
- Mazaleuskaya LL, Sangkuhl K, Thorn CF, et al. PharmGKB summary: pathways of acetaminophen metabolism at the therapeutic versus toxic doses. Pharmacogenetics and Genomics. 2015;25(8):416-426. doi:10.1097/FPC.0000000000000150
- Ghanem CI, Pérez MJ, Manautou JE, Mottino AD. Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity. Pharmacological Research. 2016;109:119-131. doi:10.1016/j.phrs.2016.02.020
- Bateman DN, Carroll R, Pettie J, et al. Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment. British Journal of Clinical Pharmacology. 2014;78(3):610-618. doi:10.1111/bcp.12362
- Prescott LF. Paracetamol: past, present, and future. American Journal of Therapeutics. 2000;7(2):143-147. Seminal review of the history, pharmacology, and clinical significance of paracetamol.
- Brune K, Renner B, Tiegs G. Acetaminophen/paracetamol: A history of errors, failures and false decisions. European Journal of Pain. 2015;19(7):953-965. doi:10.1002/ejp.621
Editorial Team
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