To not realise just how dangerous paracetamol is?

[HarshingMyMellow]

My friend is currently in hospital after taking an accidental overdose of paracetamol.

I say 'accidental', she was taking more than she should because she had a killer toothache but not huge amounts.
I think she took around 8 doses in a day instead of 4 and the repercussions aren't pretty.

I didn't realise a basic, widely available drug was so toxic.

@ChazsBrilliantAttitude I agree, totally. Paracetamol is a cheap and widely available drug marketed at parents for tiny babies as young as a few weeks, as well as adults.
I remember when the calpol adverts were prominent on daytime kids TV. You wouldn't think that a drug that can potentially be so poisonous would be targeted in such a way.

IIRC The US radio programme linked above referred to surveys showing 1/4 of those surveyed exceeded the dosage of medicines.
Yes other things are dangerous but it would be harder to accidentally ingest fatal amounts of alcohol or cleaning products.
I don’t think paracetamol should be on open shelves. I think it should be a medicine you have to ask for not one where you can potentially grab 16g for 50p on an open shelf.

My daughter took 20 Codeine tablets and had no treatment at all other than observation overnight. They repeatedly came and asked us if we were sure she had not had any Paracetamol, which was when I realised how much more serious that is considered.

As long as she's breathing okay, codeine's not going to be a big worry. If her breathing does slow down significantly they can treat her with naloxone to reverse the effects of the codeine. Codeine, like all opioid drugs, acts through enkephalin/endorphin receptors in the central nervous system and elsewhere. In the brainstem (the bulge at the top of the spinal cord, where it enters the brain), activation of these receptors causes a reduction in respiratory drive, i.e. the frequency of firing of the nerves that cause the diaphragm to contract. This is why heroin addicts who survive the hepatitis and endocarditis tend to die of respiratory failure when they accidentally overdose. Naloxone blocks the receptors and therefore reverses the effects of opioids.

With paracetamol, on the other hand, the liver damage isn't going to become apparent until quite a bit later and once the NABQI (toxic metabolite of paracetamol) has started to bind to proteins in liver cells the damage is irreversible, whereas if doctors are aware of a paracetamol overdose soon enough they can prevent the damage by giving intravenous acetylcysteine. Normally, little or no paracetamol gets metabolised to NABQI (N-acetyl-para-benzoquinone imine, sometimes called NAPQI rather than NABQI (in case you're Googling it)). It's only when the paracetamol concentration in the liver cells gets high and the normal metabolic pathways become saturated that NABQI starts being formed. Even then, it is immediately "mopped up" by a substance called reduced glutathione (GSH, where SH indicates sulfhydryl: a chemical group that is very good at binding to and inactivating oxidants). When the NABQI concentration gets very high the liver cells run out of GSH and the NABQI starts reacting with sulfhydryl groups on other substances, most signifcantly proteins that contain the amino acid cysteine. This disrupts the function of those proteins and kills the cells. If you can replace the GSH (itself a molecule made of one molecule each of three amino acids: glycine, cysteine and glutamic acid) with something that rapidly gets into cells and has sulfhydryl groups the NABQI can attack instead of the proteins, you can stop the cells from being destroyed. This is what acetylcysteine is used for.

The problem with shouting 'just read the label' is that we are so used to warnings on labels that are over the top:

'May contain traces of nuts' = an insurance policy to cover food manufacturers' backs.

'Do not take while breastfeeding' drugs are often prescribed by doctors for breastfeeding women because they're not actually unsafe.

Then there's the dosages: under the instruction of my allergy clinic at one point I was taking 4 antihistamines a day, way over the stated dose.

Then there's the long list of side effects on the leaflets for all medications when most of us won't know anyone who have suffered any of those complications.

It is no surprise that without a very specific explanation of the problem with paracetamol that some people will think an extra couple of tablets will be ok. There needs to be some sort of health awareness campaign about this. I didn't realise that just a few extra could cause such dire consequences.

I was teaching this in a primary level health lesson recently. We did a lot on reading information, paying attention to age limits and not going over the recommended dosage.

I explained that all/most drugs have acceptable side effects when used properly but can be dangerous if misused.

Because like many people I seldom take aspirin, I was surprised that the age limit for taking it was 16. I suppose stomach bleeds in a small person are more significant.

These threads always descend into medical top trumps.
"High dose paracetamol" that's not a thing... it would just be "more paracetamol"
Codeine "signed off by a surgeon" because they're always the best people in a hospital to advise on pain. That's why so many of them work in pain clinics.

This thread is bordering on dangerous and the absolute abrogation of personal responsibility in "reading the label" is embarrassing.

I think they recently changed the aspirin limit from 12 -16. It was stopped for under 12s many years ago because of the risk of children developing Reye's syndrome.

I agree INeedNewShoes.

@Britnay the thing is, most people don't buy their paracetamol from a pharmacy. It is freely available in supermarkets, Wilkinsons, BM, Bodycare, and dozens of other shops on the High Street, costing about 19p.
Now, both as INeedNewShoes says - people become a little jaded about all the 'warnings' you get about all sorts of things, so struggle to compute that the warning on these packets is an actual serious warning, and when people are in extreme pain or ill with flu type symptoms, they just aren't thinking straight anyway. Then, I think many people on this thread are underestimating the number of people who really struggle with some aspects of life such as time management, or organisational skills generally.

Another common thing is that people take paracetamol and lemsip at the same time, not realising that lemsip actually contains paracetamol already! I always tell this to people who have colds/flu symptoms! I just get so worried because it's an easy mistake to make.

Opiates are considered an extremely valuable and necessary class of drug by the world health organisation. Please, to all, do not unquestioningly accept and repeat the misinformation that currently dominates the discussion around opiate use here and across the pond. It is a literal life saver for so, so many people.
Agreed. I wouldn't be able to live, work or dress myself with out them!

I hope I don’t sound like I’m judging but I’ve never understood why people don’t know the risks? It’s clear on the packaging and on the leaflet inside. I tend to read and re read most of them just to be safe and sure but everyone should at least read it once and take note. Always check what’s in other medication too so you can avoid overdosing by accident. Never take more than the recommended amount. You can take the next dose about 10-15 minutes before it’s due so that it starts working in time. I got told this by a paediatric nurse so it should be true. Medicine terrifies me and so I’m always cautious using it.

Because like many people I seldom take aspirin, I was surprised that the age limit for taking it was 16. I suppose stomach bleeds in a small person are more significant

Nothing to do with stomach bleeds, everything to do with Reye’s syndrome.

I don’t understand how people are shocked by this - I thought it was common knowledge. Why else would it be restricted?

Also am really genuinely amazed that someone used a dessert spoon to give their kid Calpol - I always thought that was an urban myth.

I once spoke to a very well-respected cardiologist who said that an aspirin a day has huge health benefits in terms of both cancer, stroke and heart health for middle aged people, and the only reason it's not recommended as health advice is that a small number of people end up with a gastric bleed.

as a full grown adult I was 5 1/2 stone and 5"3. Not that underweight really,...

That’s a BMI of 13.
Really?

t is no surprise that without a very specific explanation of the problem with paracetamol that some people will think an extra couple of tablets will be ok

If you’re taking as directed, for the recommended 3 days, a couple of extra tablets if you forget or an extra dose of calpol by mum not realising dad has already dosed will be fine. There is a built in margin for error that means parecetamol is still safe in these situations.

It is prolonged, consistant overuse, or acute untreated overdose that has the catastrophic effects. Especially in high risk groups such as alcoholics or anorexics, who don’t have the best grasp of their own welfare.

*as a full grown adult I was 5 1/2 stone and 5"3. Not that underweight really,...

That’s a BMI of 13.
Really?*

This is mumsnet, where over 8st is treated with a head tilt and the suggestion you should cut out carbs. Because “you might feel ok, but i’d feel massive and wobbly at anything over 7.5st”.

Paracetamol is a risk for sure, and checking you don't take too much can be a problem.

Can I just suggest something really simple to help with paracetamol dosing? I get migraines and can't think straight when I have one, let alone remember when I took meds, so when taking a dose, I get a thin sharpie or similar and just write how many tablets and the time on my hand. e.g. 2p 0800 would be 2x 500mg tablets at 8am. I'd then know not to take any more until at least midday and preferably 2pm. Today my hand says 2p 0705 cos I've got the start of a cold and so have the shivers.

OP I really hope your poor friend is OK.

When I had severe post-extraction wisdom tooth pain I wrote out a schedule of painkiller and antibiotics and set alarms. As soon as the pain dulled a bit I was immediately asleep for 2 hours until the painkiller started to wear off so 2-hour alarms weren't much of a problem.

@moonbells that's actually an excellent idea. No messing about and it's right in front of you then.

She's getting there, thank you!

@QuackPorridgeBacon - I hope I don’t sound like I’m judging but I’ve never understood why people don’t know the risks?

I think it has a lot to do with the fact that paracetamol is available to pick off the supermarket shelf. A large proportion of people will assume that it therefore mustn't be that dangerous. They make the same judgement about alcohol, which is also very dangerous. The fact that tobacco has to be hidden in featureless cupboards and specifically asked for at special counters reinforces the impression that alcohol and off-the-shelf drugs must be safe, as these kinds of measures aren't in place for them.

I find it enormously convenient to be able to buy paracetamol, ibuprofen, aspirin, loratadine/cetirizine, ranitidine, phenylephrine, pseudoephedrine, etc. at the supermarket whenever I want them and without having to stand in a separate queue. However, I have two degrees in pharmacology and nearly 20 years' experience of teaching it, and am aware that a man of my age probably shouldn't be taking ibuprofen, that I shouldn't be mixing antihistamines with alcohol, that if I had an enlarged prostate I shouldn't be taking phenylephrine (LemSip®, etc.) or pseudoephedrine (Sudafed®), and so on. I'm not sure that current arrangements are very wise given how hidden from general view these dangers are. My preferred action would be to require prominent warnings on packets (not in 8-point type on folded-up leaflets inside), as with tobacco, but there might be a case for restricting the points at which they can be bought and requiring warnings to be read to customers before the sale is completed. However, while this is fine for big 24-hour-a-day supermarkets I worry it would lead to difficulties for people in rural locations or areas where they only have easy access to small convenience stores.

I could add that I think advertising companies should have to pay a levy to fund public safety adverts in the same media, so among the slick adverts for Nurofen®, Voltarol®, etc. there would be similarly professional adverts explaining the risks of self-medicating.

Given that Nurofen® 200 mg ibuprofen costs £1.98 for 16 tablets at Asda (and 2-3 times as much at petrol stations), while 16 tablets containing exactly the same amount of exactly the same drug cost 30p if they don't have the word "Nurofen" printed on the packet, I think the Mother London ad agency could quite easily pass on the cost of the levy to Reckitt Benckiser.

This thread has got me thinking and worrying.

I don't go in much for painkillers, but do have a lot of antihistamines, especially liquid Piriton. Is this safe?

I assumed it to be safe because it has a picture of a baby on the front, but I usually take it at night and sometimes after a few glasses of wine.

Stately - of all the OTC antihistamines available you really don't want to be taking that much Piriton. All others are non-drowsy, but Piriton isn't. You're probably not doing your general well being much good!

I take loratidine or cetirezine as my preventatives for hayfever and save Piriton for more significant reactions. When I take Piriton I end up asleep by 6pm and still feel foggy the next day.