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.

"For anorexic, underweight and elderly patients, even the normal dose of 2 tablets can over time cause dangerous effects."

This. At my lowest weight as a full grown adult I was 5 1/2 stone and 5"3. Not that underweight really, but taking 2 paracetamol would make me shake, sweat, feel sick and have abdominal cramps. This doesn't seem to happen much now I am a stone and a bit heavier. I only ever take 1 now in the direst of circumstances, like if I have had a headache for days.

Paracetamol is extremely dangerous if misused, accidentally or not.

Due to a couple of medical issues, in the last year I have had IV paracetamol 3 times.

Given IV it’s a very powerful painkiller and my absolute “go to” request.

I think people think because it’s so readily available that it’s “mild”.

Terrifyingly I took decongestants ( contains paracetamol) when I had bad sinuses, forgetting that I'd already had paracetamol earlier that morning . Total dosage 1400mg. Was ok ( checked NHS website for advice).
I hate combo drugs, threw them away and if am ill or child is I do write it all down now ensuring I alternate drugs and stick to the dosage.
A nurse told me recently that fever and inflammation is the body's way of fighting infection or injury and yes if your in pain take the meds but don't feel you immediately have to counter those natural reactions which I thought was interesting.

As I understand it some people are more vulnerable to paracetamol overdose than others, dependent partly on sex and weight but also on internal factors that you won’t neves know.

A large male knowall work colleague of mine was heard confidently reassuring his 8 stone secretary that she’d be absolutely fine doubling up her paracetamol dose for her nasty cold: he did it all the time with no ill-effects. I intervened in no uncertain terms. She would probably have got away with it, but this is not a situation where probably is good enough.

We’re still not entirely sure of the long term effects of regular low doses either.

My DGM used to take paracetamol like nobodies business. She was a slender lady too.

If she had a cold or headache she would easily take double the daily recommended dose, she was fine.
I can't believe it's had such a different effect on my friend.

Does it depend on the individual?

I take four paracetamol and 4 tramadol a day for pain I can take up to 8 of each but try to limit myself to just 4 of each. I hate taking them every day but hate the pain too it prevents me from living. It’s an awful catch 22.

If I have the cold I’ll take lemsip and not take the paracetamol.

paracetamol is really not for pain.

OftenHangry is talking bollocks. Paracetamol is an effective painkiller. Wherever in the world you come from. Or perhaps the World Health Organisation is wrong?

Paracetamol is a very very safe medication when taken appropriately - it has a narrow therapeutic window which means the safe and effective dose and the dangerous OD dose are not that far apart.

Yes, damage it does can depend on the individual, mainly quite how good the liver is in metabolising it.
Body weight as mentioned upthread is a really important factor also; also wether anything else liver toxic was taken alongside it (typically alcohol).

The reason the Paracetamol pack size available otc has been reduced to 16 tablets in a blister pack was to make it less 'easy' to take an impulsive OD. I have seen more than one (typically teenaged) patient who took, say, 10 Paracetamol because their cat ran away/they had a spat with their boyfriend or parents/their best friend had been nasty to them, they had NO intention to actually die, and only rocked up in A+E a couple of days later with signs/symptoms of liver failure. Liver transplant as a consequence of minor Paracetamol OD is less common since the pack sizes were reduced.

The instructions are on the packet.

Follow them.

Fuck sake.

The saddest thing about paracetemol is that people take too many to kill themselves. They wake up, are pleased it didn't work, then die anyway because of liver failure.

Maybe Hangry has nerve pain, in which case her doctor might well have just put her on something like amitriptyline or gabapentin, as paracetamol is not so useful in that case.

To treat other types of pain paracetamol is usually prescribed as the base and then NSAIDs, narcotics etc layered on top for additional relief, or for flare ups.

PerfectlyDone - Coming from the UK I was really shocked when I first saw that they sell plastic tubs of 500x 500mg acetaminophen (same drug, different name) over here in Canada!!

There is a very good reason nurses will not deviate from four hourly, four doses a day, even when patients are begging. They are not being horrible, they are protecting the patient, especially their kidneys!

I hope your friend turns out to be ok.

There is controversy about quite how effective a painkiller it is - probably rubbish for chronic pain (but so are opiate, and they are even more dangerous, in different ways).

I said it was safe in that it can be given to pregnant women and young babies at the appropriate dose.

V dangerous in OD, often even minor ones.
Fulminant liver failure being the worst risk.

Yes, Assigned. I can't remember the exact figure now as I was 15, but my dad OD'd and I counted the packet and it was over 40. Luckily he was a very heavy man at the time, around 25st. He collapsed in the street and survived, but had a lot of renal issues during recovery.

MountainPeakGeek, my parents always stock up when they are in the States

They wake up, are pleased it didn't work, then die anyway because of liver failure.

Yes, exactly that. Tragic

There's a pain ladder according to the world health organisation with opiates being the last available option.
Different drugs work on different pains.
Paracetamol is fabulous for most mild to moderate pain, and also works to bring down temperature in fevers. IV paracetamol is particularly effective and fast acting.
If you need more pain relief, see a doctor.

Sorry to side track a bit, but, I have pain on a daily basis and have for as long as I can remember. I never take anything because I'm scared of the effects it would have on my kidneys and liver if I did on a long-term basis. Then I wonder, how do people manage with chronic conditions? Is it just something that you take the risk of?

IV paracetamol is particularly effective and fast acting.

IV paracetamol is actually like magic. I struggle with anything else, due to side effects, so was given this post C-section. It was amazing!

@TarragonChicken
Exuse me? Common decency exists, so maybe use bit more polite words when talking to someone you don't know.
It's mainly for a fever, hence me saying it is not "really" a painkiller. It can be used for MILD pain but anything above that should be treated with proper painkiller, for the benefit of the patient. I know people from many countries who are baffled by the overuse of it here. There are just so much better options to use for pain. So many of them, which last longer, act faster and are just better suited for serious and long lasting pains. And since they work better, there is lesser risk of overdose, when people are in serious pain.

If you take drugs as prescribed the chances of side effects are reduced. Make sure you get them prescribed or take under the influence of your doctor. People can and do take long term paracetamol but they have to take them safely.
If you have chronic pain you need it assessing as something is wrong.

Sayhellotothesun

This
They wake up, are pleased it didn't work, then die anyway because of liver failure.

Yes, exactly that. Tragic 

Please follow the instructions. And with your kids- write it down.
When my kids are ill, and esp when I'm sleep deprived, I have a list on the fridge of who I gave what when.

Paracetamol kills people. There's a reason why you can't buy several bottles of calpol at the same time.

@Newname12
They could remove an element of paracetamol which causes the toxicity when it's digested but it costs too much.
There is an antidote called acetylcysteine, this I think stops the absorption of any paracetamol left in the bloodstream, but it has to be given within the first 24 hours of ingestion, the sooner the better.

Not true.

A) they can’t remove the “toxic element”. The toxic element is the chemical produced by the breakdown of paracetamol by the liver. It isn’t in the paracetamol preparation to remove. If you’re thinking of methionine, which works in a similar way to nac in preventing toxic metabolism, expense isn’t the reason it isn’t added.

B) n- acetyl cysteine doesn’t block metabolism. Nac is needed to breakdown paracetamol to it’s non toxic metabolites. It is when we run out of our body’s nac that the toxic, liver damaging metabolite is created instead- see a). The toxic metabolite isn’t even produced unless overdosed.

C) nac really needs to be given by about 8 hours after an overdose. It takes about 8 hours for our own nac to be used up, so after about 8 hours nac needs to be started so the body can continue to make the non toxic metabolite.

Paracetamol is safe if used as directed.

Thank you. I have asked for my post to be deleted due to the incorrect information.