DiseasesParacetamol — Is the popular painkiller quietly harming the liver?
Sources: 6 · Article: 7 838 characters
Andrzej Frydrychowski warns that an overdose of paracetamol can lead to liver failure, and that, rarely, the risk also exists at normal doses.
- Paracetamol from different medicines can add up and lead to serious complications.
- Henryk Różański says that alcohol increases the harmful effects of paracetamol, and that the body neutralizes its toxic metabolite with glutathione.
- Severe liver failure and alcohol-related disease are contraindications or require special caution when using the medicine.
What the authors write
Andrzej Frydrychowski
An overdose of paracetamol can lead to liver failure; Andrzej Frydrychowski also notes a rare risk of liver failure at standard doses.
„It is known that paracetamol causes liver failure in cases of overdose, but it also causes liver failure in people taking standard doses to relieve pain. The risk is only about one in a million, but it is a risk.”Wiadomo, że paracetamol powoduje niewydolność wątroby w przypadku przedawkowania, ale powoduje również niewydolność wątroby u osób przyjmujących standardowe dawki w celu złagodzenia bólu. Ryzyko wynosi tylko około jednego na milion, ale jest to ryzyko.
Andrzej Frydrychowski
Paracetamol is processed in the liver, and an overdose can cause toxic symptoms, including jaundice and elevated liver markers.
„It is worth watching for symptoms such as sweating, feeling unwell, a drop in blood pressure, nausea and vomiting, jaundice, increased liver marker levels, kidney problems, including kidney failure, or a drop in granulocyte levels.”Warto zwrócić uwagę, czy nie występują takie objawy jak: pocenie się, pogorszenie samopoczucia, spadek ciśnienia tętniczego, nudności i wymioty, żółtaczka, zwiększenie wartości wskaźników wątrobowych, zaburzenia pracy nerek, w tym niewydolność czy spadek poziomu granulocytów.
Andrzej Frydrychowski
Andrzej Frydrychowski points out that severe liver failure and alcohol-related disease are contraindications or require special caution when using paracetamol.
„Liver and kidney diseases should be a reason to use these medicines only after consulting a doctor, because severe liver or kidney failure and alcohol-related disease are contraindications, or certainly reasons to take special precautions when using paracetamol because of the risk of liver damage.”Choroby wątroby i nerek powinny być okolicznością, w której te leki stosujemy jedynie po konsultacji z lekarzem, ponieważ ciężka niewydolność wątroby czy nerek oraz choroba alkoholowa są przeciwwskazaniem, lub na pewno wskazaniem do stosowania szczególnych środków ostrożności w stosowaniu paracetamolu z uwagi na ryzyko uszkodzenia wątroby.
Andrzej Frydrychowski
Andrzej Frydrychowski warns that paracetamol from different medicines can add up and lead to serious complications.
„We buy medicines with different names, and often each one contains paracetamol. Its dose can therefore build up and lead to serious complications. It is worth watching for symptoms such as sweating, feeling unwell, a drop in blood pressure, nausea and vomiting, jaundice, increased liver marker levels, kidney problems, including kidney failure, or a drop in granulocyte levels.”Kupujemy leki różniące się nazwą, a często każdy z nich zawiera paracetamol. I tak jego dawka się kumuluje i może doprowadzić do ciężkich powikłań. Warto zwrócić uwagę, czy nie występują takie objawy jak: pocenie się, pogorszenie samopoczucia, spadek ciśnienia tętniczego, nudności i wymioty, żółtaczka, zwiększenie wartości wskaźników wątrobowych, zaburzenia pracy nerek, w tym niewydolność czy spadek poziomu granulocytów.
Henryk Różański
Paracetamol forms a metabolite that can damage the liver, especially after an overdose.
„Paracetamol is metabolized into N-acetyl-p-benzoquinone (more precisely, N-acetyl-p-hydroxyphenylquinone imine), which is hepatotoxic (especially after an overdose), and also into para-aminophenol (through deacetylation and oxidation), as is phenacetin.”Paracetamol jest metabolizowany do N-acetylo-p-benzochinonu (właściwie N-acetylo-p-hydroksyfenylochinoimina) o działaniu hepatotoksycznym (zwłaszcza po przedawkowaniu), a także do para-aminofenolu (deacetylacja i utlenienie), podobnie jak antyfebryna.
Henryk Różański
Henryk Różański describes paracetamol’s toxic metabolite as harmful to the liver and says the body neutralizes it with glutathione.
„The hepatotoxic and nephrotoxic metabolite of paracetamol (N-acetyl-p-benzoquinone) is neutralized after binding with glutathione. In this way, glutathione prevents necrosis of parenchymal organs. With frequent, long-term use of paracetamol, and also in cases of overdose, glutathione stores are depleted.”Hepatotoksyczny i nefrotoksyczny metabolit paracetamolu (N-acetylo-p-benzochinon) jest neutralizowany po związaniu z glutationem. W ten sposób glutation zapobiega martwicy narządów miąższowych. Podczas częstego i długotrwałego stosowania paracetamolu, a także w razie jego przedawkowania – zapasy glutationu ulegają zużyciu.
Henryk Różański
Henryk Różański says that frequent, long-term use and overdose deplete glutathione stores.
„With frequent, long-term use of paracetamol, and also in cases of overdose, glutathione stores are depleted. They can be replenished if the diet provides enough methionine. However, doctors do not monitor their patients’ diets.”Podczas częstego i długotrwałego stosowania paracetamolu, a także w razie jego przedawkowania – zapasy glutationu ulegają zużyciu. Regeneracja jest możliwa w razie dostatecznej podaży metioniny w diecie. Lekarz nie kontroluje jednak diety swoich pacjentów.
Henryk Różański
Henryk Różański claims that paracetamol damages the liver and that alcohol increases its harmful effects on this organ.
„It damages the liver, disrupts the liver’s enzyme balance, and damages the kidneys. When combined with alcohol, paracetamol becomes more hepatotoxic. When cysteine and methionine levels are low, the body cannot neutralize and efficiently eliminate the toxic metabolites produced as paracetamol is broken down.”Uszkadza wątrobę, zaburza gospodarkę enzymatyczną wątroby, uszkadza nerki. W połączeniu z alkoholem paracetamol zyskuje większe właściwości hepatotoksyczne. Przy niedoborze cysteiny i metioniny organizm nie ma zdolności unieszkodliwiania i sprawnego wydalania toksycznych metabolitów powstałych z przemian paracetamolu.
Henryk Różański
Henryk Różański warns that paracetamol can cause serious harm when liver metabolism is impaired.
„The problem is that if someone has impaired liver metabolism, one of the most popular painkillers, available without a prescription even in grocery stores, can seriously harm them. Why don’t those institutions issue a similar warning to the one about greater celandine?”Taki, że jeśli ktoś ma upośledzony metabolizm w wątrobie zaszkodzi mu mocno jeden z najpopularniejszych leków przeciwbólowych, dostępny bez recepty nawet w sklepie spożywczym. Dlaczego ów instytucje nie wydadzą podobnego ostrzeżenia, jak dla glistnika?
Andrzej Frydrychowski
Andrzej Frydrychowski describes the widespread belief that paracetamol is safe, but says that this belief may be wrong.
„It is safe, and many guidelines recommend it as a first-line treatment for a raised body temperature or pain of various kinds. At least, that is the conventional view of this medicine. It is so firmly established that it is rarely questioned. The problem is that the conventional view is probably wrong.”Jest bezpieczny i wiele wytycznych zaleca go jako podstawowe leczenie przy podwyższonej temperaturze ciała czy bólu różnego pochodzenia. Przynajmniej taki jest konwencjonalny pogląd na ten lek. Jest on tak zakorzeniony, że rzadko się go kwestionuje. Problem polega na tym, że konwencjonalny pogląd jest prawdopodobnie błędny.
Research from PubMed · Europe PMC
We selected 1 studies with the best, positive results. This is a selection, not a full review of all research.
Total number of studies on this topic in PubMed: 5 226.
In this analysis, liver damage associated with paracetamol was very rare at therapeutic doses.
Aim of the study: Acute liver injury (ALI) induced by paracetamol overdose is a well known cause of emergency hospital admission and death. However, there is debate regarding the risk of ALI after therapeutic dosages of the drug.The aim is to describe the characteristics of patients admitted to hospital with jaundice who had previous exposure to therapeutic doses of paracetamol. An assessment of the causality role of paracetamol was performed in each case.
Results: In four cases the role of paracetamol was judged to be unrelated, in two unlikely, and these were excluded from evaluation. In seven of the remaining 26 cases, the RUCAM score associated with paracetamol was higher than that associated with other concomitant medications. The estimated incidence of ALI related to the use of paracetamol in therapeutic dosages was 0.4 per million inhabitants older than 15 years of age and per year (99%CI, 0.2-0.8) and of 10 per million paracetamol users-year (95% CI 4.3-19.4). Our results indicate that paracetamol in therapeutic dosages may be considered in the causality assessment in non-alcoholic patients with liver injury, even if the estimated incidence of ALI related to paracetamol appears to be low.
Money for the studynot stated
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studyobservation of people
“Not stated” does not mean nobody paid — the database does not always record it.
Perspectives and opinion materials
The content below presents the authors’ opinions, interpretations and hypotheses. It is not treated as equal to scientific studies and systematic reviews.
Orthomolecular Medicine News Service Opinion material
„The British equivalent of acetaminophen, Paracetamol, has been their leading cause of severe liver damage -- and that can lead to the necessity of a liver transplant. The warning is posted on the Tylenol package, but the public has no idea that Tylenol is hidden away in these "do-it-all" preparations. I have looked for safe pediatric over-the-counter products and have found very few. A warning of "not to be used for children under two" could make one think that it might not be healthy for adults either.”The British equivalent of acetaminophen, Paracetamol, has been their leading cause of severe liver damage -- and that can lead to the necessity of a liver transplant. The warning is posted on the Tylenol package, but the public has no idea that Tylenol is hidden away in these "do-it-all" preparations. I have looked for safe pediatric over-the-counter products and have found very few. A warning of "not to be used for children under two" could make one think that it might not be healthy for adults either.
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