Acetaminophen warning

Most of us must have taken acetaminophen at one time or another for pain or fever. It is a popular over-the-counter analgesic and antipyretic.

Taken usually without a doctor’s prescription, it is generally believed to be safe. We take it for the slightest discomfort thinking it’s safer than nonsteroidal anti-inflammatory drugs and other commonly used pain relievers.

However, a recently published review of observational studies shows worrisome findings of increased risk of deaths and other serious side effects associated with intake of acetaminophen.

Researchers headed by Prof. E. Roberts conducted a systematic review of eight long-term studies with a duration of two to 20 years. The eight studies involved a total of 664,000 adults who had a history of taking standard-dose acetaminophen (500-1,000 mg every four to six hours, with a maximum of 4,000 mg daily). The researchers reported increased incidence of various adverse events including risk of death in two studies, which were evaluated.

The increased risk of death among acetaminophen users in one study had an apparent cumulative dose-response effect, meaning that the total cumulative dose taken correlated with the increased risk of death.

The researchers made adjustments for all possible risk factors that could be implicated for the increased death risk, but still found the risk attributable to acetaminophen intake to be significant.

The researchers also reported a dose-response effect in studies that showed associations between acetaminophen use and adverse cardiovascular events (e.g. heart attacks and strokes in four studies), adverse upper gastrointestinal events (e.g. ulcers, stomach bleeding in one study) and adverse kidney events (i.e., deterioration in kidney function and acute kidney failure in three studies).

Although there appears to be some risk associated with acetaminophen intake especially in big doses, it doesn’t mean we should completely avoid taking the drug. We should interpret the findings in this study with caution since there might be other medical conditions present in the patient population involved in the study, which might be partly responsible for the seemingly increased risk of death with acetaminophen.

But we should also think twice and always ask ourselves if we really need to take this analgesic every time we feel the slightest ache or pain. We should always remember that all drugs, with no exception—even tried-and-tested over-the-counter drugs—have side effects and may cause potential harm. We just have to weigh the benefits we expect to get from the drug with its potential for harm.