Paracetamol itself is not toxic, but in large amounts it overwhelms the body's ability to process it safely. This can lead to build up of a toxic metabolite (or break-down product), which binds to liver cells, causing these cells to die.
Paracetamol is known to cause liver failure in overdose, but it also causes liver failure in people taking standard doses for pain relief. The risk is only about one in a million, but it is a risk.
Many people confuse acetaminophen (Tylenol) and ibuprofen. This is because they can treat many of the same symptoms. But there are key differences, especially when it comes to how they affect the liver and kidneys. Acetaminophen is harder on the liver than ibuprofen.
Scientists at the University of Edinburgh studied the impact of paracetamol on liver cells in human and mouse tissue, and tests showed that in certain settings paracetamol can damage the liver by harming vital structural connections between adjacent cells in the organ.
In conclusion, it is important to remember that paracetamol toxicity can present with acute renal impairment in the absence of liver damage, and these patients should be properly treated to prevent them from developing chronic renal failure.
Taking 1 or 2 extra tablets is unlikely to harm you. Do not take more than 8 tablets in 24 hours. Taking too much paracetamol can be dangerous and you may need treatment.
The maximum dose within a 24-hour period must never be exceeded. Paracetamol overdose is one of the leading causes of acute liver failure. Adults can usually take one or two 500mg tablets every 4-6 hours, but shouldn't take more than 4g (eight 500mg tablets) in the space of 24 hours.
Acetaminophen (paracetamol), when taken in reduced doses (maximum 2–3 grams per day), is generally considered to be the safest pain relief option for your liver.
Untreated paracetamol poisoning may cause varying degrees of liver injury over the 2 to 4 days following ingestion, including fulminant hepatic failure. Rarely, massive overdose may initially present with coma and severe metabolic acidosis.
Paracetamol overdose can result in liver damage which may be fatal. Intravenous acetylcysteine is the antidote to treat paracetamol overdose and is virtually 100% effective in preventing liver damage when given within 8 hours of the overdose.
Luckily, a low dose of paracetamol is perfectly safe for everyone with liver disease. That means you can take 4 to 6 tablets in one day. Non-steroidal anti-inflammatory drugs like ibuprofen and aspirin are not the best choice of painkiller for people with liver disease as they can affect the kidneys.
Choosing the Right Pain Relief for You
Panadol products contain paracetamol; do not take them with other medicines that also contain paracetamol. Paracetamol is in many medicines to treat pain, fever, symptoms of cold and flu, and sleep medicines.
HEPATOTOXICITY RISK FACTORS
While acute liver injury can occur when used at or below the recommended daily maximum dose (4000 mg)[4], paracetamol toxicity is often the result of ingestion of paracetamol over this maximum dose.
The recommended paracetamol dosing for adults and children 12 years and over is 500 to 1000mg every four to six hours as necessary, with a maximum of 4000mg in any 24 hour period.
Long-term paracetamol use could increase the risk of heart disease and strokes in people with high blood pressure, a study suggests.
These symptoms include feeling tired, abdominal pain, or nausea. This is typically followed by absence of symptoms for a couple of days, after which yellowish skin, blood clotting problems, and confusion occurs as a result of liver failure.
Side effects of paracetamol
blood disorders, such as thrombocytopenia (low number of platelet cells) and leukopenia (low number of white blood cells) liver and kidney damage, if you take too much (overdose) – this can be fatal in severe cases.
Acetaminophen remains the drug of choice for occasional use in patients with kidney disease because of bleeding complications that may occur when these patients use aspirin.
Foods that support liver health include berries, cruciferous vegetables, beans, whole grains, nuts, and fatty fish. Coffee and green tea contain antioxidants that are helpful for liver health.
Certain NSAIDs such as diclofenac and naproxen have been associated with hepatotoxicity. Therefore, low-dose acetaminophen (2 grams or less/day on non-consecutive days) is preferred over NSAIDs in patients with chronic liver disease.
Based on the dose of paracetamol ingested (mg/kg body weight): Less than 150 mg/kg - unlikely. More than 250 mg/kg - likely. More than 12 g total - potentially fatal.
Paracetamol is a common painkiller that is normally safe. If you take more than the recommended amount (an overdose), it can harm the liver, and occasionally the kidneys.
Limit the amount of alcohol you drink. Eat a well-balanced diet every day. That's five to nine servings of fruits and vegetables, along with fiber from vegetables, nuts, seeds, and whole grains. Be sure to include protein for the enzymes that help your body detox naturally.