Paracetamol you well known as brand in INDIA or USA as DOLO, TYLENOL.(Commonly known as acetaminophen). First produced by Harmon Northrop Morse at Johns Hopkins University (1877)and it’s often classified as NSAID’S(non-steroidal anti-inflammatory disease.Although it is prescribed as an antipyretic and analgesic
General Information
- Generic name: Paracetamol (International), Acetaminophen (U.S.)
- Common brand names: Tylenol, Panadol, Calpol, Dolo, etc.
- Drug class: Analgesic (pain reliever) and antipyretic (fever reducer)
- Availability: Over-the-counter (OTC) and prescription
⚙️ Mechanism of Action
Paracetamol works mainly in the central nervous system:
- Reduces pain by inhibiting the enzyme cyclooxygenase (COX), primarily COX-2, in the brain and spinal cord.
- Reduces fever by acting on the hypothalamic heat-regulating center.
Unlike NSAIDs (like ibuprofen or aspirin), it has minimal anti-inflammatory effects, likely due to its poor activity in peripheral tissues.
📋 Common Uses
Paracetamol is widely used for:
- Headaches
- Toothaches
- Muscle aches
- Menstrual cramps
- Fever (due to infection or vaccination)
- Minor arthritis pain (without inflammation)
💡 Pharmacological Facts
- Onset of action: ~30–60 minutes
- Duration: ~4–6 hours
- Metabolism: In the liver via glucuronidation and sulfation; a small portion is converted into a toxic metabolite (NAPQI), which is usually neutralized by glutathione.
✅ Safe When Used Correctly:
- Adult dose: Up to 4,000 mg/day (usually 500–650 mg every 4–6 hours in major condition we can use 1000 mg every 6-8 Hour)
- Available in tablets, liquid suspensions, suppositories, and IV formulations
❌ Risks of Overdose:
- Taking more than recommended (especially over 7,000–10,000 mg in a day) can lead to acute liver failure.
- Symptoms of overdose may be delayed but can be fatal.
- Antidote: N-acetylcysteine (NAC) — most effective if given within 8–10 hours of overdose.
⚠️ Watch For:
- Combining multiple drugs that contain paracetamol (e.g., cold/flu medications, sleep aids, opioids).
- People with liver disease or those who consume alcohol heavily are at higher risk of liver toxicity.
👶 Use in Children
- Widely used in pediatric care.
- Doses are weight-based, and safe when dosed correctly.
- Preferred antipyretic in children over 3 months.
🤝 Drug Interactions
- Alcohol: Increases risk of liver damage.
- Warfarin: Chronic use of paracetamol may increase bleeding risk due to effects on INR.
- Carbamazepine, rifampin: May increase liver metabolism and toxicity risk.
🧪 Major role of improper or Habitual use of Paracetamol
Diclofenac is having a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional non-steroidal anti-inflammatory drugs, as per research. The research was conducted by Morten Schmidt and published at the BMJ.
The cardiovascular risks of non-aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) remain a major safety concern after rofecoxib’s thromboembolic properties were revealed. Diclofenac is a traditional NSAID with cyclo-oxygenase-2 (COX 2) selectivity similar to COX 2 inhibitors,2 but its cardiovascular risks compared with those of other traditional NSAIDs have never been examined in a randomised controlled trial.
Diclofenac is the most frequently used NSAID in low, middle, and high income countries, and is available over the counter in most countries, therefore, its cardiovascular risk profile is of major clinical and public health importance.
As per result of the trial, the adverse event rate among diclofenac initiators increased by 50% compared with non-initiators, 20% compared with paracetamol or ibuprofen initiators, and 30% compared with naproxen initiators. The event rate for diclofenac initiators increased for each component of the combined endpoint for atrial fibrillation/flutter, ischaemic stroke, heart failure, myocardial infarction, and cardiac death as well as for low doses of diclofenac, compared with non-initiators.
Although the relative risk of major adverse cardiovascular events was highest in individuals with low or moderate baseline risk (that is, diabetes mellitus), the absolute risk was highest in individuals with high baseline risk (that is, previous myocardial infarction or heart failure). Diclofenac initiation also increased the risk of upper gastrointestinal bleeding at 30 days, by approximately 4.5-fold compared with no initiation, 2.5-fold compared with initiation of ibuprofen or paracetamol, and to a similar extent as naproxen initiation.