High-Dose Acetaminophen May Increase Risk of Poisoning

If you’re buying acetaminophen to lower a fever or relieve pain, the highest dose you can usually find in American and Canadian drug stores is 500 milligrams.

That’s because, while acetaminophen does a good job of treating fever and pain, it has a dark side. Too much of the drug can cause liver failure. In fact, it is the leading cause of liver failure in many western countries.

High dose paracetamol and overdoses

Higher doses of acetaminophen may be prescribed under medical supervision in U.S. and Canadian health facilities. And since October 2003, people in Switzerland have been able to buy 1,000 mg paracetamol (known as paracetamol in Switzerland and many other countries) with a prescription.

Researchers at ETH Zurich, a public research university, observed an increase in the popularity of high-dose 1,000 mg paracetamol after its introduction. They also saw an increase in acetaminophen-related poisoning or overdosage reported to the Swiss National Poison Center and decided to investigate.

They analyzed the country’s National Pharmacists Association sales and poison center data since 2003. They found that sales peaked in 2005, surpassing the 500 mg tablets. Today sales of 1,000 mg tablets are ten times higher than that of 500 mg tablets.

Reported poisonings

In the period from January 1, 2000 to December 31, 2018, 15,790 poisoning calls related to paracetamol were reported to the national poison center.

  • 1,395 women called the poison center before the higher dose was introduced. That number rose to 9,233 at the end of 2018.
  • 154 reports of unknown gender before the start. They rose to 216.
  • For children under six, the number was 234 before the start, and that rose to 1,924.
  • Teenagers ages 10-15 got 217 calls prior to launch, and that jumped to 1,295.
  • For adults aged 25 to 44, the number was 430 pre-start calls, an increase to 2,926.

“A problem with [acetaminophen] is that it is not effective for all patients or against all forms of pain. If the medication doesn’t help relieve a person’s symptoms, they may be tempted to increase the dosage without consulting a doctor. That’s the real problem, “said Dr. Andrea Burden in a press release. Dr. Burden is Professor of Pharmacoepidemiology at ETH Zurich. The study was published in October 2020 in the JAMA Network Open.

Dr. Burden added that patients with pain should seek medical advice. Taking more pain medication can simply increase the risk of side effects. When people take paracetamol or paracetamol, Dr. Burden the lower dose (500 mg) because they have some control over the dose. You can take a 500 mg pill and see if it is working, which will reduce the risk of an overdose. On the other hand, taking a 1,000 mg tablet increases the likelihood of exceeding the maximum daily dose of 4,000 mg.

Acetaminophen Prescriptions In The US

An online statistics portal showed the number of paracetamol prescriptions in the US between 2004 and 2017. This only applies to prescribed paracetamol, not to drugs bought over the counter.

There were many recipes:

  • 29.72 million prescriptions in 2013
  • 31.93 million prescriptions in 2014
  • 31.01 million prescriptions in 2015
  • 29.33 million prescriptions in 2016
  • 24.74 million recipes in 2017.

The other years had prescriptions less than 7 million, with 2010 being the lowest at 3.24 million prescriptions.

Meanwhile, the U.S. Centers for Disease Control and Prevention reported that paracetamol was one of the top 15 drugs involved in overdose deaths from 2011 to 2016. In 2014, acetaminophen was involved in 879 deaths from overdose. In 2016, the pain reliever was among the top 10 drugs involved in overdose deaths due to suicide. 343 deaths were reported.

Paracetamol can be present in drug combinations

Cold and flu medications, as well as other pain relievers, may contain paracetamol. If you are taking medication containing paracetamol this should be calculated in your maximum daily dose. Overdoses can – and do – happen if people don’t take it into account.

If your preferred medicine for pain or fever is paracetamol, do not exceed the recommended daily dose. And if you take it for more than a few days, speak to your doctor to see what else you can try instead of continuing with the acetaminophen.

Ralph Chen is an enthusiast for medical topics and advanced technology. When he’s not writing, he spends a lot of time playing popular PC games.