The risks for patients who take paracetamol long term may have been underestimated, reseachers warn today.
The UK team of researchers examined the link between regular use of paracetamol, known as acetaminophen in the USA, and major adverse events in the general adult population.
Now they call for a systematic review to ensure the effectiveness of drug and to establish how it is tolerated for certain conditions.
The research team, led by Professor Philip Conaghan, of the Leeds Institute of Rheumatic and Musculoskeletal Medicine, analysed eight studies for the research, which is published in Annals of the Rheumatic Diseases.
Of the two studies that showed death rates, one found a dose–response and reported there had been an increased relative rate of mortality from 0.95 to 1.63 for increasing standard doses of paracetamol when comparing patients who had been prescribed paracetamol with those who had not.
Four studies reported heart-related adverse events and they showed a dose–response with one study reporting an increased risk ratio of all cardiovascular adverse events from 1.19 to 1.68.
One study that reported gastrointestinal adverse events showed a dose–response with a higher relative rate of events or bleeds from 1.11 to 1.49.
Of the four studies that revealed kidney-related adverse events, three reported a dose–response with one reporting a more likely decrease in estimated glomerular filtration rate – a test used to check how well the kidneys are working – from 1.40 to 2.19.
The authors said their findings demonstrated a consistent dose–response relationship between paracetamol at standard analgesic doses and adverse events that are typical among non-steroidal anti-inflammatory drugs.
“Based upon the data presented above, we believe the true risk of paracetamol prescription to be higher than that currently perceived in the clinical community,” they write.
“Given its high usage and availability as an over-the-counter analgesic, a systematic review of paracetamol’s efficacy and tolerability in individual conditions is warranted.”
Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Annals of the Rheumatic Diseases. Online First doi 10.1136/annrheumdis-2014-206914 [abstract]
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