Drug induced liver injury (DILI) is a common cause of acute liver injury. Paracetamol, also known as acetaminophen, is a widely used anti-pyretic that has long been established to cause liver toxicity once above therapeutic levels. Hepatotoxicity from paracetamol overdose, whether intentional or non-intentional, is the most common cause of DILI in the United States and remains a global issue. Given the increased prevalence of combination medications in the form of pain relievers and antihistamines, paracetamol can be difficult to identify and remains a significant cause of acute hepatotoxicity, as evidenced by its contribution to over half of all acute liver failure cases in the United States.
Paracetamol (Acetaminophen or para-hydroxy acetanilide) is a medication commonly used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferior to ibuprofen in that respect, and the benefits of its use for fever are unclear. Paracetamol may relieve pain in acute mild migraine but only slightly in episodic tension headache. However, the aspirin/paracetamol/caffeine combination helps with both conditions where the pain is mild and is recommended as a first-line treatment for them. Paracetamol is effective for post-surgical pain, but it is inferior to ibuprofen.The paracetamol/ibuprofen combination provides further increase in potency and is superior to either drug alone. The pain relief paracetamol provides in osteoarthritis is small and clinically insignificant.The evidence in its favor for the use in low back pain, cancer pain, and neuropathic pain is insufficient.
In the short term, paracetamol is safe and effective when used as directed.Short term adverse effects are uncommon and similar to ibuprofen, but paracetamol is typically safer than Nonsteroidal anti-inflammatory drugs (NSAID) for long term use. Paracetamol is also often used in patients who cannot tolerate NSAIDs like ibuprofen.Chronic consumption of paracetamol may result in a drop in hemoglobin level, indicating possible gastrointestinal bleeding, and abnormal liver function tests.
Paracetamol was first made in 1877.It is the most commonly used medication for pain and fever in both the United States and Europe It is on the World Health Organization's List of Essential Medicines.In 2020, it was the 118th most commonly prescribed medication in the United States, with more than 5 million prescriptions.
You can take paracetamol for: mild to moderate pain, for example backache, headache, migraine, muscle strains, period pain, toothache and aches and pains due to colds and flu. fever (high temperature) in combination with other pain killers for stronger pain.
The recommended maximum daily dose for an adult is three grams (3000 mg) to four grams (4000mg).It is OK to take paracetamol every day in standard dose.
It's safe to take paracetamol regularly for many years, as long as you do not take more than the recommended dose.
Higher doses may lead to toxicity, including acute liver failure. Paracetamol poisoning is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand.
Paracetamol is a widely known over-the-counter analgesic and antipyretic which, in acute poisoning usually causes liver damage, and less commonly damage to the kidney, heart, and pancreas.
You have severe liver or kidney disease or problems, seek medical advice before taking Dolo( Paracetamol)650 mg tablet. You are taking any other medicines or products that contain paracetamol. Taking too much of the same can cause liver damage. You consume alcohol too often or are suffering from chronic malnutrition.
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.
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 4 gm (eight 500mg tablets) in the space of 24 hours.The American Liver Foundation recommended patients not exceed 3 gram of paracetamol daily and the American Geriatric Society suggested no more than 2−3 gram daily in older patients with hepatic insufficiency or a history of alcohol abuse.
Paracetamol in high single doses (typically 15 gram or more) causes liver injury through a toxic metabolite, NAPQI (N-acetyl-p-benzoquinone imine). Alcohol consumption and possibly starvation induce cytocrome P-450 and therefore increase NAPQI synthesis.
The first signs liver damage are yellowing of the skin or whites of the eyes (jaundice) swelling in the legs, ankles and feet caused by a build-up of fluid (oedema) swelling in your abdomen caused by a build-up of fluid known as ascites. a high temperature and shivering attacks.
The best blood indicators of liver damage are
Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia. Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
Liver function tests (also known as a liver panel) are blood tests that measure different enzymes, proteins, and other substances made by the liver. These tests check the overall health of your liver.
The liver has a unique capacity among organs to regenerate itself after damage. A liver can regrow to a normal size even after up to 90% of it has been removed. But the liver isn't invincible. Many diseases and exposures can harm it beyond the point of repair.
Liver transplant is surgery to replace a diseased liver with a healthy liver. In liver transplant surgery the diseased liver is removed through an incision made in the upper abdomen. The new liver is put in place and attached to the patient's blood vessels and bile ducts.
You may not be able to have a transplant if you: Have a current or chronic infection that can't be treated. Have metastatic cancer. This is cancer that has spread from its main location to 1 or more other parts of the body.
In general, about 75% of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 75 will live for five years and 25 will die within five years.
The long-term outlook for a liver transplant is generally good. More than 9 out of every 10 people are still alive after one year, around 8 in every 10 people live at least 5 years, and many people live for up to 20 years or more.
Information compiled by:
Dr. Bhairavsinh Raol
