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Taking slightly too much paracetamol day after day
can be fatal, experts have warned.
A dangerous dose might just be a few pills too many taken regularly over
days, weeks or months, they said.
Researchers at Edinburgh University saw 161 cases of "staggered
overdose" at its hospital over a 16-year period.
People taking tablets for chronic pain might not realise they were
taking too many or recognise symptoms of overdose and liver injury, they
said.
The researchers told the British Journal of Clinical Pharmacology that
this life-threatening condition could be easily missed by doctors and
patients.
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Doctors may not initially spot the problem because blood tests will not
show the staggeringly high levels of paracetamol seen with a
conventional overdose, where someone may have swallowed several packets
of the drug.
Patients who have taken a staggered overdose tend to fare worse than
those who have taken a large overdose, the study suggests.
Dr Kenneth Simpson and colleagues looked at the medical records of 663
patients who had been referred with paracetamol-induced liver injury to
the Scottish Liver Transplantation Unit at the university hospital.
The 161 who had taken a staggered overdose were more likely to develop
liver and brain problems and need kidney dialysis or help with their
breathing. They were also more likely to die of their complications.
Dr Simpson said: "They haven't taken the sort of single-moment, one-off
massive overdoses taken by people who try to commit suicide, but over
time the damage builds up, and the effect can be fatal."
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Professor Roger Knaggs of the Royal Pharmaceutical Society said patients
should heed the warning.
"If people experience pain and paracetamol doesn't help, rather than
thinking a 'top up' dose may work, they should consult their pharmacist
for alternative pain control or referral to someone who can help with
the cause of the pain.
"The message is clear: if you take more paracetamol than is recommended,
you won't improve your pain control but you may seriously damage your
health.
"At this time of year people should also take care with combination cold
and flu products which may have paracetamol as one of the ingredients.
It's easy to take more than intended, so if in doubt consult your
pharmacist."
Meanwhile, researchers at King's College London and Lund University in
Sweden say they have discovered precisely how paracetamol works in the
body. It is via a protein on nerve cells called TRPA1, says Nature
Communications.
Now that they understand this principal mechanism, scientists can start
to look for molecules that work in the same way to effectively relieve
pain, but are less toxic and will not lead to serious complications
following overdose.
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