Many parents are familiar with paracetamol: in the form of suppositories or  juice  , it helps with  fever  and pain. But not only children benefit from this well-tolerated drug. At the end of the 19th century, English and German chemists in particular were researching alternatives to the natural painkillers used up until then, such as willow bark. The substances acetanilide and phenacetin, newly developed around 1886, proved to relieve pain and even reduce fever.

effects of paracetamol

In addition to  acetylsalicylic acid  and  ibuprofen  , paracetamol is one of the most commonly used painkillers worldwide. Paracetamol is used for mild to moderate pain and belongs to the group of so-called cyclooxygenase inhibitors (non-opioid analgesics). Since paracetamol also reduces fever (antipyretic) and is particularly well tolerated, it is mainly used in children.

In contrast to the other two active ingredients, however, paracetamol is less effective for pain caused by inflammation, such as rheumatic diseases.

function of the active substance

Paracetamol is also known chemically as N-acetyl-para-aminophenol (abbreviated: APAP), 4′-hydroxyacetanilide or 4-acetamidophenol. Although paracetamol has been used for decades, like many other drugs, the exact mechanism of action was unknown for a long time.

Even today, not every detail has been unraveled. It is now known that paracetamol inhibits the cyclooxygenase Cox-2 – an endogenous substance that is activated when cells are damaged and stimulates the production of pro-inflammatory and pain-increasing prostaglandins. However, since the inhibitory effect of paracetamol is only comparatively weak, other mechanisms must be involved in its effectiveness. However, these have not yet been decrypted.

Paracetamol is often offered in  combination preparations  together with caffeine. This is said to increase the pain-relieving effect of paracetamol.

Paracetamol: dosage

Paracetamol is commercially available in various dosage forms. Suppositories or juices or syrups are usually used for children, tablets and capsules for adults. Infusions are also available.

Paracetamol can be taken once or in three to four divided doses per day. There should be at least six to eight hours between taking the individual doses.

When dosing paracetamol, it is important not to exceed the recommended  maximum amount,  as an overdose can lead to life-threatening liver damage.

  • Adults  are not allowed to take more than eight tablets of 500 milligrams each, i.e. a total of four grams per day.
  • In children  , the paracetamol dose – depending on age – is lower. 10 to 15 milligrams of paracetamol per kilogram of body weight are recommended per single dose, with a daily upper limit of 50 milligrams per kilogram of body weight.

Paracetamol side effects

In the recommended dosage, paracetamol has few possible side effects and is well tolerated. The following side effects occur rarely to very rarely:

  • Disorders of blood formation
  • allergic reaction
  • stomach pain
  • nausea
  • an increase in liver values
  • a spasm of the airways with  shortness of breath

Overdose: Danger for the liver

However  , an overdose  of paracetamol can have serious side effects. The liver in particular can be severely damaged if an adult takes more than 10 to 12 grams once a day or more than 7.5 grams over a longer period of time (correspondingly smaller amounts in children).

For this reason, paracetamol has been available on prescription in Germany since July 2008 in larger packs (from ten grams of the active ingredient), smaller quantities can still be purchased in pharmacies without a prescription.

Simultaneously taking potentially liver-damaging substances (e.g. anticonvulsant drugs) or alcohol abuse is also critical for the liver.

Interactions of paracetamol

Paracetamol can interfere with the elimination of other drugs metabolized by the liver, such as the antibiotic chloramphenicol. It should also be noted that the onset of action can be accelerated or slowed down by drugs that affect gastric emptying.

In the case of blood tests, the doctor should be informed about the intake of paracetamol, as this can affect certain  laboratory values  ​​(e.g.  blood sugar , uric acid).

During  pregnancy and breastfeeding  , paracetamol may be taken for a short time and only after consulting a doctor.

Research into paracetamol

Although paracetamol was first synthesized in 1893, it was not until 1948 that Brodie and Axelrod discovered that this white, odorless powder with a bitter  taste  is a breakdown product of the two substances acetanilide and phenacetin mentioned above and is responsible for their effects. Paracetamol was   introduced to the market as a pain reliever in 1956.


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