Paracetamol is the most widely used painkiller in the UK, and the one people are most likely to take too much of without realising — usually because it is hidden inside a cold and flu remedy or a combination painkiller. Taken at the right dose it is remarkably safe. Taken above it, it damages the liver, and it does so quietly.
Paracetamol treats mild to moderate pain — headache, toothache, period pain, sprains, backache — and reduces a high temperature. It is often the first choice because it suits more people than anti-inflammatories such as ibuprofen, including many who cannot take those because of stomach, kidney or asthma problems.
It does not reduce inflammation, so for a swollen joint or an inflammatory condition it is less useful on its own than ibuprofen or naproxen.
The usual adult dose is one or two 500mg tablets up to four times in 24 hours, with at least four hours between doses. The absolute maximum for an adult is 4,000mg (eight 500mg tablets) in 24 hours — never more, even if the pain is not controlled.
Children’s doses are worked out by age and weight, and liquid strengths differ between products. Always measure with the syringe or spoon provided and follow the dosing on that specific bottle.
The number one safety point: check whether anything else you are taking already contains paracetamol. Cold and flu sachets, night-time remedies and combination painkillers such as co-codamol almost all do. Doubling up is the most common route to an accidental overdose.
Paracetamol can be taken with or without food, and works within about an hour.
Side effects are uncommon at normal doses, which is part of why it is so widely used. Rarely, people get a rash or, very rarely, blood disorders.
Overdose is the serious risk. Liver damage from too much paracetamol can be severe, and the early hours often feel deceptively normal — nausea and vomiting at most. Treatment works far better when it is started early.
Speak to us or your GP before taking paracetamol regularly if you:
Regular paracetamol can slightly increase the effect of warfarin. Occasional doses are generally fine, but tell your anticoagulant clinic if you start taking it every day.
Paracetamol is the usual first-choice painkiller in pregnancy and while breastfeeding. Use the lowest dose that works, for the shortest time.
For children, use a product designed for their age and follow the label. Infant paracetamol can generally be used from two months for teething and after vaccinations in babies born after 37 weeks, and from three months for other pain and fever — ask us if you are unsure.
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