A fellow and ex-president, Pharmaceutical Society of Nigeria, Olumide Akintayo, tells ARUKAINO UMUKORO about the uses and side effects of paracetamol
What is paracetamol?
The chemical name for paracetamol is N-Acetyl-p-aminophenol. Paracetamol is classified pharmacologically as an analgesic. An analgesic is a pain-relieving medication or pain killer, and it comes in various dosage forms; liquid dosage forms for paediatrics, tablets or capsules for geriatric patients, and in more recent times, we have had the etheral form, that is, injection form, especially in situations where one does not want to use what we conventionally call non-steroidal anti-inflammatory agents.
What is the correct maximum daily dosage of paracetamol?
Let me give a general background. It is not only paracetamol that is misused. Most medications are routinely misused and abused in our country. One of the reasons for this is that, generally speaking, people have unrestricted access to medications. Also, most nations of the world place drug matters under the jurisdiction of the central or federal government. Nigeria is not an exemption. That is why drug matters are listed as Item 21 in Part One of the second schedule of the 1999 Constitution, so that it is only the Federal Government and its agencies that have the jurisdiction to regulate and modulate the use of medicine. Despite all this, there is still a lot of misuse and abuse because the regulatory process is still largely poor. So, from stark illiterates who know nothing about medicine to the stakeholder in care provisioning, everybody dabbles into this, which is most unfortunate.
To answer your question, paracetamol tablets come in 500mg. The ideal dose is 1g as needed. So, one gramme would be two tablets. The most common prescription is two tablets in the morning, afternoon and night, which makes up six tablets. But under normal circumstances, one is not supposed to exceed eight tablets in a 24-hour period.
It is common for some persons to take paracetamol with other pain relieving tablets. Is it advisable for people to take a drug like ibuprofen and paracetamol together?
Ibuprofen is one of the drugs I referred to earlier as non-steroidal anti-inflammatory agents. In conventional health practice, one can actually combine analgesic and drugs like ibuprofen. So, one could find some formulation like chlofenac-paracetamol tablet combinations. It is allowed. But usually, these are not medicines, people should buy without expert advice. It should be taken based on the prescription and advice of a pharmacist. Also, there are specific pieces of information that must be conveyed by the pharmacist when one needs to buy such combination.
Can combining paracetamol with other drugs cause any problem for a patient?
Yes. I give you a classical example of a drug interaction profile, which is very common in our environment. If one takes paracetamol tablets with chloramphenicol for instance, which a lot of people use in the management of typhoid fever, what one sees is that the paracetamol reduces the half-life of the chloramphenicol by a factor of about two. Prescribers sometimes make that mistake. That means the person taking it would be vulnerable to chloramphenicol-induced toxicity, and that would usually manifest as excessive destruction of the white blood cells in the body. The white blood cells are like soldiers of the body because they protect the body against normal infection. So, if a drug destroys these white blood cells, the body becomes very vulnerable to infection.
What are the side effects of taking paracetamol?
One of the chronic side effects, which have been confirmed, is that if an individual indulges in the excessive use of paracetamol, that person is likely to develop kidney damage. Excessive overdose is if one takes more than eight paracetamol tablets in a day, or takes the tablets against the prescription, like taking more than the prescribed two tablets thrice during an eight-hourly interval for 24 hours. Sometimes, it is a little more dangerous to indulge in the excessive use of paracetamol than aspirin because of the factor I highlighted. If the kidneys, which are vital organs of the body, are destroyed, it would cause more problems, such as renal failure and renal diseases. Some recent studies have also linked infertility to the use of paracetamol. It is not good to indulge in excessive use of paracetamol or any other medicine, because these medicines could in turn become poisonous to the body.
What is the correct dosage for children if adults are supposed to take six to eight tablets in 24 hours?
It is the same thing for children. The body weight would indicate. For instance, children between the ages of eight to 11 years need a half dosage of what an adult is supposed to take, that indicates one tablet daily, which is about 200mg. Age five and below is lower. That is why the prescription of a pharmacist is important to determine an appropriate dose based on the weight of the child through appraisal, even if there is no weighing scale.
As a pharmacist, what have you observed as the most common form of abuse of paracetamol by Nigerians?
One of the major things I have observed in my practice is that people think paracetamol is a routine drug. Often times, people take paracetamol for anything whether they have pains, headache or not. They just wake up in the morning and take paracetamol. They relegate it to the level of a multivitamin. They just feel they must take paracetamol. There are a few other drugs that can fit into this category. In essence, I am saying that except it is proven that one has a headache or pain, one does not need to indulge in the use of paracetamol.
What is your advice to the health practitioners who prescribe paracetamol tablets?
For a trained health care provider or health worker, I do not have a problem, because often times, they would not recommend the usage except there is a dire need for it. The people that need more counselling are the consumers of health care. They need to source their medicines form registered pharmacists, because there is a benefit package that goes with sourcing one’s medicine from accredited and licenced premises. Apart from the fact that one can guarantee the quality of medicine being purchased and taken, one can be sure of also getting the requisite counsel and advice.