[cyphar]

Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose[1] (this is one of the reasons you are told not to drink alcohol when taking paracetamol -- if your liver is struggling to process alcohol you're more susceptible to liver failure).

In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2]. And in 2006, [3] found it was the most commonly used compound for intentional overdosing (i.e. suicide by overdose).

But of course, this depends on taking a very high dose -- paracetamol isn't dangerous in moderate doses.

[1]: https://en.wikipedia.org/wiki/Paracetamol_poisoning [2]: https://www.ncbi.nlm.nih.gov/pubmed/18312195 [3]: https://www.ncbi.nlm.nih.gov/pubmed/16805658

[DanBC]

> In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2].

No, it isn't, and for the people who die from paracetamol it's an intentional overdose, it's very rarely an accidental overdose.

In the US about 500 people die each year from acetaminophen overdose per year, compared to over 70,000 from opioids.

Your link number 3 is talking about compounds containing paracetamol. For example, this includes coproxamol. Anyone overdosing on coproxamol was dying from the opioid (dextropropoxyphene), not from the paracetamol.

In the UK we have the ONS deaths related to drugs poisoning. Figure six shows deaths compared by drug type, and paracetamol clear isn't the highest: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

We also have the NCISH data. Item 120 here: https://documents.manchester.ac.uk/display.aspx?DocID=38469

3095 deaths by self-poisoning.

    Substance                    Number   
  Opiates/opioids                 947    33%
  - opiates only                  746    26%
  - paracetamol/opiate compound   201     7%
  Non-opiate analgesics           205     7%
  Antipsychotics                  302    11%
  Antidepressants                 587    21%
  - tricyclics                    271     9%
  - SSRI/SNRIs                    260     9%
  - other antidepressants          56     2%

Paracetamol is dangerous in overdose, but that says nothing about its safety in normal usage.

[abathur]

I can't cite a source, but I recall being told when I was prescribed a few days of vicodin+acetaminophen after an appendectomy that acetaminophen is (often? sometimes? always?) combined with some potentially-addictive painkillers to limit the extent to which they can be abused without the user needing treatment for liver issues.

This doesn't really undercut anything you say, but if I was given accurate information I assume a subset of those acetaminophen OD deaths are from people abusing painkillers it's combined with. I haven't looked into it, but I assume this is also a partial explanation of why OTC cold medications with Dextromethorphan in them tend to be combined with a relatively high dose of acetaminophen. I would guess there are other good examples of abusable pharmaceuticals combined with acetaminophen.

[xiii1408]

There's a little bit of truth to this--historically, lower doses of hydrocodone and oxycodone mixed with acetaminophen were a lower drug schedule in the US, allowing for less stringent requirements on security during production and transportation. Presumably, this was because the DEA thought there was less potential for abuse in the combinations drugs.

However, there's a more important medical reason: acetaminophen accentuates the analgesic affects of opioids, although the mechanism for this is not clearly understood. This makes acetaminophen-enhanced opioids more effective drugs.

Opioid abuse has become so rampant, though, that we're moving away from prescribing acetaminophen-enhanced opioids like Vicodin and Percocet to try to stop them entering the recreational drug market. As opioid use has increased, so has the number of liver toxicity deaths due to the acetamiophen in some prescription opioid drugs.

[cyphar]

This was mentioned in the Wikipedia article about paracetamol poisoning (though the reason paracetamol is added to opiod painkillers is because apparently the combination works better than either drug separately).

But the original point was about whether paracetamol is toxic, not how often people overdose on Panadol (though that does happen in suicides). And the answer is "yes, but not in the dosages you'd normally see".

[naasking]

> Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose

Sure, and drinking too much water causes hypernutremia that can also kill you. Toxicity is always dose dependent, so the initial unqualified claim seemed to imply toxicity at normal dosages.

[cyphar]

Botulinum toxin (botox) doesn't kill most people in the standard dosage, but it is obviously toxic (it's in the name).

Paracetamol poisoning is fairly common, hypernutremia isn't. Don't get me wrong, I disagree with the original statement that paracetamol is toxic (with the implication that this is a reason not to use it in normal dosages). But it's definitely not harmless.

[naasking]

I agree it's not harmless, but strictly speaking this kind of phrase is meaningless because nothing is intrinsically harmless. Dosage dictates all harm.

Probably the closest to harmless you can get are the inert gasses, and even then they can cause harm by displacing oxygen to deadly levels.

[justtopost]

It is easily the most lethal otc. Its not some dihydrogen monoxide fear mongering.