Author : Carolina Marques (pharmacist) Paracetamol is one of the most widely used medications worldwide. It is indicated for the treatment of mild to moderate pain and for fever control in both adults and children. It is included in the World Health Organization’s list of essential medicines , reflecting its effectiveness, good safety profile, and significant impact on public health, as well as its excellent cost‑effectiveness, making it indispensable for addressing the population’s priority health needs. What are the indications for paracetamol? The main indications for paracetamol are: Mild to moderate fever and/or pain associated with the flu; Mild to moderate fever and/or pain associated with vaccination reactions; Mild to moderate headache; Mild to moderate toothache; Mild to moderate earache; Mild to moderate menstrual cramps; Mild to moderate muscle or joint pain. Paracetamol relieves pain (has analgesic action) and reduces fever (has antipyretic action) . It does not reduce inflammation because it has no anti-inflammatory action. It is effective in treating pain and fever, but it does not treat the underlying cause . It should always be used according to medical and/or pharmaceutical recommendations to avoid undesirable effects. What are the recommended doses and how to take paracetamol? Paracetamol is available in several pharmaceutical forms , some with different concentrations of the active substance, including tablets, capsules, syrups, granules, suppositories, and intravenous solutions . Up to the age of 12, syrups and suppositories are the most appropriate and commonly used pharmaceutical forms; from that age onwards, tablets and capsules are typically used. Medicines packaging and information leaflets indicate the age group for which they are intended, the concentration of paracetamol it contains, how it should be taken, as well as other useful information that is important. The dose of paracetamol depends on age and body weight. More frequently, the following is recommended for healthy people without risk factors or other relevant clinical conditions apart from the reason for taking paracetamol: Adolescents aged 16 years and older and adults weighing over 50 kg 500 mg to 1000 mg of paracetamol per dose; Doses may be repeated at intervals of 6 to 8 hours, that is, up to 3 or 4 times a day; The maximum daily dose of paracetamol is 4 g (4,000 mg). However, some information leaflets indicate a maximum daily dose of 3 g (3,000 mg) of paracetamol, especially when taken without specific medical guidance; In particular situations, the interval between doses can be reduced to 4 hours, but the maximum daily dose must never be exceeded. Children and adults weighing less than 50 kg 10-15 mg of paracetamol per kilogram of body weight, per dose; It is always recommended to consult the dosage instructions (weight-based dose) provided in the information leaflets or consult a healthcare professional; Doses can be repeated at intervals of 6 to 8 hours, that is, up to 3 or 4 times a day, never exceeding 60 mg/kg/day. Is paracetamol a safe medication? Paracetamol is safe for most people when taken at the recommended doses . However, there are situations in which it should not be taken and/or in which its use should only occur after medical evaluation. This applies, for examples, to people who: Have experienced previous adverse reactions or have a known allergy to paracetamol; Have liver disease; Have impaired kidney function; Take other medication that may interfere with paracetamol or the organs involved in its metabolism (liver and kidneys); Show signs of malnutrition or dehydration; Have habits of excessive and regular alcohol consumption. Prolonged and frequent use of paracetamol is also not advisable, except when prescribed by a doctor. Medical attention should be sought if, after three days, the issue that led to taking paracetamol is not resolved , particularly in pregnant women, breastfeeding women, and children. Is paracetamol safe during pregnancy and breastfeeding? Paracetamol can be taken during pregnancy when clinically necessary. However, it should be taken at the lowest dose and for the shortest possible time, and preferably under medical guidance. When paracetamol is taken during breastfeeding, this is excreted into breast milk, but in very small amounts. Therefore, in general, it is not necessary to interrupt breastfeeding when paracetamol needs to be taken. Is paracetamol safe for children and the elderly? Paracetamol is a safe option for children and the elderly, provided that the doses appropriate to age, weight and health status are respected , and medical advice should always be followed. What happens if the recommended dose of paracetamol is exceeded? Despite its benefits, paracetamol has a narrow therapeutic margin . This means that the difference between a recommender and beneficial dose and a potentially harmful dose is small . Therefore, taking slightly more than recommended, even unintentionally, increases the risk of adverse effects. Serious adverse effects associated with paracetamol overdose can occur unintentionally, both with occasional excessive dosing and with repeated overdosing. Liver and kidneys are the main organs affected and effects include the possibility of acute liver failure and kidney failure which, in severe cases, can lead to coma. Paracetamol overdose is one of the leading causes of acute liver failure in developed countries. Even in the absence of symptoms, suspected or confirmed paracetamol overdose requires immediate medical attention . Urgent treatment may include the administration of an antidote and other measures, such as gastric lavage, depending on the time elapsed since ingestion. Can paracetamol be taken with other medications? It depends on the medications and the individual health status. Before combining paracetamol with other medications, it is essential to read the information leaflet and, if in doubt, speak to a doctor or pharmacist. For example, many medications used to treat cold and flu symptoms contain paracetamol and combining such medications can lead to an inadvertent overdose . Are paracetamol and ibuprofen the same thing? No ! Paracetamol and ibuprofen are different medications. Although both are used to relieve pain and reduce fever, paracetamol acts primarily on the central nervous system, helping to relieve pain and lower fever, but it does not have an anti-inflammatory effect. Ibuprofen, on the other hand, is a non-steroidal anti-inflammatory drug (NSAID), which means it also helps reduce inflammation in addition to its analgesic and antipyretic effects. In general, paracetamol is better tolerated, while ibuprofen has more adverse digestive effects. Therefore, paracetamol is often the choice for those with gastric problems or who need a milder analgesic. Do paracetamol and ibuprofen have other names? In some countries, mainly the United States, Canada, and Japan, paracetamol is known as acetaminophen . Therefore: Paracetamol and acetaminophen are different names for the same medication. The chemical name (IUPAC) of paracetamol is N-(4-hydroxyphenyl)ethanamide . Paracetamol (or acetaminophen) and ibuprofen are different medications. The chemical name (IUPAC) of ibuprofen is (RS)-2-(4-isobutylphenyl)propanoic acid . There are other names for these medications, but neither these nor the chemical names mentioned above are commonly used. In summary Vigilance and timely medical attention is essential. Paracetamol is easily accessible. It is an over-the-counter medication, meaning it can be purchased without a prescription. However, strict adherence to the recommended doses is crucial to avoid undesirable side effects. If excessive paracetamol intake is suspected, even in the absence of symptoms, immediate medical attention is essential. In many cases, the effects of overdose can be reversed, but in some situations the damage may be irreversible. Medical care should also always be sought when taking paracetamol and: Pain and/or fever persist for more than three days; Pain and/or fever are very intense and do not respond to medication; There is uncertainty about the correct dose or about combining paracetamol with other medications. Sources British National Formulary (BNF). Paracetamol. Summary of Product Characteristics for various commercial medicines containing paracetamol. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
