Why patients choose paracetamol

Paracetamol if the most commonly abused substance in deliberate self-poisoning, due in part to it being widely available without prescription.

Despite widespread use and availability, paracetamol has a narrow safety margin compared to other over-the-counter analgesics. For example, the toxic dose of paracetamol is 10 times a therapeutic dose, whereas the toxic dose of ibuprofen is 60 times a therapeutic dose.

It has been estimated to be used in 6% of poisonings, implicated in 56% of cases of severe acute liver injury and acute liver failure and 7% of drug-induced liver injury.

Approximately 0.4% of paracetamol overdose cases are fatal. The three main factors making hepatotoxicity more likely are;

(i) larger overdoses

(ii) overdose with MR/ER paracetamol

(iii) delays to treatment.

Reference

1. Chidiac A et al. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol. 2023 Jan-Jun;19(5):297-317.