Paracetamol

Paracetamol, internationally known as acetaminophen, is a widely used non-opioid analgesic and antipyretic medication. Commonly available over the counter, it is marketed under numerous brand names, most notably Tylenol and Panadol. Its popularity is attributed to its broad availability, relative safety in short-term use and its effectiveness in relieving mild to moderate pain and reducing fever.

General Pharmacological Profile

Paracetamol is employed to manage a wide range of mild to moderate pain conditions, including headaches, muscular aches, minor arthritis, toothache, and pain associated with colds, influenza and menstrual cramps. It is also used to relieve pain in acute migraine and episodic tension-type headaches. The drug’s antipyretic action produces a modest reduction in body temperature, although its effect is generally less pronounced than that of ibuprofen. The clinical benefit of using paracetamol for fever, especially in viral illnesses, remains uncertain due to variable research findings.
Combination preparations containing aspirin, paracetamol and caffeine are particularly effective for mild headache and migraine, and such combinations are frequently recommended in guidelines for self-managed acute headache. Paracetamol combined with ibuprofen is another formulation shown to improve analgesic potency, especially in post-surgical discomfort, where the combination performs better than either drug alone.

Use in Pain Management

Pain relief from paracetamol is considered reliable for acute pain, but evidence for its use in chronic pain is limited. In osteoarthritis, paracetamol provides only small and clinically insignificant improvements in symptoms, leading to conditional recommendations that it be used sparingly or only when nonsteroidal anti-inflammatory drugs (NSAIDs) are unsuitable. Similar conclusions apply to back pain, where studies show no meaningful benefit in either acute or chronic low back pain, and little evidence supports its use in radicular or neuropathic pain.
In dental and other post-operative pain, full-dose NSAIDs outperform paracetamol, although combining paracetamol with an NSAID may offer enhanced relief. Paracetamol-codeine combinations, once widely used, are now often judged inferior to standard NSAID therapy. Nevertheless, paracetamol maintains a role in situations where NSAIDs are contraindicated, such as in patients with gastrointestinal sensitivity or cardiovascular risk factors.

Effectiveness in Fever Reduction

Paracetamol is frequently used to reduce fever in adults and children, though studies highlight gaps in evidence regarding its antipyretic efficacy. While it can modestly lower temperature, its therapeutic value in febrile episodes, particularly those caused by viral infections, is not firmly established. Research shows that in critical care settings, paracetamol reduces body temperature only slightly and does not influence mortality. Findings for its role in sepsis are inconsistent, and it offers no benefit in diseases such as dengue fever, where it may be associated with raised liver enzymes.
In children, paracetamol should not be administered solely to reduce fever, but may be considered if the child is distressed. It does not prevent febrile seizures. Some analyses show paracetamol is marginally less effective than ibuprofen for childhood fever, although both have similar safety profiles. Combined simultaneous use in young children is not advised, though alternating dosages may be permitted when necessary.

Safety, Risks and Toxicity

Short-term use of paracetamol is generally safe, with adverse effects similar in frequency to those associated with ibuprofen. It is often preferred over NSAIDs for long-term management because it avoids common NSAID-associated complications such as gastrointestinal irritation, cardiovascular risk and renal impairment. Paracetamol is therefore widely recommended for individuals unable to take NSAIDs.
Chronic consumption, however, carries risks. Prolonged use may reduce haemoglobin levels, suggesting possible gastrointestinal blood loss, and may elevate liver enzyme levels. The usual maximum recommended adult dose is three to four grams per day. Ingesting doses above this range increases the risk of toxicity, particularly liver failure. Paracetamol overdose is the leading cause of acute liver failure in numerous Western countries and accounts for a significant proportion of medication-related emergency presentations in places such as the United States, the United Kingdom, Australia and New Zealand.

Historical Development and Global Use

Paracetamol was first synthesised in the nineteenth century, with historical records crediting its creation to Harmon Northrop Morse in 1878, though earlier work in 1852 by Charles Frédéric Gerhardt may also have produced the compound. Since the twentieth century it has become one of the most commonly used medications for pain and fever in both Europe and North America.
Its importance in global public health is reflected in its inclusion on the World Health Organization’s Model List of Essential Medicines. It is widely available in generic formulations, ensuring broad accessibility. In the United States alone, millions of prescriptions are issued annually for paracetamol-containing medicines, with the drug commonly used in both community and hospital settings.