Paracetamol: A Review of Guideline Recommendations

Abstract

Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.

Pharmacological management of chronic non-cancer pain in frail older people

“…Evidence supporting its long-term use in chronic non-cancer pain is limited, but it remains in multiple guidelines as the first-line drug, especially for older people, given that other options are often contraindicated. 19 Regular paracetamol for up to three months provided mean pain relief of 0.3 points (on a 10-point pain scale, 95% confidence interval –0.6 to –0.1 points) in a systematic review of five trials involving 1686 patients with knee or hip osteoarthritis. Its efficacy in other painful conditions is uncertain.…”

Scientific Foundations in medicine and Pharmacy

“…Comprehensive and routine therapy includes treatment with nonsteroidal antiinflammatory drugs (NSAIDs) and analgesics. Paracetamol has gained wide popularity [283]. The ratio of efficiency and safety has allowed it to gain the popularity of doctors around the world.…”

Probiotics: Evolving as a Potential Therapeutic Option against Acetaminophen-Induced Hepatotoxicity

“…Acetaminophen (APAP), commonly known as paracetamol, is the most routinely prescribed antipyretic and analgesic agent for all age groups under the class of non-steroidal anti-inflammatory medicine drugs (NSAID) [ 1 ]. Over 100 over-the-counter analgesics and antipyretics contain APAP [ 2 ].…”

“…Pediatricians routinely prescribe it to treat fevers in children. APAP is included in several prescription medications as a single-drug formulation or in combination with other drugs for effective and safe management of pain and fever [ 1 ]. However, a single overdose or frequent application of APAP has been revealed to develop acute hepatotoxicity, and even death, due to acute hepatocellular injury [ 3 ].…”