Is Paracetamol harmful for liver? Doctor explains how much is too much

Digital Desk: Paracetamol, known globally as acetaminophen, is a go-to medication for relieving pain and reducing fever. Found in nearly every household, it’s often perceived as a safe and effective option for treating minor ailments like headaches, muscle pain, and the common cold. 

However, its widespread availability and over-the-counter status can create a false sense of security, leading to dangerous misuse. Medical professionals warn that paracetamol, while generally safe in recommended doses, can be highly toxic to the liver if taken improperly.

Understanding Paracetamol’s Impact on the Liver

The liver is the body’s main detoxification organ, breaking down various substances, including medications like paracetamol. When taken in recommended doses, the liver processes paracetamol efficiently, converting it into harmless substances that are excreted in urine. However, when consumed in excessive amounts, the liver's capacity to safely metabolize the drug is overwhelmed. 

Excess paracetamol is converted into a toxic metabolite known as N-acetyl-p-benzoquinone imine (NAPQI). Normally, NAPQI is neutralized by glutathione, a liver enzyme. But when paracetamol levels are too high, glutathione stores become depleted, allowing NAPQI to accumulate and cause liver damage, potentially leading to acute liver failure.

The maximum recommended daily dose of paracetamol for an average adult is 4,000 milligrams, typically taken as 500 to 1,000 milligrams every 4 to 6 hours. Exceeding this limit, whether intentionally or accidentally, significantly increases the risk of liver injury. 

An hepatologist expert at a leading medical center, explains, “Paracetamol toxicity is one of the most common causes of acute liver failure. Even a slight overdose—taking just a bit more than the recommended dose over a short period—can cause serious harm.” She warns that individuals with pre-existing liver conditions, chronic alcohol use, or those taking other medications that affect the liver should be especially cautious, as they are at a higher risk of toxicity even at lower doses.

Warning Signs and Precautions

Early symptoms of paracetamol overdose may include nausea, vomiting, sweating, and abdominal pain, which can easily be mistaken for other minor illnesses. If untreated, liver damage progresses rapidly, leading to jaundice, confusion, and eventually, liver failure. Immediate medical attention is crucial if an overdose is suspected.

To avoid accidental overdose, expert advises checking the active ingredients in all medications you are taking, as many over-the-counter cold and flu remedies also contain paracetamol. It’s easy to unknowingly consume more than the safe amount if you’re taking multiple medications.

While paracetamol is a valuable medication when used correctly, it poses a significant risk to the liver if misused. Always adhere to the recommended dosage, be mindful of the cumulative amount when taking other medications, and consult a healthcare professional if you are unsure about your risk factors. Remember, when it comes to paracetamol, more is definitely not better.