Even with safe doses, taking paracetamol can be risky. Long-term use of this pain reliever increases the risk of kidney or gastrointestinal side effects.
The most prescribed analgesic in France has long-term side effects. According to a meta-analysis published in Annals of the Rheumatic Diseases, long-term consumption of paracetamol increases the risk of cardiovascular, renal and gastrointestinal disorders. This association concerns prescriptions not exceeding 4 grams per day.
“The risk remains minimal”
Researchers at the Institute for Rheumatology and Musculoskeletal Medicine in Leeds (UK) reviewed more than 1,880 studies. They selected 8, the results of which suggest the long-term adverse effects of paracetamol. Half report an increased risk of cardiovascular disorders (19 to 68%), with a dose-dependent relationship. The same observation is made on gastrointestinal and renal side effects, with a variation in the risk elevation.
In these cohort studies, participants did not exceed the recommended daily doses of paracetamol (4 g / day). On the other hand, they consumed this analgesic on a regular basis. “Paracetamol remains an effective and not very dangerous drug”, underlines François Chast, head of the pharmacy, pharmacology and toxicology department at the Hôtel-Dieu (Paris) contacted by why actor. “But it is necessary to measure the impact of a long-term prescription. “
Listen to Prof. François Chast, pharmacist at Hôtel-Dieu: “ When we increase the doses and the duration of treatment, we have an increased risk. But the risk remains minimal. “
A subject to be discussed in consultation
Paracetamol is the 4e most reimbursed drug in France, according to the latest figures from the Health Insurance. Data that does not take into account non-prescription consumption, which is also very high. If this analgesic is so consumed, it is thanks to its relatively safe profile. Apart from its toxicity on the liver, in the event of acute poisoning, it is better tolerated than other analgesics (non-steroidal anti-inflammatory drugs, opioids). Its effectiveness in chronic pain is also recognized.
This apparent safety does not exempt doctors from being cautious and asking patients about their consumption. And for good reason: the more the dose consumed per day increases, the more the risk of side effects increases. But patients must also mention any consumption of paracetamol to their doctor, believes François Chas.
Listen to Prof. François Chast : ” When in consultation, it should be noted that paracetamol is taken regularly so that the doctor integrates it when he prescribes. “
Non-prescription risks
Another major problem arises: many patients take paracetamol without prescription but not always in the right indications. “They take it in chronic pain, which is rather mechanical. Some patients will take them for chronic low back pain, osteoarthritis, but also headaches ”, explains Dr Virginie Piano, pain specialist at La Timone hospital (Marseille, Bouches-du-Rhône) contacted by why actor. These are precisely indications in which the interest of paracetamol has been called into question. And this lack of efficacy increases the risk of acute poisoning.
Listen to Dr Virginie Piano, pain specialist: ” If you take more than the prescribed dose, you are taking risks. These are emergencies that happen regularly. “
These non-prescription consumptions are the responsibility of pharmacists. But neither the Order of Pharmacists, nor the Academy of Pharmacy, contacted by why actor, have not looked into the subject.
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