Paracetamol (called acetaminophen in the United States) is probably the most widely used medicine in the world for pain and fever — and for exactly that reason the most underestimated when it comes to risks. It is safe at the correct doses, but dangerous in overdose. Here is the safe dose, the accidental overdose trap and how it compares with ibuprofen.
What it does and what it doesn't
Paracetamol is an analgesic and antipyretic (it lowers pain and fever), but it is practically not an anti-inflammatory — unlike ibuprofen or diclofenac. Its major advantage is gentleness: it does not irritate the stomach the way anti-inflammatories do, and it is generally the first choice for pain or fever in pregnancy (with your doctor's agreement). It is sold without a prescription (OTC); common brands in Romania: Panadol, Efferalgan, generic paracetamol.
The safe dose in adults
Usually: 500–1000 mg every 4–6 hours, without exceeding 4000 mg in 24 hours. For people with low body weight, older adults, and those with chronic alcohol use or liver disease, many specialists recommend a more cautious limit of about 3000 mg/day. In children, the dose is calculated per kilogram (generally 10–15 mg/kg per dose) — always read the leaflet and use the syringe or measuring device supplied in the pack.
The accidental overdose trap
The biggest danger is not a large dose taken on purpose, but the hidden build-up: a great many cold and flu products (Coldrex, Theraflu and others) already contain paracetamol. If you also take a "plain" paracetamol tablet on top of a cold remedy powder, you can go over the limit without noticing. Overdose damages the liver and can be serious; the antidote (N-acetylcysteine) only works if it is given in time. The rule: read the ingredients of every "cold" product and do not combine sources of paracetamol.
Paracetamol vs. ibuprofen
In short: paracetamol — gentler on the stomach, no anti-inflammatory effect, preferable if you have stomach problems or are pregnant. Ibuprofen (an NSAID) — anti-inflammatory (useful for muscle, joint and period pain), but with gastric, kidney and cardiovascular risks when used often. When a fever won't come down, doctors sometimes alternate the two — but in children, alternating should only be done on a doctor's recommendation, with clear intervals and doses.
Alcohol and other precautions
Combining paracetamol with alcohol raises the risk to the liver — avoid it. If you have liver disease, ask your pharmacist or doctor first. And remember: paracetamol treats the symptom (the pain, the fever), not the cause.
- ANMDMR (Romania's medicines agency) — SmPCs for paracetamol products
- EMA / FDA — guidance on the maximum dose and liver toxicity
- BNF — paracetamol, dosing in adults and children