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An over-the-counter analgesic used for headaches, muscle or joint pain, and fever, which lacks anti-inflammatory activity.

Therapeutic range 10–25 mg/L

Critical value ≥ 300 mg/L

Toxicology Overdose can cause fatal liver failure. Up to 10% of hospitalisations for overdose and 40% of acute hepatic failure are linked to paracetamol overdose, which is more often accidental—e. g. children, alcoholics—than suicidal. Doses of > 150 mg/kg/24 hours cause acute liver failure.

Clinical stage of paracetamol toxicity 1. 1–24 hours—Non-specific. 2. 24–48 hours—Right upper quadrant pain, tenderness with elevated liver enzymes. 3. 72–96 hours—Marked increase in liver enzymes; fulminant hepatic failure, coagulopathy, acidosis. 4. 4–14 days—Liver recuperates or patient dies.

Pathogenesis of paracetamol overdose 90% is metabolised in the liver to non-toxic glucuronide and sulphate conjugates; 5% is oxidised by cytochrome p450 to NAPQI, which covalently binds to hepatocyte macromolecules, leading to hepatocyte death; 5% is excreted unchanged in urine.


A drug widely used to relieve pain and reduce fever. The drug does not irritate the stomach, as ASPIRIN does, but overdose causes liver and kidney damage and may cause death from liver failure. 15 g or more is potentially serious. The victim remains well for a day or two and liver failure develops between the third and fifth day. The drug is on the WHO official list. Brand names are Alvedon, Calpol Disprol Paediatric, Infadrops, Medinol and Salzone. Preparations that include paracetamol include Cosalgesic, Distalgesic, Domperamol, Fortagesic, Kapake, Midrid, Migraleve, Paradote, Paramax, Remedeine and Solpadol. acetaminophen; N - acetyl - p - aminophenol; paracetamol a non-opioid analgesic with little or no anti-inflammatory action; first-line painkiller of choice; used with care in patients with hepatic or renal impairment, or alcohol dependency, or those taking metoclopramide; overdose causes severe liver damage and death; recommended adult dose: daily maximum of 4 g (i. e. 8 × 500 mg tablets) ( see Table 1 )

Table 1: Principles of pain management

Examples of drug