Paracetamol should not be taken on a regular basis, leading doctors have warned—even at ‘safe’ doses—amid growing concern over the drug’s long-term impact on the liver.
The caution comes as the world’s most commonly used painkiller was thrust into the spotlight this week after President Trump claimed it could be linked to autism.
The 79-year-old said government health warnings would soon be printed on packets—often sold under the brand name Tylenol in the US—advising pregnant women to avoid the drug.
His remarks provoked outrage from medical experts worldwide, who dismissed them as fear-mongering with ‘no robust evidence’ to back them up.
Britain’s regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), also stressed there is ‘no evidence that taking paracetamol during pregnancy causes autism in children.’
But specialists say the real danger lies elsewhere. While an occasional couple of tablets to treat a headache or short-term pain is considered safe, regular use can damage the liver—even when people stick within the recommended limits.
Pharmacists have urged the public not to be lulled into thinking paracetamol is risk-free simply because it is widely available without prescription.
Thorrun Govind, a TV pharmacist and former chair of the Royal Pharmaceutical Society, told the Daily Mail: ‘People often think paracetamol is harmless because it’s so easy to get hold of. But the reality is very different.’
President Trump declared that government health warnings will be printed on Paracetamol packets—often sold under the brand name Tylenol in the US— telling pregnant women to avoid the painkiller over fears it could raise the risk of autism in their unborn children
The claim has attracted outrage from the medical community worldwide who have argued there is ‘no robust evidence’ to support the claim, with the announcement merely a ‘fear mongering’ tool that ‘risks stigmatising families’
Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, added: ‘Whilst paracetamol can be effective and safe when taken in recommended doses and during the time period advised, it can be very harmful and even fatal if this is regularly exceeded—even by a few tablets.’
The official maximum dose is two 500mg tablets, taken up to four times a day within 24 hours, with at least four hours between each dose.
‘Paracetamol can significantly damage the liver if taken incorrectly and can cause death,’ Dr Hannbeck warned.
‘If the patient has taken paracetamol and the pain is not going away, speak to your pharmacist for an alternative painkiller rather than topping up on paracetamol. Only a few tablets regularly over the recommended dose, over days or weeks, can lead to significant damage to the liver, brain cells and kidneys.’
Professor Andrew Moore, of the respected Cochrane Collaboration’s Pain, Palliative Care and Supportive Care group, has also challenged the long-held belief that paracetamol is a harmless ‘go-to’ treatment.
‘The studies we have tell us that paracetamol use is associated with increased rates of death, heart attack, stomach bleeding and kidney failure,’ he said.
‘Paracetamol is known to cause liver failure in overdose but it also causes liver failure in people taking standard doses for pain relief. The risk is only about one in a million, but it is a risk. All these different risks stack up.’
Concerns about overdosing led the Government in 1998 to restrict sales, limiting supermarkets and corner shops to packs of 16 tablets, and pharmacies to packs of 32.
Yet the danger remains, particularly from so-called ‘staggered overdosing’—where patients take just a little more than the recommended daily limit over several days or weeks, leading to a dangerous build-up in the liver.
Accidental overdosing is also common because paracetamol is hidden in many other medicines.
Ms Govind added: ‘Many over-the-counter cold, flu and combination remedies contain paracetamol. People can accidentally exceed the recommended 4g-per-24-hour limit by taking several different products. Read medicine labels carefully and ask a pharmacist if you’re unsure.’
Surveys suggest as many as two in five people who buy over-the-counter remedies don’t realise they contain paracetamol. In recent years, grieving families have called for the drug to be made prescription-only after loved ones died from inadvertently taking too much while self-medicating.
Paracetamol is now the leading cause of acute liver failure in UK adults. Research shows that taking nearly twice the recommended daily dose — around 7.5g in 24 hours—can be enough to trigger toxicity in some people.
The problem lies in the way the body processes the drug. As paracetamol is broken down, it produces a toxic by-product called NAPQI. Normally the liver neutralises this using glutathione, but at high doses, or after prolonged use, supplies of this protective substance run out, allowing liver damage to set in.
Adding to the concerns, several studies have found that over-the-counter painkillers, including paracetamol, offer little benefit for some of the conditions they are most often used to treat, such as back pain and osteoarthritis.
In 2020, the National Institute for Health and Care Excellence (NICE) revised its guidelines to advise against using paracetamol for chronic pain, citing a lack of evidence that it works. Officials warned that regular use could in fact cause harm—including liver toxicity, kidney damage and gastrointestinal problems.
Health secretary Wes Streeting today urged Britons not to ‘pay any attention whatsoever to what Donald Trump says about medicine’
By contrast, claims that the drug raises the risk of autism—particularly in children whose mothers took it during pregnancy—have not been supported by credible science.
Paracetamol is widely used by pregnant women to treat pain, headaches and fever, and remains the NHS’s recommended ‘first choice’ painkiller during pregnancy, but only for short periods and at the lowest effective dose.
A handful of well-publicised studies have suggested a possible link between maternal use of paracetamol and higher rates of autism or ADHD.
But the findings are inconsistent, and experts stress that any association remains based on very limited and conflicting evidence.
The most recent, published last month by researchers at Mount Sinai in New York and Harvard’s School of Public Health, urged women to take paracetamol in pregnancy only on the advice of a doctor—though the authors acknowledged the evidence was not conclusive.
The scientists, whose analysis of more than 100,000 people was billed as the most comprehensive yet, said their findings provided the ‘strongest evidence so far’ of a possible link.
They urged mothers-to-be to use paracetamol sparingly, taking only the lowest effective dose for the shortest possible time.
But they stressed their results did not prove the drug directly causes autism or other neurodevelopmental disorders. Instead, they said the association was consistent enough to warrant further investigation.
Dr Diddier Prada, assistant professor of population health science at Mount Sinai, added: ‘Pregnant women should not stop taking medication without consulting their doctors. Untreated pain or fever can also harm the baby.’
President Trump, by contrast, told reporters that taking paracetamol was simply ‘not good’, declaring: ‘All pregnant women should talk to their doctors about limiting the use of this medication while pregnant.’
He later doubled down: ‘Fight like hell not to take it.’
Scientists on both sides of the Atlantic reacted with scepticism—a some criticised the claims as stigmatising parents of children with autism.
Health Secretary Wes Streeting also dismissed the remarks.
‘Don’t pay any attention whatsoever to what Donald Trump says about medicine,’ he said.
‘In fact, don’t even take my word for it as a politician—listen to British doctors, British scientists, the NHS. It’s really important, at a time when there is scepticism, to follow medical science.’
Paracetamol itself has a chequered history stretching back more than a century. Its forerunner, acetanilide—sold under the trade name Antifebrin—was found to turn some users’ lips and skin blue.
In 1893, German physiologist Joseph von Mering published clinical results comparing paracetamol with another painkiller, phenacetin.
He warned, however, that the new drug might be too toxic after noting cases of methaemoglobinaemia—a condition that reduces oxygen in the blood, causing dizziness, headaches, nausea, muscle weakness and, in severe cases, bluish discolouration of the skin.
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