Paracetamol (Acetaminophen): Clinical Applications, Safety Profile and Toxicity

Paracetamol (acetaminophen; N-acetyl-p-aminophenol) is one of the most frequently consumed pain and fever medicines in the world. Sold without prescription in most countries and listed as an essential medicine by the WHO, it is the usual first choice for mild to moderate pain and for febrile illness across all age groups, including pregnancy. When taken within recommended limits it is much gentler on the stomach, kidneys and cardiovascular system than NSAIDs. Its weakness is a small gap between a safe dose and a liver-damaging one. Combined with easy access and its inclusion in a great many multiingredient products, this has made paracetamol a leading cause of drug-induced acute liver failure in numerous regions. This article reviews how the drug works and is handled by the body, what it is used for, its adverse effects, the biochemistry of its toxicity, the presentation of overdose, and present-day treatment centred on N-acetylcysteine (NAC).