{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:45:59Z","timestamp":1781613959706,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["DTB"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Paracetamol, on its own or in combination with other analgesics, is widely used to treat pain associated with acute and chronic conditions. It is considered safe enough to have a general sales licence (GSL) for use by \u201cadults, elderly and children over 16 years\u201d and has few listed cautions or contraindications.1,2 However, recently the effectiveness and safety of paracetamol for some conditions have been challenged, 3,4 and there are published case reports of liver failure associated with therapeutic doses.5\u20139 Here, we review the use of paracetamol, its pharmacokinetics, the mechanisms by which it can cause liver damage and consider whether frail older people are at greater risk of adverse effects. We also discuss if dose reduction should be considered in some circumstances.<\/jats:p>","DOI":"10.1136\/dtb.2018.6.0636","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T04:24:55Z","timestamp":1528950295000},"page":"69-72","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["What dose of paracetamol for older people?"],"prefix":"10.1136","volume":"56","member":"239","published-online":{"date-parts":[[2018,6,14]]},"reference":[{"key":"2025082700522953000_56.6.69.1","unstructured":"Joint Formulary Committee. British National Formulary. Edition 75. London: BMJ Group and Pharmaceutical Press, March 2018."},{"key":"2025082700522953000_56.6.69.2","unstructured":"Panadol original tablets. Summary of product characteristics, UK. GlaxoSmithKline Consumer Healthcare (UK) Trading Limited, January 2018."},{"key":"2025082700522953000_56.6.69.3","unstructured":"Moore A , 2018. Paracetamol: widely used and largely ineffective [online]. Available: http:\/\/uk.cochrane.org\/news\/paracetamol-widely-used-and-largely-ineffective [Accessed 23 May 2018]."},{"key":"2025082700522953000_56.6.69.4","doi-asserted-by":"crossref","first-page":"h1352","DOI":"10.1136\/bmj.h1352","article-title":"Managing back pain and osteoarthritis without paracetamol","volume":"350","author":"Mallen","year":"2015","journal-title":"BMJ"},{"key":"2025082700522953000_56.6.69.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1352"},{"key":"2025082700522953000_56.6.69.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206914"},{"key":"2025082700522953000_56.6.69.7","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw067"},{"key":"2025082700522953000_56.6.69.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c6764"},{"key":"2025082700522953000_56.6.69.9","doi-asserted-by":"crossref","unstructured":"Moling O et al. Severe hepatotoxicity after therapeutic doses of acetaminophen. Clin Ther2006; 28: 755\u201360.","DOI":"10.1016\/j.clinthera.2006.05.002"},{"key":"2025082700522953000_56.6.69.10","unstructured":"National Institute for Health and Care Excellence, 2015. Clinical knowledge summaries: analgesia \u2013 mild-to-moderate pain [online]. Available: https:\/\/cks.nice.org.uk\/analgesia-mild-to-moderate-pain [Accessed 23 May 2018]."},{"key":"2025082700522953000_56.6.69.11","doi-asserted-by":"crossref","first-page":"h1225","DOI":"10.1136\/bmj.h1225","article-title":"Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials","volume":"350","author":"Machado","year":"2015","journal-title":"BMJ"},{"key":"2025082700522953000_56.6.69.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1225"},{"key":"2025082700522953000_56.6.69.13","unstructured":"National Institute for Health and Care Excellence, 2014. Osteoarthritis: care and management (CG177) [online]. Available: https:\/\/www.nice.org.uk\/guidance\/cg177 [Accessed 23 May 2018]."},{"key":"2025082700522953000_56.6.69.14","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/ageing\/afs200","article-title":"Guidance on the management of pain in older people","volume":"42","author":"British Geriatric Society","year":"2013","journal-title":"Age Ageing"},{"key":"2025082700522953000_56.6.69.15","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afs200"},{"key":"2025082700522953000_56.6.69.16","unstructured":"Perfalgan 10mg\/ml solution for infusion. Summary of product characteristics, UK. Bristol-Myers Squibb Pharmaceuticals Ltd, October 2014."},{"key":"2025082700522953000_56.6.69.17","unstructured":"Paracetamol 10mg\/ml solution for infusion. Summary of product characteristics, UK. Accord Healthcare Limited, July 2017."},{"key":"2025082700522953000_56.6.69.18","unstructured":"Medicines and Healthcare products Regulatory Agency, 2010. Intravenous paracetamol (Perfalgan ): risk of accidental overdose. Drug Safety Update 2010; 3: 2 [online]. Available: https:\/\/www.gov.uk\/drug-safety-update\/intravenous-paracetamol-perfalgan-risk-of-accidental-overdose [Accessed 23 May 2018]."},{"key":"2025082700522953000_56.6.69.19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2165\/00003088-198207020-00001","article-title":"Clinical pharmacokinetics of paracetamol","volume":"7","author":"Forrest","year":"1982","journal-title":"Clin Pharmacokinet"},{"key":"2025082700522953000_56.6.69.20","doi-asserted-by":"crossref","unstructured":"Kalsi SS et al. A review of the evidence concerning hepatic glutathione depletion and susceptibility to hepatotoxicity after paracetamol overdose. 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