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SPONSORSHIP: What should GPs consider when deciding whether to recommend paracetamol or another analgesic to patients?
There is good quality evidence for the use of paracetamol in headaches and toothache, among other painful conditions.
Paracetamol is the most widely used painkiller in Australia, and its low cost and over-the-counter availability also make it the most common form of self-prescribed pain reliever. The drug is also listed as one of the essential medicines of the World Health Organization as effective, safe and cost-effective. However, a University of Sydney study published in the April 2021 issue of the Medical Journal of Australia (MJA) generated some media reports questioning the value of paracetamol (N-acetyl-para-aminophenol). (APAP) as a molecule. So what should GPs consider when deciding whether to recommend paracetamol or another analgesic to patients? Professor Andrew McLachlan is Head of School and Dean of Pharmacy at the University of Sydney School of Pharmacy as well as co-author of the MJA paper. He told newsGP that the study reconfirms the evidence behind the registered indications of APAP as a safe molecule and paracetamol remains an effective and safe drug for many, but not all, painful conditions. “Real-world experience has shown that paracetamol is well tolerated by most patients when used at the recommended doses … especially when a person experiences mild to moderate pain,” Professor McLachlan said. ‘[But] Recent studies and systematic reviews of the available evidence, and now the guidelines, show that paracetamol has limited efficacy in people with acute low back pain and only modest efficacy in people with osteoarthritis of the hip and knee. “However, there is still good quality evidence on the use of paracetamol in headaches and toothache. And combining paracetamol with nonsteroidal anti-inflammatory drugs [NSAIDs] and opioid analgesics for some moderately painful conditions have been shown to be an effective analgesic combination. When selecting an appropriate painkiller for patients, Professor McLachlan said it is essential to consider medical and medication history. “The best guide to effective analgesia is usually found in the patient’s history,” he said. “If a person has previously used and benefited from paracetamol, it makes sense to use it as a first-line analgesic. Patients should be advised to use an adequate daily dose of paracetamol that will relieve pain. contraindications should be considered, says Professor McLachlan, especially when a patient’s comorbid health problems such as kidney failure and cardiovascular disease preclude the use of other medications. ”It is important to note that paracetamol it has limited potential to cause adverse effects and drug interactions, especially compared to other commonly used painkillers such as NSAIDs and opioid painkillers, “he said. ‘[It] should be used with caution in people with chronic liver disease, due to the increased risk of liver damage, but use during pregnancy and lactation is safe. “There are several brands of paracetamol, so patients should be encouraged to avoid using more than one product that contains paracetamol at the same time because of the risk of liver damage.” More information can be found in a session of clinical speakers organized by the Pharmaceutical Society of Australia, which talks about the safety and efficacy of acute indications for which paracetamol is registered, with the aim of strengthening confidence when recommending APAP as a first step. This item has been commissioned and paid for by GSK Australia. Sign in below to join the conversation.
Acetaminophen analgesics for the treatment of paracetamol pain
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