Paracetamol, or as you Americans call it acetaminophen, is, it seems, back in the headlines, amid concerns about new guidelines.I have a couple of thoughts on this that are vaguely connected to the story in Nature Medicine, which you can read here. First, we tend to forget how good a drug paracetamol is – Lewis Nelson, Chair of the FDA advisory committee – (paracetamol)
‘is still extraordinarily safe when used correctly.’
This might be why 28 billion doses were sold in the US in 2008 (remember that figure because it will come up in the trivia quiz at the 2010 noigroup conference in Nottingham, which, incidentally, will be superb). Second, and the main point of the article, it is sill a drug – Lewis again:
‘But it’s not candy. It’s a potent drug.’
There seems to be a risk of liver toxicity and asthma. Using paracetamol to reduce fever after immunisation might reduce the immune response (Lancet, 374, 1339–1350; 2009), but we don’t know if it reduces the immunity that the immunisation imparts (Lancet, 374, 1305–1306; 2009). It seems we are at least in need of a good chat about paracetamol – but I would like to see someone throw this option into the debate – why don’t we start having packs of paracetamol that include 10% placebos. You don’t have to get that pack, but the pack clearly states that ‘2 of these 20 are not like the others, 2 of these 20 just don’t belong….’ We know the analgesia induced by taking these two will be similar, it will reduce the cost of the pack by…….10%…… Any ethical considerations? Go on I am sure there is someone with a compelling reason to support this idea. I am also sure there is someone with a compelling reason to oppose it. In fact, I am sure there are books written on this. Anyway, my fondness for paracetamol remains, albeit with a renewed respect for its potency AND the fact that the molecules are not selective in where they bind.
Prymula R, Siegrist CA, Chlibek R, Zemlickova H, Vackova M, Smetana J, Lommel P, Kaliskova E, Borys D, & Schuerman L (2009). Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet, 374 (9698), 1339-50 PMID: 19837254
Chen, R., Clark, T., & Halperin, S. (2009). The yin and yang of paracetamol and paediatric immunisations The Lancet, 374 (9698), 1305-1306 DOI: 10.1016/S0140-6736(09)61802-X