Paracetamol use was linked to increased mortality, and heart, kidney and gastrointestinal problems, especially when used at higher doses and over a longer period of time, a systematic review found.
The researchers advised GPs to carefully consider potential risk to patients before prescribing or recommending the drug for long-term use.
‘Prescribers need to be aware of patients’ individual responses to paracetamol and the observed increased toxicity with regular and higher dosing within standard analgesic dose ranges,’ the authors wrote in the BMJ’s Annals of the Rheumatic Diseases.
‘We believe the true risk of paracetamol prescription to be higher than that currently perceived in the clinical community.’
Doctors often recommend paracetamol as a ‘safer’ alternative to NSAIDs such as ibuprofen, the study authors said, but the side effects are similar in both.
The study found the risk of heart attack and stroke was increased by up to 68%, risk of stomach ulcers and bleeding by up to 49% and risk of death by up to 63%, depending on dosage and accumulated use, although overall risk remained small.
‘When analgesic benefit is uncertain, as has been recently suggested for paracetamol in the treatment of osteoarthritis joint pain and low back pain, more careful consideration of its usage is required,’ the authors wrote.