April 3, 2020, by aeyavb

Investigating the adverse effects related with long term use of paracetamol

Guidelines often recommend paracetamol as a first-line analgesic, particularly for osteoarthritis (OA), based on its perceived safety. However, there is growing discussion, highlighted in the National Institute for Health and Care Excellence OA (NICE) 2014 guidance on OA, that paracetamol is not as safe as originally thought, especially at the highest therapeutic dose of 4gm/day.

Jaspreet Kaur conducted a systematic review and meta-analysis that assessed the gastrointestinal, liver, renal and cardiovascular adverse effects of paracetamol. Her study comprised of two stages; a meta-analysis and a cohort study that used real world data.

A systematic search of MEDLINE, EMBASE, PUBMED, AHMED, CINAHL, Web of Science and Google Scholar for published literature to the end of November 2018 was carried out for RCTs of paracetamol in symptomatic OA, and observational studies irrespective of an underlying condition, to determine the risk of adverse effects. Studies that assessed oral paracetamol in people aged >18 years and reported clinically relevant adverse effects were also included in the study.


What was found was that compared to placebo, paracetamol was associated with increased incidence of treatment-related adverse events. In particular, diarrhoea and abnormal liver function in short-term trial data, and upper GI bleeding and renal impairment in long-term observational data. However, methodological limitations of observational data, such as channelling bias, were acknowledged to possibly confound the results.


She presented the results of her work in EULAR- congress 2019 in the opening plenary session and successfully won a bursary for 250 euros and travel grant to Madrid, for this presentation.


Co-investigators: Burak Kundaki, Georgina Nakafero, Dr Abhishek Abhishek, Prof Michael Doherty, Prof Weiya Zhang


Amelia Bell

Posted in BoneFrailtyJointsmobilityMusculoskeletalOsteoarthritisPainUncategorized