Repeated doses of paracetamol in older patients can lead to an increased risk of several severe complications, researchers have reported.
An analysis of 20 years of GP data found an increased risk of gastrointestinal, cardiovascular and renal complications associated with regular use of the painkiller.
The researchers from the University of Nottingham said the findings highlighted that care must be taken when used regularly for chronic conditions such as osteoarthritis.
Analysis of health records from 180,483 people over the age of 65 years who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months) and 402,478 controls of the same age found an increased risk of peptic ulcers, heart failure, hypertension and chronic kidney disease.
The study also identified a dose-response relationship for paracetamol use and perforation or ulceration or bleeding, uncomplicated peptic ulcers, and chronic renal failure.
That pattern was the same when researchers only looked at the patients who had taken paracetamol, they reported.
It is also difficult to calculate exposure when most people take paracetamol episodically or for multiple reasons, they added.
A subgroup analysis focusing on patients with osteoarthritis also aligned with the overall findings, the researchers reported in Arthritis Care and Research.
The team did note they could not account for paracetamol bought over the counter which is why they focused on those who would have received free prescriptions.
Study leader Professor Weiya Zhang, from the NIHR Biomedical Research Centre at the University of Nottingham, said to its perceived safety that paracetamol has long been recommended as the first-line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications.
Yet their findings further challenge ‘whether acetaminophen should be retained as the first-line oral analgesic’, especially in older people for common chronic painful conditions, given its non-clinically meaningful benefits and potential harms, he concluded.
It also supports recent recommendation by NICE to not prescribe paracetamol for osteoarthritis, he added.
‘Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered.’
Not this again. There is no way this is going to change the prescribing habits of primary or secondary care doctors anytime soon. If I was any good at critical analysis I’d look at the original article but until someone with a huge brain comes along and actually convinced me not to, I’ll carry on prescribing. It’s better than the alternatives and the claim that paracetamol isn’t a particularly good analgesic anyway is dubious at best.
So long as you look at ‘medical complications’ rather than quality of life I suspect you can find that nobody should take any analgesia at all. After all, being stuck at home with OA probably doesn’t kill you, or make you more likely to attend hospital. All drugs carry risks – let’s see if the benefits outweigh those risks before calling for a reduction in the use of the drugs.
Not much left to offer. Learn to put up with pain?
Association is not causation.
Alternative hypothesis – people more ill take more analgesia; and people more ill are more likely to die. Hence association between increased analgesic use and increased risk of death.
When I look at these articles I think of my patients with high analgesic usage especially the over 65’s. You know what the high use is a pretty close correlation with being pretty knackered and decrepit. Biologically old. Thus not a surprise they have other health conditions. I suspect the paracetamol is a bell weather of aging and terminal decline rather than a cause in itself.
Cause or effect? very likely that older sicker populations take paracetamol to improve symptoms not the other way around.
There seem to be too many researchers telling us to stop prescribing Paracetamol, Aspirin, NSAIDs, opioids, opiates, Gaba-drugs, and not enough telling us what to prescribe instead.
Can we have some constructive and useful contributions please, not useless destructive criticism all the time?