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What diseases and medications are incompatible with paracetamol?

Published 24 Jun 2019 • By Louise Bollecker

Paracetamol is a widely used drug. Used under normal conditions, it is safe and effective, but do you know the drug interactions and diseases for which it is contraindicated?

Read our guide to learn more!

What diseases and medications are incompatible with paracetamol?

What is paracetamol?

Paracetamol is the most widely sold drug in the UK. Paracetamol is the active substance of a number of analgesic drugs, i.e. it relieves mild to moderate pain. It can also be used in case of fever.

Paracetamol is a safe and effective drug when used under normal conditions. It can therefore be used in children and pregnant or breastfeeding women.

When and how to take paracetamol?

For an adult over 50kg, the maximum recommended dose of paracetamol is 3 grams per 24 hours. This corresponds to 3 tablets of 1g maximum per day, knowing that 1g = 1000mg. In case of more severe pain and on the advice of a doctor, the maximum dose may be 4 grams per day for a short period of time.

In both cases, the paracetamol intakes should be at least 4 hours apart, the best time to leave 6 hours between intakes.

Be careful, in some cases, the maximum dose and duration between doses may change. These cases are explained below.

The most effective dose of paracetamol remains, as with many drugs, the lowest dose for the shortest period of time.

If paracetamol is used for acute pain, if it persists after 5 days of treatment, it is recommended to seek medical advice. In the case of fever, if after 3 days of treatment with paracetamol there is no improvement or even aggravation, you should consult a doctor.

What drugs contain paracetamol?

There are many specialties containing paracetamol. In some cases, it is combined with other molecules.
It is recommended to avoid combining two drugs containing paracetamol and, if this is not possible, not to exceed the maximum dose of 3 grams per 24 hours. Here is a list of the main drugs containing paracetamol:

Paracetamol alone

Drugs containing paracetamol in combination with other molecules

Over-the-counter (OTC) containing paracetamol in combination

What conditions may be incompatible with paracetamol?

Renal failure

In the case of renal failure, it is recommended to leave an interval of 8 hours between two doses of paracetamol and not to exceed 3g per 24 hours.

Liver failure

Severe liver failure is an absolute contraindication to the use of paracetamol. Indeed, its elimination depends on the liver, so when the liver does not function properly, paracetamol cannot be eliminated properly.

In case of mild to moderate hepatic insufficiency, it is advisable to limit the consumption of paracetamol to 2 to 3 grams per 24 hours and to use it only for short periods of time, while always remaining cautious. Consult your doctor if you have any doubts!

>> Read our article on the benefits of teleconsultation

What drugs may be incompatible with paracetamol?

Anti-vitamin K: AVK (Warfarin)

When taking paracetamol with AVK, caution should be exercised. Indeed, when taking 4g of paracetamol per day for at least 4 days, there is a risk of an increase in the effect of KVA and therefore an increase in the risk of bleeding.

In this case, biological monitoring by INR measurement should be performed during and at the end of paracetamol treatment.

Bile acid chelating resins: Questran®

As Questran® can cause poor intestinal absorption of paracetamol, it is advisable to take both drugs at least 2 hours apart.

Liver toxicity

When paracetamol is eliminated by the liver, a small part is transformed into a toxic product for the liver. In case of paracetamol overdose, there is a significant increase in toxic metabolite. Paracetamol overdose is defined as the consumption of more than 6 grams of paracetamol per day.

An overdose can therefore lead to severe liver toxicity and acute hepatitis.

This toxicity may also be increased when certain drugs are taken at the same time as paracetamol.

Here are some medications that may increase liver toxicity:


If you regularly take paracetamol without a prescription to relieve pain, do not hesitate to discuss it with your doctor, who may be able to offer you other more appropriate solutions to relieve it.

 

How often do you use paracetamol? Did you know about these contraindications?

Share your thoughts and questions with the community in the comments below!

avatar Louise Bollecker

Author: Louise Bollecker, Community Manager France

Community Manager of Carenity in France, Louise is also editor-in-chief of the Health Magazine to provide articles, videos and testimonials that focus on patients' experiences and making their voices heard. With a... >> Learn more

Who reviewed it: Charlotte Avril, Pharmacist, Data Scientist

Charlotte holds a PharmD and a master's degree in Pharmaceutical and Biotechnology Management from ESCP Business School in Paris. She has a strong interest in e-health, health tech, rare diseases and... >> Learn more

15 comments


bobjen
on 25/06/2019

Thanks for info ,


JosephineO • Community manager
on 25/06/2019

@DawnMarieEmma You're right, it is always important to make sure none of your medications counteract negatively with each other, it is always best to ask and do research! You can rate your medication carbamazepine by clicking here. Some members have already given their opinions :)

 @bobjen‍  You're welcome :) 


JosephineO • Community manager
on 25/06/2019

@lizches Thank you for your vigilance and for reporting this error, which was immediately corrected. We do our best to provide you with quality content :)

Kind regards,

Josephine and the Carenity Team


JazzyC • Ambassador
on 26/06/2019

Any drug in excess is dangerous and after a while your body gets used to it so less effective. 

I am supposed to be on paracetamol and tramadol 2 tablets of each upto 4 times a day.. However unless the pain is very bad I don't take that much. My repeat prescription runs to 6 pages so that might give you some idea of the number of medicines I am on. It really is quite frightening. 


Pasport2020
on 26/06/2019

I have had surgery for a mortons nuroma but twelve months on the pain is just as bad I have had insoles fitted in my shoes but there isn't much relive has anyone else experienced this

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