Acetaminophen

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Acetaminophen

As a non-opioid analgesic and antipyretic agent, paracetamol (acetaminophen or para-hydroxyacetanilide) is widely used as an over-the-counter medication to treat fever and mild to moderate pain. It is also available under more than just the brand name Tylenol and Panadol, but it is not addictive.

A standard dose of paracetamol does not decrease body temperature at all; it is inferior to ibuprofen in this respect, and its use for fever treatment is not proven to be beneficial. In cases of acute mild migraines, paracetamol may provide some relief, but not much relief in episodic tension headaches. However, the aspirin/paracetamol/caffeine combination helps with both conditions where the pain is mild and is recommended as a first-line treatment for them both. Despite the fact that paracetamol is effective for treating post-surgical pain, it is inferior to ibuprofen. In addition to providing further potency, the combination of paracetamol and ibuprofen provides better pain relief than either drug alone. However, the pain relief paracetamol provides for osteoarthritis is insignificant in terms of clinical significance, and there is insufficient research to support its use in treating low back pain, cancer pain, and neuropathic pain.

after that…

In the short term, paracetamol is safe and effective when used as directed. generally, paracetamol has the same short term adverse effects as ibuprofen, but for long term use, it is usually safer than non-steroidal anti-inflammatory drugs (NSAIDs). In addition, paracetamol is also frequently
used by patients who cannot tolerate NSAIDs like ibuprofen. When paracetamol is
used for a long period of time, the hemoglobin level may drop, indicating gastrointestinal bleeding or abnormal liver function tests. A number of epidemiological studies have linked paracetamol to cardiovascular disease, renal disease, and gastrointestinal disease; however this is largely due to confounding biases and of insignificant significance when paracetamol is
used for a short period of time.

Taking 4 grams of paracetamol a day is likely to slightly increase the systolic blood pressure in hypertensive patients. Paracetamol is
associated with an increased incidence of asthma and developmental and reproductive disorders in the offspring of pregnant women who have consumed paracetamol for a prolonged period, although it is unclear whether paracetamol is the true cause of this increase in asthma. According to some studies, paracetamol may be
associated with autism spectrum disorders and attention deficit hyperactivity disorder during pregnancy, although further research is
required to establish if there is any causal link, and this has led to some calling for its use in pregnancy to be
limited to the minimum effective dosage and for the shortest period of time possible.

then…

A maximum daily dose of 3 to 4 grams is recommended for an adult. Higher doses may cause liver damage. In the Western world, paracetamol poisoning is the leading cause of acute liver failure, and it is one of the leading causes of drug overdoses. In the United States, the United Kingdom, Australia, and New Zealand, it is the leading cause of drug overdoses.

In 1878, Harmon Northrop Morse created the first version of paracetamol or perhaps in 1852, Charles Frédéric Gerhardt also invented it. Paracetamol is the most commonly
used medication in the United States and in Europe for pain and fever. According to the World Health Organization, it is one of the essential medications. In addition to being available as a generic medicine, paracetamol is also available under the brand names Tylenol and Panadol. In 2020, it was the 118th most commonly
prescribed medication in the United States, with more than 5 million prescriptions.

Etymology of Acetaminophen 

“Acetaminophen” is the short form of the compound N-acetyl aminophenol and was
coined and marketed by McNeil Laboratories for the first time in 1955.

As the name suggests, paracetamol is a shortened form of paraacetyl-amino-phenol, and it was
coined, manufactured and sold by Frederick Stearns & Co in 1956, which is when the drug was
invented.

Medical uses of Acetaminophen

Fever

Although paracetamol is the drug of choice to reduce fever, there has been little research on its antipyretic properties, especially in adults. In a recent review of paracetamol and fever management in general practice (2008) it was
argued that its benefits are unclear. Paracetamol has also been
shown to relieve a stuffed nose or runny nose when used for the common cold, but not other cold symptoms such as a sore throat, malaise, sneezing, or cough; however, these data are of poor quality, so the quality is unclear.

As far as patients in critical care are
concerned, paracetamol only decreased their body temperature by 0.2–0.3 °C when compared to control interventions, but there was no difference in their mortality. In febrile stroke patients, it did not have any effect on the outcome. Paracetamol use in sepsis has led to contradictory results: it has been
reported that the mortality rate increased, the mortality rate decreased, and the mortality rate did not change. In the study, paracetamol did not offer any benefit for treating dengue fever, and it was also
associated with a higher risk of elevated liver enzymes, which could indicate liver damage. Currently, there is no evidence to support the routine administration of antipyretic drugs, such as paracetamol, to hospitalized patients with fevers and infections.

next…

It is unclear whether paracetamol will be effective in treating fever in children. Paracetamol should not be
used purely for the purpose of reducing body temperature, but it may be
considered for children who appear distressed due to fever. In addition to the fact that it does not prevent febrile seizures and should not be
used for such purposes, it also seems that 0.2 °C of a reduction in body temperature after a standard dose of paracetamol in children is of questionable value, especially in emergency situations.

As a result, some physicians advise that higher doses of the drug could result in a temperature decrease of as much as 0.7 degrees Celsius. According to a meta-analysis, paracetamol has a lower effectiveness than ibuprofen in children, including those younger than 2 years old (marginally less effective, according to another analysis), with an equivalent degree of safety. Both medications tend to cause asthma exacerbations with similar frequency. If paracetamol and ibuprofen are
given to children under 5 at the same time, it is not
recommended that they be
given together at the same time, but the doses may be
alternated if necessary.

Pain

As a pain reliever, paracetamol can be
utilized for a variety of mild to moderate conditions, including headaches, muscle aches, minor arthritis pain, toothache, cold, flu, sprains, and dysmenorrhea, as well as pain caused by colds, flu, and sprains. This is especially true for acute mild to moderate pain, as there is insufficient evidence for the treatment of chronic pain.

Headaches

Acute migraines can be effectively
treated with paracetamol: 39% of people experience pain relief within an hour of taking the medication compared to 20% in the control group. Paracetamol on its own only slightly alleviates episodic tension headaches in people who suffer from them frequently, whereas aspirin/paracetamol/caffeine combination has strong evidence of effectiveness and can be
used as a first-line treatment for migraine. The combination of aspirin, paracetamol, and caffeine, on the other hand, was superior to paracetamol alone and placebo and offered significant relief from tension headaches.

After two hours of administering the combination, 29% of those who had the medication were pain-free, compared to 21% of those who took paracetamol and 18% who took placebo. It is
recommended that the German, Austrian, and Swiss headache societies, together with the German Society of Neurology, use this combination to self-mead tension headaches, with paracetamol/caffeine combination as a first-line treatment for tension headaches and paracetamol as a second-line treatment for tension headaches.

Dental and other post-surgical pain

For the relief of acute pain after dental surgery,
paracetamol is inferior to ibuprofen when it comes to the action of analgesics. Paracetamol provides a reliable model for the action of analgesics. There is no doubt that NSAIDs such as ibuprofen, naproxen, or diclofenac that have the full therapeutic dose
are more effective than paracetamol/codeine combinations that are often
prescribed for dental pain in full therapeutic doses. The combinations of paracetamol and NSAIDs ibuprofen or diclofenac seem promising, perhaps offering more effective pain control than either paracetamol or the NSAID alone. In addition, paracetamol/ibuprofen can also offer a superior pain control experience to paracetamol/codeine and ibuprofen/codeine combinations.

It was
determined from a meta-analysis of general post-surgical pain, including dental surgery and other medical procedures,
that the combination of paracetamol and codeine proved to be more effective than paracetamol alone:
53% of the participants experienced significant pain relief from the combination,
whereas 7% of the participants found the placebo to be effective.

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