Paracetamol: Safety in Pregnancy, Analgesia, and Hepatotoxicity Risks in Overdose and Dosage Recommendations

The paracetamol, also known as acetaminophen, is one of the most widely used analgesics globally due to its efficacy and safety profile. However, as with any medication, it is crucial to understand its side effects and dosage recommendations to maximize its benefits and minimize risks, particularly concerning hepatotoxicity and overdose potential.

Side Effects and Important Considerations

Paracetamol is generally well tolerated, but its misuse can lead to serious complications. One of the most significant risks is hepatotoxicity, especially in cases of overdose. The updated guidelines for the management of paracetamol poisoning in Australia and New Zealand highlight the importance of administering N-acetylcysteine in overdose cases to prevent severe liver damage [1].

Moreover, paracetamol is considered safe during pregnancy for managing mild to moderate pain, although the lowest effective dose should always be used for the shortest duration possible. A study on pain management in pregnancy suggests that, while it is safe, caution should be exercised, and risks and benefits should be discussed with patients [2].

Dosage Recommendations

Proper dosing of paracetamol is essential to avoid adverse effects. The maximum recommended dose for adults is 4 grams per day, divided into doses of 500 mg to 1 g every 4 to 6 hours. In patients with liver or kidney impairment, or those who consume alcohol regularly, a lower dose should be considered. An analysis on the efficacy and safety of paracetamol emphasizes that, while effective for certain conditions, its use must be carefully monitored to avoid transient elevations in liver enzymes [3].

In the context of multimodal analgesia, paracetamol can be combined with other analgesics to enhance postoperative pain control, as described in the PROSPECT guidelines for video-assisted thoracoscopic surgery [4].

Conclusions

Paracetamol remains a valuable option in the therapeutic arsenal for pain management, thanks to its efficacy and safety profile. However, it is essential to adhere to dosage recommendations and be vigilant for signs of hepatotoxicity, especially in overdose situations. Its use during pregnancy should be carefully evaluated, and the clinical context of the patient must always be considered to optimize therapeutic outcomes.

Referencias

• [1] Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand.
• [2] Medication Use and Pain Management in Pregnancy: A Critical Review.
• [3] The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews.
• [4] PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations.

Created 6/1/2025