Paracetamol and side effects - what to do?

Megrose489
Megrose489 Member Posts: 779
edited 22. Jan 2014, 02:42 in Living with Arthritis archive
I take, on average, six 500mg paracetamol a day to help with OA in my knees, feet and hands (probably hip too, but haven't got that checked yet). Now I read (as of August 2013) that NICE have advised GPs not to prescribe paracetamol as the first option for OA because of the danger to the cardiovascular and intestinal systems and the kidneys. If prescribed, it should only be used at a low dose and for a short period of time.

Has anybody else discussed this with their GP? I'm in the process of making an appointment for next week.

Comments

  • ritwren
    ritwren Member Posts: 928
    edited 30. Nov -1, 00:00
    I take regular paracetamol and have'nt heard anything about this. As always I would advise you to discuss it with your own GP.
  • hileena111
    hileena111 Member Posts: 7,099
    edited 30. Nov -1, 00:00
    Hi
    I take 8 paracetamol a day {prescribed} for OA in hips, ankle, neck and lower back......also for kypho scoliosis.
    Got to admit I have never spoken to my GP about it......I vaguely remember hearing that not that you mention it. All GP's seem to say its the safest one on the market...not sure how much that is saying :roll:

    Love
    Hileena
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    People under-estimate the strength of paracetamol because it is such a freely-available drug. It can harm the liver and the kidneys (both organs are involved in cleansing the body of the drug) so it may be time for you to discuss trying co-codamol, for example. That comes in varying strengths, I think the lowest is 8/500 (8mgs of codeine and 500 of paracetamol) because the added extra may give you the extra 'oomph' of relief. I am pleased that you will be seeing your doctor, he is the one to talk over other options with you. DD

    PS I reckon that everything we take has effects elsewhere on us - we can't win. :roll:
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • hileena111
    hileena111 Member Posts: 7,099
    edited 30. Nov -1, 00:00
    Hi DD
    I agree....they all have side effects......its a matter of which is worse, side effects or the pain :lol:

    Can I ask a question....I've never been on co-codamol. What I have is the paracetamol daily and codeine to be taken as needed. At the most I take one codeine a day {usually at night} lowest does is 15mg.
    So what would be the difference in co codamol and that?

    They'll mess them all about when I go into hospital for my THR anyway but just wanted to know what you think.....I know....you are not medically trained :lol::lol:

    Love
    Hileena
  • stickywicket
    stickywicket Member Posts: 27,760
    edited 30. Nov -1, 00:00
    All drugs have side effects, some obvious, some less so. I'm aware of the findings about paracetamol but I'm not sure any of the alternatives are any better. NSAIDS and aspirin mess with your stomach. Codeine-based stuff messes with your head. We pays our money and we takes our choice.

    People do underestimate the toxicity of paracetamol and some have paid dearly for it. I don't see cocos as an answer because, whatever the strength of codeine, there's still 500mgs of paracetamol in them.

    My solution is to take as few of anything as possible and to reduce an increased dose asap but, when I do have to take stuff, not to worry about it.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • hileena111
    hileena111 Member Posts: 7,099
    edited 30. Nov -1, 00:00
    Hi SW
    I haven't been taking codeine at night for about a week or so....but its there if I need it. That's what I think is the benefit of paracetamol /codeine over co codamol.......you can reduce one without the other one.
    I'm trying to reduce the paracetamol as well......only to 6 a day but from 8 every day I suppose that's a start :roll:

    Love
    Hileena
  • Megrose489
    Megrose489 Member Posts: 779
    edited 30. Nov -1, 00:00
    Thank you for your replies, everybody. I've got an appointment with my GP, but not till 21st Jan.

    The co-codamol I've got is the lowest, 8/500, but I usually only take that at night. I'm going to cut down the paracetamol in the day, though and see how I go. I'll let you know what the GP says when I see him.

    Thanks again.

    Meg
  • Kittkat
    Kittkat Member Posts: 309
    edited 30. Nov -1, 00:00
    Hey Meg I have never heard this.I thought they were the best of a bad bunch. But they all bad I guess :?
    How am I gonna be an optimist about this?
  • applerose
    applerose Member Posts: 3,621
    edited 30. Nov -1, 00:00
    My GP and rheumie both say there is no harm in taking 8 paracetamol every single day. A friend who was a top paediatric consultant in Italy said they don't take paracetamol for more than 3 days at a time because of the side effects. I guess you have to weigh up the side effects and the symptoms to decide whether or not to take them.
    Christine
  • barbara12
    barbara12 Member Posts: 21,281
    edited 30. Nov -1, 00:00
    Hello Meg
    Im afraid I have kidney damage and they think its is down to the paracetamol.and antiinflams, I have only on occasions taken the full amount...But I suppose most meds have side effects but the trouble with paracetamol people seem to trust it.
    Love
    Barbara
  • Megrose489
    Megrose489 Member Posts: 779
    edited 30. Nov -1, 00:00
    Sorry to hear about your kidney damage, Barbara. I'm sure I read in that NICE report that the main damage occurs because of taking both paracetamol and NSAIDs at the same time. You're right about paracetamol being trusted. Maybe it's because you can buy it over the counter and it's always been thought to be safer than aspirin. I knew about the dangers of overdose, but hadn't realised the effects of long-term use.

    I agree, Applerose. It all comes down to personal choice in the end, doesn't it? The important thing is to have all the relevant information in order to make that informed choice.

    Meg
  • bubbadog
    bubbadog Member Posts: 5,544
    edited 30. Nov -1, 00:00
    I can't take Paracetamol because they make me violently sick!! my body just doesn't like them! So I stay clear of them!!
  • Starburst
    Starburst Member Posts: 2,546
    edited 30. Nov -1, 00:00
    Interesting post. I have been taking co-codamol (30/500mg) for 4.5 years. I've become very unwell over the last few month; vomiting every day and severe upset stomach. My GP feels it may be related to the co-codamol or perhaps the celecoxib (NSAID) - although I've never had a problem before. Do you have a link to the NICE guidelines please?
  • Megrose489
    Megrose489 Member Posts: 779
    edited 30. Nov -1, 00:00
    I hope it's OK to put this on here. If not, just Google 'NICE draft recommendations on paracetamol August 2013'. The main section on paracetamol is 9.7, with the recommendations on 9.7.6.

    http://www.nice.org.uk/nicemedia/live/13505/64904/64904.pdf

    There is also an article in Pulse.

    http://www.pulsetoday.co.uk/clinical/therapy-areas/musculoskeletal/nice-warns-against-prescribing-paracetamol-for-osteoarthritis/20003979.article#.Us7-tHmaFjQ
  • Helenbothknees
    Helenbothknees Member Posts: 487
    edited 30. Nov -1, 00:00
    My GP deliberately prescribed me paracetamol and codeine separately so that I didn't have to take the full dose of codeine if I didn't need it, as you do with any of the paracetamol/codeine mixtures. He seemed to think that was the advantage of taking them separately. The advantage of taking them in one table is a) less tablets, and b) less thinking required. That's just a paraphrase of what he said.
  • frogmella
    frogmella Member Posts: 1,111
    edited 30. Nov -1, 00:00
    The anaesthetist for my second operation thought it was good to take the paracetamol and codeine separately for that exact reason, helenbothknees. She said then I could titrate the codeine up and down as need be, which is what I had been doing and continued to do. What I tended to do was take the para and see how I felt then add the codeine when required! Normally I only took the codeine at night to help me sleep more than anything else. Having said that as I approached my last surgery last year and the daytime pain became too much I did buy some OTC cocos so that I could take a lower dose of codeine than the 30mg tabs I had and then I took some when I got home from work as well as my 30mg tabs at bedtime.

    I heard somewhere that if paracetamol was discovered today it would never get approval because it is so toxic. A lot of people underestimate it. I am fairly well educated and always research everything so I know only to take 4g a day spread out over 4 doses at least 4 hours apart but I am amazed how many people say they take 3 or 4 at a go. My cousin has some strange idea that they make him sleepy but I am sure that is psychosomatic!

    As DD says there are side effects with all the meds we take. It is a matter of weighing up the pros and cons of taking them versus not taking them. I suppose that is where a chat with the GP comes in to play. But then all gps have their own point of view. That's probably why all of our responses are so different too!!
  • applerose
    applerose Member Posts: 3,621
    edited 30. Nov -1, 00:00
    I remember years ago, and maybe before they knew much about the side effects, my GP said the dosage on the packet was set to stop people overdosing and that, in fact, you could take much more without any ill effects.

    Frogmella, I find I sleep better if I take paracetamol at bedtime. I'm assuming it's because I can get more comfortable because of less pain.
    Christine
  • frogmella
    frogmella Member Posts: 1,111
    edited 30. Nov -1, 00:00
    I agree, applerose, that being more comfortable will help you sleep. I think that is probably what happened to my cousin too!
  • ritwren
    ritwren Member Posts: 928
    edited 30. Nov -1, 00:00
    Very interesting links. It's made me think about my paracetamol use, especially when taken along with NSAID's. Thanks.
  • Megrose489
    Megrose489 Member Posts: 779
    edited 30. Nov -1, 00:00
    Thought you might be interested in another article in Pulse:

    http://www.pulsetoday.co.uk/clinical/therapy-areas/pain-relief/nice-guidance-on-paracetamol-will-increase-risk-of-harm-to-patients-warn-experts/20005526.article#.UtPO3XmaFjQ

    It seems as though GPs aren't happy about this.

    Meg
  • stickywicket
    stickywicket Member Posts: 27,760
    edited 30. Nov -1, 00:00
    I can see why they're not happy. Where does it leave them? What should they prescribe when confronted by patients who want pain relief? Everything we take has its downside. There's no such thing as 100% safe.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • ScottiePam
    ScottiePam Member Posts: 32
    edited 30. Nov -1, 00:00
    Hi guys,
    just had a look at this Nice report. what an eyeful! been prescribed co-codamol in addition to paracetamol, and not happy. :x
    GP said to take the co-codamol when I have a "flare" - he was talking about the pain on the sciatic nerve when the wee bones at the base of my spine touch it. I don't regard that as a flare, and as I can't see it coming and may have been taking paracetamol that day, what's the point.
    We had a head-to-head on it, and I think I'll be back for a return bout.
    cheers :wink:
    Hag
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