Paracetamol only rarely causes gastrointestinal problems or allergic skin reactions. Blood dyscrasia (e.g. thrombocytopenia), methaemoglobinemia, and hemolytic anemia are very rare. A minority of the subjects with so-called aspirin intolerance responds to paracetamol with bronchospasms. It is not safely established if paracetamol can cause a nephropathy, like drug combinations containing phenacetin.

When metabolized in the liver, small amounts of an intensely active metabolite, which is normally immediately inactivated by glutathione, are produced. An overdose causes a glutathione deficiency; the reactive metabolite may then cause hepatocellular damage and necrosis leading to acute liver failure. Toxic effects have been observed in adults treated with doses of more than 10 g (20 tablets). However, if there is a pre-existing liver insufficiency, paracetamol can be hepatotoxic even in small amounts.

Paracetamol: Interactions

The suspicion that enzyme inducers increase the toxicity of paracetamol has not been confirmed. There are no other relevant interactions.

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