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What is Paracetamol and how does it WORK? – Acetaminophen, Calpol, Tylenol

Posted on October 26, 2022 By
Health

Ever wondered how Paracetamol (or Acetaminophen for our American friends) works? Well, wonder no more. Here’s the explainer with the what, how, why, side effects and history and pharmacology to boot (two advanced sections in the 2nd half).

Paraacetylaminophenol. that’s far too complicated  to say so we call it acetaminophen if you’re   from the us or japan or paracetamol if you’re  from pretty much everywhere else in the world.   now, it’s a really common awesome amazing  painkiller and you might also know it by its   common brand names like tylenol, calpol, or

Panadol.  why do you need it? well it’s a really awesome   painkiller and it’s step one on our painkiller  ladder. it’s also good at treating fever because   it reduces your body temperature just a little bit  as well. it’s so good in fact that it’s the most   commonly used painkiller in the world and is on  the who list of

Essential medicine. now i mentioned   the pain ladder earlier that’s a concept from the  world health organization from about 1986 where   they said ‘these are the painkillers you start on  and then if they don’t work you add these in, and   then these, and then these’ and so on and so on. it’s  a pretty good concept and we still

Kind of use it   today. note that i said add in that’s the key to  good pain relief so often painkillers are additive   you always look to start simple and then you add  others in over time. how does it work? well i mean…   have a couple of guesses but in order to   explain how a painkiller works i probably need  to

Explain a little bit about pain. so what is pain? sensory or emotional experience associated with   degree of your pain is not just the pressure   it’s also things like personality and emotion can  go into it as well, but it’s awesome – pain keeps us   with nociceptors – that’s the fancy name for the   receptors which are

Responding to things and you  have a ton of them and loads of them work in loads   of different ways – some respond to pressure and  hard pressure soft pressure, some to heat, to cold,   to spice and so on. when a receptor is activated  it shoots off a signal to your spinal cord   and when that happens well number one there’s a 

Reflex which tends to move your hand or something   else – away from the pain, and two it shoots off more  signals to your brain and your brain perceives the   pain and turns the signal into an experience. now  paracetamol probably works centrally in the brain   and the spinal cord activating pain inhibiting  pathways and blocking

Receptors which trigger   pain signals… but like i said we’re not entirely  sure how it works. side effects – well it can cause   pretty safe drug. that is when it’s taken in the   right dose. overdosing on paracetamol is extremely  dangerous – it leads to acute liver failure if you   don’t catch that early and sometimes

Even if you  do it can lead to extremely unpleasant symptoms   and sometimes even death. it’s worth pointing out  that some people have had acute liver failure just   from a little overdose it’s not like they’ve been  like chugging the bottle or anything, they’ve just   taken a few doses too many. often the maximum  dose of

An adult is about four grams a day so   don’t go over that, oh and another word of warning – what we see pretty commonly in hospital is that   some drugs contain paracetamol and you might not  know it and that leads to accidental overdoses.    a really common drug is co-codamol – that’s a stronger  painkiller because it contains an

Opioid called   codeine but the ‘co’ in co-codamol is paracetamol  and some people don’t know that and they take   their dose, so don’t make that mistake!   but look, as always if you don’t feel right when  you’re taking a drug just talk to your doctor.   of you but please do subscribe before you go!  okay for those of you

Who are sticking around  here’s the history and the pharmacology – two   sections which i’m putting in because most people,  even a lot of doctors don’t know where these drugs   came from or what they actually do to you. so the  history – well the story of paracetamol isn’t one   of systematic research and cautious evaluation 

But rather one of serendipity, errors and failure.   whippersnapper medics asked their famous professor   of their patients who had a ton of ailments   which included a worm infestation. now kussmaul  suggested that they try naphthalene which was   thought of as a gut disinfectant. it didn’t work,  but much to their surprise

The patient’s fever   subsided shortly after being given that drug. now  that was unusual that never happened before but   out that the pharmacy had mixed up the drugs   and instead of giving them naphthalene it had  given them acetanilide. now research began on   acetanilide and it bloody worked! yeah you had  this

Weird side effect where the skin turned   a bit blue but don’t worry about that it was mass  produced of course later on it was found that the   bluish skin was actually the drug destroying your  hemoglobin, so later on search for a safer chemical   synthesized a compound called phenacetin.   following this scientists tried

To find another  drug with a better side effect profile and voila   they didn’t use that because when testing it   one of the scientists saw that it turned your  blood blue like before so set it aside. this   on hindsight years later people realize there’s  probably an error because of that scientist but   whatever

Paracetamol was put on the back burner  until about 1946 when a few american scientists   realized that paracetamol was actually the main  metabolite of phenacetin and it was actually   much safer and more active than the other one.  i mean it did produce a biproduct called   napqi – a very dangerous reactive chemical but 

Don’t worry about that we’ll come back to that   later. indeed phenacetin was becoming a bit too  dangerous anyway as watchmakers in switzerland   who took a lot of it to deal with the headaches  from staring at those tiny mechanics all day long   ended up dying of kidney failure. so paracetamol  took off but it was only decades

Later when people   realized that paracetamol causes liver failure  in overdose because of that napqi bastard, and   i know i said paracetamol was pretty safe earlier but as time goes on we’re actually beginning to learn   of the more negative side effects of paracetamol  especially when you take it long term. so it is  

Paracetamol for too much longer in fact   probably wouldn’t approve it for human use!   like i said we don’t know for sure. less than   inhibits prostaglandin produced by cox, not   only in the central nervous system but also in  the peripheral tissues. now what does that mean?   so when your tissues get damaged they

Break and  release a ton of inflammatory mediators and those   mediators lead to pain – some of those mediators  are fully formed and they’re good to go, some are   like precursor chemicals which need to react with  an enzyme to turn them into a mediator which then   signals the pain. prostaglandins are little lipid 

Hormones which are one of those potent mediators.   once your prostaglandin is going you’re going  to feel pain but they have to be made and those   paracetamol interferes with the cox enzymes which  reduces your pain. it doesn’t interfere in it   that’s why they’re known as a weak painkiller   but they’re a painkiller

Nonetheless. paracetamol  also seems to break down in the central nervous   system forming something called am404 which seems  to interfere with your cannabinoid receptors and   that’s what cannabis hits, which explains some of  the pain relief as well. and while here it also   reduces the production of il-1 which is a cytokine 

Which leads to increased temperature in fever so   helping to reduce fever as well by cutting off  il-1. the key issue we spoke about is that about   napqi and that’s highly reactive and dangerous.   your liver can deal with a little bit because  it’s got a substance called glutathione in it   but in overdose you use up all

The glutathione  which means the napqi starts burning away   the liver. in the uk it causes about 200 deaths  per year so don’t overdose kids. and there you   go – paracetamol a really interesting painkiller  discovered by luck that we still don’t really   sell it to you over the counter. lots more   drug explainers in

This series so see you next  time please do like and subscribe. toodles!

Transcribed from video
What is Paracetamol and how does it WORK? – Acetaminophen, Calpol, Tylenol By Stealth Health

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