Australian Medical Association

“Paracetamol-induced liver failure an English-speaking problem”

Kirsty Waterford, Published: 21 JUL 2015

Researchers have identified major differences between European countries in the rate at which people suffer paracetamol-induced acute liver failure, with some at six times the risk of others.

Paracetamol is extensively used to combat pain, but when taken above the recommended dose it can cause severe liver damage. In extreme cases, the damage can be so severe that it leads to complete liver failure, often requiring a liver transplant.

Researchers examined the amount of paracetamol-linked acute liver failure in France, Greece, Ireland, Italy, Netherlands, Portugal and the UK between 2005 and 2007, comparing how frequently it occurred and how much paracetamol was sold.

The average rate of acute liver failure across the participating countries was one case for every six million inhabitants per year, but was as high as one case for every 286,000 people in Ireland, compared with the equivalent of just one instance for every 180 million people in Italy. The results were similar when looking at the frequency of acute liver failure for each tonne of paracetamol sold. Ireland had one event per every 20.7 tonnes of paracetamol sold, compared with Italy, where there was one event for every 1074 tonnes sold.

The researchers also found that paracetamol overdose represented 20 per cent of all causes of acute liver failure across Europe, but increased to 52 per cent in Ireland and 28 per cent in the UK. However, this dropped to only one per cent in Italy, and there were no cases recorded in Greece. Additionally, the researchers found that while France had the highest per-person use of paracetamol, it had the third lowest acute liver failure transplant rate.

Lead researcher Associate Professor Sinem Ezgi Gulmez said that, overall, they found a six-times higher risk in Ireland and a two-fold higher risk in the UK compared with the average of the countries participating in the study.

A/Professor Gulmez also highlighted that the highest rates of overdose for acute liver failure per metric ton of paracetamol sold per person were found in the two English speaking countries.

“Since we do not have event rates for overdoses not leading to liver failure, we cannot conclude anything about the rates of non-acute liver failure overdoses in the different countries, but indicators point to more common use of paracetamol poisoning in these countries,” A/Professor Gulmez said.

“The differences in the figures for harm caused by paracetamol within different countries in Europe are not marginal, and suggest that there are some underlying causes.

“Paracetamol overdose is a serious public health issue, and we should start looking into hepatotoxicity associated with paracetamol at normal doses.”

The research was published in the British Journal of Clinical Pharmacology.