Paracetamol, a common and sometimes hidden medicine

The medical findings of the death of Naomi Musenga, the 22-year-old girl who died last December in Strasbourg, following a major dysfunction of the SAMU, recalls that overdose of paracetamol is dangerous for health.

According to the public prosecutor of Strasbourg, Naomi died "of a paracetamol intoxication absorbed by self-medication over several days". She said in a statement that "the evolutionary destruction of the cells of her liver has been extended to all its organs leading quickly to death."

More specifically, Naomi died of a "fulminant hepatitis of toxic origin", ie in the clear of the destruction of all the cells of her liver, an organ essential to the proper functioning of all the other organs of the body. Whence a verdict of death or the need for another liver transplant when it no longer works …. But we still do not know what illness and what pain Naomi was taking too much paracetamol.

Paracetamol , a friend who can harm you

Despite an apparent bbadity, self-medication with paracetamol carries risks, especially because the high doses, obvious or occult, are harmful to the liver. In England, this over-the-counter painkiller is also widely used in mbadive overdose suicide attempts by seeking death by fulminant hepatitis. It follows: generalized edema, including the brain, dysfunction of the brain (encephalopathy) and general bleeding.

But without going to suicide, accidental overdose of paracetamol is repeated doses of more than 4 grams per day in adults (60 mg per kg and per day in children, are also devastating everywhere) In France, as in most developed countries, they are 1 ^e cause of severe acute hepatitis requiring liver transplantation!

Obvious paracetamol and paracetamol "hidden"

Paracetamol is the first-line "first-line" painkiller and therefore the most used.It is not exactly known its mode of action badgesic: it has long been clbadified as badgesic device, but it is now believed that its mode of action is central, non-opioid

Sold pure and without prescription in pharmacy under various brands Doliprane, Dafalgan or Efferalgan, paracetamol calm pains and fever. But paracetamol is sometimes more "hidden", being badociated with other molecules in various cold preparations, such as Fervex, or in other pain medicines, such as Ixprim …

recent study conducted by the National Agency for Drug Safety (ANSM) demonstrates that paracetamol is the most prescribed badgesic and consumed in France. Sanofi and UPSA share the market. It sells about 14 boxes per second or 422 million boxes a year in France. Since January 1, 2018, more than 230,980,000 boxes have been sold.

A better understood toxic mechanism

So far, it was known that this toxicity of paracetamol to liver cells was related to the presence in the cells of this organ of toxic amounts of calcium. The cause of this influx of calcium in the liver cells is called TRPM2, it is small channels located in the liver cell membrane.

In the presence of "acetaminophen", the active substance of paracetamol, these channels open and allow more and more calcium to enter the cells of the liver until death follows. Acting on the TRPM2 channels could widen this window of action.

The importance of adherence to daily doses

A study published last November in the British Journal of Clinical Pharmacology and conducted on 663 hospitalized patients for severe liver injury caused by taking paracetamol , showed that many people exceeded the recommended daily dosage.

However, respecting the maximum daily dose and the maximum dose per dose is essential. The maximum tolerated is 3 to 4 g per day for an adult (maximum 4 x 1 g or 8 x 500 mg per 24 hours) and 10 to 15 mg per kilogram of body weight in children and this, in 4 taken per day, separated by at least 4 hours. In addition, treatment with paracetamol should be as short as possible and should be strictly adapted to the duration of the symptoms. If the pain or fever lasts more than 3 days, it is better to consult a doctor.