Exactly who should consult a doctor before taking paracetamol for pain relief

Paracetamol, a common over-the-counter medication, is renowned for its ability to ease various aches, pains, and flu symptoms. Around 200 million packets are sold without a prescription each year in the UK alone.

However, it is crucial to remember that paracetamol is not suitable for everyone. The NHS recommends that five key groups of people should seek advice from a doctor or pharmacist before using this medication.

Crucially, this includes anyone who has previously had an allergic reaction to paracetamol or any other medicine, as well as those who have experienced liver or kidney issues. According to its official guidance, it also includes the following:

People who take certain medications

People with liver or kidney problems

Anyone who regularly drinks more than the maximum amount of alcohol recommended (14 units per week)

People who weigh less than 50kg (eight stone) might require a lower dosage

Anyone who has ever had an allergic reaction to paracetamol or another medicine

"Most people aged 16 and over can take paracetamol. You can also take it if you are pregnant or breastfeeding," NHS advice reads. "Paracetamol can take up to an hour to work. It keeps on working for about five hours."

While paracetamol is generally safe to use alongside most prescription medications and antibiotics, there are some exceptions. If you are prescribed warfarin to prevent blood clots, or any medication for epilepsy or tuberculosis, it's recommended to consult a doctor before taking paracetamol.

Meanwhile, regarding other painkillers, the NHS states: "It's safe to take paracetamol with other types of painkiller that do not contain paracetamol, such as ibuprofen, aspirin or codeine.

"Do not take paracetamol alongside other medicines that contain paracetamol. If you take two different medicines that contain paracetamol, there's a risk of overdose."

Typical adults can take two 500mg tablets, four times in 24 hours, with at least four hours between doses. It is advised not to exceed eight tablets within this period.

Although paracetamol is therefore considered safe in most circumstances, this advice comes shortly after a University of Nottingham study raised concerns about its long-term use. Published last November, the research indicated that repeated doses in elderly patients might increase the risk of heart, gastrointestinal, and kidney issues.

During their investigation, scientists analysed medical records from 180,483 people aged 65 and over who had been prescribed paracetamol. They compared them with 402,478 similar-aged people who had not used the medication.

The results were alarming, showing that 'prolonged paracetamol use' can substantially increase the risk of 'serious complications' such as heart failure, high blood pressure, stomach ulcers, and chronic kidney disease. The research team subsequently urged a 'careful reconsideration' of prescribing paracetamol as a first-choice treatment for long-term pain management.

Lead authorProfessor Weiya Zhang explained at the time: "Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first-line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered."

For more information on paracetamol, visit the NHS website.