Paracetamol's Promise: The Dose Is the Danger
A study published this month found that calls to poison centres involving liver injuries have risen nearly 400% between 2000 and 2024.
Paracetamol's Promise: The Dose Is the Danger
There is a box of paracetamol in almost every medicine cabinet in Malta — tucked behind the sunscreen, the old antibiotics, the vitamins someone bought in January with the best of intentions. It is the first thing we reach for. It is also, if new data from UVA Health is to be believed, something we have been reaching for without quite understanding what it is.
A study published this month found that calls to poison centres involving liver injuries have risen nearly 400% between 2000 and 2024. Acetaminophen — the molecule we know as paracetamol — sits at the top of the list of causes. Not because it is a dangerous drug. It is not. But because it is in everything: the cold tablet, the flu powder, the migraine capsule, the sleep aid. People stack doses without realising they are stacking the same compound.
The liver metabolises paracetamol well at recommended doses. The problem is the gap between "recommended" and "what I took across three different products because I felt terrible." The toxic threshold is not far from the therapeutic one — that narrow corridor is what makes this particular molecule worth understanding rather than simply trusting.
I think about the cities where I've been ill far from anyone who knows me. Singapore, with its humidity that makes a mild fever feel operatic. New York in January, the kind of cold that convinces you to take whatever is in the cabinet and rest. In none of those places did I count the combined milligrams across everything I swallowed. Most people don't. That is precisely the problem the researchers are documenting — not recklessness, but inattention. The supplement that "supports liver function" alongside the paracetamol that taxes it. The glass of wine that accompanies neither is recommended but is extremely common.
The piece of information that changes behaviour is usually a specific number, not a vague caution. For adults, the ceiling is four grams of paracetamol in 24 hours — most standard tablets are 500mg, which means eight tablets. Sounds like a lot until you count the cold sachets, the combination products, the top-up you took at midnight. The liver does not care which product the dose arrived in.
What you can do tomorrow: before you open a second product for symptoms, read the active ingredients of the first one. If paracetamol is already in there, count the total. Open pharmacies in Malta can advise on combinations — a two-minute conversation that costs nothing and means something.
*Isla Camilleri is Global Affairs & Lifestyle Editor at News Beast.*
