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Hello! My sister has terrible headache and she takes eight paracetamols a day. How bad is this? Yesterday she felt nausea and had diarrhea. I am afraid that this high quantity of paracetamol will harm her. She says you can't be allergic to paracetamol and that it has no side effects. I know paracetamol it is known as very safe drug, but I am still very concerned.

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Hi! Well, your sister is right in one way – paracetamol is considered as one of the safest drug in the therapy of mild and moderate pain and fever. It has almost no side effects and allergies are very, very rare. But, she forgot one very important thing – toxicity. Paracetamol overdose is proved to be very dangerous. When overdosed your liver's function is endangered and your life may be in danger as well. Since your sister already has symptoms of overdose (diarrhea and nausea) take her to the hospital as soon as possible!
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Provided your sister has no liver or kidney disease eight paracetamol (also known as acetaminophen in the US) is within the safe limit and she could not suffer an acute overdose at that level.

The lowest recorded instance of paracetamol poisoning is around twenty tablets in 24 hours and even that is unusually low. Paracetamol is a very safe drug and 99.9% of acute overdoses in otherwise healthy patients are deliberate and involve the consumption of huge quantities at once. The few none deliberate cases are usually split between people who have preexisting kidney and liver disorders and people who accidentally overdue because they take eight paracetamols and also take other medications without realising they also contain the drug (many cold and flu medications often have the equivalent of two paracetamol tablets in each dose - so if you take eight paracetamols for flu symptoms and five doses of a flu medication you are up to eighteen doses without even realising it.

Now please note I kept saying acute overdoses. Eight Paracetamol taken each day for over two years (especially if the patients drinks a higher than average amount of alcohol per week) can cause a different kind of overdose - known as a chronic overdose. Paracetamol, like virtually any other drug, taken for long periods will slowly start to reduce the activity of your kidneys and liver and cause damage. As this damage occurs the amount of paracetamol you can take in one day before suffering an acute overdose can drop dramatically. Sadly this is recent research and many older doctors still make the error of prescribing paracetamol over very long time periods. My advice would be that anyone taking eight paracetamol a day for more than two years gets a biannual set of liver function tests to ensure that their liver is still functioning as normal. This test will normally show up any damage to the kidneys also, but if you wish to be 100% sure then a simple urine test taken at the same time as the liver functions is also an option.

In summary for a normal healthy person eight paracetamols a day for a week or two is no issue, and even long term the risk is small. However if your sister has been taking them for years demand your doctor gives her a set of liver function test just to be safe.
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