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My wife and I got colds while vacationing in Edinburgh and had a heck of a time before realizing to ask for paracetamol rather than acetaminophen. Also, the rul

My wife and I got colds while vacationing in Edinburgh and had a heck of a time before realizing to ask for paracetamol rather than acetaminophen. Also, the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid.

closewith 1y ago
> Also, the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid. Yes, but: > Responsible for 56,000 emergency department visits and 2600 hospitalizations, acetaminophen poisoning causes 500 deaths annually in the United States. Notably, around 50% of these poisonings are unintentional, often resulting from patients misinterpreting dosing instructions or unknowingly consuming multiple acetaminophen-containing products. Source: https://www.ncbi.nlm.nih.gov/books/NBK441917/#:~:text=Acetaminophen%20toxicity%20is%20the%20second,annually%20in%20the%20United%20States. https://www.ncbi.nlm.nih.gov/books/NBK441917/#:~:text=Acetam...
- drewg123 1y ago
  I was under the impression that a lot of overdoses of acetaminophen are due to it being included in many different multiple-medicine cold/flu remidies, like cough syrup, NyQuil, decongestants, etc. So people end up exceeding the max dose accidentally when they take acetaminophen along with some of those other things. Does the UK have rules that prevent mixing acetaminophen with other drugs? Its getting so its sometimes hard to find over the counter cold/flu medicines without acetaminophen
  - tim333 1y ago
    I think it's less mixed in with other products than in the US (?)
    - zdragnar 1y ago
      My wife has negative reactions to it, which is extremely rare at normal doses (to the point many doctors don't believe her). Trying to find medicine for her when she's sick is surprisingly time consuming as it is in so many things even vaguely related to treating cold / cough / flu symptoms.
  - roryirvine 1y ago
    The UK rules apply to all medicines containing paracetamol. Non-pharmacy retailers are only allowed to sell in packs of 16, and they'll usually only allow two packs of any paracetamol-containing medication to be sold at a time (eg. one cold/flu and one cough remedy). If the name of the product doesn't already contain the word "paracetamol", then all of the packaging must prominently display "contains paracetamol" - so even small retailers that don't have computerised checkouts are expected to follow the same rules. Deaths from paracetamol overdose fell by 43% (with a similar decrease in the rate of accidental poisonings) in the first 11 years after these changes were implemented: https://www.bmj.com/content/346/bmj.f403 https://www.bmj.com/content/346/bmj.f403
- tecleandor 1y ago
  There's an interesting thing too about metamizol. It's very popular here in Spain for some types of pain (for example, teeth related stuff or post-surgery) and it's used widely without much problem. In fact, it was the most sold medication in Spain in 2023 (sold under the Nolotil brand) [0]. But it's forbidden in places like the UK. Thing is, as we are a popular destination with British tourists or even pensioners that live in the Mediterranean, we've found in the last years that British population is genetically more likely to have a very dangerous side effect, agranulocytosis, that could result in death. Can't find the exact source (I'm on my phone), but seems like at least half of the metamizol related agranulocytosis cases in Spain have been of British origin, and several deaths have been reported. There's a ongoing legal process where at least 40 deaths are being investigated [1] and doctor have stopped providing metamizol to persons of British origin, and do it carefully for other persons. So what was perfectly safe around here, was found quite dangerous for certain subset of the British population (no jokes about balconies, please). Edit for some sources: From 1998 to 2003, out of the 13 agranulocytosis cases from a hospital in Marbella, 8 were foreigner, and of those 5 were from the UK [2]. According to the ADAF association, out of the 45 deaths attributed to metamizol in Spain since 1996, only 8 of them were Spanish (they don't tell their sources in that article) [3] -- 0: https://fefe.com/wp-content/uploads/2023/05/Obs.-marzo23ok.pdf 1: https://guardian.pressreader.com/article/281857238286709 2: https://www.sciencedirect.com/science/article/abs/pii/S0014256509713104 3: https://www.elespanol.com/ciencia/salud/20231128/denuncian-sanidad-muerte-decenas-britanicos-espana-tomaron-nolotil/812919101_0.html
- lupusreal 1y ago
  Yes, but: 350 million people in this country.
stavros 1y ago
True, but paracetamol overdoses are not a fun death. Granted, you need to take a massive amount, but still.
- bigfudge 1y ago
  You don't need to take that much. LD50 is surprisingly close to the normal dose, and possible to do if you don't realise that cold remedies contain it (or that aminocetophen and paracetamol are the same thing!)
  - hallway_monitor 1y ago
    I avoid it at all costs because of the possibility of liver damage. Ibuprofen seems to have the same effect without potentially serious side effects.
    - ValentinPearce 1y ago
      Ibuprofen is anti inflammatory which paracetamol isn't. IIRC this means ibuprofen can hide infections. I had a doctor friend who avoided its use as generic pain relief for that reason.
      - deleted 1y ago
        [deleted]
      - kimixa 1y ago
        But for muscular/joint pain the anti-inflammatory aspect is a feature, not a bug. And I'd guess that's what most long term user's target is?
    - tecleandor 1y ago
      People will still happily use paracetamol when drinking or "for hangover" (headache and all that), hitting their liver really hard. :(
    - SoftTalker 1y ago
dspillett 1y ago
> the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid Worse than that: it is effectively per day per shop. In a very short space of time I can buy two packs in Boots, two in Tesco, two in Sainsbury, ooh look another small Tesco I'll get two there as well, two from Savers, two from SuperDrug, …
- xnorswap 1y ago
  And yet the policy appears to have been effective in reducing overdoses.
  - dghlsakjg 1y ago
    Overdoses declined in the US, as well, where there are no limits on quantity, but there has been a campaign to educate and create better labeling practices for medication containing acetaminophen. I think it's important to recognize that overdoses can be intentional or unintentional, and it isn't clear which ones will be affected by the policy of limiting purchase quantity per transaction. https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/
  - refurb 1y ago
    Based on what? The US went with the educational route - any product containing acetaminophen has “CONTAIN ACETAMINOPHEN - DO NOT COMBINE WITH OTHER PRODUCTS CONTAINING ACETAMINOPHEN” Overdoses went down despite the fact I can buy $1,000 tablets for $5 at Costco.
    - OJFord 1y ago
      Based on studies⁰ that examined it. The fact that another country had success with a different technique too doesn't mean it wasn't successful. [0]: E.g. https://pubmed.ncbi.nlm.nih.gov/23393081/ https://pubmed.ncbi.nlm.nih.gov/23393081/
      - refurb 1y ago
padjo 1y ago
Given how common accidental paracetamol overdose is I think it’s perfectly reasonable.
- DougN7 1y ago
  I’ve never heard of this particular overdose. In the US it’s completely unmonitored and I’ve never heard of an overdose. I’m genuinely surprised.
  - OJFord 1y ago
    It's unfortunately quite easy to do even inadvertently (not following dosage instructions) - doesn't take a lot. The reason for the rule though was to combat its use in suicide attempts. They also have to be sold in blister packs here for the same reason, not the big bottles of Tylenol/Advil etc. that you get there (and we used to here) - relatively difficult to take several, requires more preparation than just chugging a bottle.
  - padjo 1y ago
    “A study of cases of acute liver failure between November 2000 and October 2004 by the Centers for Disease Control and Prevention in the US found that paracetamol was the cause of 41% of all cases” from https://en.m.wikipedia.org/wiki/Paracetamol_poisoning https://en.m.wikipedia.org/wiki/Paracetamol_poisoning
    - yencabulator 1y ago
      From that wikipedia page: > In adults, single doses above 10 grams or 200 mg/kg of bodyweight, whichever is lower, have a reasonable likelihood of causing toxicity. 10g is 20 pills of the highest strength you'll find in a regular store. Excedrin brand "Extra Strength" is half of that, you'd have to be eating 40+ pills in 24 hours, or 20+ pills per day on multiple consecutive days. Most acetaminophen pills have 100-200 mg of the active ingredient. You're missing the context: > Intentional overdosing (self-poisoning, with suicidal intent) is frequently implicated in paracetamol toxicity.[25] In a 2006 review, paracetamol was the most frequently ingested compound in intentional overdosing.[26] So, it's not that acetaminophen will kill that easily. It's just that of the easily available ways to kill yourself, it's distinctly the one that destroys the liver quick.
Marazan 1y ago
As annoying as it is (and I agree it is fantastically annoying) much to my surprise admissions for paracetamol overdose to UK hospitals absolutely plummeted after purchasing restrictions were introduced. Score one for the nanny state.
- fifticon 1y ago
  denmark has same rule, for same purpose and effect
- dghlsakjg 1y ago
  Not sure what "plummeted" quantifies to in this context, but the US saw meaningful reductions in overdose treatments and calls to the poison control line after changing the labeling rules and a public education campaign. The cited study was even conducted before the full labeling rules change came into effect. Teach a man why not to over-fish fish vs giving him a smaller amount of fish... or something. https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/
  - laughing_man 1y ago
    The US doesn't have a significant problem with deliberate acetaminophen overdose as part of a suicide attempt, which is the problem the UK rules are meant to address.
    - dghlsakjg 1y ago
      Strictly speaking, if you wanted to solve intentional overdoses of acetaminophen, it appears that you could do it by presenting more appealing means of self-harm, like in the US. I'm pretty certain the availability of other lethal products (guns, really) directly correlates with whether OTC drug overdosing is a popular means of harm. I'm willing to bet that handing out cyanide pills OTC would effectively eliminate intentional acetaminophen poisonings in the UK. Surprised the boffins at the NHS didn't think of it first if they really want to eliminate intentional overdoses! /s
OJFord 1y ago
> Also, the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid. Its introduction pretty effectively reduced the incidence of suicide attempts by overdose resulting in death or hospitalisation. https://pubmed.ncbi.nlm.nih.gov/23393081/ https://pubmed.ncbi.nlm.nih.gov/23393081/ (The tl;dr conclusion: it worked, consider going further.)
atombender 1y ago
I'm a big fan of paracetamol in terms of how well it works; does wonders for headaches as well as joint aches. My concern is about the relatively recent findings about potential Alzheimer risk [1]: > During a median follow-up of 12.3 years, 6407 (3.0%) participants developed new-onset all-cause dementia. Participants who regularly used paracetamol had a significantly higher risk of new-onset all-cause dementia (adjusted HR, 1.18; 95%CI: 1.10-1.26), compared with non-users. However, there was no significant association between regular use of ibuprofen and new-onset all-cause dementia (users vs. non-users; adjusted HR, 1.06; 95%CI: 0.97-1.16). I don't follow the research closely enough to know if this is reliable evidence, but there are other studies showing the same thing. Paracetamol also well known as mood-altering, apparently inhibiting empathy [2], which may be part of why it has an analgesic effect. That isn't as scary on a personal level, but imagine a society full of millions of people on paracetamol whose ability to feel empathy has been blunted. [1] https://pubmed.ncbi.nlm.nih.gov/37633120/ https://pubmed.ncbi.nlm.nih.gov/37633120/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6455058/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6455058/
brianmcc 1y ago
You can buy two packs of 16 each, enough for 4 days usage at 2 per dose, 4 times per day, after which point if you still need them you maybe have a bigger problem. Or can just restock. What's "fantastically stupid" about it?
- brianmcc 1y ago
  Wife: good day at the office dear? Me: yep argued with some strangers on HN about how daft/wise UK's paracetamol laws are, highly fulfilling! :-)
kazinator 1y ago
Naproxen works like acetaminophen, ibuprofen and others. Yet, it lasts several times longer thanks to its long half life. One naproxen replaces three or four acetaminophens.
cedws 1y ago
How are you consuming a whole pack of paracetamol a day for that to be a problem?

closewith 1y ago

> Also, the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid. Yes, but: > Responsible for 56,000 emergency department visits and 2600 hospitalizations, acetaminophen poisoning causes 500 deaths annually in the United States. Notably, around 50% of these poisonings are unintentional, often resulting from patients misinterpreting dosing instructions or unknowingly consuming multiple acetaminophen-containing products. Source: https://www.ncbi.nlm.nih.gov/books/NBK441917/#:~:text=Acetaminophen%20toxicity%20is%20the%20second,annually%20in%20the%20United%20States. https://www.ncbi.nlm.nih.gov/books/NBK441917/#:~:text=Acetam...

drewg123 1y ago
I was under the impression that a lot of overdoses of acetaminophen are due to it being included in many different multiple-medicine cold/flu remidies, like cough syrup, NyQuil, decongestants, etc. So people end up exceeding the max dose accidentally when they take acetaminophen along with some of those other things. Does the UK have rules that prevent mixing acetaminophen with other drugs? Its getting so its sometimes hard to find over the counter cold/flu medicines without acetaminophen
- tim333 1y ago
  I think it's less mixed in with other products than in the US (?)
  - zdragnar 1y ago
    My wife has negative reactions to it, which is extremely rare at normal doses (to the point many doctors don't believe her). Trying to find medicine for her when she's sick is surprisingly time consuming as it is in so many things even vaguely related to treating cold / cough / flu symptoms.
- roryirvine 1y ago
  The UK rules apply to all medicines containing paracetamol. Non-pharmacy retailers are only allowed to sell in packs of 16, and they'll usually only allow two packs of any paracetamol-containing medication to be sold at a time (eg. one cold/flu and one cough remedy). If the name of the product doesn't already contain the word "paracetamol", then all of the packaging must prominently display "contains paracetamol" - so even small retailers that don't have computerised checkouts are expected to follow the same rules. Deaths from paracetamol overdose fell by 43% (with a similar decrease in the rate of accidental poisonings) in the first 11 years after these changes were implemented: https://www.bmj.com/content/346/bmj.f403 https://www.bmj.com/content/346/bmj.f403
tecleandor 1y ago
There's an interesting thing too about metamizol. It's very popular here in Spain for some types of pain (for example, teeth related stuff or post-surgery) and it's used widely without much problem. In fact, it was the most sold medication in Spain in 2023 (sold under the Nolotil brand) [0]. But it's forbidden in places like the UK. Thing is, as we are a popular destination with British tourists or even pensioners that live in the Mediterranean, we've found in the last years that British population is genetically more likely to have a very dangerous side effect, agranulocytosis, that could result in death. Can't find the exact source (I'm on my phone), but seems like at least half of the metamizol related agranulocytosis cases in Spain have been of British origin, and several deaths have been reported. There's a ongoing legal process where at least 40 deaths are being investigated [1] and doctor have stopped providing metamizol to persons of British origin, and do it carefully for other persons. So what was perfectly safe around here, was found quite dangerous for certain subset of the British population (no jokes about balconies, please). Edit for some sources: From 1998 to 2003, out of the 13 agranulocytosis cases from a hospital in Marbella, 8 were foreigner, and of those 5 were from the UK [2]. According to the ADAF association, out of the 45 deaths attributed to metamizol in Spain since 1996, only 8 of them were Spanish (they don't tell their sources in that article) [3] -- 0: https://fefe.com/wp-content/uploads/2023/05/Obs.-marzo23ok.pdf 1: https://guardian.pressreader.com/article/281857238286709 2: https://www.sciencedirect.com/science/article/abs/pii/S0014256509713104 3: https://www.elespanol.com/ciencia/salud/20231128/denuncian-sanidad-muerte-decenas-britanicos-espana-tomaron-nolotil/812919101_0.html
lupusreal 1y ago
Yes, but: 350 million people in this country.

stavros 1y ago

True, but paracetamol overdoses are not a fun death. Granted, you need to take a massive amount, but still.

bigfudge 1y ago
You don't need to take that much. LD50 is surprisingly close to the normal dose, and possible to do if you don't realise that cold remedies contain it (or that aminocetophen and paracetamol are the same thing!)
- hallway_monitor 1y ago
  I avoid it at all costs because of the possibility of liver damage. Ibuprofen seems to have the same effect without potentially serious side effects.
  - ValentinPearce 1y ago
    Ibuprofen is anti inflammatory which paracetamol isn't. IIRC this means ibuprofen can hide infections. I had a doctor friend who avoided its use as generic pain relief for that reason.
    - deleted 1y ago
      [deleted]
    - kimixa 1y ago
      But for muscular/joint pain the anti-inflammatory aspect is a feature, not a bug. And I'd guess that's what most long term user's target is?
  - tecleandor 1y ago
    People will still happily use paracetamol when drinking or "for hangover" (headache and all that), hitting their liver really hard. :(
  - SoftTalker 1y ago

dspillett 1y ago

> the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid Worse than that: it is effectively per day per shop. In a very short space of time I can buy two packs in Boots, two in Tesco, two in Sainsbury, ooh look another small Tesco I'll get two there as well, two from Savers, two from SuperDrug, …

xnorswap 1y ago
And yet the policy appears to have been effective in reducing overdoses.
- dghlsakjg 1y ago
  Overdoses declined in the US, as well, where there are no limits on quantity, but there has been a campaign to educate and create better labeling practices for medication containing acetaminophen. I think it's important to recognize that overdoses can be intentional or unintentional, and it isn't clear which ones will be affected by the policy of limiting purchase quantity per transaction. https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/
- refurb 1y ago
  Based on what? The US went with the educational route - any product containing acetaminophen has “CONTAIN ACETAMINOPHEN - DO NOT COMBINE WITH OTHER PRODUCTS CONTAINING ACETAMINOPHEN” Overdoses went down despite the fact I can buy $1,000 tablets for $5 at Costco.
  - OJFord 1y ago
    Based on studies⁰ that examined it. The fact that another country had success with a different technique too doesn't mean it wasn't successful. [0]: E.g. https://pubmed.ncbi.nlm.nih.gov/23393081/ https://pubmed.ncbi.nlm.nih.gov/23393081/
    - refurb 1y ago

padjo 1y ago

Given how common accidental paracetamol overdose is I think it’s perfectly reasonable.

DougN7 1y ago
I’ve never heard of this particular overdose. In the US it’s completely unmonitored and I’ve never heard of an overdose. I’m genuinely surprised.
- OJFord 1y ago
  It's unfortunately quite easy to do even inadvertently (not following dosage instructions) - doesn't take a lot. The reason for the rule though was to combat its use in suicide attempts. They also have to be sold in blister packs here for the same reason, not the big bottles of Tylenol/Advil etc. that you get there (and we used to here) - relatively difficult to take several, requires more preparation than just chugging a bottle.
- padjo 1y ago
  “A study of cases of acute liver failure between November 2000 and October 2004 by the Centers for Disease Control and Prevention in the US found that paracetamol was the cause of 41% of all cases” from https://en.m.wikipedia.org/wiki/Paracetamol_poisoning https://en.m.wikipedia.org/wiki/Paracetamol_poisoning
  - yencabulator 1y ago
    From that wikipedia page: > In adults, single doses above 10 grams or 200 mg/kg of bodyweight, whichever is lower, have a reasonable likelihood of causing toxicity. 10g is 20 pills of the highest strength you'll find in a regular store. Excedrin brand "Extra Strength" is half of that, you'd have to be eating 40+ pills in 24 hours, or 20+ pills per day on multiple consecutive days. Most acetaminophen pills have 100-200 mg of the active ingredient. You're missing the context: > Intentional overdosing (self-poisoning, with suicidal intent) is frequently implicated in paracetamol toxicity.[25] In a 2006 review, paracetamol was the most frequently ingested compound in intentional overdosing.[26] So, it's not that acetaminophen will kill that easily. It's just that of the easily available ways to kill yourself, it's distinctly the one that destroys the liver quick.

Marazan 1y ago

As annoying as it is (and I agree it is fantastically annoying) much to my surprise admissions for paracetamol overdose to UK hospitals absolutely plummeted after purchasing restrictions were introduced. Score one for the nanny state.

fifticon 1y ago
denmark has same rule, for same purpose and effect
dghlsakjg 1y ago
Not sure what "plummeted" quantifies to in this context, but the US saw meaningful reductions in overdose treatments and calls to the poison control line after changing the labeling rules and a public education campaign. The cited study was even conducted before the full labeling rules change came into effect. Teach a man why not to over-fish fish vs giving him a smaller amount of fish... or something. https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5676300/
- laughing_man 1y ago
  The US doesn't have a significant problem with deliberate acetaminophen overdose as part of a suicide attempt, which is the problem the UK rules are meant to address.
  - dghlsakjg 1y ago
    Strictly speaking, if you wanted to solve intentional overdoses of acetaminophen, it appears that you could do it by presenting more appealing means of self-harm, like in the US. I'm pretty certain the availability of other lethal products (guns, really) directly correlates with whether OTC drug overdosing is a popular means of harm. I'm willing to bet that handing out cyanide pills OTC would effectively eliminate intentional acetaminophen poisonings in the UK. Surprised the boffins at the NHS didn't think of it first if they really want to eliminate intentional overdoses! /s

OJFord 1y ago

> Also, the rules the UK has for limiting paracetamol purchases to small amount per day are so fantastically stupid. Its introduction pretty effectively reduced the incidence of suicide attempts by overdose resulting in death or hospitalisation. https://pubmed.ncbi.nlm.nih.gov/23393081/ https://pubmed.ncbi.nlm.nih.gov/23393081/ (The tl;dr conclusion: it worked, consider going further.)

atombender 1y ago

I'm a big fan of paracetamol in terms of how well it works; does wonders for headaches as well as joint aches. My concern is about the relatively recent findings about potential Alzheimer risk [1]: > During a median follow-up of 12.3 years, 6407 (3.0%) participants developed new-onset all-cause dementia. Participants who regularly used paracetamol had a significantly higher risk of new-onset all-cause dementia (adjusted HR, 1.18; 95%CI: 1.10-1.26), compared with non-users. However, there was no significant association between regular use of ibuprofen and new-onset all-cause dementia (users vs. non-users; adjusted HR, 1.06; 95%CI: 0.97-1.16). I don't follow the research closely enough to know if this is reliable evidence, but there are other studies showing the same thing. Paracetamol also well known as mood-altering, apparently inhibiting empathy [2], which may be part of why it has an analgesic effect. That isn't as scary on a personal level, but imagine a society full of millions of people on paracetamol whose ability to feel empathy has been blunted. [1] https://pubmed.ncbi.nlm.nih.gov/37633120/ https://pubmed.ncbi.nlm.nih.gov/37633120/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6455058/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6455058/

brianmcc 1y ago

You can buy two packs of 16 each, enough for 4 days usage at 2 per dose, 4 times per day, after which point if you still need them you maybe have a bigger problem. Or can just restock. What's "fantastically stupid" about it?

brianmcc 1y ago
Wife: good day at the office dear? Me: yep argued with some strangers on HN about how daft/wise UK's paracetamol laws are, highly fulfilling! :-)

kazinator 1y ago

Naproxen works like acetaminophen, ibuprofen and others. Yet, it lasts several times longer thanks to its long half life. One naproxen replaces three or four acetaminophens.

cedws 1y ago

How are you consuming a whole pack of paracetamol a day for that to be a problem?