Regular paracetamol use can cause severe complications in over-65s, researchers warn

15th January 2025

Repeated doses of paracetamol in older patients can lead to an increased risk of several severe complications, researchers have reported.

An analysis of 20 years of GP data found an increased risk of gastrointestinal, cardiovascular and renal complications associated with regular use of the painkiller.

The researchers from the University of Nottingham said the findings highlighted that care must be taken when used regularly for chronic conditions such as osteoarthritis.

Analysis of health records from 180,483 people over the age of 65 years who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months) and 402,478 controls of the same age found an increased risk of peptic ulcers, heart failure, hypertension and chronic kidney disease.

The study also identified a dose-response relationship for paracetamol use and perforation or ulceration or bleeding, uncomplicated peptic ulcers, and chronic renal failure.

That pattern was the same when researchers only looked at the patients who had taken paracetamol, they reported.

It is also difficult to calculate exposure when most people take paracetamol episodically or for multiple reasons, they added.

A subgroup analysis focusing on patients with osteoarthritis also aligned with the overall findings, the researchers reported in the journal Arthritis Care and Research.

The team did note they could not account for paracetamol bought over the counter which is why they focused on those who would have received free prescriptions.

Study leader Professor Weiya Zhang from the NIHR Nottingham Biomedical Research Centre and professor of epidemiology, Faculty of Medicine & Health Sciences at the University of Nottingham, said to its perceived safety that paracetamol has long been recommended as the first-line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications. 

Yet their findings further challenge ‘whether acetaminophen [paracetamol] should be retained as the first-line oral analgesic’, especially in older people for common chronic painful conditions, given its non-clinically meaningful benefits and potential harms, he concluded.

It also supports recommendations by NICE to not prescribe paracetamol for osteoarthritis, he added.

‘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.’

A version of this article was originally published by our sister publication Pulse.

Study shows nearly half of hospitalised patients had COVID-19 complications

19th July 2021

Among hospitalised patients, virtually half had COVID-19 complications, and which are likely to impact on future health services.

The mortality rate from infection with COVID-19 is high at approximately 26% and it has also become recognised that COVID-19 complications can occur in a large number of patients. Information on the incidence and type of COVID-19 complications is important for both patients and healthcare providers. For instance, patients need to know the likely time course of any complications whereas healthcare providers require this data to help with resource allocation and long-term planning for the delivery of services. Moreover, a sizeable number of patients with COVID-19 are admitted to intensive care units and while mortality is widely used as an outcome measure in many of the COVID-19 clinical trials, it fails to adequately capture the fact that survivors experience significant morbidity upon discharge.

A better understanding of the range and incidence of COVID-19 complications among those who are critically ill with the virus, is therefore critical to an assessment of the long-term burden on healthcare systems. In an effort to determine the range and prevalence of immediate complications of infection with COVID-19, a team from the Centre for Medical Informatics, Usher Institute, Edinburgh, Scotland, undertook a prospective, multi-centre cohort study in 302 UK which included adults, aged 19 years and older, with confirmed COVID-19 and admitted to hospital. Data was captured upon admission and after days 1, 3 and 9 and at discharge or the patient’s status after 28 days and included demographics and co-morbidities. The team set the primary outcome as the incidence of in-hospital complications and which was defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness.

Findings
A total of 75,276 patients were included in the analysis with a mean age of 71.1 years (56% male) and with the majority (73.5%) being of white ethnicity. The existence of one or more comorbidities was present in 81% of participants. and the overall rate of COVID-19 complications was 49.7%. The most common complications reported affected the renal system (24.3%), systemic effects (16.3%), gastrointestinal (10.8%), cardiovascular (12.3%), neurological (4.3%) and respiratory (18.4%). Males aged 60 years and over, suffered the highest rate of complications (54.5%) although COVID-19 complications were common across all demographics. For example, among patients aged 19–29 years and without any comorbidities, 21.1% experienced at least one complication, whereas in those aged 50 years and older, the complications occurred in 51.3% of patients. Interestingly, among patients who survived 28 days from first symptoms to discharge, 44% suffered complications and 26.6% of whom, had a worse ability to self-care than prior to their illness.

In discussing their findings, the authors noted the high level of complications experienced by survivors. The most common were renal and in particular acute kidney injury which is known to be associated with substantial long-term morbidity. They also remarked upon how COVID-19 complications had developed in young and previously healthy individuals and how such complications are known to have a negative impact on long-term morbidity.

Citation
Drake TM et al. Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet 2021.