Hidden paracetamol dangers: OTC products carry risk of deadly overdose as experts warn about staggered dosing

Paracetamol is found in a wide range of medicines beyond tablets, and health experts warn that the drug can be involved in deadly accidental overdoses when it is used in several products at once. Officials note that paracetamol is present in many over-the-counter cold, flu and combination remedies, which can make it easy to exceed the daily limit without realizing it. The Medicines and Healthcare products Regulatory Agency said there is no evidence that taking paracetamol during pregnancy causes autism, even as public debate continues around medication use during pregnancy.

The official maximum dose is two 500 mg tablets per dose, up to four times in 24 hours, with at least four hours between each dose. Taken together with other paracetamol-containing products, consumers can far exceed the recommended 4 g per 24 hours, which can raise the risk of liver injury over time.

Medical professionals warn that even normal doses can have long-term liver effects if used too often, and point to the risk of staggered overdosing—taking small amounts of paracetamol across several days that add up to dangerous totals. Dr. Leyla Hannbeck, chief executive of the Independent Pharmacy Association, told the Daily Mail that paracetamol "can be very harmful and even fatal" if regularly exceeded, and that people should not exceed the daily limit.

Thorrun Govind, a TV pharmacist and former chair of the Royal Pharmaceutical Society, notes many OTC cold, flu and combination remedies contain paracetamol. For example, Beechams Cold & Flu sachets contain 600 mg per sachet; Lemsip Cold & Flu Sachets Lemon contain 650 mg per sachet. Calpol remains a staple for children, with 5 ml doses containing about 120 mg of paracetamol. Sudafed and Boots Decongestant with Pain Relief tablets also include paracetamol, at varying doses per product. In combination products like Nuromal Dual Action Pain Relief Ibuprofen and Paracetamol, each tablet contains 500 mg of paracetamol. Beechams All In One Liquid and Covonia All-In-One Chesty Cough syrups also add paracetamol to their formulations, with 500 mg per 20 ml and 250 mg per 10 ml, respectively.

Surveys have indicated that as many as two in five people who buy over-the-counter remedies do not realise they contain paracetamol, a factor cited by physicians and pharmacists as contributing to accidental overdoses. Paracetamol is now the leading cause of acute liver failure in UK adults, according to researchers who warn that totals approaching 7.5 g in 24 hours may trigger toxicity for some individuals.

Public guidance remains consistent: read medicine labels carefully, keep a running tally of paracetamol doses across all products, and talk to a pharmacist if you are unsure whether a product contains paracetamol. Health officials say the safest approach is to use only one paracetamol-containing product at a time and to avoid combining multiple products that each include the drug.