Paracetamol hidden in everyday OTC products prompts overdose warnings
Health authorities stress careful use as paracetamol appears in cold remedies, cough syrups and decongestants, raising risk of accidental overuse
Paracetamol, a staple for pain, fever and headaches, is found in an expanding array of over-the-counter products, and experts warn that this can lead to deadly accidental overdoses when people use multiple medicines concurrently or exceed the daily limit.
The issue has gained new attention amid global discussion over medicine safety, including public comments by former U.S. president Donald Trump about taking painkillers during pregnancy. In the United Kingdom, Health Secretary Wes Streeting urged Britons to follow medical guidance and not be swayed by political statements. The Medicines and Healthcare products Regulatory Agency (MHRA) reiterated that there is no evidence linking paracetamol use in pregnancy to autism in children, while underscoring that the drug must be used with caution. The official maximum dose remains two 500-milligram tablets taken up to four times in 24 hours, with at least four hours between doses.
Researchers and clinicians warn that safety is not guaranteed even at the recommended doses. Dr. Leyla Hannbeck, chief executive of the Independent Pharmacists Association, said that paracetamol can be very harmful if regularly exceeded, even by a small amount, because it can cause serious liver damage or death. The risk is compounded by what experts describe as “staggered overdosing”: people may take multiple products that each contain paracetamol over days or weeks, unknowingly surpassing the daily limit.
Paracetamol does not exist only in tablet form; it is present in a wide range of over-the-counter remedies, increasing the chance of unintentional excess. Thorrun Govind, a TV pharmacist and former chair of the Royal Pharmaceutical Society, noted that many cold, flu and combination medicines contain paracetamol. Surveys have found that as many as two in five people who buy OTC remedies do not realise they contain paracetamol, prompting concerns about hidden sources as cold and flu season approaches.
Among the hidden sources cited in consumer-facing guidance are cold and flu sachets, children’s medicines, nasal decongestants, combination painkillers and cough syrups. Common cold sachets such as Lemsip Cold & Flu Sachets Lemon have paracetamol in each sachet, with brands like Beechams Cold & Flu Hot Lemon & Honey containing around 600 milligrams per sachet. Calpol, a household staple for children, lists paracetamol as its main ingredient, with a 5-millilitre dose delivering about 120 milligrams.
Nasal decongestants are another source; products such as Sudafed Sinus Max Strength Capsules and Sudafed Mucus Relief Triple Action Tablets contain paracetamol at 500 milligrams and 250 milligrams per capsule, respectively. Boots Decongestant with Pain Relief Tablets also includes 500 milligrams of paracetamol per tablet. In combination painkillers, products like Nuromal Dual Action Pain Relief Ibuprofen and Paracetamol pair paracetamol with another analgesic, typically delivering about 500 milligrams of paracetamol per tablet in the combined formulation.
Paracetamol is also present in cough syrups such as Beechams All In One Liquid, where a 20-millilitre dose can contain about 500 milligrams of paracetamol, and Covonia All-In-One Chesty Cough, which has roughly 250 milligrams per 10 millilitres.
The broader context remains clear: paracetamol is widely considered safe when used as directed, but its ubiquity makes adherence to the labeled maximum crucial. Liver toxicity can occur if the daily limit is exceeded, and the risk is not confined to tablets alone. Health authorities emphasize reading medicine labels carefully, avoiding the use of multiple paracetamol-containing products simultaneously, and consulting a pharmacist if there is any doubt about the amount being taken.
As colder weather approaches and demand for symptomatic relief rises, experts urge continued vigilance. For individuals with liver disease, regular alcohol use, or those taking other prescription medications, even standard doses can pose elevated risk. The message from health authorities is consistent: paracetamol remains a trusted option when used properly, but consumers should check every product for hidden paracetamol and coordinate with clinicians to ensure that the total daily intake does not exceed safe limits.