Pharmacists warn on paracetamol risks as Trump cites autism link

Top pharmacists issued a fresh warning about paracetamol on Thursday as controversy over the drug's safety intensified after President Donald Trump claimed it could be linked to autism and said government warnings would be printed on packets advising pregnant women to avoid the painkiller.

Britain's Medicines and Healthcare Products Regulatory Agency (MHRA) stressed there is no evidence that taking paracetamol during pregnancy causes autism in children. Thorrun Govind, a TV pharmacist and former chair of the Royal Pharmaceutical Society, told the Daily Mail that people often assume paracetamol is harmless because it is widely available, but the reality is different.

In the UK, the official maximum dose is two 500 mg tablets, taken up to four times per day within 24 hours, with at least four hours between doses. Health professionals warn that regular use can damage the liver, and that even short periods of exceeding the recommended dose can cause serious harm, particularly when people rely on multiple products that contain paracetamol. The warning comes as researchers and clinicians emphasize that paracetamol is effective only when used at the lowest possible dose for the shortest necessary duration, and that risks increase with chronic use or “staggered overdosing”—taking slightly more than the daily limit over several days or weeks.

Dr. Leyla Hannbeck, chief executive of the Independent Pharmacies Association, stressed that paracetamol is safe at recommended doses but can be very harmful if the limit is regularly exceeded. She advised patients whose pain persists after a couple of days to consult a pharmacist for alternatives rather than simply adding more paracetamol. “Paracetamol can significantly damage the liver if taken incorrectly and can cause death,” she said. “If the patient has taken paracetamol and the pain is not going away, speak to your pharmacist for an alternative painkiller rather than topping up on paracetamol.”

Experts from the Cochrane Collaboration have also questioned the idea that paracetamol is a harmless default treatment. Professor Andrew Moore, from the Pain, Palliative Care and Supportive Care group, noted that studies show associations between paracetamol use and increased rates of death, heart attack, stomach bleeding, and kidney failure. He added that while paracetamol is known to cause liver failure in overdose, some research suggests risks exist even at standard doses for certain individuals. “The risk is often framed as very small, but it is a risk and all these different risks stack up,” he said.

Regulatory and clinical caution around paracetamol has a long history. In 1998, the government restricted sales to limit packs available in supermarkets and corner shops, with larger packs allowed only in pharmacies. Health professionals say the danger persists because many over-the-counter cold, flu, and multi-ingredient remedies contain paracetamol, making accidental overdose more likely. Govind noted that surveys have found that as many as two in five people who buy OTC remedies do not realise those products contain paracetamol, underscoring the importance of reading labels carefully and consulting a pharmacist when unsure.

The debate about paracetamol’s benefits versus risks has intensified alongside new scientific inquiries. In 2020, the National Institute for Health and Care Excellence (NICE) revised its guidelines to discourage the routine use of paracetamol for chronic pain, citing limited evidence that it provides meaningful relief and highlighting potential harms. Officials have long said that paracetamol remains the NHS’s first-choice painkiller during pregnancy for short-term use at the lowest effective dose, but only when clinically appropriate.

A growing body of research has examined possible links between maternal paracetamol use and neurodevelopmental outcomes in children. A recent analysis from Mount Sinai in New York and Harvard’s School of Public Health reviewed data from more than 100,000 people and called for caution in pregnancy, though the authors stressed that their findings did not prove causation and acknowledged inconsistencies across studies. They urged doctors to weigh benefits and risks and to use the lowest effective dose for the shortest possible time. In response, health officials in the United Kingdom reiterated that there is no robust evidence tying maternal paracetamol use to autism or other developmental disorders, and they cautioned against drawing conclusions from early or inconclusive research.

Political commentary around the issue has drawn sharp responses from health officials. UK Health Secretary Wes Streeting urged the public not to rely on political statements about medicine and to follow medical advice from doctors and NHS guidance. He said, in effect, that public health messaging should come from scientific and medical authorities rather than political leaders.

Across Europe and North America, clinicians emphasise that while paracetamol remains a widely used and generally safe analgesic when taken as directed, it is not without risk. Liver toxicity can arise from a combination of factors, including preexisting liver disease, chronic alcohol use, certain drug interactions, and inadvertent consumption of multiple products containing paracetamol. The presence of paracetamol in many over-the-counter formulations means patients can unintentionally exceed the daily limit if they are not careful about dosing across different products.

In sum, public health experts say the focus should be on safe use, clear labeling, and patient education. While the autism signal remains a topic of scientific inquiry, authorities say there is no credible evidence that paracetamol causes autism. By contrast, the well-established risks associated with liver injury from overuse, particularly in staggered overdosing scenarios, remain a practical concern for patients and clinicians alike. Health professionals urge individuals to consult a pharmacist when uncertain, and to seek medical attention if pain persists beyond a few days or if there are signs of liver distress, such as yellowing of the skin or eyes, dark urine, or severe abdominal pain.