UK pharmacists warn on paracetamol risks as autism-link claims surface

Top pharmacists issued a fresh warning on paracetamol risk amid questions raised this week by President Trump’s health advisers about a possible link between the painkiller and autism. While the discourse surrounding the drug’s safety has intensified, medical experts say the danger lies in regular use and potential liver damage, not in a presumed autism connection. Britain’s Medicines and Healthcare products Regulatory Agency has reiterated that there is no evidence that taking paracetamol during pregnancy causes autism in children, but health professionals emphasize that risks remain if the drug is used every day over a prolonged period. The warnings come as paracetamol — often sold under the Tylenol brand in the United States — remains one of the world’s most widely used analgesics and antipyretics.

Pharmacists stress that occasional use is not the same as daily consumption. The official maximum dose is two 500 mg tablets taken up to four times in 24 hours, with at least four hours between doses. They warn that paracetamol can accumulate in the liver when used regularly over days or weeks, and that many over-the-counter products, including cold and flu remedies, contain the drug, increasing the likelihood of accidental overdose. “People often think paracetamol is harmless because it’s so easy to get hold of. But the reality is very different,” Thorrun Govind, a TV pharmacist and former chair of the Royal Pharmaceutical Society, told the Daily Mail.

Public health groups have long warned about staggered overdosing — taking slightly more than the recommended daily limit over several days or weeks. In some people, this can lead to significant liver damage, and in rare cases, collapse of other organs. The danger is compounded because paracetamol is hidden in many other medicines, including combination cold and flu products. Officials say patients should read labels carefully and consult a pharmacist if unsure about drug combinations.

In the United Kingdom, the issue is not new. In 1998, authorities restricted sales so that supermarkets and corner shops could only sell packs of 16 tablets, while pharmacies carried larger packs. Yet the risk persists, particularly for those who rely on multiple products to treat a range of symptoms. Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, noted that paracetamol can be effective and safe at recommended doses for short periods, but harm can occur if the limit is regularly exceeded. “Paracetamol can significantly damage the liver if taken incorrectly and can cause death,” she warned, adding that patients who have taken paracetamol and still feel unwell should seek help from a pharmacist for alternatives rather than topping up with more paracetamol.

Professor Andrew Moore, of the Cochrane Collaboration’s Pain, Palliative Care and Supportive Care group, has challenged the notion that paracetamol is a harmless default treatment. He said: “The studies we have tell us that paracetamol use is associated with increased rates of death, heart attack, stomach bleeding and kidney failure. Paracetamol is known to cause liver failure in overdose but it also causes liver failure in people taking standard doses for pain relief. The risk is only about one in a million, but it is a risk. All these different risks stack up.”

Over the years, some experts have questioned the overall benefit of paracetamol for certain conditions. Research summarized by NICE in 2020 revised guidelines to advise against using paracetamol for chronic pain, citing limited evidence of benefit and potential harms, including liver toxicity, kidney damage and gastrointestinal problems. Health officials continue to emphasize cautious use, particularly for pregnant women and those taking other medications that may contain paracetamol.

Public sentiment has also been shaped by political statements. President Trump has asserted there should be warnings on paracetamol packets advising pregnant women to limit use, and he has described the medicine as something to avoid during pregnancy. In Britain, Health Secretary Wes Streeting dismissed the remarks as politically motivated and urged the public to follow medical guidance from doctors and health agencies instead of political statements. Streeting told Britons not to rely on Trump’s words when making health decisions and to consult NHS and medical professionals for advice.

Official guidance in the United Kingdom continues to position paracetamol as a first-line option for short-term pain and fever relief, particularly during pregnancy, but only when used for the shortest possible time at the lowest effective dose. The NHS notes that paracetamol remains the preferred first-choice analgesic for many pregnant patients, though long-term use and higher doses should be avoided. The broader medical community stresses that, while some observational studies have explored possible links between maternal paracetamol use and neurodevelopmental outcomes in children, the findings are inconsistent and do not establish causation.

The discussion about paracetamol sits within a broader historical context. Paracetamol’s origins trace back more than a century, with early iterations and safety concerns prompting ongoing study and regulation. The current discourse underscores the need for clear labeling, patient education, and clinician guidance to prevent overdose, particularly as the drug remains a standard recommendation for fever and mild-to-moderate pain.

As regulators and health professionals navigate the tension between potential, unproven risks and real-world benefits, the core message remains: paracetamol should be used at the lowest effective dose and for the shortest necessary duration, and patients should be mindful of other products that may contain the drug. When in doubt, they should consult a pharmacist or clinician before combining medications or exceeding the daily limit. Health authorities reiterated that while headlines about autism risk may generate concern, they currently do not establish causation, and the emphasis remains on safe dosing and informed, cautious use.