Coroner warns against daily long-term paracetamol use

A coroner has concluded the death of a Tasmanian man was due to paracetamol toxicity after daily use for more than a decade

Maxwell John Free passed away aged 64 in a Hobart Hospital as a result of multiple organ failure, according to a coroner’s report from the Magistrates Court of Tasmania.

An investigation into the circumstances surrounding his death found Mr Free had been taking regular daily dosage of paracetamol for more than 12 years prior to his death.

He had first begun taking paracetamol in 2002 to manage lower back and abdominal pain, at a dose of 500mg four times daily if required.

This dosage was ongoing until June 2014, when a change was made to Panadol Osteo.

Coroner Rod Chandler accepted the advice of a forensic pathologist and a medical adviser that acute renal failure and liver failure, which led to Mr Free’s death, were “most probably” related to chronic paracetamol toxicity.

Medical adviser Dr A J Bell concluded that “continual long-term usage of paracetamol should be avoided if possible.”

Dr Bell said there is suggestive evidence that chronic – especially daily – paracetamol use is nephrotoxic, and older age, fasting and dehydration are associated with increased toxicity.

“When long-term use is indicated then the known factors for chronic paracetamol toxicity must be considered,” he continued.

“These include increasing age, nutritional status, chronic alcohol usage and medications.”

The coroner accepted that Mr Free’s doctors were not responsible for his death, explaining that chronic paracetamol intoxication is a difficult diagnosis to make, and the signs and symptoms of his condition were not sufficiently obvious.

However he stated that “Mr Free’s unfortunate death is a clear demonstration of the risks associated with this treatment strategy and should service as a reminder to all medical practitioners of the need to be alert to those factors identified by Dr Bell which, I accept, heightens that risk.”

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  1. Karalyn Huxhagen

    quite some years ago I was involved in a case admitted to Launceston hospital of a young man who had the flu. He had influenza A and had been vomitting, not eating, severely sweating and was very dehydrated. He had been taking Lemsip flu sachets which contain a large amount of Paracetamol in a lemon drink base. This young man was very lucky as he was very near death when he collapsed at the intake desk at Launceston hospital after driving himslef there from Perth Tas. It took many months for him to recover and many more months for him to be allowed to drive as he had developed absence seizures.
    the brief synospis of this coroners report does not mention whether the Panadol Osteo was taken correctly-did he still use it four times a day instead of three? Dose should be adjusted for weight plus dehydration is a key factor in paracetamol toxicity.
    sadly this is another event that begs the question -did the GP ask for a medication review when this gentleman started to deteriorate?

  2. Mark Dunn

    A very large number of us older pharmacists used to spend plenty of time advising our older patuients with osteoarthritis to take Panamax 2 qid regularly.

  3. Ron Batagol

    Obviously the risk factors associated with chronic use have been highlighted here- age, dehydration, poor nutrition etc. Good point Karalyn about dehydration. Having had the renal risk warning on this added for OTC NSAID packs (at least for infants and children products, not successful in having it put on adult formulations), the dehydration caution does not seem to appear on Paracetamol CMIs or PIs. Maybe time to add the dehydration warnings on ALL NSAID and Paracetamol product packs?

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