A recent study has raised concerns about the safety of paracetamol, a widely used over-the-counter medication, particularly among adults aged 65 and older. Conducted by researchers at the University of Nottingham, UK, the study found that prolonged use of paracetamol is linked to increased risks of gastrointestinal, heart, and kidney-related complications.

Paracetamol is commonly prescribed for mild-to-moderate fever and pain relief. It is also the first-choice medication for managing osteoarthritis—a chronic condition characterised by joint pain, stiffness, and swelling—owing to its perceived effectiveness, safety, and accessibility. However, growing evidence challenges its safety profile, particularly when used over an extended period.

The study revealed that paracetamol use increases the risk of peptic ulcer bleeding by 24% and lower gastrointestinal bleeding by 36%. These findings add to earlier evidence suggesting that prolonged use of the drug may cause significant gastrointestinal side effects, including ulcers and bleeding.

In addition to gastrointestinal risks, the study linked paracetamol use to a 19% higher risk of chronic kidney disease, a 9% higher risk of heart failure, and a 7% increase in hypertension cases. These findings suggest that the drug’s perceived safety might need re-evaluation, especially for seniors who are already vulnerable to such health conditions.

"This study shows a significant incidence of renal, cardiovascular, and gastrointestinal side effects in older people who are prescribed acetaminophen (paracetamol) repeatedly in the UK," said lead researcher Weiya Zhang from the University of Nottingham's School of Medicine.

The researchers analysed health records of 1,80,483 individuals aged 65 and above who were prescribed paracetamol more than twice within six months. Their outcomes were compared to 4,02,478 people of the same age group who had never been repeatedly prescribed the drug. The data, sourced from the Clinical Practice Research Datalink-Gold, covered a span of two decades, from 1998 to 2018, with an average participant age of 75.

The study’s authors emphasised the need for caution in prescribing paracetamol as the first-line treatment for long-term conditions like osteoarthritis, particularly in older adults who face higher risks of drug-related complications.

The Nottingham study aligns with findings from a 2016 research published in The Lancet. That analysis, which reviewed data from 76 randomised trials involving 58,451 patients between 1980 and 2015, found that paracetamol failed to provide adequate pain relief or improve physical function in patients with knee and hip osteoarthritis.

"Given its minimal pain-relief effect, the use of paracetamol as a first-line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered," Zhang noted.

While paracetamol continues to be widely used for pain management, these findings suggest that its risks may outweigh its benefits for certain populations. Researchers have called for further studies to confirm these results and explore alternative pain relief options for older adults.