Considerations for paracetamol use for musculoskeletal pain
Oral paracetamol is available in immediate-release and modified-release preparations. Modified-release preparations contain an immediate-release component. Both immediate- and modified-release preparations will have a similar onset of effect (approximately 30 minutes), and either preparation can be used for ‘as required’ or regular dosing. Modified-release preparations require less-frequent administration so may be preferred for convenience.
Adults with risk factors for glutathione depletion (eg decompensated cirrhosis, alcohol dependence, malnourishment, cachexia, frailty) may require reduced doses of paracetamol compared to other people. For more information, see Principles of analgesic use in patients with cirrhosis.
Adverse effects of paracetamol are uncommon but dose-related gastrointestinal, cardiovascular and renal adverse effects have occasionally been observed in people taking paracetamol long term.
In paracetamol overdose, metabolite production may lead to severe liver toxicity. Paracetamol poisoning from unintentional supratherapeutic doses is a risk for patients with glutathione depletion; advise patients to consider the paracetamol content of all medications. For more information on paracetamol toxicity, see Paracetamol poisoning: advice for primary care providers.
Patients taking paracetamol should be monitored for treatment response, adverse effects and the ongoing need for treatment. Do not continue paracetamol if there is no benefit or treatment is harmful. In patients taking paracetamol on an ongoing basis, periodically consider a trial of treatment cessation.