Paracetamol

Paracetamol (acetaminophen) has a central action, probably by inhibition of cyclooxygenase-3 (COX-3). Unlike other NSAID it does not induce gastrotoxicity, renal function impairment, or antiplatelet effects. Paracetamol is well-absorbed by oral route, it is metabolized by glucuronization, and excreted in urine. It may be oxidized by cytochrome P450 2E1 to a highly reactive metabolite, responsible for its hepatotoxicity in overdose (10-15 g or 150 mg/kg). Doses used in adults are in the range 500-1000 mg/6-8 h, with an excellent safety profile. It is recommended for use as pure analgesic (rheumatic or neoplastic chronic pain), in those patients in which NSAID are contraindicated by history of gastrointestinal hemorrhage, hypersensibility, NSAID-induced gastric lesions, renal disorders, or concomitant treatment with anticoagulant drugs, in elderly or polimedicated patients, and in pregnancy. Paracetamol is an efficacious and safe treatment for pain and fever, and remains the treatment of choice due to its profile of pharmacologic activity, efficacy, safety, convenience of use and cost.