'Indians take Dolo like Cadbury Gems;' doctor’s tweet on paracetamol overuse goes viral: What's a healthy dose?

Paracetamol, a medicine commonly known in India by brand names such as Dolo, is a staple in most first-aid kits. It’s the go-to remedy for everything from fever and headaches to cold and body aches. But over time, this everyday medicine has turned into an overused and often misused drug, with many people developing an addiction towards it.

However, it is not safe to consume these tablets by choice. Moreover, the excessive consumption of these medicines is enough to cause other troubles, including liver disease. A tweet by Dr. Palaniappan Manickam recently went viral for stating, 'Indians take Dolo 650 like it’s Cadbury Gems.' The remark, though humorous, highlights the rampant and casual consumption of paracetamol-based tablets in India. 

Why is dolo used casually?
Dolo 650, a widely used brand of paracetamol, works by reducing the production of prostaglandins, compounds that cause pain and inflammation and by lowering body temperature during fever. Like any other medication, it comes with dosage instructions and warnings. Yet, these are often ignored, and the tablets are taken without consulting a doctor.

In fact, many people consume paracetamol as casually as they would a vitamin supplement, not realising the risks involved. Since it’s readily available over the counter, few pay attention to dosage limits. But excessive or improper use of paracetamol can damage vital organs, especially the liver and kidneys.

When taken under the supervision of a doctor and in the correct dosage, this medicine is generally considered safe. However, self-medicating or relying on advice from pharmacists without a proper prescription is now becoming a worrying trend in India.

What's the healthy dose?
Dolo is available in 500 milligram and 650 milligram tablets, as well as a 1000 milligram injection. The maximum dosage a healthy adult can consume per day is from 1 gram to 2 grams. Paracetamol consumption should be avoided if a person is consuming other paracetamol-containing medicines. Taking more than this, or combining it with other medications that contain paracetamol, can lead to overdosing.

Special care should be taken during pregnancy and breastfeeding, where any paracetamol use must be guided strictly by a medical professional. Overuse during these times can have serious implications -- it may severely impact the liver and will lead to liver disease.

 In about 1–2% of people who exceed the recommended dosage, substances the liver struggles to process enter the body. Over time, this leads to liver damage and affects the kidneys' ability to filter waste.

To put things into perspective, paracetamol-related deaths are not uncommon. In 2021, England and Wales recorded 227 deaths due to excessive paracetamol use. That number rose to 261 in 2022.