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The WHO guidelines recommend prompt oral administration of drugs ("by the mouth") when pain occurs, starting, if the patient is not in severe pain, with non-opioid drugs such as paracetamol (acetaminophen) or aspirin, [1] with or without "adjuvants" such as non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors.
Paracetamol poisoning can occur accidentally or as an attempt to die by suicide. Risk factors for toxicity include alcoholism, malnutrition, and the taking of certain other hepatotoxic medications. [1] Liver damage results not from paracetamol itself, but from one of its metabolites, N-acetyl-p-benzoquinone imine (NAPQI). [6]
Pain following surgery can be significant, and many people require strong pain medications such as opioids. There is some low-certainty evidence that starting NSAID painkiller medications in adults early, before surgery, may help reduce post-operative pain, and also reduce the dose or quantity of opioid medications required after surgery. [29]
Codeine/paracetamol, also called codeine/acetaminophen and co-codamol, is a compound analgesic, comprising codeine phosphate and paracetamol (acetaminophen). Codeine/paracetamol is used for the relief of mild to moderate pain when paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, aspirin, and naproxen) alone do not sufficiently relieve symptoms.
Naproxen should be taken orally with, or just after food, to decrease the risk of gastrointestinal side effects. [24] Persons with a history of ulcers or inflammatory bowel disease should consult a doctor before taking naproxen. [24] In U.S. markets, naproxen is sold with boxed warnings about the risk of gastrointestinal ulceration or bleeding. [1]
Paracetamol (acetaminophen) class antipyretics, which have negligible anti-inflammatory activity. Apart from paracetamol itself, the medications in this class are mainly previously marketed drugs which were withdrawn owing to safety concerns, one example of this being phenacetin. A few other medications have antipyretic effects of varying strength.
The pain medication paracetamol (acetaminophen) is the first line treatment for osteoarthritis. [ 61 ] [ 94 ] Pain relief does not differ according to dosage. [ 62 ] However, a 2015 review found acetaminophen to have only a small short-term benefit with some concerns on abnormal results for liver function test . [ 95 ]
NAPQI, also known as NAPBQI or N-acetyl-p-benzoquinone imine, is a toxic byproduct produced during the xenobiotic metabolism of the analgesic paracetamol (acetaminophen). [1] It is normally produced only in small amounts, and then almost immediately detoxified in the liver.