Talk:Paracetamol/Archive 2

Mechanism of Action section too academic-y?
I mean wow, it reads like some review article. I imagine most people who browse wikipedia just want to know what the darned drug *does*, not get embroiled into some academic debate about COX-3 hypothesis. If I wanted to learn more about that, I'd go to pubmed. So anyways, added a couple of paragraphs to the beginning of it so the average joe can get the big picture. Yeah, I do realize this used to be a featured article and all, but just thought this was an aspect that could be improved upon. But feel free to revert if you guys have different opinions on this :) —Preceding unsigned comment added by Subclavian (talk • contribs) 11:12, 11 March 2009 (UTC)


 * I think its just that way because people are confused as to if its an NSAID or not, with all the press about NSAIDS...

Generally the pharmacological and pharmacokinetic sections of articles pertaining to drugs are for the pharmacologically savvy and enthused as it's not likely someone on the contrary would entertain themselves to as food for thought.

My point in writing here forever is that the mechanism of action is the most atrocious and horrendous written from a pharmacology standpoint I've ever witnessed and read from Wikipedia in the entirety that I've used it, out of hundreds and hundreds of drugs I've read and looked up as a pharmacologist. The majority of the information is anecdotal and unfounded, vague, needing clarification or just, unreliable and completely inaccurate. Because of this, at best, grossly inaccurate and spotty writing I've made sure to browse through some of the alleged citations to see if they're from poorly unreliable sources (which many I found were) or even contained within the article text, and not to my surprise did not support or include the subject matter. Therefore, this section needs immediate clean-up and anyone with any knowledge or degree's that pertain or are specifically geared towards pharmacology or similar fields with expertise or considerable knowledge, please take a moment to help clean up this page to meet or even come close to Wikipedia's standards. —Preceding unsigned comment added by Pharmakon logy (talk • contribs) 07:48, 18 January 2010 (UTC)

Section Deletion
Removed the section on 'Paracetamol Toxicity', because I havent the time to research and correct it right now but this line seemed nonsensical, confusing, and suggested the information might be dangerous: ''The toxic dose of paracetamol is highly variable. In adults, single doses above 10 grams or 200 mg/kg, which ever is lower, have a reasonable likelihood of causing toxicity.'' —Preceding unsigned comment added by 82.34.245.10 (talk) 23:15, 13 September 2008 (UTC)
 * Uh except for the part where its an issue even if you don't believe it, because of so many other predisposing factors that effect a lot of things - like the fact that a lot of adults like to consume a lot of ethanol for recreational purposes entirely too often... Glutathione depletion can result from alcoholism, not to mention the two drugs don't interact nicely to start with... and that's just scratching the surface.Zaphraud (talk) 18:18, 19 March 2009 (UTC)

Synthesis
"In the laboratory, paracetamol may be easily synthesised by the reaction of 4-hydroxybenzoic acid and ethanamine." This cannot be so! The reaction between an aromatic acid and an amine does give an amide, but not this one! So I changed it.

Sodium borohydride will NOT reduce a nitro group to an amine group! The correct synthesis is to use H2/Pd (source Organic chemistry, Claden et al page 569). —Preceding unsigned comment added by 92.27.52.88 (talk) 02:11, 9 April 2010 (UTC)

Mechanism
Can I point out that this gives too much emphasis to the incorrect COX-3 hypothesis, and that the analgesic effect has been shown by Ottani A et al 2006 to be solely due to its pro-drug effect on the CB1 receptor, and that concentrations required to inhibit COX-1 would be far higher than the theraputic dosage. Also, does anyone know the chemical structure of N-arachidonoylphenolamine, the active form?


 * I agree that there may be some over-emphasis into the COX-3 hypothesis. Though I may point out that more studies should be cited before making too many changes to the section. Info from one study alone is insufficient due to the fact that many studies often show conflicting results.--Metalhead94 (talk) 21:47, 4 November 2008 (UTC)

In addition, the role of any COX inhibition with acetaminophen is overemphasized. Predominant thought regarding acetaminophen is that it's clinical effects are largely independent of any COX (1,2, or 3) inhibition. This is plainly stated in many of the most recent pharmacological texts such as Golan's Principles of Pharmacology. The CNS effect of acetaminophen seems widely debated with many competing theories, several of which lack any mention of COX. --128.252.11.235 (talk) 18:23, 1 September 2010 (UTC)

No Side-effects and Age.
I believe that one should mention side-effects (as opposed to toxicity), even if one had the courage to say "no-one has ever had side-effects from this drug" - which is anyway the deduction a reader may make from this article. Patients taking paracetamol can complain of abdominal pain, and of sleepiness, but these have not been linked to paracetamol as such. One wonders whether people really bother to look for these - the drug is sort of "as everyone knows" safe? I recently (past year at least) read a review saying that the recommended dose for paracetamol in the aged (80-95 years) is now 3g/24h. As I recall it had to do with unexpectedly rapid decline in renal function or increase in liver enzymes at 4g/24h, but I cannot find the reference now. Has anyone else seen it? --Seejyb 23:17, 9 August 2006 (UTC)

Paracetamol has very few confirmed side effects, some would go so far as saying none in theraputic doses. The 4000mg/day dose is still accepted by the regulatory authorities of the US, European Union, UK, Australia, Canada and virtualy all other countries. There seems to be a degree of paranoia, especialy in the US, regarding toxicity, which in normal doses in normal patients, is rare.

121.209.52.159 (talk) 03:30, 2 March 2010 (UTC)Jonathan

Merge proposal with Paracetamol poisoning
Anon editor made good observation on the Paracetamol poisoning article (I've copied across the observation and adjusted tags onto both articles):
 * Information on overdose in the Paracetamol article seems to be more thorough and accurate.
 * —Preceding unsigned comment added by 12.33.232.124 (talk • contribs) 18:58, 24 July 2006

The Paracetamol poisoning does indeed seem to be a poor duplication of what is currently on Paracetamol. The options are I think:
 * 1) Delete Paracetamol poisoning, moving across anything that needs be retained or
 * 2) Split Toxicology off from Paracetamol to replace/improve on Paracetamol poisoning; leaving just short paragraph or two with a linking tag of:  David Ruben Talk 14:53, 19 August 2006 (UTC)


 * Agree with merger of paracetamol poisoning into paracetamol article. On the other hand, paracetamol poisoning is a distinct enough entity in and of itself that a separate article could probably be stand on its own as well.  Andrew73 14:47, 19 August 2006 (UTC)
 * Paracetamol poisoning ought to be merged, as that is the main encyclopedic subject. Paracetamol is not currently bloated or unwieldy. —Centrx→talk • 17:29, 21 August 2006 (UTC)

I've merged the articles. As stated above, there didn't appear to be many differences between the two articles. --Uthbrian (talk) 07:47, 28 August 2006 (UTC)

Panadol availability in the US
The article notes the locations in which various brands are sold; Panadol, while sometimes difficult to find, is available in the US. In cities with sizeable Hispanic populations (at least as far north as Indiana), certain stores (notably Walgreens and Wal-Mart) carry Panadol, presumably because of its popularity in Latin America. I'm not sure if I should add the US to Panadol's availability list, since its popularity is considerably less than Tylenol. Suggestions? Perhaps add the US to the list and note that availability is limited? Student Driver 20:15, 2 September 2006 (UTC)

Brand names
is the "brand name" section that has just been added really necessary? If i recall, the drug is available generically worldwide, so there is little to no point putting a list of the possible brands, and just adds more confusion to an allready long article. I'm reverting back to the old version for the moment.

In Hong Kong the brand name panadol is used. However the substance is called acetaminophen. I changed the line about Canada and the USA. "Only in the United States, Canada and Hong Kong is paracetamol known as "acetaminophen".[9]" Source: This is what I see on teh shelf in the stores. —Preceding unsigned comment added by 210.0.205.213 (talk) 02:59, 28 October 2009 (UTC)

PT/INR and paracetamol
There is a know interaction between tylenol and PT/INR blood clotting times. It is no where near the level of NSAIDs but persons on warfarin therapy should not read the article and believe it is safe to take tylenol as it can increase clotting times substantially. I changed to articles to reflect this. Comment? --Tbeatty 05:02, 21 September 2006 (UTC)


 * This is only true when using paracetamol in large doses over an extended period of time. I have never heard of a clinically relevant effect when using normal doses. Do you have any references for this? --WS 07:47, 21 September 2006 (UTC)


 * Usually its a max of 2 extra strength tylenol (500mg) per day, and a max of 8 per week, unless the patient is taking a medication containing apap daily, in that case dosing of the warfarin will be adjusted. --eLeigh33 00:39, 4 April 2007 (UTC)

Paracetomol in cats and dogs
Although paracetomol is highly toxic in cats as stated, it can be and is used safely in dogs at the correct dose of 10mg/kg twice daily, in fact there is a paracetomol product (Pardale-V) which has a product licence for use in dogs and has been on the market for decades. This section of the article as it stands is misleading and has led to unnecessary worry on the part of dog owners as it contradicts veterinary advice. I propose to edit the paragraph accordingly.--Vetedit1982 22:05, 6 October 2006 (UTC) The cited link to noahcompendium for pardale is dead. I will therefore delete it and amend the article.

Naming Conventions
I have noticed some confusion among pharmacy patients about the information available on the internet concerning paracetamol/acetaminophen. It is usually due to the, often undefined, interchangable use of the two names. I would like to encourage the use of the abbrevation APAP (which is does not have a second version) when referring to the drug when the other names are not defined on the page. Thank You. --Matt 161.45.236.217 17:54, 2 November 2006 (UTC)
 * There are policies on the wikipedia defining the naming of the articles. For drugs the naming is in general the INN name (which is in this case paracetamol, hence the article is on this page).  If you think there are things to clarify, then I would recommend that a section about the naming is added, with an explanation aimed at resolving the confusion.  APAP can be created as a redirect to the INN name of paracetamol, in general it is discouraged to use the abbreviation as the main name of the article, since there may be other uses for the acronym.  I hope this clarifies.  --Dirk Beetstra T  C 22:11, 2 November 2006 (UTC)
 * I understand that the use of names is usually standardized on Wikipedia, which has been fairly good about providing information to paitents. (Although the whole truth sometimes causes some fear, but that is expected and easily dealt with.) I really was suggesting the use in all cases on the internet, not just here. I just want to make sure that paitents don't get the naming conventions confused with another drug. We had a woman recently who had some liver damage because she read that her medicine contained Paracetamol, so she reasoned that she could take here usual tylenol for her pain (4tabs) She was lucky.  Personally, I think that we should only use one name, and I don't care which one, but I'm not in the position to change anything.Matt 161.45.237.73 15:45, 20 November 2006 (UTC)
 * The problem is that we are not in a position to use more than one name for a given drug. While we try to set up redirects as far as this is possible, the article has to be stored at a single place on the servers. Equally, Wikipedia does not give medical advice: we summarize published material on certain compounds which happen to be used as drugs, which is rather different. A change in the article name would make this information harder to find for many users. Physchim62 (talk) 17:42, 20 November 2006 (UTC)
 * I disagree with using the name "paracetamol" without "acetaminophen" simply because acetaminophen is almost never called paracetamol in the United States although it apparently is in the UK. We are writing an encyclopedia for the masses, so restricting ourselves to just standard INN names is really an ivory tower kind of exercise that only a chemist might appreciate.  I therefore propose that the title be changed to "paracetamol or acetaminophen" —The preceding unsigned comment was added by Woodcore (talk • contribs) 14:00, 9 January 2007 (UTC).
 * For a comparison, see Gasoline and Talk:Gasoline, where a consensus was reached to title the article "Gasoline" and to stick to that word in the article text, except in the introduction. Paracetamol presents a more difficult problem because speakers of different varieties of English usually are not familiar with both forms (whereas most people probably know both gasoline and petrol), but I think the principle holds. Sticking with one form also makes the article more readable. As long as there are appropriate redirects/links (as there are here from Acetaminophen and APAP), and all well-known names are covered in the introduction, I think that sticking with a single term for the bulk of the article makes it markedly better. There is more info at WP:Naming. I also want to clarify some points about my Gasoline example: (1) the point is not that the US term should be preferred; (2) one point is that the article should have a single name, and forms like Gasoline or petrol and Petrol (Gasoline) are strongly discouraged; (3) the other point is that the article title is decided by consensus, usually right here on the talk page. I have also raised this issue from the perspective I've just outlined in a topic below. --Tkynerd 15:44, 9 January 2007 (UTC)

I don't understand why the article can't simply be named para-acetylaminophenol with paracetamol, acetaminophen, and tylenol all redirecting to that. That's the actual name of the drug, it's not that difficult. —Preceding unsigned comment added by 66.83.10.146 (talk) 14:30, 2 July 2009 (UTC)

U.S. recall of generic paracetamol
I have moved the note added by to the top of the article into a separate section. IMHO this is a notable incident which merits inclusion in the article, although I am unsure as to the future permanence of this section — perhaps a "Notable incidents" section could be created, with a short note on the 1982 Chicago Tylenol murders as well. Comments and criticism are more than welcome. Fvasconcellos 14:05, 14 November 2006 (UTC)
 * Recalls like this are not really the stuff of Wikipedia until after the event: we are supposed to be an encyclopedia and not a news service. Physchim62 (talk) 15:25, 14 November 2006 (UTC)
 * I agree; I, however, chose to keep the information because a) I am wary of removing others' contributions when they are made in good faith and are neither damaging nor misleading, and b) it's a fair assumption that people (particularly in the U.S.) may be turning to Wikipedia for information regarding this incident. Maybe it should indeed be removed, and re-added later if it's still worth it? Fvasconcellos 16:17, 14 November 2006 (UTC)


 * Thanks for the note Fvasconcellos.
 * I'm the one who put it in. My reasoning was threefold: (1) we do sometimes document current events (for example, US hurricanes), (2) people may turn to Wikipedia for information about this event, and (3) it's a piece of information that could help our users.  If Wikinews appeared to have an article, perhaps a link to it would be most appropriate, but I couldn't find one.  My opinion is that for now it seems appropriate to at least leave the information somewhere in the article.  It can be removed with time when it is less relevant.  --zandperl 21:05, 14 November 2006 (UTC)


 * Update: I am removing the section. Nearly two months have elapsed, and there seem to have been no notable consequences; I therefore think the section is in fact not notable enough to remain in the article. If anyone objects, it will still be in page history for future reference. Fvasconcellos 13:56, 3 January 2007 (UTC)

Paracetamol in Australia
Just pointing out that Paracetamol in australia is commonly known as 'Panadol' rather than 'Herron'. Should I change the intro? --Gunny01 05:19, 1 December 2006 (UTC)
 * The list of trade names should probably be sorted into alphabetical order. Herron is still a trade name for Paracetamol in Australia (although we may possibly be spam victims given the promenance of the name). Physchim62 (talk) 17:43, 1 December 2006 (UTC)


 * I fail to see, on evidence of http://www.herron.com.au/products/analgesics/analgesics.html that Herron is specifically a trade or brand name for Paracetamol. As the link clearly shows, Herron seems to be used as a trading name for the company, i.e. name of a product range which includes paracetamol and ibuprofen, hence "Herron Paracetamol" and "Herron Blue Ibuprofen". Compare to their laxative products http://www.herron.com.au/products/laxatives/laxatives.html for which "Sennetabs" and "SenneSoft" are brand names. Hence is not Herron merely just a generic paracetamol manufacturer and so inappropriate to list in the introduction's collection of branded products ? Conversely the US Tylenol or UK Panadol ranges all contain paracetamol. However, not living in Australia, I am not aware how notable Herron is in terms of market share, primacy by dates of marketing in Australia, or of the common usage of the term "Herron" (maybe is is perceived by the Australian public as a synonym, eg as "Kleenex" is for tissues or "Hoover" for vacuum cleaner). David Ruben Talk 02:38, 10 December 2006 (UTC)


 * I've removed Herron as a brand name in Australia and added Australia to the Tylenol list. Herron is a manufacturer of many products, one of which is "Herron Paracetamol" (Mollwollfumble 01:45, 13 December 2006 (UTC))


 * Problem is no one in Australia calls it Tylenol. Ask for Tylenol in Australia and you'll get a strange look. Panadol is the common name for Paracetamol. In australia, Panadol is to Paracetamol as Hoover is to vacuum cleaner, etc etc. It's a generic name. Gunny01 22:55, 14 December 2006 (UTC)

"In Australia, the limits appear to be 24 and 100 tablets respectively." This information ought to be verified, or if it cannot be, removed. "appear to be" implies uncertainty and unverifiability. To quote the warning directly below this editing box, "Encyclopedic content must be attributable to a reliable source. " Glacialfury 23:19, 3 April 2007 (UTC)

24 is definate, 100 i've never seen a bigger pack, but who has that much pain

i swapped 24 and 100 round. even if it's not properly verified, it made no sense the other way around Snappyfool 10:21, 4 May 2007 (UTC)

Two issues about this article
(1) Given that Wikipedia standards require that the INN name (here, paracetamol) be used as the name of the article, shouldn't that name also be used consistently throughout the article? Some passages use the name acetaminophen. I could be bold and fix this, but this is my first trip to this article, and I'd prefer to see if there is any consensus on this first.
 * Go ahead. The name acetaminophen is defined in the first sentence, as guidelines require, but in the text of the article we should only use paracetamol. Physchim62 (talk) 16:06, 9 January 2007 (UTC)
 * Done. I only changed it in a few places where it seemed appropriate; there are one or two places in the article body where it seemed appropriate to leave "acetaminophen." I also had to be careful not to change the titles of any of the referenced articles! :-) --Tkynerd 18:26, 9 January 2007 (UTC)

(2) I find the following passage confusing: ''However, there are important differences between the effects of aspirin and those of paracetamol. Prostaglandins participate in the inflammatory response which is why it has been known to trigger symptoms in asthmatics, but paracetamol has no appreciable anti-inflammatory action and hence does not have this side-effect.'' What, exactly, is it that "has been known to trigger symptoms in asthmatics"? I suspect aspirin is what is referred to, but I don't know for sure; in any case, the passage as it stands is difficult to understand. --Tkynerd 00:46, 9 January 2007 (UTC)
 * The whole section needs rewriting, with a little less speculation. Physchim62 (talk) 16:06, 9 January 2007 (UTC)
 * That's not me. I'm no scientist. :-) I would like to see it clarified, though. --Tkynerd 18:26, 9 January 2007 (UTC)

Considered safe
I modified the word "safe" to "considered safe." (The actual phrase conventionally used is "generally considered as safe.") Geoffrey.landis 14:50, 24 January 2007 (UTC)

Proposal
How do people feel about taking the Metabolism paragraph and moving it above Mechanism of Action since then it would be easier to merge Mechanism... with Comparison with NSAIDS -- those two sections repeat each other quit a bit, and the possibility of liver toxicity I would think should be added in the Comparison... paragraph (just as a sentence, as the Toxicity section otherwise gets into liver metabolism, but a good comparison with nsaids... maybe take the sentence from further down about nsaids being recommended over apap for hangovers). If Physchim62 or others could list some of the stuff that sounds too speculation on Talk then we could root those out while merging/clarifying those paragraphs. Gaviidae 18:49, 29 January 2007 (UTC)

Narrow therapeutic index?
This diff shows where I reverted edits by an anon asserting that paracetamol actually does not have a narrow therapeutic index. I find it difficult to believe this is true, considering the review process this article has been through, but I wanted to bring up the issue here for discussion. (Leaving aside the fact that the anon took it upon himself to E-mail me -- not through Wikipedia, either -- to take issue with my revert. Also, the anonymous edits were unsourced, which was the main reason I chose to revert them.) I would recommend that someone explain here in detail exactly WHY paracetamol is said to have a narrow therapeutic index. Thanks. --Tkynerd 23:48, 30 January 2007 (UTC)


 * The therapeutic index is defined as the TD50/LD50. This means that the dose required to reach a toxic level in 50% of subjects divided by the dose that is effective in 50% of subjects.  For obvious reasons these kinds of tests are most commonly done on rats.  The closer this number approaches 1 the more narrow the therapeutic index occurs.  If the therapeutic index is 1 then the drug will become toxic at the same dose that it becomes effective at.  The FDA web site defines having a narrow therapeutic index as having a therapeutic index of less than 2-you may go there and search therapeutic index to verify this information(http://www.fda.gov/cder/news/ntiletter.htm).  That is, the toxic dose is less than 2 times the therapeutic dose.  Also, the FDA website lists acetaminophen as a "safe and effective drug" (http://www.fda.gov/fdac/features/2003/103_pain.html).  With some simple math it becomes obvious that acetaminophen does not have a narrow therapeutic index.  In the wikipedia article the toxic dose is suggested to be 10g or 150mg/kg body weight.  It also says that if taken chronically at 4g/day toxicity could occur.  Given that we know that the effective dose is about two tylenol tablets-for headaches (1000mg or 1g) and the effective dose for more severe pain is about two perscription tablets (1600mg or 1.6g) we can now divide the suggested toxic dose by the effective dose.  Even at best, (4/1.6) we still do not get a ratio of less than 2, so acetaminophen does not have a narrow therapeutic index.  By the way, the recommended does of acetominophen suggests not going over 4g in 24 hours on the side of every bottle, which could be considered overdoseing.  The FDA also recommends not overdosing or liver damage could occur.  The fact that liver damage could occur at less than 4g a day is a side effect of the drug and does not cause the therapeutic index to shrink-every drug has a side effect.  The fact is that in the wikipedia article the therapeutic index is called "narrow" under the toxicity heading, which implies that it is dangerous because the effective dose is very close to the toxic dose.  The truth of the matter is that acetaminophen is a very safe drug.  If the therapeutic index was narrow it would be not be perscribed to pregnant women, children, elderly, or anyone for that matter who didn't seriously need it.  Citation 9 in the article discuss the overdoes problems not that the therapeutic index is narrow, and the fact that the UK and Ireland don't sell it over the counter doesn't mean that the therapeutic index is narrow either.  For example, antibiotics in the US don't necessarily have a narrow therapeutic index, but perscriptions are still needed to obtain them.  This portion of the article makes acetaminophen sound like a deadly drug and is very misleading, especially because it doesn't have a narrow therapeutic index.  It should be altered.--William mcfadden 05:12, 31 January 2007 (UTC)
 * It doesn't have a narrow therapeutic index. —Preceding unsigned comment added by 67.166.96.147 (talk • contribs)
 * Maybe for prescription medication, the therapeutic index must be lower than 2 to be considered narrow, but for OTC medications, or worse yet, medications which anyone can buy off the shelf at any corner store, the therapeutic index should be significantly higher than 2 to be considered safe. For decades Tylenol has been pandering acetaminophen as much more safe than any other painkiller and doctor recommended.  Recent studies prove otherwise.  BTW, liver damage is a very serious "side effect".  I hope you're not trying to compare liver damage to side effects like nausea, dry mouth, constipation or drowsiness!   --Thoric 16:08, 31 January 2007 (UTC)
 * Side effects
 * I am merely trying to distunguish between what a side effect and toxic effect of a drug are. A generic definition could be that side effects occur at any concentration of the drug, but a toxic side effect only comes into play when too much of a drug is given.  The side effects of a drug don't effect the therapeutic index because they are present at therapeutic dosing levels.  Liver damage can occur with overdosing when the metabolic products of acetaminophen overcome the systems ability to handle them; but to reach the level needed to produce toxicity, there would need to be a lot taken. Perscription drugs only give a higher dose of the drug, which doesn't change the fact that toxic side effects are seen only on overdose or large doses.  The perscription drugs, because they are given in a higher dose, are much easier to overdose on.  BTW, the therapeutic index for acetaminophen is much larger than 2.  In fact, it is much higher.  I merely used 4g in the calculation above because the article states that 4g/day is the lowest dose that could cause toxic side effects in chronic users.  The article states that the narrow therapeutic index is causing overdosing and toxic problems.  That isn't true.  The commonality of the drug makes it easy to overdose on without knowing it.  Without a doubt all drugs that have a narrow therapeutic index will be perscription, but even drugs that have a broad therapeutic index can be perscription, mostly because they are given in high doses-like acetaminophen.  Common overdosing of acetominophen is caused by naive suicide attempts or because a person is taking too many medications that contain acetaminophen.  Given that the drug is commonly used in a lot of medications it is easy to overdose on; however, the therapeutic index is still the same-wide.  It still takes a lot of acetaminophen to become toxic, much more than a therapeutic dose, which means that the therapeutic index isn't narrow.  The recent articles on acetaminophen are describing what can happen when overdose occurs.  It is fairly recent knowledge that acetaminophen can cause liver damage, but the key word here is "overdose".  The articles aren't saying that acetaminophen is dangerous at therapeutic doses-quiet the contrary.  It is a vary safe drug at therapeutic doses, but as soon as you reach a toxic level it isn't so safe anymore.  Fortunately we know that acetaminophen has a therapeutic index that is fairly large.  This still means that the therapeutic index is not narrow.  Even if extremely low doses were associated with liver damage, it would be considered a side effect and not a toxic effect, which means it wouldn't affect the therapeutic index.  Side effects can be anything that a drug causes at therapeutic levels-including serious side effects.  The article should say that the therapeutic index is large, but the commonality of the drug make it easy to overdose on; this can lead to liver damage.--William mcfadden 19:40, 31 January 2007 (UTC)

I have edited out the portion that says that paracetamol has a narrow therapeutic index. The original article had no reference for this claim. The article that was sighted shortly after looks at the potential for overdose and does not indicate that the drug has a narrow therapeutic index. The article was never used to as a citation that said that paracetamol has a narrow therapeutic index anyway. I have not listed a citation because I added no claim to the article and did not say that it has a wide therapeutic index. However, it has become clear, from the above, that it doesn't have a narrow therapeutic index and this should not be in the article. It would be nice if someone would look up a citation for this.--William mcfadden 21:11, 5 February 2007 (UTC)
 * It's not at all "clear from the above" that paracetamol does not have a narrow therapeutic index. There is no consensus on this point. I'm reluctant to revert your edit, although I'm tempted to do so, but you should do so yourself, since the edit concerns a controversial point on which there is no consensus yet. --Tkynerd 21:58, 5 February 2007 (UTC)

I have taken out the controversy. I have not claimed that paracetamol has a wide or a narrow therapeutic index in my edit. The previous article claimed a narrow therapeutic index with no citation. If it is in fact a controversial point in your eyes then no claim should made, and I have changed the article to reflect that. If Tyknerd is right about the controversy, reverting my edit would be staking a claim in an un-source claim that is controversial. Recent articles claim new evidence of toxcity based on the wide availability of paracetamol; they in no way claim a narrow therapeutic index. Even if side-effects are discovered, a side-effect doesn't change the therapeutic index at all! Again, if you have had background in pharmacology, then it would be very clear from the above that paracetamol does not have a narrow therapeutic index. I would refer you to the FDA pages as a reference. Just as a side note, Harvard recently produced a new textbook for medical students on pharmacology. If this book is not consensus, I don't know what is. It says that acetaminophen is very safe, but the common nature of it makes it easy to overdose on. It is not a controversial point. I leave the reference out because most people don't have the physiology background to just start reading this book, but to satisfy the needs of anyone who thinks it is controversial, I have made no claim.--William mcfadden 22:25, 5 February 2007 (UTC)


 * You didn't take out the controversy; you took out what YOU thought was controversial. It was explained above that the ratio below which a drug's therapeutic index is called "narrow" is much higher for OTC drugs. Your response ("Perscription drugs only give a higher dose of the drug") applies only to different dosage levels of the same drug, not to different drugs. Again, you need to revert your removal of this information until consensus is reached. --Tkynerd 23:48, 5 February 2007 (UTC)

Okay, first of all, the therapeutic index DOESN'T CHANGE whether the paracetamol is given OTC or by perscription. However, the potential for toxic overdose is much higher with higher dosages being taken. I think where you are making an error is that if you get paracetamol in Tylenol or if you get it in a straight perscription form it is still exactly the same! The name of the brand doesn't change the drugs chemical structure, so we want the information to apply to different dosing levels not different drugs (it is all the same chemical structure). You would know this if you had a background in pharmacology. Tkynerd claimed "I am no scientist" in the above comments. It makes it clear that you have no idea what you are talking about when it comes to pharmacology. If you want to stake a claim that a narrow therapeutic exists please source your information, and there still has not been a citation for paracetamol having narrow therapeutic index. The only controversy is that you think it is controversial, and you don't have a source or a leg to stand on. Secondly, I have made not claim in the article, and until you can get some sources claiming a narrow therapeutic index you are entering faulty information. You asked for an explaination of a narrow therapeutic index, and no one can give one for paracetamol because it doesn't exist. I have played your little game and still you are unhappy about more accurate edits. You watch this paper like a hawk and you don't allow updates from people more experience than you. It is people like you that keep wikipedia from becoming accurate and prevent me from being able to use it as a viable source in any collegic paper. I feel you have done nothing but belittle me over something you know nothing about. I really don't think you understand therapeutic indeces or have ever studied them, so until you get a PhD, MD, can source something or prove something please stop asking me to revert my edits based on no data.--William mcfadden 05:51, 6 February 2007 (UTC)


 * References to paracetamol/acetaminophen having a low/narrow therapeutic index:      --Thoric 06:13, 6 February 2007 (UTC)

Thoric- these references don't say it has a narrow therapeutic index. I have read all of them, and it only indicates risks of acetaminophen. In fact references 3 says "However, unlike the classical NSAIDs such as aspirin or indomethacin, therapeutic doses of paracetamol do not damage the stomach." Reference 6 says "anti-inflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce the risk of serious upper gastrointestinal complications", which is a given because you don't want to reach toxic doses. Do you think that this paper would even suggest giving the drug in non-life threatening situations if it had a narrow therapeutic index? NO. None of these articles stake the claim that there is a narrow therapeutic index they only are speaking about problems that might exist. These references don't claim the therapeutic index is narrow.--William mcfadden 07:12, 6 February 2007 (UTC)


 * You read all of them? The second one says, and I quote, "It has been suggested that the therapeutic index for paracetamol may be as low as 1.7", and cites references to back up that claim.  How about reading those references again?  --Thoric 18:20, 6 February 2007 (UTC)

Keep in mind that it says "suggested" and "may be" these in no way establish a narrow therapeutic index. As I have said, these references talk about problems that might exist not those that do exist. The author is in no way saying with absolute certainty that a narrow therapeutic index exists, but it has been suggested. I stand by my previous comments. Additionally, the study is in children not adults and says that reports of liver toxicity from paracetamol are rare. The Google scholar has cited a reference having a narrow therapeutic index in alcholics, but it also says that damage from it can vary. This could indicate a narrow therapeutic index for alcoholics, but I am not convinced that it applies to healthy adults. If so, as cited above, I don't think the FDA would list it as "safe". Again, no claim in the article has been made about therapeutic indeces. If you would like to add a sentence saying that paracetamol has been suggested as having a narrow therapeutic index in children and alcoholics, but the FDA lists it as a safe and effective drug at therapeutic levels, by all means do so.--William mcfadden 18:50, 6 February 2007 (UTC)

Google Scholar shows
One swallow does not a summer make and this is a published letter in a reputable journal, not a refereed paper. Still, seems like there's enough support to note the claim, perhaps with qualificationn. The clear point of the letter seems to be that doctors shouldn't perscribe paracetamol to alcoholics. David.Throop 14:23, 6 February 2007 (UTC)
 * "It is well known that acetometaphen has a narrow therapeutic index and the potential for hepotoxicity can vary greatly among individuals, depending on the clinical environmental situation."
 * "It is well known that acetometaphen has a narrow therapeutic index and the potential for hepotoxicity can vary greatly among individuals, depending on the clinical environmental situation."

This document(in Finnish) claims that a few studies have shown that for others than chronic alcohol users, alcohol would in fact protect the liver from paracetamol's adverse effects. This seems to contradict the beginning of the article, which says: "[Paracetamol] is considered safe for human use at recommended doses; however, acute overdose can cause potentially fatal liver damage. The risk is heightened by the use of alcohol." The studies referred to are given as "DrugDex. Micromedex. 2002.", "Riordan and Williams: Exposure and paracetamol-induced hepatotoxicity. Hospital and University of New South Wales, Sydney. Medline. 2002." and "Schmidt, Dalhoff, Poulsen: Acute versus chronic alcohol consumption in asetaminophen-induced hepatotoxicity. Hepatology 35 (4). Abstract. Medline. 2002." Could someone more familiar with the subject look into this? Hirvinen (talk) 00:19, 17 July 2008 (UTC)

Obsolete?
User:The Right Honourable has just removed the British Approved Name, the INN and the USAN from the infobox, describing them in an edit summary as "obsalete" [sic]. Is there any basis for this? In what sense are they obsolete? --Tkynerd 04:43, 10 February 2007 (UTC)
 * I believe he is referring to this discussion, which hasn't gone too far. Fvasconcellos 14:25, 10 February 2007 (UTC)
 * OK. Then "obsolete" isn't really the right term; maybe "premature" would have been more appropriate? :-) In any case, I assume the template will be sorted out in due time, and with it the version carried by this article. Thanks. --Tkynerd 14:31, 10 February 2007 (UTC)

Synthesis
As this is an article on a chemical, shouldn't it include one or more total synthesis of the compound as is customary on other articles on chemicals? There should also be descriptions of industrial synthetic pathways. Loom91 06:00, 21 February 2007 (UTC)

This article http://www.chemsoc.org/pdf/LearnNet/rsc/paracetamol.pdf from the Royal Society of Chemistry explains the process of making it in the lab, nothing really about manufacture in industry, I would write it up, but I really don't quite feel qualified enough since I'm just a first year 6th form student. I may do my best at some point, but no promises.

mbree 08/07/2007 16:11

Acetaminophen
Does amoxicillin have a reaction with acetaminophen? --myselfalso 00:28, 22 February 2007 (UTC)

Not at all! Hope that answers your question. 82.32.203.68 11:04, 19 March 2007 (UTC)

Passing through system
How long does it take for acetaminophen to pass through one's system? If one were to take four capsules during the day, and then hours later at night decide to have a few drinks, is there still a risk factor for toxicity? Altamer 02:15, 4 March 2007 (UTC)

it's half life is 1-4 hours so i doubt a few drinks would hurt you.

toxicity only occurs above 4 grams, that's 8x 500mg pills. with stomach problems try to avoid paracetamol, it won't help! if your already taking 4 per day you should really be going to a doctor Markthemac 00:14, 17 June 2007 (UTC)

name differance
could we have a page for names of pharms which have different names in UK and US —The preceding unsigned comment was added by The Right Honourable (talk • contribs) 07:41, 4 May 2007 (UTC).

The History of paracetamol
I think it might be interesting for the article to discuss the work of professor Kussmaul in 1880 using acetanilide, not paracetamol, which led to the discovery of it's antipyretic properties - which then led on to the discovery of dirivitives which include paracetamol.

I say this just because the story is interesting and would be beneficial to the article.

I source my information from the Royal Society of Chemistry student document on Paracetamol, which can be found here: http://www.chemsoc.org/pdf/LearnNet/rsc/paracetamol.pdf

It states:

'' At the University of Strassburg in the 1880s Professor Kussmaul, of the Department of Internal Medicine, asked two assistants to give naphthalene as a treatment for intestinal worms. The medicine had little effect on worms, but one patient had a great reduction in fever temperature. It was found that this patient had, in fact, been given acetanilide instead of naphthalene due to a mistake at the pharmacy!''

If you read further, it explains the need for a better drug to be obtained due to it's bad side effects, this was the basis of the necessity for paracetamol to be discovered, and in this way it is quite relevant to the article.

mbree, 07/June 07

Overdose prevalence
User:Assassin3577 added:
 * However, overdosing on paracetamol is extremely difficult owing to it's extremely disgusting taste, and therefore by ingesting too much, the body will simply reject the dosage and expel the analgesic via emesis

Without citation, this seems unlikely: compare "Acetaminophen overdose is one of the mose common poisonings worldwide" [] and "Now, a new study shows a rise in cases of acute (sudden) liver failure reportedly linked to Tylenol overdoses." [].

Mention methionine treatment for overdose?
As mentioned in, menthionine used to be very popular, and is cheaper than n-Acetylcysteine. Antidotes for Poisoning by Paracetamol also talks about it, and it's quite effective within 8 hours or so. These are all from the 80s, and I'm not sure what current fashion is. Here's a paper from 2003: Oral methionine compared with intravenous n-acetyl cysteine for paracetamol overdose claiming that acetylcysteine is better. 71.41.210.146 06:45, 10 July 2007 (UTC)


 * The article has been updated. Dr. Cash 19:50, 17 August 2007 (UTC)

Of interest?
http://www.dailymail.co.uk/pages/live/articles/health/dietfitness.html?in_article_id=483993&in_page_id=1774&ICO=HEALTH&ICL=TOPART Anyone know where to find the study that the popsci article here is based on? MrZaius talk 07:02, 28 September 2007 (UTC)

Redid Mechanism
As has been mentioned before, the mechanism section of this article was pretty bad. It kind of rambled and jumped from point to point, and still talked about the debunked COX-3 hypothesis. I rewrote it from scratch. It's got some good references in their now, some recent reviews and all the important original research articles. To me it seems painfully obvious that paracetamol's anti-pyretic action is via COX modulation, while it's anti-nocicpetive action is via AM404, but I haven't found a paper that puts it like that, so I haven't said it (original research). I could go into more detail about how paracetamols action on COX doesn't quite fit the picture, but I feel this might be a bit above and beyond the scope of this article. Thoughts? Bilz0r 09:14, 4 October 2007 (UTC)

At minimum, this passage The activity of the COX enzyme relies on its being in the oxidized form to be specific, tyrosine 385 must be oxidized to a radical. needs a period (a.k.a. full stop) after 'form'. However, I would like to reword it. See what you think of this To metabolize arachidonic acid, an amino acid in the COX enzyme must be oxidized. To be specific, the tyrosine at position 385 in the COX enzyme must be oxidized into a radical.

OR?
This paragraph, from "Risk factors", should probably be removed: Surprisingly, paracetamol can be physically addictive: the needed dose increases with each administration, and there is a distinct withdrawal syndrome, which resembles the headache for which the drug was first taken, but not exactly. This is easily demonstrated, at least in rural France, where this common drug is not sold in bottles of 100 pills but in boxes of 16 blister packs of 500-mg tablets/caplets/capsules. (As in the U.S., it is hard to find 325-mg "regular strength" pills: the 500-mg "extra-strength" pills have become the more usual dose.) If one takes two every six hours until the 16 pills are exhaused, one will discover that, as the time for the next dose approaches, the headache will return, with a slightly different kind of pain and greater intensity. After the 16 are exhausted, the intensity is severe enough to be mistaken for a migraine. (This is of little concern to those who have easy access to emergency rooms and to pain management specialists (physicians unafraid to treat pain with narcotics and who are trained to distinguish real addicts from people in pain), but these are not easily found on short notice, particularly in rural areas.)[citation needed] —Fvasconcellos (t·c) 15:30, 4 October 2007 (UTC)
 * OK, three days have passed and there has been no objection, so I've removed the text. It was uncited, anecdotal, and contained arguably POV statements; at the very least, it didn't fit into the "Risk factors" section. I'll leave it here anyway for convenience, should there be anything worth rewording and adding back in. Fvasconcellos (t·c) 22:36, 7 October 2007 (UTC)

The seratonin (5HT) system
"Paracetamol reinforces the decending inhibitory pain pathways" A study which also confirmed thats the central 5HT mechanism isn't stimulus dependednt —Preceding unsigned comment added by Blonde2max (talk • contribs) 22:33, 7 November 2007 (UTC)

Error in one of the external links
This external link: http://www.ch.ic.ac.uk/rzepa/mim/drugs/html/paracet_text.htm, labeled "History & chemistry of paracetamol," contains a major error. It states, "When mixed with codeine, it goes under the tradename Tylenol." This is completely untrue. The only active ingredient in Tylenol is acetaminophen/paracetamol. Prescription-only forms of Tylenol (with numbers following the word Tylenol) contain codeine, but not Tylenol itself. Suggest this external link be removed, especially since I see no way, even on the home page, of contacting that webmaster. Suggest finding a U.S. site to link re: history and chemistry of Tylenol, especially since that UK one is incorrect and the drug was first produced in the U.S. Softlavender (talk) 01:49, 13 December 2007 (UTC)

Brand Name Table
I added, what I hope is, a complete list of brand names. I forgot to log in when I did this so it posted as anonymous. I just wanted to let the community know who to contact with comments if neccesary. --Remark knights (talk) 18:55, 28 December 2007 (UTC)

In Italy I've come across Tachipirina which I did not see in the table but I do see here http://en.wikipedia.org/wiki/List_of_paracetamol_brand_names Halconen (talk) 23:36, 20 January 2009 (UTC)

Error in mechanism?
Under the metabolism section, there is a scheme showing the biological fate of paracetamol. After N-hydroxylation, the scheme shows square brackets with a "c" subscript. What does that mean? In addition, the next arrow says "rearrangement", and then shows a product which presumably result from expulsion of hydroxide. As written, that would be an elimination, not a rearrangement. Also, there is an apparent double bond missing to the bottom oxygen, if the mechanism is what I think it is. Finally, the toxic metabolite NAPQI is mentioned in the text, but not labeled. Eugene Kwan (talk) 09:41, 2 January 2008 (UTC)

I agree that there's a problem in the mechanism. The toxic metabolite should have the same structure shown in NAPQI, but it's got an OH group where it should be quinone (double bond to O). Queerwiki (talk) 00:56, 6 May 2008 (UTC) (wrote this comment without logging in and then corrected by logging in)

Make the article reader friendly by saying that it is about a painkiller
Use a few words to explain in common English that this article is about a painkiller. I see no harm and only advantages in this. Thanks Andries (talk) 21:38, 11 April 2008 (UTC)

See Explain_jargon which supports my opinion. Andries (talk) 20:49, 12 April 2008 (UTC)

Toxicity section; UK limits on sales
Present passage:

"In the UK, sales of over-the-counter paracetamol are restricted to packs of 32 tablets in pharmacies, and 16 tablets in non-pharmacy outlets.[33] Up to 100 tablets may be sold in a single transaction, however in pharmacies, 32 may only be sold, with more being sold at a pharmacists discretion."

This reference is bit vague and misleading ; the law has changed a number of times in the meantime, to reflect the prevalence of paracetamol in many otc preparations. For the text, I would propose (not least because the above is slightly misleading):

"Broadly speaking, in the UK sales of paracetamol are restricted to packs containing no more than 16 tablets of up to 500mg (for adult consumption) at non-pharmacy outlets, and packets containing no more than 32 tablets at Pharmacy outlets. Pharmacies may dispense quantities greater than 32 tablets, with a prescription, but the sale of quantities greater than 100 tablets is a criminal offence. However, the quantities applicable to effervescent, powdered, granulated and liquid forms and limits for use in children vary widely. see http://www.rpsgb.org/pdfs/medsparacettable.pdf

THe current reference (33) is the interpretation of the law (as it was in 1997) by one trading standards office; the law has been amended a number of times in the meantime to reflect the prevalence of paracetamol in many OTC preparations. I propose the link: http://www.rpsgb.org/pdfs/medsparacettable.pdf as it is published by the relevant professional body, and is more detailed and up to date.

Myredroom (talk) 17:26, 21 April 2008 (UTC)


 * Qualified pharmacists have quite a bit of discretion when it comes to UK OTC sales. They *can* sell up to 100 paracetamol tablets, but would be very unlikely to do this if a stranger walked in and asked for that amount. They would probably offer 32 tablets. The assumption is that pharmacists are trained professionals and can use their professional judgment.


 * Non-pharmacy sales are restricted to 16 tablets *per blister pack*, but there is nothing to stop such outlets selling multiple packs AFAIK. The restriction on pack size is primarily to discourage ill thought out suicide attempts, which are subsequently regretted but still fatal because of liver damage. --80.176.142.11 (talk) 01:07, 9 September 2009 (UTC)--80.176.142.11 (talk) 01:07, 9 September 2009 (UTC)

Grammar Minor Error
Was just surfing wikipedia. "lack side effects of aspirin" in the introductory paragraph doesnt sound correct, its as if side-effects are a good thing to have ...i think the word "lack" should be replaced.

thanks 220.253.201.59 (talk) 13:37, 28 May 2008 (UTC) anonymous surfer

Absurd Degree of Redundancy
This article is a mess. Two mechanism of action sections, two toxicity sections. Doesn't anyone read before they write on Wikipedia? —Preceding unsigned comment added by 66.168.153.147 (talk) 19:30, 22 July 2008 (UTC)


 * Perhaps it needs to go to FA review. JFW | T@lk  13:18, 25 July 2008 (UTC)


 * If it goes to FAR now, it won't pass. It needs a massive rewrite.  The redundancy is extensive, and comparisons with other drugs are all over the article.  A table may be helpful. --Una Smith (talk) 02:56, 13 September 2008 (UTC)

Treatment of poisoning
http://content.nejm.org/cgi/content/extract/359/3/285 - NEJM rv. JFW | T@lk  13:18, 25 July 2008 (UTC)

False Statement
"In fact, the human toll of paracetamol, in terms of both fatal overdoses and chronic liver toxicity, likely far exceeds the damage caused by the opioids themselves." Opioids are generally safe for the treatment of pain, especially chronic pain where a user is required to use pain relief for long durations or for life. The reason opioids are preferred are simply because besides addiction and tolerance, they tend to be relatively safe, not causing any significant changes to any of the bodily organs and certainly causing no damage to any organs unlike paracetamol. No long term studies have ever managed to show any harmful side effects from that of natural opium alkaloids, and besides addiction and tolerance, opioids are the safest treatment for pain. Paracetamol is known to cause liver deterioration when used long term, NSAIDs are known for breaking down muscle tissues when used long term, whereas opioids have no destructive effect at all when used long term, unless you consider the addiction as a destructive side effect. Also, BMJ statistics themselves show almost 13x more deaths are directly associated with paracetamol, than deaths associated with opioids, of which nearly all were associated with heroin (diamorphine). Even though the article statement in regards to paracetamol being safer than opioids is wrong, it's unprofessional and unscientific to compare death tolls associated from a medical use of a group of drugs to that of its street use. Regardless, far less people die of heroin in the UK than they do of Paracetamol or Alcohol, not to detail almost 2/3 of heroin deaths are a result of overdose associated with mixing opioids with benzodiazepines or alcohol. I could not check the source for that statement as it is a book, but if anyone has this book, please double check the source as it seems false or perhaps a generalized statement from a paragraph referring to damage caused by opioid addiction rather than damage to organs or other such significant side effects. --78.86.159.199 (talk) 17:41, 31 August 2008 (UTC)

The Lancet study showing a link between Paracetamol and asthma
I added a ref to the study in the Lead section. However, the results of this study should be elaboreted further, probably with a new section in the main body of the article "Side effects". (ref: Does paracetamol cause asthma in children? Time to remove the guesswork, The Lancet - Vol. 372, Issue 9643, 20 September 2008, Pages 1011-1012) MaxPont (talk) 07:18, 19 September 2008 (UTC)

Paracetamol poisening
The second half of the following sentence is unclear to me:

"Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.[2][3][4][5]"

"most drug overdoses" - Is that really ALL drug overdoses, or all legal-drug overdoses, or all OTC_drug overdoses (OTC=over-the-counter (which I'm sure you knew...)). The footnotes do not seem to cover this.

Naturally, one can overdose on legal drugs, but the term "drug-overdose" leads one's mind first to the illegal drugs - cocaine, heroine, etc.; when one hears in the news that someone "OD'd", it is usually from illegal drugs - thus one suspects that the illegal overdosings far outnumber the legal ones. This may be erroneous, but since that suspicion is there, perhaps if paracetamol overdoses really do account for most of the drug overdoses, the phrase "...including illegal drugs..." (or some such) could be added.

Of course, if it is NOT ALL drug overdoses, then clarification will be necessary. 89.61.203.224 (talk) 20:30, 19 September 2008 (UTC)


 * I think the reference is to suicide attempts, but I agree the section is unclear.Nobody ODs on paracetamol - what would be the point? Paracetamol isn't exactly an MDMA analogue --80.176.142.11 (talk) 01:13, 9 September 2009 (UTC)--80.176.142.11 (talk) 01:13, 9 September 2009 (UTC)

New risk
http://www.guardian.co.uk/society/2008/sep/19/health.children —Preceding unsigned comment added by 69.121.221.174 (talk) 23:23, 20 September 2008 (UTC)


 * Interesting. I had a friend once who took 2 tylenol gelcaps and 20 minutes later was feeling short of breath. Anecdotal of course, but the asthma link may definitly show something happened there.--Metalhead94 (talk) 17:58, 19 October 2008 (UTC)

Link to autism
A user wrote on my talk page:


 * I'm new to wikipedia so I apologise for any faux pas I make straight away.

I noticed on the paracetamol page you added a paragraph in the adverse effects section stating that paracetamol giving post MMR vaccination is apparently linked to autism. After examining the source, a parent survey with only 83 parents and another 80 controls, the link seems pretty weak. I couldn't find any other sources to back up a link apart from another journal article hypothesizing a link with anti-pyretics and autism. Does this information really belong on the page with such a small amount of evidence?Capcapone (talk) 04:01, 8 November 2008 (UTC)

I agree that the evidence is weak, certainly compared to the evidence about an association between paracetamol and asthma. (Which raises the question: why isn't asthma discussed under Paracetamol ? my goodness, but this article has problems!) Whether one preliminary study based on a parent survey is enough to make the cut here is a judgment call, and I wouldn't object that much if the paragraph was removed. If we do that, though, I suggest also adding a wikilink to Causes of autism, as a small/cheap replacement for the paragraph. Eubulides (talk) 06:16, 8 November 2008 (UTC)


 * I agree with Capcapone. The study is weak and really more of a survey than a study. Let's not add to the universe of autism misconceptions with one researcher's speculation. I am removing this paragraph; feel free to add it back if you can find a second source. &mdash;Voidxor (talk) 05:33, 21 December 2008 (UTC)

Pronunciation of American
Is it possible to have the pronunciation for Acetaminophen as well in the lead?  bibliomaniac 1  5  04:01, 4 December 2008 (UTC)

Review of article
Paracetamol is in bad shape. Needs a review and therefore I have nominated it for one. -- Doc James (talk · contribs · email) 05:35, 16 January 2009 (UTC)

Tylenol factually disputed
I tagged it as such because it contains information that contradicts this article, especially in the historical part. Since I've verified this article against medical journals during the FA review, I'm pretty sure it is right. Xasodfuih (talk) 13:50, 18 January 2009 (UTC)
 * Perhaps it's best to keep the discussion there. Xasodfuih (talk) 14:01, 18 January 2009 (UTC)

subsections of "chemistry"?
Synthesis/preparation/production sections are usually top level in articles concerning chemicals. Paracetamol may be a drug, but it still is a chemical! See WikiProject_Chemicals/Style_guidelines. Need we bury it under "chemistry"? Also, by WP:CHEM/WP:CHEMISTRY convention, reaction schemes are indented, and text goes above or below, but never beside. --Rifleman 82 (talk) 19:01, 23 January 2009 (UTC)
 * I was just trying to fit the pictures better. The level-2 subsection don't have lines that the pictures can cross. Feel free to revert me. The best thing would be to add more text to those sections, but I'm not familiar with non-medical uses of APAP or what else might be interesting about it from a chemist's perspective. Xasodfuih (talk) 19:58, 23 January 2009 (UTC)

I've restored the previous version, and added two reactions. What do you think? --Rifleman 82 (talk) 20:15, 23 January 2009 (UTC)
 * No problem with restoring, but I think the synthesis of phenacetin is off-topic here. Phenacetin doesn't appear to have any useful (legit) applications anymore. Xasodfuih (talk) 21:27, 23 January 2009 (UTC)
 * I've edited to explain it's for pedagogical purposes... or should we take it out? I'm of two minds. On one hand, this is nowhere near an industrial route, or even a laboratory route (what you'd find in org/inorg synth). On the other hand, there are multiple sources online which describe this reaction as an experiment performed in university labs. --Rifleman 82 (talk) 04:06, 24 January 2009 (UTC)
 * The article on phenacetin already has this reaction, and given its lack of importance relative to paracetamol I would remove it from here. If you have any knowledge of industrial routes for paracetamol synthesis, that would be a welcome addition. Xasodfuih (talk) 14:21, 24 January 2009 (UTC)

Comparison with NSAIDs
I think this is a very poor heading. We could just as easily say comparison with placebo or narcotics. We need a section that discusses its effectiveness. Compared to placebo and other available treatments. Have never seen another page were the only section effectiveness is a comparison to another class of drug.-- Doc James (talk · contribs · email) 10:46, 28 January 2009 (UTC)

Asthma
"In 2008 a study conducted in 31 countries on over 200,000 children indicates that infants who are given paracetamol may be at an increased risk of developing asthma as children.[6]"

"In 2008 the Lancet published the largest study to date on long term side effects of paracetamol in children. Conducted on over 200,000 children in 31 countries, the study determined that use of paracetamol for fever in the first year of life was associated with a 46% increase in the risk of developing asthma symptoms when aged 6–7 years. Higher doses and more regular use of the drug are associated with a greater risk of developing asthma; up to a three-fold increase for heavy use. Furthermore, paracetamol use, both in the first year of life and in children aged 6–7 years, was associated with an increased risk of symptoms of rhinoconjunctivitis and eczema.[6]"

I have some serious issues with the above. First this is primary research not a review. Second this level of detail does not belong in the lead. Third it forgot to mention that this is not a double blinded placebo controlled trial and therefore shows only association not causation.

Here is a review

-- Doc James (talk · contribs · email) 11:00, 28 January 2009 (UTC)

This is from uptodate.com "Many of the studies that have described an association between acetaminophen use and asthma are retrospective and therefore subject to recall bias [86]. An additional problem with studies evaluating over-the-counter medications such as acetaminophen is the possibility that the indication for the medication will introduce confounding bias. As an example, asthmatics and those who are at risk for developing asthma are more likely to have co-morbidities (eg, respiratory infections) for which they may take acetaminophen for its analgesic or antipyretic effects. In a study of 1164 children enrolled in a birth cohort, intake of acetaminophen during the first year of life was associated with wheezing at two years of age; however, this association was significantly attenuated when respiratory infection was controlled for [87]. Thus, the association of acetaminophen and asthma requires further study, using designs that eliminate or minimize confounding bias." -- Doc James (talk · contribs · email) 11:38, 28 January 2009 (UTC)


 * Ok made two big changes on this issue.


 * 1. Removed the lancet 2008 study from 2nd paragraph - putting it in the article so early on gives it undue weight, and may unduly worry people that this is a recognised issue. When compared to liver toxicity which is well undhrstood and established the link with asthma is poorly understood and not proven to be causal. Of course if research is published that shows a significant increase in asthma "caused" by paracetamol use then moving up this information to the first few paragraphs is probably warrented.


 * 2. In adverse effects section (where I moved the lancet reference too) I changed "risk" to "incidence" (with appropriate change in grammar). I have done this because this Lancet study is not a casual relantionship - it is only saying that when children have more paracetamol use then they are more likely to have asthma in later years. Many uncontrolled variables are not accounted for, and by using "risk" it sounds like the casual relationship is confirmed. Cheers Lethaniol 22:11, 13 May 2009 (UTC)

Primary research
This article uses extensive primary research "Paracetamol, particularly in combination with weak opioids, is more likely than NSAIDs to cause rebound headache (medication overuse headache), although less of a risk than ergotamine or triptans used for migraines.". This is based on a questionaire.

It makes no sense. It is not more likely to cause rebound headaches. It is that if one was to take everyone with rebound headaches more of them would have them due to acetaminophen because it is a more commonly used drug. This is not only confusing, based on poor quality research, but is wrong.

From up to date "In one study, no one medication was consistently identified as causative, although acetaminophen, butalbital-aspirin-caffeine (Fiorinal), and aspirin were commonly implicated [46]. In another study, overuse involved analgesics (35 percent), ergots (22 percent), opioids (12.5 percent), triptans (2.7 percent), and different combinations of medications (27.8 percent) [47]."

But is this anything more than trivia?

Ref 39 and 40 are another example of more primary research. There are however good reviews available and from more recent than the 1990s.

-- Doc James (talk · contribs · email) 11:07, 28 January 2009 (UTC)

Side effects
Should we add key interactions such as with warfarin?

-- Doc James (talk · contribs · email) 11:14, 28 January 2009 (UTC)


 * Yes I think we should put all key drug and non-drug interactions - which I can do using UK resources - which basically means the British National Formulary and Stockley Drug Interactions. Having said that, many interactions are not considered significant (as identified by the BNF), and should in my opinion not be mentioned here, as otherwise it will become an unwieldly list. Also I do not think explaining the individual primary research or case studies for each interaction should generaly be included, only for the most important, relevant or interesting of studies.


 * With regard to the paracetamol-warfarin interaction, it is not considered significant in the BNF (exact wording: anticoagulant effect of coumarins possibly enhanced by prolonged regular use of paracetamol) and so probably should not be mentioned. I will double check in Stockly when in work next week and check it detail. Of course if other countries treat the interaction much more significantly that can should be mentioned, and this potential difference between countries identified.


 * Cheers Lethaniol 10:20, 16 May 2009 (UTC)


 * Hmm just double checked all paracetamol interactions in BNF - and none are highlighted as highlighted as significant (being with Busulfan, Carbamazepine, Metoclopramide, Colestyramine, and Courmarins (warfarin class)). Cheers Lethaniol 10:32, 16 May 2009 (UTC)

Comment on the name
Just a comment from an American user. Every reference to this drug that I have heard/seen in my entire life has called it acetaminophen, and for all I know the article name is made-up. Just thought you should realize what Americans think of that. —Preceding unsigned comment added by 18.241.7.63 (talk) 07:00, 13 February 2009 (UTC)
 * Yes, but I'd never heard of acetaminophen until I moved to the US; Wikipedia serves the entire world, and will never please people in every single country. However, if you type acetaminophen into the search box, it takes you to this article, which also mentions acetaminophen in bold in the first sentence.  I think that's perfectly reasonable. Walkerma (talk) 08:09, 13 February 2009 (UTC)

If I may make a correction, Wikipedia en. serves the English speaking world, in which acetomiophen is the prevalant term, however, the article name is still correct, as paracetamol is the IUPAC name, thus technical naming conventions prevail, and the article stays as is. Ronk01 (talk) 03:34, 12 May 2010 (UTC)

Reads like a med text book
I came to the article looking for information on the 'pop culture' of paracetamol (if you can call it that). Ie; things such as it's prevelance in young suicides and the media etc. The entire page reads like a medical text book for a physician. Maybe it's just me that thinks this? But I certainly got no useful information from it... Dvmedis (talk) 07:11, 2 March 2009 (UTC)


 * Yep, it's just you that thinks that. This is an encyclopedia, not USA Today. --80.176.142.11 (talk) 01:19, 9 September 2009 (UTC)

Acetaminophen > Paracetamol
The names are chemically equally as accurate, but acetaminophen is FAR more widely used. Naming this article paracetamol doesn't really seem to make any sense.  Anonabyss  [ Talk ] [ Contribs ] 15:39, 18 March 2009 (UTC)

In the UK, Paracetamol is paracetamol and called pretty much called solely that - never seen it marketed under any sort of brand name here?? Dvmedis (talk) 00:36, 19 March 2009 (UTC)

In the UK its only ever called paracetamol. The name acetaminophen is generally unkown here.

But it gets worse.... IIRC, acetaminophen is a separate but related drug thats no longer used, a forerunner of paracetamol known for causing malignant growths. But that is from memory, so might not be 100% on the mark.

As said, this is not a US Wiki, this is a world wiki. 82.31.207.100 (talk) 13:42, 12 April 2009 (UTC)


 * Two thoughts: (i) Perhaps you're thinking of acetanilide, which is metabolized to various toxins as well as para-acetyl-amino-phenol (a.k.a. paracetamol or acetaminophen - you may be able to see the origin of both product names in the chemical name)? (ii) Indeed this is a world-wiki, not a US- (nor UK-) wiki.  Is there a reliable source stating that "paracetamol" is the worldwide designation?  If so, we should cite it and stop re-hashing this issue.  --Scray (talk) 21:29, 12 April 2009 (UTC)


 * Nevermind point #2 that I just made. The article already contains the proper link from the  "INN" in parenthesis (second set of characters in this article), which points to the WHO's international reference on this topic.  It seems an established fact that "paracetamol" is the international designation.  --Scray (talk) 22:02, 15 April 2009 (UTC)


 * Over at epinephrine they are debating naming, where they don't want to use the international name because its only used in the US. Is paracetamol name used much outside UK or its former colonies? Fuzbaby (talk) 20:22, 26 June 2009 (UTC)
 * Yes, even in non-English speaking countries. "Acetaminophen" is not used outside the U.S. Fvasconcellos (t·c) 23:28, 26 June 2009 (UTC)
 * Have a look at the inter-wiki links to this article. Almost all of the ones in Latin script (which are the ones I can read) are to Paracetamol or minor variations of it.  The only exception seems to be in Bahasa Melayu, where there it appears to be called "Asetaminofen" (although a google search for "Asetaminofen" site:my only turns up 13 results, so I am not so sure this is very reliable).  In a nutshell - let's stick to "Paracetamol".  --SmilingBoy (talk) 21:28, 2 July 2009 (UTC)
 * In Canada they mostly follow the US in naming schemes, and it's known as Acetaminophen there as well (check Tylenol.ca)Kyprosサマ (talk) 07:31, 11 July 2009 (UTC)

I should poinnt out that this is the English language Wikipedia, so we need only consider the needs of English speakers, not the entire world, the other Wikipedias can handle that. From there we need to consider population, more Engligh speakers worldwide use acetominophen (the US and Canada together have a greater population that the rest of the commonwealth nations). All this of course would matter if Wikipedia policy didn't explicitly state that IUPAC names are to be used for organic compounds, so paracetamol it is. Ronk01 (talk) 03:39, 12 May 2010 (UTC)

OK, This further complicates the issue. In the US, this drug has been referred to using a couple of different names. One is APAP, the other is Acetaminophen, and then there are the brand names like Tylenol and so forth. I think I've seen Panadol as a brand name of Acetaminophen here, but as I understand it, the label might be able to say Panadol, but it would also have to say, in large type, "Acetaminophen". The FDA has noted that the daily limit has to include the Acetaminophen from all sources, and they have said that everything containing Acetaminophen has to use that name to label the content, and it has to have the word Acetaminophen in large type on the label. Synonyms are not allowed - the user has to be able to easily determine that the product contains acetaminophen so that the user is aware that this is another source of Acetaminophen.

See, for example, http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCommittee/UCM164897.pdf and a bunch of other stuff on their web site.

So, it looks like the FDA is trying to establish a single name for the drug, in the US, by regulation, for what they consider to be good reason. I agree that we have to take care of all English language users. But, in any case, an alternate generic product name, (such as paracetamol) would just confuse American users. I think we are stuck with using both names in the article - and it might even make sense to explain that there is an American regulation that limits the name that can be used on a consumer product. Simicich (talk) 22:55, 8 July 2010 (UTC)

Paracetamol is safe in pregnancy
this line should include the fact people shouldn't take it without the advice of a doctor, because paracetamol isn't safe for everyone Markthemac (talk) 00:44, 4 June 2009 (UTC)
 * No drug is safe for everyone, and no drug should be taken during pregnancy without medical advice (particularly during the first trimester, and most specifically during the first ten weeks). I don't really think qualification is necessary, but I'm open to other opinions. Fvasconcellos (t·c) 23:36, 26 June 2009 (UTC)

This edit
I reverted this edit because the headings that had been added seemed overly negative, and the new sections created overlapped with existing sections. --Scray (talk) 04:26, 30 June 2009 (UTC)

http://www.nytimes.com/2009/07/01/health/01fda.html?hp
http://www.nytimes.com/2009/07/01/health/01fda.html?hp

finally, they listen about Tylenol dangers in fulminant liver failure. need more attention on this.99.22.220.61 (talk) 01:32, 1 July 2009 (UTC)

Another ref: FDA Scrutinizes Acetaminophen's Liver Risk. http://abcnews.go.com/Health/PainManagement/story?id=7955370&page=1 MaxPont (talk) 08:11, 2 July 2009 (UTC)

Paracetamol, NYtimes ref
I have reverted this for 2 reasons.

1. This is not a final FDA regulation but so far only a discussion and opinion of the advisory committee. As such it is not established fact as long as no regulatory action has resulted. Then we can take the FDA guidance as a ref. Now I feel it is too early. They don't imply that the mixture is particularly damaging to the liver, but that it may lead to high dosage and long term use. The other concerns of the committee are similar: Lowering tablet dosage to 325mg and limiting package size like in the UK - also these are only valid concerns and opinions so far, as seen in other countries and their attempt to damage control.

2. As soon as this becomes final regulation, some higher value ref will be available in the form of a FDA released decision. NYtimes is generally not to be used as a medical ref, but such resulting peer reviewed decision or report. I propose to wait until then. It is now too new. The connection of mixtures to liver damage is cloudy in this description, is better taken from the reasoning in the final ruling once and if it is released. That is why I deleted it until it is final. 70.137.141.26 (talk) 06:05, 2 July 2009 (UTC)


 * This an action by the government regulator. It belongs to the article. WP:MEDRS only applies to medical claims. Articles about medical topics can also cover regulatory and political controversies and these parts are not covered by WP:MEDRS. MaxPont (talk) 08:31, 3 July 2009 (UTC)

Yes, but then we wait until it is a final regulation, not a mere discussion from hearsay in some newspaper. We also can then take the reasoning behind the guidance directly from the FDA release. And dosage guidelines as well as guidelines on pharmaceutical formulation and composition are medical in nature, not political or societal, so WP:MEDRS certainly applies. That this is a discussion in the context of governmental regulatory action does not make it non-medical or political. 70.137.139.239 (talk) 20:20, 3 July 2009 (UTC)

More metabolism errors
I know in the 80s that University of Washington had studies on slow and fast acetylators  and that para-aminophenol was the active metabolite, and historicly toxic. At the time the mechanism was para-aminophenol was oxidized to the quinone then conjugated or acetylated (and recycled). The N-hydroxylation seems speculative.

Anyway the point is different Humans metabolize APAP differently, as well as different APAP affecting its own and other toxins' metabolism. Industrial toxicity of para-aminophenol was well known by the early 1900s. On a personal note about the variation of toxicity, my brother had contact dermatitis from using para-aminophenol as a film developer and I worked in a film lab using it and did not get dermatitis. Significantly the metabolic interaction with alcohol which is nearly impossible to regulate in our society, and interaction with other medications is a problem with APAP that isn't mentioned.

The promotion of Tylenol by that manufacturer hinged around malpractice liability for Asprin caused(prescribed) unmonitored bleed out in ulcer patients and failure to treat children properly. Usually liver failure was delayed and difficult to attribute. Still looking for the seminal case in findlaw.

The anandamide section is contraindicated by anadamide research. --Shjacks45 (talk) 13:46, 9 November 2009 (UTC)

May alleviate psychology pain
Interesting: Stated in Finding, p 80, Harper's Magazine, March 2010. 99.232.211.136 (talk) 05:27, 23 February 2010 (UTC)

Relative Effectiveness
"Paracetamol is much more effective[citation needed][who?] than aspirin, especially in patients where excessive gastric acid secretion or prolongation of bleeding time may be a concern"

I think most studies have shown that in equal doses (eg 1000mg) aspirin is more effective than paracetamol, however, most aspirin tablets contain 300mg vs most paracetamol tablets cntaining 500mg. The daily maximum dose of both is 4000mg, therefor, aspirin can provide a greater degree of pain relief than paracetamol.

I think the above should be ammended to read that paracetamol is safer than aspirin, but a weaker analgesic

121.209.52.159 (talk) 03:49, 2 March 2010 (UTC) Jonathan

Poor quality, repetitive, off topic images of Panadol
Editor182 insists on keeping two poor quality images of Panadol branded paracetamol. These are frankly a detriment to a very good article. Both images are over exposed, out of focus and done with a flash. Moreover, he wishes to remove photos which are not branded Panadol - however, the article is on the compound paracetamol and NOT the brand Panadol. Indeed, there is a separate article on Panadol. Please arrive at a consensus regarding removal of one or both of the Panadol images.--Kristoferb (talk) 19:40, 26 June 2010 (UTC)


 * Editor182 declared this dispute closed . I reinstated the above re. WP:TPOC.  Chzz  ► 09:20, 27 June 2010 (UTC)
 * Thanks. Editor182 knows he will lose this dispute just like he lost the last one. Why else would he delete the dispute talk page? --Kristoferb (talk) 11:48, 27 June 2010 (UTC)

Getting to the Point


Kristoferb (talk) refuses to understand that the English version of Wikipedia requires English spelling. The image of the generic paracetamol tablets from Korea is not in English. The vast majority of readers can't read it and won't ever come across it. I have told you this several times, NuclearWarfare (talk), another established user has reverted your edit following our dispute, but you continued the edit warring regardless. This image does not belong here. Neither does the other image in sertraline which was also reverted by myself and NuclearWarfare (talk), but this still doesn't get through to you. Take your images and post them on the correct version of Wikipedia. Wikipedia represents a worldwide view on subjects, but in a language relevant to that of the article. Take a look at this German article of sertraline. It is not simply a page translation, but a completely different article, different writing, and different images where applicable. The Panadol images aren't in dispute, they're both different forms and they were both under the "Available forms" section. Instead, you replaced the Panadol Rapid caplets with another photo of tablets, that nobody on this version of Wikipedia has any use for, it's completely unessessary. This warring is about this generic image which is not suitable for the context of this article. Editor182 (talk) 05:41, 27 June 2010 (UTC)
 * Can't read it?! The box is written in English! --Kristoferb (talk) 12:19, 27 June 2010 (UTC)
 * "Available forms" is not only tablets and caplets, but brand and generic. Moreover, your images are in dispute. They are very poor quality and should be replaced. --Kristoferb (talk) 12:27, 27 June 2010 (UTC)
 * Why do we need two (poor quality) images of Panadol brand but none of a generic version? The article is ON the generic. --Kristoferb (talk) 12:33, 27 June 2010 (UTC)


 * You used the same argument about the images in Sertralin and you LOST the dispute. Consensus was that your images are of poor quality and that alone is reason enough to replace them. Moreover, why do we need two images of the same brand? The article is not on Panadol! The image of the generic says Paracetamol on the box and the title of this article is... Paracetamol. --Kristoferb (talk) 11:42, 27 June 2010 (UTC)

Stop being childish and do not twist the facts, there was no consensus, I ended the dispute on sertraline and then I came here to put an end to this one. There was only one user who had any input on the discussion in sertraline and they weren't for or against any decision. They wanted it to end more than anything else, and I agreed. Editor182 (talk) 13:07, 27 June 2010 (UTC)
 * To quote: It's not like it's written in Chinese or something - it's fairly clear what it is. There's no rule forbidding the use of photos that might have foreign writing, provided there's adequate explanation in the caption. And I have to say that as a picture, I like it [kristoferb's photo] better than the blue-and-white box [Editor182's] picture, because I had to look 3 times before I saw that there were indeed pills sitting on the tinfoil. The pills need to be sitting on their own so they can be seen easily. That is, someone should re-shoot that [Editor182's] photo. I think there's been overreaction on both sides. There's really nothing wrong with the Turkish photo as such. I'm just not convinced that it's needed. How many illustrations of a given pill do we need? It's not the Venus de Milo or something, it's just a freakin' pill. ←Baseball Bugs What's up, Doc? carrots→ 07:34, 27 June 2010 (UTC)" --Kristoferb (talk) 13:25, 27 June 2010 (UTC)

They said they're not convinced it's needed, read everything, not just what you want to read. This dispute is closed. Editor182 (talk) 14:25, 27 June 2010 (UTC)
 * The dispute isn't closed just because you say so. The bottom line is they agree with me: your photo was bad and had to be re-done. If anything were to be removed, it would be your photo, not mine. Indeed, you did re-shoot your photo, but it is almost as bad as the first one you uploaded. A better way to solve this dispute would be for you to learn how to take good pictures. --Kristoferb (talk) 14:32, 27 June 2010 (UTC)

I didn't re-shoot the photo, I just renamed it. There goes your credibility. Also, who is "they"? Editor182 (talk) 14:37, 27 June 2010 (UTC)
 * That would explain why it is as bad as the first one, since it is the same bad one with a new name! Why don't you re-shoot it? Are you not able to take a good photo? --Kristoferb (talk) 14:39, 27 June 2010 (UTC)

Images, suggestions from outside parties.
Paracetamol was first marketed as Tylenol, therefore having the first packaging image SHOULD be Tylenol. We have File:Extra Strength Tylenol and Tylenol PM.jpg which shows the PM version as well, probably not ideal, so I sourced a couple images and uploaded. — raeky ( talk 07:35, 30 June 2010 (UTC)
 * The next mentioned brand is Panadol, I sourced one image and we have another non-english package on Commons. I don't find it a big deal it's not in english, but I would lean more towards the non-trademark just pills one I uploaded. — raeky ( talk 07:35, 30 June 2010 (UTC)
 * Generic Images, Of the generic images, the Koren looks best imho. — raeky ( talk 07:35, 30 June 2010 (UTC)

I suggest we have 3 images of packaging, 1 Tylenol, 1 Panadol and 1 Generic. — raeky ( talk 07:35, 30 June 2010 (UTC)
 * I suggest the following image box be placed in Available forms and File:Panadol_Rapid.jpg be removed entirely or replaced with one of the other pill closeups, maybe File:Tylenol 8 hour pills closeup.jpg. — raeky ( talk 07:47, 30 June 2010 (UTC)


 * Editor182 has removed all images but his own on Panadol. --Kristoferb (talk) 13:58, 30 June 2010 (UTC)
 * Layout proposed by an images expert and admin Raeky has been inserted. --Kristoferb (talk) 01:55, 1 July 2010 (UTC)
 * I'm not an admin and you was told on the ANI to not get involved with adding these images..... — <i style="color:#6600FF;">raeky</i> ( talk 14:12, 1 July 2010 (UTC)

Consensus of images
I personally feel there would be more EV for the article by including the generic Koren image (File:Generic_paracetamol_dprk.jpg), but I'm not going to fight over it. I'd like others opinion on that image being added to the 3 2 existing already though. I also feel that instead of putting two rapid release types, one of each. The Tylenol rapid release pills is a nice picture, that in contrast with Panadol is acceptable to me. I've made that change. — <i style="color:#6600FF;">raeky</i> ( talk 14:58, 1 July 2010 (UTC)
 * I would hope the Korean generic is eventually added. I think it has a high EV in illustrating the wide use of the compound and multiplicity of formulations on the market. --Kristoferb (talk) 17:36, 1 July 2010 (UTC)

Can we also drop the "cell phone image" propaganda? I use the Nokia N82. "The first Nokia phone with Xenon flash, the N82 has a 5 megapixel camera with Carl Zeiss optics, and was considered the best camera phone on the market." Do you think an iPhone could take images like those? Whatever. Editor182 (talk) 17:18, 1 July 2010 (UTC)
 * As an editor, I agree with this proposal. --Kristoferb (talk) 15:06, 1 July 2010 (UTC)
 * It's still a cell phone image... and irregardless the quality is poor. — <i style="color:#6600FF;">raeky</i> ( talk 17:27, 1 July 2010 (UTC)
 * Taking a photo of foil with a flash is always a bad idea. --Kristoferb (talk) 17:37, 1 July 2010 (UTC)

Wrong reference
Sorry, haven't got the time to figure out how to do this myself, but the volume number in reference 21 should be 97 (not 94). The full correct reference would be: B. B. Brodie, J. Axelrod, J. Pharmacol. Exp. Ther., 97(1), 58-67 (1949)

Halloumchen (talk) 13:05, 30 July 2010 (UTC)
 * 94 came from pubmed. Materialscientist (talk) 13:16, 30 July 2010 (UTC)