I suffer from migraines and have recently been trying to cut back on my paracetamol use as I've had to take them nearly daily for over 8 years. I was trying to cut my doses in half. Instead of taking a full dose of 2 x 500mg of paracetamol every four hours, I would only take 1 500mg, then if the pain didn't subside, I'd take another inside the four hour window, usually about 2 hours after my first dose. I thought that once I didn't exceed the max dose (2 x 500) in 4 hours that there was no difference between taking 1 every two hours rather than 2 every four hours. I'm panicking now that I've done damage because of this. I never exceed the maximum daily dose and I don't mean I take them every two hours all day. After I take the second tablet two hours after the first one, I tend to leave 4-6 hours after that last tablet just to make sure I'm not overloading my system. I'm terrified of liver failure, hence my reason for cutting back on pain relief. Will doing this cause harm?
Can I take 1 paracetamol (acetaminophen) every two hours instead of 2 paracetamol every four hours?
Question posted by anxiousheadachegirl on 14 Nov 2018
Last updated on 15 November 2018
Answers
Firstly, the guidance for paracetamol use in the US and some other countries has changed from 4000 mg/day to 3000 mg/day (2 x 500mg every 6 hours or 2 x 325 mg every four hours) due to its potential liver toxicity at high doses. Interestingly however is that the guidance for the extended release formulation remains unchanged at 3900 mg/day. Given that you have been taking it for 8 years it might be wise to talk to your doctor about getting a liver function blood test done just to make sure you are not doing actual damage. Worrying about potential damage is just going to cause headaches. Given its relatively short, but quite individually variable, half life to elimination of 1-4 hours and its relatively slow time to onset of action of 37 minutes I doubt that taking it every two or every four hours makes an appreciable difference but every 6 hours may well give your liver a break. If you are in the fast metabolizer group then every two hours might be advantageous but that is just speculation. Your doctor should really have the final word on this issue. The directions for use without the approval or guidance of a doctor is taking them for a maximum of 4 days in my country due to long term use safety issues.
Thanks for your answer. I've had quite a few liver function tests recently (all normal) and my gp doesn't seem all too bothered by the amount of paracetamol I've been taking though I have voiced my worries. I'm 32 and in the UK where max daily dose is 4g, so according to him, liver damage is unlikely given my age. My concern is more to do with potentially staggering doses by taking 1 500mg then a second one 2 hours later as I'm not entirely how sure my system processes the stuff. I very rarely take more than 2000mg a day as I'm very conscious of the fact it can be quite damaging. I was just scared that taking 1 500mg and waiting 2 hours before taking another if I needed it would create some kind of delayed effect in my liver. I was attempting to take a half dose for the sole fact that if I felt better, then I wouldn't need to take a second, and slowly keep cutting back.
Given your response that you rarely take more than 2000 mg/day I would not be concerned at all.
Take care.
PS. The UK is one of the countries that has taken on board new guidance rules following the US!
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paracetamol, migraine, acetaminophen, dosage, liver
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