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?
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.
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