Research links soluble paracetamol to increased risk of CVD

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Doctors have warned that people should try to avoid taking fizzy, dissolving paracetamol which contains salt, after a large study found a link to a significantly increased risk of heart attack, stroke, heart failure and death.


The findings come from a study of nearly 300,000 patients registered with UK GPs, published in the European journal of the heart.


In the research, more than 4,500 hypertensive patients who were prescribed paracetamol containing sodium were compared to 146,866 hypertensive patients who were prescribed paracetamol without sodium.


The comparison showed that the risk of heart attack, stroke or heart failure after one year for hypertensive patients taking sodium-containing paracetamol was 5.6%, compared to 4.6 % in those taking paracetamol without sodium.


The one-year risk of death was also higher at 7.6% (404 deaths) versus 6.1% (5,510 deaths).


Meanwhile, there was a similar increased risk in patients without high blood pressure.


Among those taking sodium-containing paracetamol, the one-year risk of cardiovascular disease (CVD) was 4.4%, compared with 3.7% for those taking sodium-free paracetamol. The risk of death was 7.3% and 5.9%, respectively.


All the patients were between the ages of 60 and 90 and the researchers followed them for a year.


Professor Chao Zeng of Xiangya Hospital in China led the research and said his team also found that the risk of cardiovascular disease and death increased as the duration of sodium-containing paracetamol intake increased.


“The risk of cardiovascular disease increased by a quarter for patients with high blood pressure who had a prescription for paracetamol containing sodium, and it increased by almost half for patients who had five or more prescriptions for paracetamol containing sodium,” he said. .


“We saw similar increases in people without high blood pressure. The risk of death also increased with increasing doses of sodium-containing paracetamol in patients with and without high blood pressure.


Sodium, one of the main components of salt, is widely used in drug preparations to improve solubility and disintegration; in 2018, 170 people per 10,000 population in the UK used medicines containing sodium, with a higher proportion among women.


However, effervescent and soluble formulations of 0.5 g paracetamol tablets also contain large amounts of sodium – 0.44 g and 0.39 g, respectively.


Therefore, a person taking the maximum daily dose of two 0.5g effervescent tablets every six hours would consume up to 3.5g of sodium – a dose that exceeds the total daily intake of 2g per day recommended by the World Health Organization.


In an editorial accompanying the research paper, Professor Alta Schutte and Professor Bruce Neal of the George Institute wrote that there were 42 million paracetamol-containing medicines prescribed in the UK alone in 2014, with 200 million additional packs sold without a prescription.


‘This is equivalent to [roughly] 6,300 tonnes of paracetamol sold each year in the UK, with a figure for France close to 10,000 tonnes,” they wrote.


“Fortunately, only a small proportion of paracetamol formulations contain sodium, but with the growing popularity of ‘fast-acting’ and ‘fizzy’ drugs, the adverse effects of drug-related sodium intake are expected to increase rather than decrease. “


Paracetamol is also one of the most commonly used over-the-counter painkillers in Australia, and Professor Zeng said clinicians and patients should be aware of the risks associated with sodium-containing tablets and avoid unnecessary consumption, especially when the drug is taken for a long time. period of time.


“Since the pain relief effect of sodium-free paracetamol is similar to that of sodium-containing paracetamol, clinicians can prescribe sodium-free paracetamol to their patients to minimize the risk of cardiovascular disease and death,” did he declare.


“People need to be careful not only about the salt intake in their diet, but also not to overlook the hidden salt intake of medicines in their cupboard.”


Meanwhile, Professors Schutte and Neal have called for urgent action to be taken.


The editorial says the most plausible and effective strategy is likely to be mandatory labeling of all drugs containing significant amounts of sodium with a front-of-package warning label.


“The weight of evidence makes continued inaction on sodium-containing drugs untenable,” they wrote.


“It is particularly worrying to observe in some surveys that up to 94% of fizzy drug users practice self-medication using over-the-counter preparations.


“There is an immediate need for consumer protection against these risks.”



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