Paracetamol – not so safe?

One of the most common questions I’m often asked relates to the safety of natural medicines with warfarin therapy.
Many theoretical issues occur within a test tube environment, but the word “warfarin” sends many pharmacists into a spin.
Misunderstanding and misinformation about the interaction between omega-3 fish oils and warfarin has been topical since Adam and Eve’s first pharmacy practice.
And as has been shown at the Alfred Hospital, there’s no issue.

An interesting study in the Journal of Pharmacy Practice and Research Vol 45 Issue 1 March 2015 exhorts pharmacists to become more interactive with their patients in all aspects of paracetamol prescribing and usage.

It’s about time, especially when considering the latest clinical findings showing that paracetamol is no better than placebo in osteoarthritis.

Why then is it so readily suggested in the pharmacy setting anyway? And I’m continually surprised at how few pharmacists are aware of these findings.

Surely the suppliers of high-dose paracetamol would be sharing the facts…..or maybe not.

Arthritis Australia, Osteoporosis Australia and the Rheumatologists Association have aired their concerns publicly, but not a whimper from PSA or NPS!

What really concerns me though, is the potential interactions between warfarin and paracetamol – bearing in mind that patients never take a consistent dose…..sometimes two a day, six a day, none a day depending on the discomfort they feel. I know they tell you that they take their pills consistently, but that’s all part of getting a pat on the head for doing the right thing and being compliant.

What does this ever-changing dose do to INR values?

More importantly, are these issues discussed with the patient? In my experience, discussions don’t happen.

However, when a request for turmeric is made, and the test-tube reference is brought up, dire warnings are issued, and interestingly, many people just then use turmeric in their cooking or buy a supplement from the grocer.

Surely, we can do better than this when you consider the prevalence of joint pain in the community?

We need to be informed, genuine and up-front in our care-giving. Instead, judgemental opinions are handed out without clarification, in turn, causing disappointment and disillusionment in our patients who look to us for medicinal guidance.


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