Doctor Pēteris Apinis warns about excessive paracetamol use and the risk of liver damage
In a column for the Latvian newspaper Latvijas Avīze, doctor Pēteris Apinis, responding to reader questions, explains that paracetamol is safe at therapeutic doses but an overdose can cause acute liver failure. He also lists maximum daily doses for different groups and criticises the pricing of combination cold remedies.
In a column published by the Latvian newspaper Latvijas Avīze on 5 November 2026, doctor Pēteris Apinis responded to patients' questions about whether the frequently prescribed paracetamol (also known as acetaminophen, an over-the-counter painkiller and fever reducer) is beneficial or harmful. He stresses that the drug is very safe at therapeutic doses, but that the margin between a normal and a toxic dose is narrow.
The danger of overdose
Apinis writes that paracetamol overdose is among the most common causes of acute liver failure in the United States, the United Kingdom and Western Europe. He says it often happens accidentally: a sick person takes cold powders, tablets and syrups for several days without realising they contain the same substance, and exceeds the daily limit.
The danger, he explains, is that symptoms appear late. During the first day or two a person may feel fairly normal while liver tissue is already being damaged. Jaundice, severe abdominal pain and hepatic coma may appear on the third or fourth day. Even with intensive care and the antidote N-acetylcysteine, a patient can die. The doctor says he has seen such cases in intensive care, and a friend of his, also a physician, died of an overdose.
Maximum daily doses
For an adult man the maximum is 4,000 mg, but for people who drink alcohol regularly it is no more than 2–2.5 grams. For children the dose is 10–15 mg per kilogram at a time, with no more than 60 mg/kg per day. Pregnant women are advised not to exceed 3,000 mg, and elderly people 2,000–2,500 mg.
Combination products
Paracetamol is often combined with ibuprofen, caffeine, tramadol or codeine, and with decongestants and antihistamines in cold remedies such as Theraflu, Coldrex or Fervex. Apinis notes that plain paracetamol is cheap, but in flavoured packaging with other ingredients it can be sold for 10–20 times more.
He acknowledges that paracetamol is gentler than ibuprofen or diclofenac on the stomach and circulation and can be used by pregnant women and infants, but says that for chronic back pain it works no better than a placebo. The doctor adds that his own view should not be taken as absolute truth.
