From the Guidelines
You should seek immediate medical attention as taking 5 paracetamol tablets at once exceeds the recommended dose and can lead to serious liver damage. The maximum recommended dose for adults is typically 1-2 tablets (500-1000mg) every 4-6 hours, with a maximum of 8 tablets (4000mg) in 24 hours, as suggested by guidelines to prevent liver injury 1. Taking 5 tablets at once could lead to paracetamol overdose, which can cause serious liver damage even if you feel fine initially, and symptoms of overdose may include nausea, vomiting, abdominal pain, and eventually liver failure 1. Some key points to consider include:
- The FDA recommends limiting daily acetaminophen intake to a maximum of 4 g to reduce the risk of severe liver injury from acetaminophen overdosing 1.
- Acetaminophen hepatotoxicity is suggested by historic evidence for excessive ingestion, and most ingestions leading to acute liver failure exceed 10 gm/day, although severe liver injury can occur rarely when doses as low as 3-4 gm/day are taken 1.
- Treatment for paracetamol overdose, such as N-acetylcysteine, is most effective when given within the first few hours after ingestion, so it is crucial to act quickly if you have taken an overdose 1. If you've taken this amount, call your local poison control center, emergency services, or go to the nearest emergency room immediately.
From the FDA Drug Label
Warnings Liver warning This product contains acetaminophen Severe liver damage may occur if: an adult takes more than 6 doses in 24 hours, or greater than 4000 mg of acetaminophen, the maximum daily amount Overdose warning Taking more than the recommended dose (overdose) may cause liver damage. In case of overdose, get medical help or contact a Poison Control Center right away. (1-800-222-1222). Quick medical attention is critical for adults as well as children even if you do not notice any signs or symptoms.
The information provided does not specify the exact dose of paracetamol in each tablet, so it's unclear if taking 5 paracetamol tablets exceeds the recommended dose. However, severe liver damage may occur if more than 4000 mg of acetaminophen is taken.
- If the dose of each paracetamol tablet is less than 800 mg (4000 mg / 5 tablets), then you may not be at risk of liver damage from exceeding the maximum daily dose.
- However, overdose warning indicates that taking more than the recommended dose may cause liver damage, and quick medical attention is critical. It is recommended to get medical help or contact a Poison Control Center right away 2 if you suspect an overdose.
From the Research
Paracetamol Overdose
- The toxicity of paracetamol is dose-dependent, and overdoses can cause hepatotoxicity 3.
- Taking 5 paracetamol tablets at once is considered an overdose, as the recommended dose is typically 1-2 tablets every 4-6 hours 4.
- Activated charcoal, gastric lavage, and ipecacuanha can reduce the absorption of paracetamol, but the clinical benefit is unclear 4.
Treatment Options
- N-acetylcysteine (NAC) is an effective antidote for paracetamol overdose, and it can reduce mortality in patients with fulminant hepatic failure 4, 5.
- NAC has a well-established safety profile, and its toxicity is uncommon and dependent on the route of administration and high dosages 5.
- Liver transplantation may be life-saving in fulminant hepatic failure, but refinement of selection criteria for transplantation and long-term outcome reporting are required 4.
Risks and Complications
- Paracetamol overdose is a common cause of acute liver injury and acute liver failure, and it can lead to hepatotoxicity and death 6, 3.
- Chronic paracetamol use has been linked to an increased risk of gastrointestinal bleeding, hypertension, and other adverse effects 7.
- The evidence base for the adverse effects of chronic paracetamol use consists of many cohort and observational studies, with few randomized controlled trials 7.