Acetaminophen, known as Tylenol in the United States or paracetamol in other parts of the world, has long been considered a safe and reliable option for managing pain, especially in older adults suffering from chronic conditions like osteoarthritis. However, recent studies are raising concerns about its prolonged use and its potential to cause serious health complications.
New Findings in the United Kingdom
A recent study conducted by Nakafero and collaborators at the University of Nottingham analyzed the effects of repeated acetaminophen use in individuals aged 65 and older. The study, published in Arthritis Care and Research, evaluated data from the UK’s Clinical Practice Research Datalink-Gold, spanning a period from 1998 to 2018. Researchers examined the health records of more than 180,000 individuals who regularly took acetaminophen (two or more prescriptions within six months) and compared their outcomes with over 400,000 individuals who did not use the medication repeatedly.
The findings revealed a concerning association between prolonged acetaminophen use and a higher risk of:
- Heart failure
- Chronic kidney disease
- Hypertension (high blood pressure)
- Peptic ulcers, which affect the lining of the stomach and small intestine
These results underscore the need for caution when using acetaminophen as a long-term treatment, particularly in older adults who are more vulnerable to medication-related complications.
Heart implications
This is not the only study shedding light on the risks of acetaminophen. Earlier this year, researchers from the University of California, Davis explored the drug’s impact on cardiovascular health. Their study, published in April, revealed that even at safe doses equivalent to 500 mg/day, acetaminophen altered proteins in heart tissue, disrupting pathways related to energy production, antioxidant use, and the breakdown of damaged proteins. The researchers noted that these biochemical changes could lead to long-term heart problems, particularly due to oxidative stress and increased toxins as the drug breaks down.
Lead author Gabriela Rivera emphasized the importance of using acetaminophen at the lowest effective dose for the shortest possible duration to minimize risks.
Figure 1. The risks associated with prolonged use of acetaminophen according to recent studies. Findings include an increase in blood pressure with regular doses, alterations in the heart’s biochemical pathways due to oxidative stress, and a higher risk of heart failure, chronic kidney disease, hypertension, and peptic ulcers in frequent users. These studies emphasize the importance of using this medication with caution.
Impact on Blood Pressure
Adding to these concerns, a 2022 study published in Circulation linked regular acetaminophen use to increased blood pressure. MacIntyre et al analyzed 110 individuals with hypertension, administering either 1,000 mg of acetaminophen (three regular-strength Tylenol tablets) or a placebo four times a day for two weeks. The results were striking: those taking acetaminophen experienced an average 5-point increase in blood pressure.
This finding is significant because even small increases in blood pressure can raise the risk of cardiovascular events, especially in individuals already managing hypertension.
What This Means for You
While acetaminophen is often considered a safer alternative compared to other pain relievers, these findings suggest that its prolonged use may carry hidden risks. Researchers from the University of Nottingham and other institutions stress the need to reassess acetaminophen as a first-line treatment for chronic conditions like osteoarthritis.
Conclusion
Acetaminophen remains a valuable tool for pain management, but its perceived safety may need reconsideration, particularly for older adults and those with chronic conditions. As the evidence grows, being informed and proactive is key to safeguarding your health.
Main Reference:
Kaur, J., Nakafero, G., Abhishek, A., Mallen, C., Doherty, M., & Zhang, W. (2024). Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink. Arthritis Care & Research. https://doi.org/10.1002/acr.25471
Other References:
Rivera, G., Sule, R., & Gomes, A. (2023). Acetaminophen causes mitochondrial dysfunction in heart cardiomyocytes. Physiology (Bethesda, Md.), 38(S1). https://doi.org/10.1152/physiol.2023.38.s1.5733274
MacIntyre, I., Turtle, E. J., Farrah, T. E., Graham, C., Dear, J. W., Webb, D. J., for the PATH-BP (Paracetamol in Hypertension–Blood Pressure) Investigators, Melville, V., & Caparrotta, T. M. (2022). Regular acetaminophen use and blood pressure in people with hypertension The PATH-BP Trial. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.121.056015
