Talk:Paracetamol/Archive 1

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Paracetamol or acetaminophen?

I could not find any information about standard dosage amounts in the UK when sold as paracetamol. Is it similar to the US?

standard UK dose is 1-2 500mg tablets for adults or children over 12 years. Some tablets contain ~65mg caffene as well. 'Co-Codamol' is availible by prescription in 8/500mg and 30/500mg and is codine/paracetamol. Other tablets ('Anadin Extra' etc) are availible that combine a smaller paracetamol dosage with Asprin

I believe acetaminophen is mainly just an American usage and the rest of the world and official authorities use paracetamol ?
Kpjas 14:39 May 13, 2003 (UTC)

Yeah, in New Zealand we call in paracetamol, and it doesn't contain any codeine. Paracetamol is the name of the chemical by itself. Tristanb 09:21 27 May 2003 (UTC)

acetaminophen doesn't contain any codeine either. acetaminophen is the generic USAN name. All USAN names are generic and refer just to the chemical itself -Nathan J. Yoder 14:55, 29 Apr 2005 (UTC)

Well, in Canada, it is called acetaminophen as well. I take "American" to mean USA not North America.
RedWolf 05:28, Nov 20, 2003 (UTC)

The World Health Organisation's list of recommended International Non-proprietary Names (rINNs) lists paracetamol. I believe acetaminophen is now only listed in the United States "Pharmacopeia" (as all European Union members use the rINNs in the European Pharmacopoeia). Much of the world recognises the British Pharmacopoeia, which has now standardised with the European Pharmacopoeia. (Just a quick explanation: pharmaceutical non-proprietary names are usually definitively listed in a pharmacopoeia such as the EP, BP or USP). Techelf 10:55, 27 Jun 2004 (UTC)

So why does the article repeatedly refer to acetaminophen if paracetamol is the correct international name? Shouldn't this be changed? Dan100 10:03, Dec 19, 2004 (UTC)

In accordance with Wikipedia:WikiProject_Drugs naming policy, I propose we move this page to the INN paracetamol. If you have any concern with this proposal, please discuss it on this page. Matt 17:55, 24 Dec 2004 (UTC)

None, I agree it should be moved. Dan100 17:59, Dec 24, 2004 (UTC)

Chicago poisoning event

This might be a good place to put in a discussion of the 1980's deliberate poisoning event that occurred in the Chicago area -- multiple deaths. No time right now, but this would also be a cross link to terrorism, crime, etc.

I put the general history of the poisoning in. Not sure how to word it to link it in to terrorism or crime. Ksheka 22:06, Apr 14, 2004 (UTC)

This article conains a factual innacuracy. According to http://www.assistpainrelief.com/info/paracetamol/ Paracetomol is not a NSAID G-Man 23:46, 2 Nov 2003 (UTC)

Not really, read more clearly, its written that aspirin and ibuprofen are NSAIDs

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Sorry if I hijacked this page a bit. I changed the graphic of the structure to make it look better (The word "Acetaminophen" is no longer part of the picture -- This should display better in most browsers).

I also plan to add quite a bit in the next week about Tylenol overdose, treatment of Tylenol overdose, and stuff like that.

A side-effect of this is that the article (at least the overdose section) is going to be a bit more oriented to those with a technical/ scientific/ chemical/ physiological/ medical background.

Any objections? Ksheka 00:05, Apr 12, 2004 (UTC)

Nope. Just a round of applause for a thorough and informative addition. I learned some things I did not previously know - and that's what it's all about. Thanks! Pollinator 12:55, 13 Apr 2004 (UTC)

Thanks. I found it kind of fun. :-) I had some of it already written as part of a handout I gave students. It's nice to put it where anyone can gain from it. I'll try to fill out some of the empty links (ie: the coagulation factors) in the next couple weeks. Ksheka 02:07, Apr 14, 2004 (UTC)

Okay. I added the overdose section. The length of the section overwhelms the entire article. I'd rather not cut parts of it out. Maybe, in the future, the rest of the article will expand.

I will try to make some subsections out of it, however.

Ksheka 12:18, Apr 13, 2004 (UTC)

General agreement on activated charcoal

What is the evidence that that is widely agreed upon? Kd4ttc 23:09, 11 May 2004 (UTC)

Featured article candidate

I'm nominating this article for featured article (see top of this page). Ksheka 22:29, May 8, 2004 (UTC)

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It seems that this article has been copied (with a citation back to the wiki). I'm flattered! Ksheka 14:36, May 9, 2004 (UTC)

well done! --e 22:44, 9 May 2004 (UTC)

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I recommend changing the text of ==Treatment== to not say "Mucomyst". This is a brand name that isn't the same worldwide. In Singapore, for instance, intravenous N-acetylcysteine is known as "Parvolex". IMHO, I think it's better to go with an acronym like NAC instead of Mucomyst. Alex.tan 18:26, 9 May 2004 (UTC)

Taken care of. Thanks for the idea. Ksheka 22:00, May 9, 2004 (UTC)

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these are a few musing that could be integrated:

1. because of widespread availability it's effectiveness is often underestimated
   • Added to the Overview section. Ksheka 11:52, May 10, 2004 (UTC)
2. need to emphasise need for early Px of OD
3. ? mention phenomenom of deliberate od --> no effects --> remorse and desire to live ---> fulminant hepatic failure ---> death after a few weeks ???
   • Added to the Natural history section. Ksheka 11:52, May 10, 2004 (UTC)
   1. There's actually two different scenarios. If someone more elequoent that I would like to write them up, I would be much obligded. :-) Ksheka 01:33, May 10, 2004 (UTC):
      • An individual ingests acetaminophen in a suicide attempt, changes their mind, and then develops hepatic necrosis
      • An individual ingests acetaminophen, not as a suicide attempt, but just as a call for attention. They choose acetaminophen because they think it's harmless. Then they develop hepatic necrosis.
4. can be taken in combination with NSAIDs providing additive analgesic effects
5. ???used to be recomended prophylacticly before childhood immunistations but not any more?? don't know details or why thinking changed... ?alex? --e 22:44, 9 May 2004 (UTC)
   • I'm not sure. My baby's pediatrician tells us to take it. :-) Ksheka 01:33, May 10, 2004 (UTC)

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There was a question about the 150 mg/kg number. I don't recall where I got it from, but a google result came up with this. Ksheka 00:14, May 10, 2004 (UTC)

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History

This page has a bit of history of acetaminophen. Googling for some of the names & terms on this page should find more information. http://www.assistpainrelief.com/info/paracetamol/ Ksheka 02:55, May 14, 2004 (UTC)

Added to article page. Ksheka 02:01, May 15, 2004 (UTC)

Featured article

This article has gone through the review and is now a featured article. Congrats, everyone! Ksheka 20:05, May 16, 2004 (UTC)

Splitting the page

what do people think about splitting the toxicity out of this page into a separate article? I think toxicity is so common and so well covered it is deserving of going solo! Erich 04:35, 14 Jun 2004 (UTC)

On toxicity - is it possible to tone down the medical language somewhat? For instance, I have no idea what "gastric lavage" is beyond schoolboy Latin which tells me it's a "bowel wash" of some kind. Similarly we could just say "liver poisoning" for "hepatotoxicity".

What would be very good (for the very keen) is some kind of diagram of the metabolism of the stuff.

NSAID?

In http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11113024&dopt=Abstract I read that acetaminophen is counted among the NSAIDs, yet our articles claims otherwise. AxelBoldt 20:00, 21 Oct 2004 (UTC)

Some people group paracetamol as an NSAID because of its mechanism of action. However, since paracetamol has no appreciable antiinflammatory effect, it would be inappropriate to classify it as an NSAID. (see NSAID for more details). Techelf 08:06, 4 Nov 2004 (UTC)

Isoniazid

I removed the reference to isoniazid and stimulation of cytochrome P450. Isoniazid actually inhibits cytochrome P450 (perhaps there was confusion with rifampicin?). The mechanism of isoniazid-induced hepatotoxicity is not fully understood. Isoniazid is metabolized by N-acetyltranferase. The gene for this enzyme has polymorphisms that cause variation in the enzyme's activity. These different phenotypes are commonly called 'slow acetylators' and 'fast acetylators'. Once the acetylation pathway becomes saturated, metabolism switches to cytochrome P450. Slow acetylators typically have a higher incidence of hepatotoxicity, probably because the cytochrome P450 degradation products are toxic. [Cytochrome P450 inducers, such as barbiturates and rifampicin, lead to increased risk of isoniazid toxicity.] Isoniazid does increase the risk of paracetamol toxicity, but this is probably due to an additive effect of isoniazid degradation products with NABQI. Axl 17:08, 10 Nov 2004 (UTC)

Isoniazid is an inducer of CYP2E1 [1]. In any case I've put additional references in the main article concerning interactions. You are right though about the complexity of isoniazid-induced hepatotoxicity; it seems that the hepatotoxicity of the combination with paracetamol may not necessarily relate to CYP2E1 induction. Techelf 07:22, 11 Nov 2004 (UTC)

I accept that my claim that isoniazid is an inhibitor of cytochrome P450 is simplistic. Isoniazid inhibits CYP1A2, 2A6, 2C9, 2C19 and 3A (and probably many others). However even your reference is too simplistic. Isoniazid has a complex interaction with CYP2E1, involving first induction, later followed by inhibition.

[2]

[3]

[4]

Axl 12:20, 11 Nov 2004 (UTC)

NSAID side-effects

"Unlike NSAIDs, in normal doses acetaminophen does not irritate the lining of the stomach, or affect blood coagulation, the kidneys or the fetal ductus arteriosus." - that seems to imply that those side-effects are possible with normal dosages of NSAIDs, which I don't believe to be true (only true with extraordinary high doses or prolonged usage). Should the sentence be revised? Dan100 23:41, Dec 17, 2004 (UTC)

Dan, NSAIDs can cause those side-effects at normal doses. Of course, the risk is increased with high doses or prolonged use. Axl 10:05, 18 Dec 2004 (UTC)

Especially considering what Americans think are "normal" doses of NSAIDs... =) (often twice what we use in the rest of the world) -Techelf 11:17, 18 Dec 2004 (UTC)

Well, this is the English-language wikipedia, not the American one ;). Axl, yes NSAIDs can cause those side-effects. That doesn't mean they do. A very important difference. I think I should've been clearer - while GIT irritation is possible with NSAID use, it doesn't happen every time you take one, so the statement is incorrect and misleading. Also, only aspirin affects blood coagulation, not all NSAIDs. Dan100 16:54, Dec 18, 2004 (UTC)

Well, I rephrased the line to imply 'can' instead of 'do'. What do people think? Dan100 10:03, Dec 19, 2004 (UTC)

From Patrono C et al. Platelet-activating drugs: the relationships among dose, effectiveness and side effects. Chest 2001;119:Suppl.39S-63S.

"A variety of NSAIDs can inhibit TXA₂-dependent platelet function through competitive, reversible inhibition of platelet COX-1. In general, these drugs, when used at conventional analgesic dosages, inhibit reversibly platelet COX activity by 70 to 90%. This level may be insufficient to block adequately platelet aggregation in vivo because of the very substantial biosynthetic capacity of human platelets to produce TXA₂.... The only reversible COX inhibitors that have been tested in randomized clinical trials for their antithrombotic efficacy are sulfinpyrazone, indobufen, flurbiprofen, and triflusal.... The conflicting or negative results obtained in randomized clinical trials of sulfinpyrazone in patients with MI or unstable angina are not surprising in light of the drug being a weak COX inhibitor with no other established antiplatelet mechanism of action. In contrast, indobufen is a very potent inhibitor of platelet COX activity.... Thus, at therapeutic plasma levels achieved after oral dosing of 200 mg qid, indobufen inhibits TXB₂ by >95% throughout the dosing interval and reduces urinary TXA₂ metabolite excretion to an extent quite comparable to aspirin."

The article also discusses antiplatelet effects of flurbiprofen and triflusal. [The split infinitives were included by the author. ;-) ]

To summarise, some NSAIDs may cause significant platelet inhibition, even at standard doses. Axl 18:53, 20 Dec 2004 (UTC)

Dan, regarding your recent edit, it is fine. Axl 19:04, 20 Dec 2004 (UTC)

I stand corrected on the coagulation issue! Dan100 23:15, Dec 20, 2004 (UTC)

Aspirin Reference

"While aspirin acts as a competitive inhibitor of COX..."

I believe aspirin permanently acetylates COX enzymes, rather than inhibiting it by competition with it's natural substrate (the page on aspirin - [5] - appears to agree)

It is irreversible, and the main article has been corrected. -Techelf 11:51, 12 May 2005 (UTC)

Two wikiprojects are relevant: Drugs and Chemicals

The paracetamol article is listed both in the Drugs wikiproject as well as the Chemicals wikiproject. Both wikiprojects have developed a standardized infobox for providing drugs cq. chemical data information. Obviously they are different. How should this be handled: both infoboxes, merged infoboxes, the largest infobox (= Chemicals). My preference goes to completeness, i.e., do the Chemicals infobox and specially include the (only 4) extra entries of the Drugs infobox. How to people feel. This is a FA already, so I'm hesitant in doing this boldly. Wim van Dorst 13:59, 2005 Jun 4 (UTC).

History issue

I was reading through this and was very surprised to see, in a peer-reviewed article, the first sentence of the History section, which began "Prior to the creation of paracetamol, the only antipyretic agent available was cinchona bark..." I'm sorry, but that's not remotely true. Willow bark (and salicin) antipyretics were known since the 5th century BC, as noted in the aspirin article, and were in use and under development in much of the 18th & 19th centuries. MCB 23:55, 27 August 2005 (UTC)

In ancient and medieval times, the only antipyretic agents known were compounds contained in willow bark (a family of chemicals known as salicins, which led to the development of aspirin)

Aspirin-like compounds, among others are supposed to be available in Yarrow. It was used as a drink and topical wash.

Tumeric, which has long been used an herb, has activity both by COX-2 inhibition and other mechanisms. [6]

Anti-inflammatory activities of aqueous extract from Radix Ophiopogon japonicus and its two constituents. [7]

There were lots of anti-pyretic agents being consumed prior to paracetamol. Some were even used medically. This statement needs some serious qualifications. Was it the only anti-pyretic agent administered medically by a certain American medical body at the time Pracetamol was invented? Where does this assertion come from? --Ryan Wise 03:05, 29 March 2006 (UTC)

Low therapeutic index?

In the section on toxicity overview shouldn't it read: "narrow therapeutic index" instead of "low therapeutic index"? This would favourably tie in with the hyperlink to therapetuic index.

You're quite right. I've changed it. JFW | T@lk 12:28, 5 September 2005 (UTC)

Rise in Acetaminophen-linked liver poisoning

Per this article[8], acetaminophen was to blame for 28 percent of the liver poisonings in 1998, but caused 51 percent of cases in 2003. The FDA may "revisit the issue," considering that more than 56,000 emergency-room visits a year are due to acetaminophen overdoses and that 100 people die annually from unintentionally taking too much. Is there anything in this which can be folded into this Wiki article? UncleFester 07:37, 28 December 2005 (UTC)

The CBS got the statistic from somewhere. Could you recover the original source, e.g. a medical journal article? You did not mention the the absolute increase. Perhaps people took less other hepatotoxic agents (troglitazone was withdrawn in the meantime). JFW | T@lk 13:50, 28 December 2005 (UTC)

alcohol link

I notice the article here mentions interactions with alcohol - does anyone have a reference for this? My september 2005 issue of the British National Formulary conspiculously doesn't mention this. I've tried a quick google and I can't find any good sources to support this.

Well, chronic alcoholism predisposes to paracetamol toxicity. PMID 11605310. JFW | T@lk 17:09, 24 January 2006 (UTC)

http://www.australianprescriber.com/magazine/27/1/14/5/ suggests otherwise. The wiki article states "Paracetamol should not be taken after alcohol consumption, because the liver, when engaged in alcohol breakdown, cannot properly dispose of paracetamol, thus increasing the risk of hepatotoxicity." , rather than talking about cases of chronic liver damage. There seems to be some suggestion that if anything alcohol might have a theoretical benefit to paracetamol poisoning by inhibiting the cytochrome p450 enzymes which produce paracetamol's toxic metabolites. I'll keep looking and see if I can find anything definative.

Alcohol up-regulates cytochrome p450 enzymes in the liver, so any intake of alcohol along with paracetamol pushes more paracetamol down the cyt p450 pathway and increases the likelihood that NAPQI will build up. Chronic alcoholics will have a particularly active cyt p450 system so will be even more at risk. They also tend to be malnourished, which itself is a risk factor because it means the body runs our of glutathione quicker. I don't have a reference for this but it will be found in any decent medical or clinical biochemistry textbook. --Purple 18:53, 20 February 2006 (UTC)

This article from Br J Clin Pharmacol goes into the issue in a fair amount of detail. -Techelf 13:09, 21 February 2006 (UTC)

Pronunciation

The pronunciation is given as [pærəˈsitəmoʊl], which normally would be spelled <paracetamole>. Is it really pronounced that way? I'd have thought [pærəˈsitəmɔl]. --Macrakis 19:25, 1 March 2006 (UTC)

Maybe it's my Australian accent. =) But that's actually what we use in the clinical setting. For the sake of completeness, however, I'll add the other main pronunciations from the Oxford English Dictionary. -Techelf 10:20, 2 March 2006 (UTC)

So you don't distinguish the -ol of 'alcohol' and 'cholesterol' from the -ole of 'indole' and 'thiazole'? Interesting. --Macrakis 15:26, 2 March 2006 (UTC)

I say indole as in-dol-AY.. 203.218.91.57 03:26, 26 March 2006 (UTC)

That's a pretty unusual pronunciation... -Techelf 07:49, 26 March 2006 (UTC)

Blonde2max 16:26, 21 April 2006 (UTC) Par-seat-a-mall =)

APAP

I have noticed that pharmacy labels (at least here in the United States) usually mark drugs containing acetaminophen with the letters "APAP". I see that Apap is a redirect term here. But the term is unexplained. Can someone add some language explaining what APAP means? --TreyHarris 09:32, 5 March 2006 (UTC)

Could it be: N-acetyl-para-aminophenol  ?????

Panthro 23:58, 21 March 2006 (UTC)

Thanks, I didn't realize until now that the "para" could go on either side of "acetyl", and so I was getting "paap", not "apap". --TreyHarris 06:25, 22 March 2006 (UTC)

Contradictory safety statements

The overview of toxicity notes that a low T.I. makes acetaminophen "relatively dangerous substance," but the fourth paragraph says, "When used responsibly, Paracetamol is one of the safest medications available for analgesia." While confusing, I can understand how the qualifications on the second statement allow the two taken together to make sense, if one considers all analgesics dangerous. But I still have a problem with calling acetaminophen "relatively dangerous" -- dangerous relative to what? Maybe this could be described some other way. Prithason 05:19, 17 March 2006 (UTC)

• British Medical Journal just released news item that unintentional overdosage of paracetamol is the No 1 cause of liver failure in UK (matching a similar study published re USA in Dec 2005 by Gastroenterology), yet it is the commonest used medication. So at the right dosage it may be safely taken indefinitely without any accumulative risk occuring or any need for monitoring, but potentially just double up on the dose for a few days and one might within a week be needing life-saving liver transplant. That makes it certainly "relatively" dangerous within its own context (i.e. correct-dose to over-dosage risks), as well as in comparison to other drugs (e.g. many chemotherapy drugs for cancer, that are inherently dangerous/risky even at correctly used dosages, are only taken for very compelling reasons of the alternative outcome to the patient (death from the cancer) and certainly are not "safe" to use longterm). David Ruben ^Talk 11:02, 17 March 2006 (UTC)

Paracetamol as a "booster"

I think it would be interesting if a more clued up person to put a bit in about how paracetamol increases the analgesic effect of other drugs.

For example:

1000mg of paracetamol gives mild-moderate pain relef 60mg of codeine gives mild pain relief (no it really is just mild reliefe- taken oral, codeine does not actually provide a large reliefe to pain)

Where as combined they are able to give powerful pain relief.

Part of problem is that whilst most doctors perscribe such combinations (e.g. co-codamol, co-dydramol and before its withdrawal co-proxamol) and patients report better pain relief, the advice from UK Department of Health has often been that studies have failed to confirm the additional benefits over paracetamol alone, nor therefore the additional costs of combination products. This is at varience though with "common experience" when elderly patients´ complaint of increased pain is not infrequently due to taking tablets from their old paracetamol container rather than their newer combination product prescribed the previous week. Anyone else got any thoughts, and then we can perhaps cite some references to add a suitable NPOV comment. David Ruben ^Talk 22:11, 25 March 2006 (UTC)

I remember reading criticism somewhere saying that APAP/codeine products have never actually been shown to be more effective than acetaminophen alone. I believe similar criticisms have been made about propoxyphene products. I don't have any references, though. --Bk0 (Talk) 00:26, 26 March 2006 (UTC)

Blonde2max 14:57, 3 April 2006 (UTC)

Codeine and DHC are themselfes useless in the body as painkillers- they don't act on receptors. in the body they are converted to morphine- and it's the MORPHINE that kills that pain. I think DHC and codeine do provide additional pain reliefe, especially if you have stomach cramps, because the opiates cause mild paralysis of the smooth muscles.

Effect on coagulation

A line in this article states

   "In normal doses, paracetamol does not...affect blood coagulation"

While correct for one off doses, the Australian Medicines Handbook, or AMH, states that in doses above 3.5g per week, an increase in the International Normaised Ration (INR) may occur. This is substantial enough to warrant a change in the oral anticoagulant, Warfarin. In elderly patients (likely to be on 4g of paracetamol daily for such things as arthritis), I feel this is significant. Any thoughts??

The article passage is correct – paracetamol does not have any effect on coagulation per se. The statement you quoted from the AMH concerns a drug interaction between warfarin and paracetamol (i.e. prolonged use of paracetamol doses can increase the anticoagulant activity of warfarin). -Techelf 12:56, 22 May 2006 (UTC)

Merge with Tylenol

Tylenol has been suggested to be merged into this article. Tylenol is a brand while Paracetamol is the name of the drug. I think they can manage as seperate articles, but if they can be merged seemlessly, then I'm for it. --Chris 14:08, 5 June 2006 (UTC)

• No, I am against this. Tylenol is one of the most popular brand of pain killers. It is not merely a drug, but to an extent an iconic symbol and it has its own history that is worth an article. (With cleanup, of course) Hobbeslover ^{talk/contribs} 02:25, 9 June 2006 (UTC)

• I support merger and a redirect. There are really only two things in that article which are worth merging here: a sentence on current marketing trends (combination products), and a paragraph on the 1982 cyanide incidents. Everything else of importance in the Tylenol article is covered here in paracetamol; the "laundry list" of products is not really of encyclopedic value; Wikipedia is not a product directory or collection of indiscriminate information. MCB 06:17, 9 June 2006 (UTC)

• ? - Certainly the laundry list should go, but the first part of the article is a history of the brand. Note that at the absolute least it would need a disambiguation page, because there are several different tylenol products, with codeine, pseudophedrine, etc. —Centrx→talk • 07:18, 24 June 2006 (UTC)
• Disagree. (Er, not with Centrx, but with the merge...) - BalthCat 03:28, 10 July 2006 (UTC)
• Leave as separate articles - such an iconic product (and only one by which Americans know of paracetamol), with its multiple forms, deserves own article. However merge history section with that of paracetamol, leaving this article just specifdic story & description of the Tylenol brand. David Ruben ^Talk 12:46, 10 July 2006 (UTC)
• no merge I've never heard of Tylenol, but if U.S. contributors say that it is a notable brand then it should have its own article. I've never been particularly easy about the situation at Asprin, and I think a merge would recreate the same problems. But, as a general rule, brands should redirect to INNs unless (as seems in this case) there is particular notability. --Physchim62 (talk) 14:39, 11 July 2006 (UTC)

Abnormal LFTs

Up to 40% of chronic paracetamol users have abnormal liver enzymes[9]. JFW | T@lk 21:05, 4 July 2006 (UTC)

Change to opening passage - paracetamol is not only for "minor" pain

I think that the opening paragraph should be changed to remove reference to "minor aches and pains." Paracetamol is an highly efficacious analgesic useful in many serious conditions and the public perception that it is weak is both a barrier to proper utilisation of this drug and also a contributor to the frequency of dangerous overdose of paracetamol. It is not just appropiate for slight pain, and even in severe pain where paracetamol is insufficient alone it is highly beneficial in allowing safe and adverse-effect free sparing of other analgesics such as opioids. I'm always eager to get my patients settled into a routine dosage of paracetamol before advising risky NSAIDs or opioids which have many side effects. What does anyone else think about this? Thanks, ben 16:06, 8 July 2006 (UTC)

Good point, but if we stated, without your quite correct fuller explanation, "useful for severe pain" then this would also be incorrect for a larger majority of users (most use of paracetamol will be for minor conditions) - and your full explanation would be too lengthy in the introduction. So how about this addition to indicated that in combition useful for severe pain (I've left exposed the wikimarkup for easier copy&paste to the article if you agree): "... and other minor aches and pains. It is also useful in managing more severe pains, allowing lower dosages of additional [[Non-steroidal anti-inflammatory drug|NSAID]] or [[opioid]] analgesics to be used, so minimising overall side-effects."  ? David Ruben ^Talk 22:50, 8 July 2006 (UTC)

Cheers, I think that puts it very nicely! ben 08:24, 9 July 2006 (UTC)

Regarding pop culture trivia

This is an encyclopedia, not a collection of trivia (see WP:5P and WP:NOT#Wikipedia is not an indiscriminate collection of information). While cultural references can be appropriate for indicating the impact someone or something has had on a culture, they are not otherwise, and listing several random song mentions does not indicate its cultural importance. Except in relation to cultural icons—which paracetamol is not, and perhaps in some unusual cases, pop culture references are not relevant to knowing what paracetamol is, to understanding the subject of this article. For a drug and a sold product, this importance, and what cultural relevance there is, is indicated by its action on the body, its level of sales, and its historical uses, not by someone putting a word into a song because it rhymes, in some cases without any semantic connection. —Centrx→talk • 00:41, 31 July 2006 (UTC)

You'll have to be more specific. There is a low amount of trivia in the section I reverted, and this discussion does not fall under the indiscriminate collection of information. SynergeticMaggot 01:00, 31 July 2006 (UTC)

The section is entirely trivia; it is a list of loosely associated topics; and aside from being covered by WP:NOT, the reason for its exclusion stems from the principles described at WP:5P and from the overall cohesion and purpose of this particular article. This section is irrelevant to this analgesic or antipyretic drug. It is irrelevant to its chemical synthesis, its biological effects, and its use in medicine. It is irrelevant to the history of its discovery and the history of its commercial use. It is even irrelevant to its cultural significance; these lyrics use "paracetamol" as a rhythmic filler or fancy, and could have been replaced just as well with either any word that also was about some pill, or any word that rhymed with "paracetamol". Why do you think they should be included? —Centrx→talk • 01:41, 31 July 2006 (UTC)

Its no longer a list. And you still have not specified where in WP:NOT this cant be included, since this is a featured article, or was, I think it should stay. Please understand that I do not wish to argue about this, but I'm asking again to state a policy or guideline that states this shouldnt be in the article. Thank you and I appreciate your concerns. SynergeticMaggot 01:45, 31 July 2006 (UTC)

I added the Spooks entry in the Cultural References section for Paracetemol. I often use the Wikepedia to look up information after hearing a reference in film, tv, song, or a book, and find the Cultural References valuable. I don't know what the consensus policy is, but in my very humble opinion, including more information is better, as long as it is accurate and unbiased. If the goal of removing Cultural References is to make the entry more concise, maybe there is a convention for moving this to a separate entry linked from the Paracetemol page.

I believe there is. Its called forking, and thats if the material gets too long. I don't forsee this section getting too long though. So theres no need to move it to its own article page. SynergeticMaggot 03:25, 31 July 2006 (UTC)

Note that if this section were forked out, it would be quickly deleted at AfD. —Centrx→talk • 03:28, 31 July 2006 (UTC)

I have already pointed you to the relevant pages, WP:5P and WP:NOT; the purpose here is to determine their application to this article and that section of this article. Formal policies do not often have a long list of every particular thing that is contraindicated, but that does not mean that every biography should have a list of the person's favorite foods, or that we should fill up the section in this article with twenty descriptions of uses in literature. There is no explicit policy that forbids "John Doe has said that he favors chocolate ice cream over vanilla ice cream", but that does not mean it belongs in an encyclopedia article about a senator, though perhaps in an article about Ben or Jerry (creators of ice cream company and recipe, Ben & Jerry's). These distinctions, of which there are particular millions, are not to be added to reams of Wikipedia policies. Instead, the editors of the individual articles decide whether perhaps the ice cream mention is relevant to a biography of a businessman who, among his many executive positions from automobiles to printing, made an ice-cream-related statement while CEO of an ice cream company.

In the particular case of paracetamol, the mention in music lyrics does nothing to help a reader who is coming here to learn about the drug and its history, effects, medical treatments, etc. They were not added by someone writing about paracetamol and this section was not present when the article was a featured article [10]. Instead, they were added over time by readers passing through, who happened to be fans of a band (e.g. [11] [12] [13]) —Centrx→talk • 03:27, 31 July 2006 (UTC)

I don't want to put words into your mouth, but from my reading of the policy pages the relevant issues seem to be trivia and self-promotion. The policy on trivia is clearly a gray area. It appears at least 18,000 Wikipedia pages have "Cultural References" sections, and I'll argue that is evidence that many people find them useful. As far as self-promotion, at least 2 of the 3 bands mentioned are very successful, and even if it was, for example, Neil_Peart who added the entry refering to Rush_(band), I doubt his goal was to significantly boost their score of 23 gold records. —The preceding unsigned comment was added by 70.107.87.79 (talk • contribs) 04:10, 31 July 2006 (UTC)

I'm not sure where you get that number, but if it based on some linkage, many of those articles could be articles that no one really edits and just get stuff randomly added. There are thousands of articles about garage bands without albums too, but that's not par, and the sort of cultural reference that is in this article is the sort that, if it were normal, could be found on a hundred thousand Wikipedia articles, but it's not because it is not the norm. Also references to cultural impact are relevant to certain articles, like the Julia Child one I mentioned on my Talk page, or for example, having a band mentioned on television programs, but that is not the same thing as a medicine. I don't mean the bands are self-promotion, I just mean that the readers who are interested in the bands are the ones who add it. The reader who already knows that the word appears in a song is the one who adds it, and the reader who doesn't know it doesn't care about it; it doesn't help the school project or someone trying to find out about this drug they are taking. It isn't an explanation of the subject of "paracetamol". —Centrx→talk • 04:42, 31 July 2006 (UTC)