Paracetamol is the most widely used painkiller in the world. It relieves mild to moderate pain — headache, period pain, backache, toothache, body aches — and reduces fever. The single most important thing to know is not to take it twice, because it hides in a great many combination products.

What is Paracetamol?

Paracetamol, known internationally as acetaminophen, is available in South Africa in strengths from 120 mg/5 ml paediatric syrups to 500 mg tablets, under many names — Panado, Donapan, Napamol, Painamol, Pacimol, Cetapon and others. Most are general sale or pharmacy medicines.

Exactly how it works is still not fully settled, which is remarkable for a medicine this old and this widely used. It acts mainly within the central nervous system to reduce the perception of pain and to lower a raised temperature, probably through effects on cyclo-oxygenase pathways in the brain and on other pain-signalling systems.

What matters practically is what it does not do. Unlike anti-inflammatories, paracetamol has little effect on inflammation itself. That distinction drives most sensible choices between them:

For a swollen joint, sprain or inflammatory condition, an anti-inflammatory such as ibuprofen often works better.
For general pain and fever — and especially for people who cannot take anti-inflammatories — paracetamol is usually the first choice, because it is far gentler on the stomach, kidneys and heart.

Paracetamol is also found in an enormous number of combination products: cold and flu tablets and sachets, sinus preparations, cough mixtures, period-pain products, and prescription painkillers containing codeine. South African examples include Stilpane, Propain, Tensodol, Mepromol and many more. This is the source of nearly all serious accidental overdose.

What is Paracetamol commonly used for?

Headache, including tension headache.
Period pain, though an anti-inflammatory is often more effective.
Backache and muscular aches.
Toothache, as short-term relief while awaiting dental treatment.
Cold and flu symptoms — the aches and fever, not the infection.
Fever in adults and, at paediatric strengths, in children.
Osteoarthritis pain, particularly where anti-inflammatories are unsuitable.
Pain after minor injury, surgery or a procedure.

It is often recommended first because it suits people who cannot take NSAIDs — including many with stomach, kidney or heart conditions, people on blood thinners, and those who are pregnant, where paracetamol is generally regarded as the preferred painkiller.

It relieves the symptom rather than treating the cause. Pain that persists needs a diagnosis, not indefinite suppression.

How Paracetamol fits into this medicine category

Group	Examples	What it does
Simple analgesics	Paracetamol (Panado, Donapan)	Pain and fever; little anti-inflammatory effect
Non-selective NSAIDs	Ibuprofen, diclofenac	Also reduce inflammation; stomach and kidney cautions
COX-2 selective	Celecoxib, etoricoxib	Anti-inflammatory, gentler on the stomach
Corticosteroids	Prednisone	Powerful anti-inflammatory, given as courses
Compound analgesics	Stilpane, Mybulen, Propain	Paracetamol plus codeine and others
Opioids	Tramadol, codeine	Moderate to severe pain

That fifth row is where the crucial caution lies. Paracetamol and an anti-inflammatory are different medicines and may be taken together on advice — the danger is taking paracetamol twice without realising. See the pain, inflammation and musculoskeletal medicines hub.

What to check before using Paracetamol

Check every other product you are taking for paracetamol. This is the check that matters most. Read the active ingredients on every cold, flu, sinus, cough and pain product you are using, including anything prescribed. If a product contains paracetamol, do not add more on top.

Beyond that, speak to a pharmacist or doctor if you:

Have liver disease, or drink alcohol heavily. Paracetamol is processed by the liver, and both raise the risk.
Have kidney disease.
Weigh under 50 kg, which reduces the maximum safe amount.
Are malnourished, eating very little, or significantly underweight — this genuinely lowers the threshold for liver harm.
Are buying for a child. Children are dosed by weight and age using paediatric preparations; adult tablets are not suitable for young children.
Are pregnant or breastfeeding. Generally the preferred painkiller, but use the lowest effective amount for the shortest time and confirm with your clinician.
Take warfarin. Regular use can affect anticoagulation control.
Take medicines for epilepsy or tuberculosis, which can affect how the liver handles paracetamol.

Follow the pack instructions for how much and how often, and do not exceed the stated maximum in 24 hours. With paracetamol that ceiling matters more than with most everyday medicines, because the margin between a normal dose and a harmful one is narrower than people assume. This page does not set doses.

Do not take it for more than a few days for a new pain without advice.

Possible cautions and when to ask a pharmacist or doctor

Taken as directed, paracetamol is well tolerated and side effects are uncommon. Allergic reactions are rare — stop and seek attention for a rash, swelling of the face or lips, or difficulty breathing.

Paracetamol overdose is a medical emergency, and it does not feel like one at first. This is the single most important thing on this page. Someone who has taken too much may feel completely well for a day or more while serious liver damage develops silently. By the time nausea, vomiting and abdominal pain appear, treatment is far less effective — and by the time jaundice appears, the damage may be irreversible.

If you think you or someone else has taken too much — even if they seem entirely fine, even if it was accidental, even if it was only somewhat over the limit — go to an emergency department immediately and take the packaging. There is an effective antidote, and it works best given early. Do not wait to see whether symptoms develop.

This applies equally to gradual excess: taking slightly too much over several days, or combining a cold remedy with a painkiller, can cause harm without any single large dose.

See a doctor if:

Pain lasts beyond a few days, or worsens.
Fever persists past three days, or returns.
Pain is severe.
Other symptoms appear — a rash, stiff neck, breathlessness, confusion, or unusual drowsiness.
You need painkillers most days. Regular use can itself cause medication-overuse headache.

For a child, use a lower threshold for seeking advice, particularly with a high fever, drowsiness, a rash that does not fade under pressure, or reduced fluid intake.

Related medicine guides

Frequently asked questions

What are paracetamol tablets used for? Mild to moderate pain — headache, period pain, backache, toothache, body aches — and fever.

What is paracetamol 500 mg used for? The standard adult tablet strength for the same purposes. Follow the pack for how many and how often.

Is paracetamol an anti-inflammatory? No. It relieves pain and fever but has little effect on inflammation, which is why an NSAID may work better for a swollen joint or sprain.

Can I take it with ibuprofen? They are different medicines and are sometimes used together on advice. The risk is taking paracetamol twice through a combination product — check the ingredients.

Is it safe in pregnancy? It is generally regarded as the preferred painkiller in pregnancy, but use the lowest effective amount for the shortest time and confirm with your doctor or pharmacist.

What happens if I take too much? Liver damage can develop without early symptoms. Go to an emergency department immediately with the packaging, even if you feel well — the antidote works best given early.

Can I give it to my child? Yes, at paediatric strengths dosed by weight and age. Adult tablets are not suitable for young children — ask a pharmacist.

Can I drink alcohol with it? Occasional moderate drinking with normal doses is generally acceptable, but heavy or regular drinking raises the risk of liver harm. Ask your doctor if this applies to you.

What Is Paracetamol Used For?