Paracetamol (
acetaminophen) is well established as a leading non-prescription
antipyretic analgesic drug. Future developments are likely to include new formulations to achieve rapid absorption for a fast onset of action, and prolonged absorption to extend the duration of action for regular long-term administration. Better
dosage forms are also required for
rectal administration. The availability of intravenous
paracetamol has greatly extended the use of this
drug as an adjunct to postoperative
analgesia and for control of
fever in the
intensive care setting. Intravenous
paracetamol is available in only a few countries at present, but it seems inevitable that it will be marketed much more widely in the future. The misuse of
paracetamol as a fashionable agent for self-
poisoning seems likely to continue, and
liver failure may still occur in the small proportion of overdose patients who present too late for effective antidotal treatment with
N-acetylcysteine. Much effort is being devoted to the study of the molecular mechanisms of
paracetamol hepatotoxicity, and it is hoped that further advances may make it possible to prevent
liver failure in all patients, irrespective of delays in presentation. At the same time, there is great interest in the mechanisms of the therapeutic actions of
paracetamol and its effects on the different
isoforms of
cyclo-oxygenase. There will probably be important new findings in this area and these may lead to wider clinical use. Meantime, possible novel therapeutic applications for
paracetamol include its use as an
antioxidant to prevent
atherosclerosis and
cardiovascular disease by inhibiting the oxidation of
low-density lipoproteins, and to prevent the formation of
cataracts.