BHF Centre of Research Excellence (CoRE), Queen's Medical Research Institute, Pharmacology, Toxicology & Therapeutics, Edinburgh, UK.
Br J Clin Pharmacol. 2018 Oct;84(10):2218-2230. doi: 10.1111/bcp.13656. Epub 2018 Jul 20.
Paracetamol (acetaminophen) is the most commonly used drug in the world, with a long record of use in acute and chronic pain. In recent years, the benefits of paracetamol use in chronic conditions has been questioned, notably in the areas of osteoarthritis and lower back pain. Over the same period, concerns over the long-term adverse effects of paracetamol use have increased, initially in the field of hypertension, but more recently in other areas as well. The evidence base for the adverse effects of chronic paracetamol use consists of many cohort and observational studies, with few randomized controlled trials, many of which contradict each other, so these studies must be interpreted with caution. Nevertheless, there are some areas where the evidence for harm is more robust, and if a clinician is starting paracetamol with the expectation of chronic use it might be advisable to discuss these side effects with patients beforehand. In particular, an increased risk of gastrointestinal bleeding and a small (~4 mmHg) increase in systolic blood pressure are adverse effects for which the evidence is particularly strong, and which show a degree of dose dependence. As our estimation of the benefits decreases, an accurate assessment of the harms is ever more important. The present review summarizes the current evidence on the harms associated with chronic paracetamol use, focusing on cardiovascular disease, asthma and renal injury, and the effects of in utero exposure.
对乙酰氨基酚（扑热息痛）是世界上应用最广泛的药物，在急性和慢性疼痛的治疗中已有长期使用的记录。近年来，人们对其在慢性疾病中的应用益处提出了质疑，尤其是在骨关节炎和腰痛方面。同期，人们对长期使用对乙酰氨基酚的不良影响的担忧也在增加，最初是在高血压领域，但最近在其他领域也有所增加。慢性使用对乙酰氨基酚的不良影响的证据基础包括许多队列研究和观察性研究，随机对照试验很少，其中许多相互矛盾，因此这些研究必须谨慎解读。尽管如此，在某些领域，对损害的证据更为确凿，如果临床医生期望患者长期使用对乙酰氨基酚，那么在开始治疗前与患者讨论这些副作用可能是明智的。特别是，胃肠道出血风险增加和收缩压升高约 4mmHg，这两种不良影响的证据特别确凿，且具有一定的剂量依赖性。随着我们对其益处的评估降低，对其危害的准确评估就变得愈发重要。本综述总结了与慢性使用对乙酰氨基酚相关的危害的现有证据，重点关注心血管疾病、哮喘和肾损伤，以及宫内暴露的影响。
