Availability of Paracetamol Sold Over the Counter in Europe: A Descriptive Cross‐Sectional International Survey of Pack Size Restriction
Open accessAbstract
Due to the risk of hepatotoxicity when excessive amounts of paracetamol are consumed, Poisons Information Centers ( PIC s) frequently receive paracetamol‐related enquiries. This study examined how widely pack size restrictions of paracetamol sold over the counter have been implemented in Europe and also availability of paracetamol through non‐pharmacy outlets and their possible associations with frequency of poisoning enquiries. A cross‐sectional European multi‐centre questionnaire study was performed using a questionnaire to identify the extent and nature of paracetamol pack size restrictions, non‐pharmacy outlet sales and the frequency of paracetamol‐related enquiries to PIC s. In total, 21 European countries participated. All PIC s provided telephone hotline services. In 14 (67%) countries, pack size restrictions had been implemented in pharmacies (range: 8–30 g). No significant difference (median difference 0.7%, p ‐value = 0.36) was found when comparing median frequencies of paracetamol‐related enquiries in countries with pack size restriction to countries without restrictions. A significantly lower median frequency of paracetamol‐related enquiries was found in countries without non‐pharmacy outlet sales compared to those with such sales (median difference 2.2%, p = 0.02). Pack size restrictions on pharmacy sales of paracetamol have been implemented in two‐thirds of examined countries. There was no difference in the proportion of paracetamol‐related enquiries to PIC s among countries with and without pack size restrictions. However, a lower rate of paracetamol‐related enquiries was noted in countries where paracetamol was not available in non‐pharmacy outlets.
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The rate of paracetamol-related poisoning enquiries was lower in most of these countries.
“A study of 21 European countries found that over half of the participating countries including France, Italy, and Switzerland did not have paracetamol available for purchase outside of pharmacies and that the rate of paracetamolrelated poisoning enquiries was subsequently lower in most of these countries [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
Restrictions on paracetamol sales in Sweden were reintroduced in 2015.
“The introduction of paracetamol sales from non-pharmacy outlets in Sweden in 2009 was associated with an increase in the rate of paracetamol poisonings [234], however restrictions were reintroduced in 2015 [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
Over two-thirds of European countries have paracetamol pack size restrictions within pharmacies, ranging from 8 to 30 g.
“Over two-thirds of European countries have paracetamol pack size restrictions within pharmacies, ranging from 8 to 30 g [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
The number of paracetamol-related poisoning enquiries was higher in some of these countries.
“The number of paracetamol-related poisoning enquiries was higher in some of these countries [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
A study of 21 European countries found that over half of participating countries including France, Italy, and Switzerland did not have paracetamol available for purchase outside pharmacies.
“A study of 21 European countries found that over half of the participating countries including France, Italy, and Switzerland did not have paracetamol available for purchase outside of pharmacies and that the rate of paracetamolrelated poisoning enquiries was subsequently lower in most of these countries [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
Countries such as the UK, Denmark, and Ireland allow sales of paracetamol outside pharmacies however pack sizes are limited to 5-8 g.
“Countries such as the UK, Denmark, and Ireland allow for sales of paracetamol outside of pharmacies however the pack sizes are limited to 5-8 g [233].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [233]
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- Authors
- Morthorst, B. R., Erlangsen, A., Nordentoft, M., Hawton, K., Hoegberg, L. C. G., & Dalhoff, K. P.
- Affiliations
- University of Copenhagen (DK)
- Johns Hopkins University (US)
- University of Oxford (GB)
- Bispebjerg Hospital (DK)
- Corresponding author
- Morthorst, Britt Reuter
- ORCID
- Venue
- Basic & Clinical Pharmacology & Toxicology
- Publisher
- Wiley
- Published
- 2018-02-08
- Volume
- 122
- Issue
- 6
- Pages
- 643-649
- ISSN
- 1742-7835 (ISSN-L)
- 1742-7843
- OpenAlex
- W2783012614
- Cited by
- 61
- References
- 35
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 10 · 2023: 10 · 2022: 5 · 2021: 10 · 2020: 8 · 2019: 7 · 2018: 2
- FWCI
- 8.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Basic & Clinical Pharmacology & Toxicology (publishedVersion)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (acceptedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Funders
- Københavns Universitet
- Topics
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Keywords
- paracetamol, over-the-counter drug sales, poison control centers, hepatotoxicity, drug regulation, Europe
- MeSH terms
- Acetaminophen, Cross-Sectional Studies, Drug Packaging, Nonprescription Drugs, Europe, Humans, Surveys and Questionnaires, Analgesics, Non-Narcotic, Drug Overdose
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