German pharmacies sold 24.3 million packs of paracetamol in 2025. This is shown by figures from the Federal Association of German Pharmacists Associations (Abda). The active ingredient is in second place among over-the-counter medications behind ibuprofen with 48.1 million packs. Paracetamol is an indispensable part of household pharmacies nationwide.

But “what exactly paracetamol does and how it works is not yet entirely clear,” reveals British pharmacist Deborah Grayson in an interview with the British “Daily Mail“.

In the video: Doctor warns about ibuprofen and paracetamol – what you need to consider when taking them

The effect on the nervous system is still unclear

What is certain is that the active ingredient primarily works in the central nervous system. It influences processes in the brain and spinal cord and thus the perception of pain. Researchers assume that it dampens the production of messenger substances that are involved in pain and temperature regulation.

Grayson has been studying pharmaceuticals and their interactions for more than 30 years. In the interview she explains: “It reduces the production of certain substances – prostaglandins – and thus essentially inhibits the enzymes that are responsible for the transmission of pain signals.” It seems to weaken pain signals that reach the brain to a certain extent,

How to take paracetamol safely

The correct dosage of paracetamol depends on age and body weight. The rule of thumb is a single dose of ten to 15 milligrams per kilogram of body weight. In total, no more than 60 milligrams per kilogram of body weight should be taken per day, but a maximum of four grams.

• Always consult a doctor before taking.
• Hold absolutely the recommended or prescribed dosage.
• Do not take paracetamol for more than three days in a row.
• Also check other medications for their paracetamol content to minimize the risk of an overdose.
• Avoid alcoholwhile you are taking paracetamol.

These side effects can occur

When dosed correctly, paracetamol is considered to be relatively well tolerated. Nevertheless, pharmacist Grayson warns: “Paracetamol is gentler on the stomach than ibuprofen, but an overdose would be significantly more dangerous because high doses of paracetamol can cause irreversible damage to the liver.”

• 0 to 24 hours after ingestion: anorexia, nausea, vomiting
• 24 to 72 hours after ingestion: tenderness in the upper right abdominal area
• 72 to 96 hours after ingestion: vomiting and symptoms of liver failure, sometimes kidney failure and pancreatitis (inflammation of the pancreas)
• Over five days after taking: Recovery from liver damage or this progresses into multi-organ failure, which can be fatal.

An overdose is always a medical emergency. The risk of this is significantly increased for people with poor liver function or high alcohol consumption, says Grayson.

Warning about paracetamol combinations

Many cold medicines combine several active ingredients, for example Paracetamol with decongestants for a stuffy nose. These preparations are usually significantly more expensive than pure paracetamol. Grayson does not recommend these combination remedies. “Although decongestants can lead to a slight improvement in the short term, they can actually make the symptoms worse over time,” explains the pharmacist.

In some cases, the nose is even more blocked than before. For colds and flu, she usually recommends a simple solution. “It is usually better to take regular acetaminophen two to four times a day to reduce fever and relieve pain.”

Doesn’t have to be a branded product

A good effect doesn’t have to be expensive. When asked about the difference between branded products and cheap private labels, the pharmacist says: “Standard 500 mg paracetamol tablets are all about the same,” she says.

The higher price of branded products usually depends

• Packaging,
• marketing
• and advertising.

The active ingredient is identical.

This is how fast-acting preparations work

Some manufacturers advertise particularly fast-acting tablets. Additives are used: “Manufacturers typically add ingredients such as sodium carbonate. This causes the tablet to dissolve more quickly,” explains Grayson. Particularly finely chopped active ingredient particles can also help paracetamol to be absorbed more quickly through the intestinal wall.

However, Grayson is cautious about its practical benefits. Although the functionality is plausible, the difference in effect usually remains small. The time saved is often only about half an hour.