The Story of PCM (Panadol) Overdose

(this entry was written exactly a year ago)..

PCM is the most widely used medicine in the world. We, in health-care setting usually called it PCM as a short form for Paracetamol (in US, they call it Acetaminophen). It’s the same thing actually. Here, in Malaysia the brand Panadol is known by everybody. Why suddenly I’m writing about PCM?

I woke up this morning with a headache. I’ve slept since 9pm last night. Am i feverish? I can’t tell that. I don’t keep thermometer so i do the traditional way of putting the back of my hand on my forehead and neck. I didn’t feel any unusual rise in temperature. The question is, should I take PCM now? I got up and stared at the medicine box I own. I keep the basic medicines for emergency. Then, I decided not to take.

Hmm.. I’m thinking by myself. I can say that I’m not very fond of medicines/drugs, though I’m a pharmacist. Most probably because I’m one of those who are allergic to Penicillin group antibiotic. I developed whole body rash after I took Amoxicillin, and it scared me like sh**. The second reason maybe as I know the mechanism of side effects of the drugs, I become paranoid enough to imagine how it might happen in my body.

But, I want to tell you that if you take them according to the therapeutic (prescribed) dose, it should be no problem. As medicines have undergone many stages of laboratory and clinical trials before they are approved to be marketed.

PCM overdose/poisoning is one of my favourite topic. Cases of alleged PCM poisoning are very common actually. In simpler words, meaning that people swallowing a lot of Panadol tablets at one time with the intention of committing suicide. I only knew that these cases really happen when I was doing internship in hospital.

There were cases of 18 year old (silly) Malay girl doing that as she just being dumped by her boyfriend, and another case I found during the time SPM result was out that year. The girl wanted to commit suicide as she was so frustrated with her SPM result. Hey, it’s just SPM result! The world has not ended yet. Another case I managed is a case of 45 year old Chinese female who did that as she found out that her husband was having an affair with another woman. She was very depressed at that time. I strongly feel that the dramatic action was just to grab her husband’s attention. She doesn’t really want to die as she immediately called her son after she took 20 tablets of Panadol :-). All these patients are alive, but with some degree of liver injury (In high doses, PCM produces toxic metabolite in the liver).

For general info, if you take like 10 tablets of PCM at one shot, you would not die. Chances of you getting serious hepatic (liver) toxicity is very high. And, surely pharmacist-on-call would be called (if is’s beyond office hour) to analyze your blood level of PCM; to know whether the level is toxic or not and to decide whether PCM antidote should be given or not. See, all government hospitals have the PCM antidote. So, this might be the reason you woke up in hospital bed after that instead of in heaven (or hell) as u intended to 😛

I know how to calculate the toxic dose based on a person’s body weight (meaning, if you weighs 60kg, how many tablets of the 500mg PCM you should take if you wanna commit suicide). But, I won’t dare writing it here. I don’t wanna be the one contributing in that matter of case.

Ok, the take home message:

1. For adult, the recommended PCM dose is 1000mg (2 tablets), 3-4 times a day.
2. Do not exceed 4gram/day (8 tablets).
3. If you take the ‘normal’ daily dosing for a long period of time, you may also get the risk of liver side effects. So, if you take PCM as self-medication and the fever/pain not subside by 3 days, please see a doctor.

Lastly, suicide is haraam in Islam and other religions also prohibit it.