Changes are coming into effect from February 1 about how paracetamol is sold in Australia.

This mainly affects pack sizes of paracetamol sold outside pharmacies and how paracetamol is accessed in pharmacies.

The changes, announced by Australia’s drug regulator, are in line with moves internationally to reduce the harms of liver toxicity and the risk of overdose.

However, there are no new safety concerns when paracetamol is used as directed. And children’s products are not affected.

What is paracetamol?

Paracetamol is commonly sold under brand names such as Panadol, Dymadon and Panamax. It’s used to treat mild pain and fever for short periods or can be prescribed for chronic (long-term) pain.

Millions of packs of this cheap and accessible medicine are sold in Australia every year.

Small packs (up to 20 tablets) have been available from supermarkets and other retailers such as petrol stations. Larger packs (up to 100 tablets) are only available from pharmacies.

Paracetamol is relatively safe when used as directed. However, at higher-than-recommended doses, it can cause liver toxicity. In severe cases and when left untreated, this can be lethal.

Why are the rules changing?

In 2022, we wrote about how the Therapeutic Goods Administration (TGA) was considering changes to paracetamol access because of an increase in people going to hospital with paracetamol poisoning.

An expert review it commissioned found there were about 40–50 deaths every year from paracetamol poisoning between 2007 and 2020. Between 2009–10 and 2016–17, hospital admissions for this increased (from 8,617 to 11,697), before reducing in 2019–20 (8,723). Most admissions were due to intentional self-poisonings, and about half of these were among people aged ten to 24.

After the report, the TGA consulted with the public to work out how to prevent paracetamol poisonings.

Options included reducing pack sizes, limiting how many packs could be bought at once, moving larger packs behind the pharmacy counter and restricting access by age.

Responses were mixed. Although responses supported the need to prevent poisonings, there were concerns about how changes might affect:

• people with chronic pain, especially those in regional areas, where it may be harder to access pharmacies and, therefore, larger packs
• people on limited incomes, if certain products were made prescription-only.

Although deaths from paracetamol poisoning are tragic and preventable, they are rare considering how much paracetamol Australians use. There is less than one death due to poisoning for every million packs sold.

Because of this, it was important the TGA addressed concerns about poisonings while making sure Australians still had easy access to this essential medicine.

So what’s changing?

The key changes being introduced relate to new rules about the pack sizes that can be sold outside pharmacies, and the location of products sold in pharmacies.

From February 1, packs sold in supermarkets and places other than pharmacies will reduce from a maximum 20 tablets to 16 tablets per pack. These changes bring Australia in line with other countries. These include the United Kingdom, which restricted supermarket packs to 16 tablets in 1998, and saw reductions in poisonings.

In all jurisdictions except Queensland and Western Australia, packs sold in pharmacies larger than 50 tablets will move behind the pharmacy counter and can only be sold under pharmacist supervision. In Queensland and WA, products containing more than 16 tablets will only be available from behind the pharmacy counter and sold under pharmacist supervision.

In all jurisdictions, any packs containing more than 50 tablets will need to be sold in blister packs, rather than bottles.

Several paracetamol products are not affected by these changes. These include children’s products, slow-release formulations (for example, “osteo” products), and products already behind the pharmacy counter or only available via prescription.

What else do I need to know?

These changes have been introduced to reduce the risk of poisonings from people exceeding recommended doses. The overall safety profile of paracetamol has not changed.

Paracetamol is still available from all current locations and there are no plans to make it prescription-only or remove it from supermarkets altogether. Many companies have already been updating their packaging to ensure there are no gaps in supply.

The reduction in pack sizes of paracetamol available in supermarkets means a pack of 16 tablets will now last two days instead of two-and-a-half days if taken at the maximum dose (two tablets, four times a day). Anyone in pain that does not improve after short-term use should speak to their pharmacist or GP.

For people who use paracetamol regularly for chronic pain, it is more cost-effective to continue buying larger packs from pharmacies. As larger packs (50+ tablets) need to be kept out of sight, you will need to ask at the pharmacy counter. Pharmacists know that for many people it’s appropriate to use paracetamol daily for chronic pain.

Natasa Gisev, Clinical pharmacist and Scientia Associate Professor at the National Drug and Alcohol Research Centre, UNSW Sydney and Ria Hopkins, Postdoctoral Research Fellow, National Drug and Alcohol Research Centre, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nearly five years into the pandemic, COVID is feeling less central to our daily lives.

But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as long COVID.

In September, Grammy-winning Brazilian musician Sérgio Mendes died aged 83 after reportedly having long COVID.

Australian data show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023.

In the United States, the Centers for Disease Control and Prevention reported 3,544 long-COVID-related deaths from the start of the pandemic up to the end of June 2022.

The symptoms of long COVID – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple.

How could long COVID lead to death?

There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” virus fragments may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of SARS-CoV-2 proteins in the blood might explain why some people experience ongoing symptoms.

We know a serious COVID infection can damage multiple organs. For example, severe COVID can lead to permanent lung dysfunction, persistent heart inflammation, neurological damage and long-term kidney disease.

These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate.

Of the 3,544 deaths related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above.

COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%).

These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions.

‘Cause of death’ is difficult to define

Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited.

However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).

Like long COVID, ME/CFS is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life.

Some research indicates people with ME/CFS are at increased risk of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome.

So what is the emerging data on long COVID telling us about the potential increased risk of death?

Research from 2023 has suggested adults in the US with long COVID were at greater risk of developing heart disease, stroke, lung disease and asthma.

Research has also found long COVID is associated with a higher risk of suicidal ideation (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress.

But long COVID is more likely to occur in people who have existing health conditions. This makes it challenging to accurately determine how much long COVID contributes to a person’s death.

Research has long revealed reliability issues in cause-of-death reporting, particularly for people with chronic illness.

So what can we conclude?

Ultimately, long COVID is a chronic condition that can significantly affect quality of life, mental wellbeing and overall health.

While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way.

Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop models of care for the optimal management of people with long COVID with a focus on multidisciplinary care.

Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.

Rose (Shiqi) Luo, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, RMIT University; Catherine Itsiopoulos, Professor and Dean, School of Health and Biomedical Sciences, RMIT University; Kate Anderson, Vice Chancellor’s Senior Research Fellow, RMIT University; Magdalena Plebanski, Professor of Immunology, RMIT University, and Zhen Zheng, Associate Professor, STEM | Health and Biomedical Sciences, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.