Minutes after taking some painkillers she’d bought in the supermarket, Ginny Davis felt light-headed and noticed a ringing in her ears.

‘I then began to itch intensely on the palms of my hands and within an hour noticed a red rash spreading over my body,’ recalls the actress and writer.

Ginny, 61, who lives near Stratford-upon-Avon, had taken paracetamol and ibuprofen after waking up with a sore shoulder. She had used both drugs many times before without problems.

But on this occasion, two years ago, her symptoms were so concerning that she went straight to her GP. Finding her blood pressure had dropped dangerously low, the doctor gave Ginny some antihistamines and called an ambulance.

‘At the hospital they gave me adrenaline and put me on a drip, saying I was suffering an allergic reaction,’ she says. ‘I was sent home with an EpiPen to inject myself if it ever happened again.’

At the time, Ginny was not sure what had triggered the reaction. But two weeks later, she took another paracetamol for shoulder pain and the itching erupted again, leading to another hospital trip.

A test confirmed she was allergic to paracetamol, and she has now stopped taking it completely. ‘I’m surprised a painkiller I’d always regarded as a friend to stop mild pain could cause life-threatening symptoms,’ says Ginny, who is married to William, 62, a judge.

In fact, allergic reactions to paracetamol — which occur when the immune system mistakes the drug for a pathogen, and produces a chemical called histamine — are relatively uncommon.

But Ginny’s symptoms — light-headness, itchy skin and ringing in her ears — can also be experienced as side-effects of taking paracetamol and ibuprofen, even by those who are not allergic to them.

Dr John Dickson, founder of the Primary Care Rheumatology Society, says hundreds of thousands of people experience side-effects from paracetamol alone. ‘Paracetamol is the most dangerous drug we’ve got, but people just don’t realise it,’ he says. 

Millions of us take these painkillers for everyday aches and pains without imagining they may cause side-effects. Figures from market research group Mintel suggest 75 per cent of us have used paracetamol (which treats pain and fever) in the past year, while 56 per cent have used ibuprofen (which also tackles inflammation).

But a study published last week suggested women who take either drug twice a week for more than six years could be permanently damaging their hearing. It is the latest in a string of scientific studies to highlight the possible side-effects of these very commonly taken pills.

The study of more than 55,000 women by Brigham and Women’s Hospital in Boston in the U.S. found prolonged use of ibuprofen and paracetamol was linked with a slightly higher risk of developing hearing loss.

Previous research has shown paracetamol can reduce the blood supply to the inner ear. It’s also believed to deplete antioxidants in the ear, making it more vulnerable to noise damage. And painkillers are thought to possibly damage the tiny hairs in the ear that help us hear.

 I’m surprised a painkiller I’d always regarded as a friend to stop mild pain could cause life-threatening symptoms.

Study author Professor Gary Curhan said although the risk was ‘modest’, given how commonly these medications are used even a small increase in risk could have important health implications.

Sohaila Rastan, executive director of biomedical research at the charity Action on Hearing Loss, says more research is needed to establish whether painkillers are the cause of this hearing loss, or whether other factors are involved.

The biggest danger of paracetamol is liver damage from overdosing, which causes around 200 deaths a year in the UK. Less well known side-effects include itchy skin rashes, nausea, vomiting, diarrhoea, abdominal pain, wheezing and coughing.

And in a tiny proportion of cases paracetamol can also cause a rare but potentially life-threatening skin reaction called Stevens-Johnson syndrome, which often begins with a flu-like illness, followed by a red or purple rash that forms blisters and causes the upper layer of skin to detach.

Meanwhile, it is well established that ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) can cause stomach irritation, gastric bleeds and ulcers. Lesser known side-effects include ringing in the ears, dizziness, headache and mild itching or rash.

And some people may be unaware that higher doses of NSAIDs — including prescription-only ibuprofen at doses of more than 2,400mg a day — have been shown to be associated with a higher risk of heart attack, stroke and kidney problems.

Although the risk increases with the strength of the dose, it theoretically exists at any dose, explains Sultan Dajani, a community pharmacist and spokesman for the Royal Pharmaceutical Society.

‘People sometimes take more of the lower-strength tablets to get more of an effect, so these risks aren’t just restricted to higher dose prescription NSAIDs,’ he says.

Current advice from the National Institute of Health and Care Excellence (NICE) is that regular use of NSAIDs should be reviewed periodically, particularly in people who have or are at higher risk of gastrointestinal, cardiovascular and kidney disease, including older people.

NICE says if an NSAID is used, it should be ‘at the lowest effective dose to control symptoms for the shortest duration of time’.

 At the hospital they gave me adrenaline and put me on a drip, saying I was suffering an allergic reaction . I was sent home with an EpiPen to inject myself if it ever happened again.

The effect of such findings has meant that in older people in particular (who are more likely to have heart, gastric and kidney problems and long-term pain conditions, such as arthritis) paracetamol has come to be regarded as the ‘safer’ painkiller.

But what’s confusing for patients is that some studies are now linking paracetamol to gastric bleeding and a higher risk of heart attack, stroke and kidney problems.

This year, a review published by UK academics in the Annals of Rheumatic Diseases concluded paracetamol can be toxic, especially at high doses. ‘We believe the true risk of paracetamol prescription to be higher than currently perceived in the clinical community,’ the researchers said.

Dr Roger Knaggs, a member of the British Pain Council and an associate professor of pharmacy at Nottingham University, says it seems paracetamol is not necessarily safer than ibuprofen after all.

‘You could now say about paracetamol what we say about NSAIDs — it should be taken at the lowest possible dose for the shortest time — not necessarily regularly but just for intermittent flare-ups.’

Another issue with paracetamol is that there’s increasing evidence that it’s often ineffective, he adds. ‘There’s now evidence paracetamol doesn’t work for persistent long-term back and arthritis pain that lasts longer than three months, and the new NICE guidelines on the treatment of lower back pain published a few months ago do not recommend it for this reason.’

Professor Philip Conaghan, a professor of musculoskeletal medicine at Leeds University and an author of the paracetamol review, says he doesn’t believe most paracetamol users should be concerned about hearing loss, but that the side-effects of both ibuprofen and co-codamol (paracetamol with codeine, a weak opioid) are a major issue in treating patients with osteoarthritis and other long-term pain conditions.

One problem, he says, is a lack of options. ‘We’ve had only three groups of drugs for pain for 100 years — paracetamol, NSAIDs and opioids.

‘Only 25 per cent of people can take NSAIDs in the long term because stomach upsets are common. Opioids cause drowsiness and constipation and paracetamol has the smallest effect on pain.

‘There is a huge gap in the market — we know 50 per cent of people with osteoarthritis are not getting pain relief from their pills.’

In some people, such as those over 65 with risk factors for heart disease, the risks of taking anti-inflammatories outweigh the benefits, says Professor Conaghan.

‘I always advise people with mus-culoskeletal conditions to have pill “holidays” for a few days from time to time, as a lot of conditions wax and wane and you don’t need to take them all the time — taking them intermittently is probably safer.’

He says muscle strengthening exercises are often more effective than painkillers for patients with osteoarthritis in the knee, for instance. It’s impossible to say if one painkiller is safer than another as it depends on who is taking it, adds Sultan Dajani. ‘Some drugs are better for some individuals than others — it depends on what’s wrong with them and what other medication they are taking.’

Dr Martin Johnson, clinical lead with the Royal College of GPs, believes paracetamol or ibuprofen for shorter term pain is fine. It is long-term use without monitoring that’s of concern. ‘You shouldn’t take painkillers out of habit,’ he says.

‘We’re pressing for an annual pain review for anyone on painkillers long term.’

Anyone who is unsure about painkillers should ask their pharmacist for advice and always tell their GP they are taking over-the-counter medication, advises Sultan Dajani.

‘Both drugs are largely safe but need to be treated with respect. Just because you can buy them at the local garage doesn’t mean they can’t do you any harm.’

 

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