The Pharmaceutical Journal Vol 264 No 7101 p914
June 17, 2000 Letters

Paracetamol

Tenuous association

From Dr B. K. Shapiro, MB ChB

SIR,-In response to the letter from Mr Schmidt regarding the study recently published in Thorax (PJ, March 25, p459), two keys issues were raised: glutathione depletion, asthma and other conditions; and the possible utility for paracetamol and N-acetylcysteine combinations to prevent glutathione depletion.
In relation to the link between glutathione and asthma, the study authors conclude that their findings should be interpreted with caution: "A study of this kind cannot establish that the association we have observed is causal." In addition, they recommend: "Paracetamol should remain the preferred analgesic and antipyretic because of the potential risks associated with aspirin and NSAIDs, namely, severe sensitive reactions in those with asthma."
The association between asthma, aspirin and non-steriodal anti-inflammatory drugs is well documented, with only limited reports of cross-sensitivity occurring with paracetamol.¹
Mr Schmidt suggested revisiting the use of paracetamol combined with N-acetylcysteine in order to raise glutathione levels. Given the tenuous nature of any association between paracetamol use and asthma morbidity, there is presently no justification for developing such a product.
Smithkline Beecham is carefully evaluating the data reported in the Thorax article and will review any appropriate action as part of that assessment. Currently SB recommends that pharmacists adopt the guidance issued by the Medicines Control Agency after consideration of the reported study: "There is no reason for advising any change in the use of paracetamol. Paracetamol is a safe and effective pain killer for many patients including asthmatics, children, the elderly and pregnant women."

Bryan K. Shapiro
Medical Director, Dermatology, Analgesics and Respiratory Tract, Smithkline Beecham Consumer Healthcare, Surrey

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