OTC spotlight: paracetamol

Why this matters

Paracetamol is safe and effective when used as directed. Taken above the daily maximum it can cause serious liver damage, and the early signs of an overdose are easy to miss. Counter staff sell it many times a day, so the questions become routine. This spotlight is about keeping them meaningful.

What support staff need to know

• Adults and children aged 16 and over: 500 mg to 1 g every 4 to 6 hours as needed, no more than 4 g (usually eight 500 mg tablets) in 24 hours, and at least four hours between doses.
• Children under 16: use a children's product and follow the dose for the child's age on the pack. Do not adjust adult tablets for children.
• Pack sizes: general sale packs contain up to 16 tablets or capsules. Pharmacy (P) packs contain up to 32. It is illegal to sell more than 100 tablets or capsules of paracetamol in one transaction without a prescription, and best practice is no more than two packs of pain relief in one sale.
• Many other products contain paracetamol: cold and flu remedies, combination painkillers, some sleep aids. Taking two of these together is the most common way people exceed the maximum by accident.
• Paracetamol remains safe to use in pregnancy at the recommended dose. The MHRA reminded professionals of this in September 2025.

WWHAM in practice

Who is it for and how old are they? What are the symptoms? How long have they had them? Action taken: what have they already taken today, including cold and flu remedies? Medicines: anything else regular, and do they drink heavily or have a liver condition?

The 'action taken' question matters most with paracetamol. Ask specifically about cold and flu products and combination painkillers, because customers often do not realise they contain paracetamol.

Signs that someone needs the pharmacist

• Pain or fever lasting more than three days, or getting worse
• Someone who has already taken the maximum today and wants more
• Any possible overdose, even if they feel fine. Liver damage can take days to show and treatment works best early. This is an urgent referral.
• Regular large purchases, or requests for several packs
• Known liver problems, heavy alcohol use, or very low body weight
• Children under 16, unless you are trained and the product is licensed for them

When to refer to the pharmacist

• Any of the signs above
• Requests for more than two packs, or for a P pack when a general sale pack would do
• Anyone taking other medicines that contain paracetamol
• Anyone who is unsure what they have already taken

PPets learning connection

This spotlight supports the OTC consultation and WWHAM learning in the Level 2 Certificate. Our free WWHAM cheat sheet is a useful counter reference.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• MHRA best practice guidance on the sale of medicines for pain relief (March 2025)
• MHRA Drug Safety Update: paracetamol and pregnancy (September 2025)
• NHS: paracetamol for adults

Related from PPets

• WWHAM training
• OTC consultation training
• Level 2 Certificate for pharmacy support staff

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

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