LONDON (TIP): The number of deaths and liver transplants, due to overdose of paracetamol — a drug commonly popped by Indians for fever and cough, has fallen by a whopping 43% in England and Wales, thanks to an UK legislation to make pack sizes smaller. In September 1998, a new legislation was introduced by the UK government which restricted pack sizes to a maximum of 32 tablets through pharmacy-sales and 16 for nonpharmacy sales.

The first results of that intervention, to be announced on Friday in the British Medical Journal shows that the number of registrations at liver units for paracetamol-induced liver transplantation in England and Wales following the legislation was 482 fewer than expected: a 61% reduction .

This resulted in an overall decrease of 43% in the 11 years post-legislation period in deaths due to overdose of paracetamol. Lead author professor Keith Hawton, University of Oxford Centre for Suicide Research , said in many countries , self poisoning with paracetamol (acetaminophen) is a common method of suicide and nonfatal self harm, it is responsible for many accidental deaths, and is a frequent cause of hepatotoxicity and liver unit admissions.

He further said, “The 43% reduction in deaths in the UK over 11 years was equivalent to 765 fewer deaths with a suicide or open verdict, or 990 fewer deaths if accidental poisoning verdicts were included. The 61% reduction in registrations at liver units represented 482 fewer registrations.” India in 2011 also brought in legislation and put a cap on the prescription formulations of paracetamol combo drugs. The drug controller general of India said it should not exceed 325 mg in each tablet or capsule.

Earlier the drug was sold to the strength of 500 mg overthecounter . India is yet to ascertain what impact that legislation had. But the UK now wants to follow the India model as it continues to see a considerable number of deaths each year due to paracetamol poisoning — at an average of 121 per year.

The researchers therefore suggest further measures may be required to limit this death toll including stronger enforcement of the legislation, further reduction in pack sizes and possibly a reduction in paracetamol content of tablets. Hawton said, “Another measure to reduce deaths might be to decrease the paracetamol content of tablets from 500 mg to 325 mg in prescribed compound preparations.”