Paracetamol has been used as an analgesic and antipyretic for many years, with toxicity first noted in the 1960s. Since then the incidence of poisoning has increased, and paracetamol is now the most common drug in self-poisoning, with a high rate of morbidity and mortality. The use, abuse and ways of reducing paracetamol toxicity are reviewed, but in view of the potential for harm, serious consideration should be given to changing the legal status of paracetamol, possibly to a prescription-only medicine.

It seems that the paracetamol pack size reduction has not achieved as large an overdose rate reduction as might have been expected. Instead, a shift to the use of ibuprofen may lead to an increase in gastrointestinal adverse events and continue the burden on healthcare resources.

Aims To investigate the death rate due to paracetamol poisoning in Scotland and what effect the reduction in over-the-counter paracetamol pack sizes in 1998 had on the death rate. Methods Records from 1994 to 2000 were examined to identify the number and annual incidence of paracetamol-related deaths. Numbers of deaths before and after the pack size reduction were compared. Results No significant differences were shown due to the pack size reduction. The Scottish paracetamol-related death rate was twice as high as in England and Wales. Conclusions Further measures to reduce paracetamol-related morbidity and mortality in Scotland should be considered.

An increasing number of drugs are becoming available over‐the‐counter, empowering patients to treat them‐ selves. Although drugs presently available over‐the‐counter are generally safe, there are issues of safety and possible delays in diagnosis of serious conditions. Therefore it is vital that patients are made aware of the indications and limitations of over‐the‐counter drugs through improved communication and education. Pharmacists and drug companies will have an increasingly important role in giving information and advice to patients. This review looks at the present and future of over‐the‐counter medication, highlighting the safety aspects.

NSAIDs are frequently used as analgesics. They have a high incidence of GI adverse effects that have both social and economic costs. These costs impose a considerable strain on healthcare resources. This review discusses the epidemiology and economic cost of these adverse GI events. It also highlights the variability in risk and the impact of newer drugs. Risk stratification and the subsequent guided use of NSAIDs is likely to limit the pharmacoeconomic implications.