Acetaminophen (paracetamol) appears not to increase the risk of gastrointestinal bleeding.
The safety of acetaminophen has been shown in a large number of studies. In a Spanish study of 875 patients with upper gastrointestinal bleeding and 2682 hospital controls 1 , the odds ratio for acetaminophen did not significantly differ from 1, but for aspirin it was 7.2 and for piroxicam 19.1.
Comment: The quality of evidence is upgraded by strong association.
The following decision support rules contain links to this evidence summary:
1. Laporte JR, Carné X, Vidal X, Moreno V, Juan J. Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding. Lancet 1991 Jan 12;337(8733):85-9. [PMID:1670734]
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Acetaminophen and gastrointestinal side effects. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/450099/all/Acetaminophen_and_gastrointestinal_side_effects. Accessed January 25, 2021.
Acetaminophen and gastrointestinal side effects. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved January 25, 2021, from https://evidence.unboundmedicine.com/evidence/view/EBMG/450099/all/Acetaminophen_and_gastrointestinal_side_effects
Acetaminophen and Gastrointestinal Side Effects [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2021 January 25]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/450099/all/Acetaminophen_and_gastrointestinal_side_effects.
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