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NASOPHARYNGITIS: Are Patient’s Overusing Paracetamol?

The rains are here and with it is a high prevalence of Nasopharyngitis or the common cold. The common cold is an acute, self-limiting viral infection of the upper respiratory tract. It is caused mostly by human Rhinoviruses (HRV)1. A common complication of common cold is acute otitis media and sinusitis. The symptoms of common cold includes coughing, nasal congestion, low-grade fever and fatigue that occurs within 24 to 48 hours after exposure. As a self-limiting illness, symptoms generally subside within 10 days but in some cases can last up to three weeks. The incidence of common cold is highest in children and declines with advancing age. A recent study by Akinloye et al in 2011 indicates that HRV accounted for 39% of the virus findings in Nigerian children2. Other factors that can increase the risk of a common cold are lack of sleep or poor sleep quality, stress, immunocompromised states and co-morbidities such as asthma, chronic obstructive pulmonary disease and Pneumonia.
There is no known cure for the common cold. To seek out relieve from their symptoms, many patients buy non-prescription medicines in the form of cold and cough over-the counter (OTC) drugs. Many patients tend to combine multiple over-the counter cold and cough products. One of the major components of these medications is paracetamol at a concentration of 325mg to 1000mg in both solid and liquid cold and cough preparations. Paracetamol is one of the most frequently abused and used OTC3. Studies have shown that paracetamol overdosing increases significantly during the cold-flu season. A study by Shiffman et al in 2018 indicates that 6.3% of users of OTC cold and cough products exceeded the maximum recommended daily dose of 4 g of paracetamol with an average of 3.7% usage days exceeding the maximum daily dose4. The primary reason given for such paracetamol overdose is the use of multiple OTC combination medications to treat upper respiratory cold/flu symptoms.
We are in the midst of the common cold season and it is important that patients are aware of the limits on paracetamol use. It is important that patients or the consumers of OTC products seek out the help of Pharmacists, the most available healthcare provider, before using such products.


1. A. Ruohola, M. Waris, T. Allander, T. Ziegler, T. Heikkinen, and O. Ruuskanen, “Viral etiology of common cold in children, Finland,” Emerging Infectious Diseases, vol. 15, no. 2, pp. 344–346, 2009. Accessed 8 August, 2021.
2. Akinloye, O. M., Rönkkö, E., Savolainen-Kopra, C., Ziegler, T., Iwalokun, B. A., Deji-Agboola, M. A., … & Hovi, T. (2011). Specific viruses detected in Nigerian children in association with acute respiratory disease. Journal of tropical medicine, 2011.Accessed 8 August, 2021.

3.Sansgiry, S. S., Bhansali, A. H., Bapat, S. S., & Xu, Q. (2017). Abuse of over-the-counter medicines: a pharmacist’s perspective. Integrated pharmacy research & practice, 6, 1.Accessed 8 August, 2021.

4. Shiffman, S., Battista, D. R., Kelly, J. P., Malone, M. K., Weinstein, R. B., & Kaufman, D. W. (2018). Prevalence of exceeding maximum daily dose of paracetamol, and seasonal variations in cold‐flu season. British journal of clinical pharmacology, 84(6), 1250-1257.Accessed 8 August, 2021.



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