IT IS one of those pieces of advice that gets passed around Malaysian households with the confidence of established medical fact: never take paracetamol on an empty stomach, or your "perut" will suffer the consequences.
The pill gets blamed for all manner of gastric drama, and well-meaning relatives will insist you eat at least a biscuit first before you dare open the foil.
But should you actually avoid taking paracetamol on an empty stomach?
Verdict:
FALSE
Paracetamol is safe to take on an empty stomach, and the belief that it damages the stomach lining is a myth that has been thoroughly contradicted by decades of pharmacological research.
The UK's National Health Service states clearly in its official guidelines that paracetamol tablets and capsules can be taken with or without food, and that no food buffer is needed.
The reason for this is straightforward: unlike ibuprofen and aspirin, which work partly by inhibiting the enzymes that protect the stomach lining, paracetamol works through an entirely different mechanism and is metabolised primarily in the liver, not the stomach.
A peer-reviewed gastrointestinal safety review published in Inflammopharmacology confirmed that paracetamol does not cause the gastric irritation associated with non-steroidal anti-inflammatory drugs, and noted that it remains a recommended first-line painkiller even for patients who are prone to gastric and duodenal ulcers.
In fact, a study published in PLOS ONE found that taking paracetamol without food may actually speed up its absorption slightly, because a high-fat meal can delay the rate at which the stomach empties its contents into the small intestine, where paracetamol is absorbed.
The overall amount of paracetamol that reaches the bloodstream remains essentially the same whether you have eaten or not, but on an empty stomach it tends to get there about 15 to 20 minutes faster.
So if you have a headache and no biscuit in the house, the science suggests you are actually in luck.
A 2006 study published in Springer's Inflammopharmacology journal found that gastric damage from paracetamol in animals only occurred when pre-existing inflammation, hyperacidity and other aggravating factors were all present simultaneously — conditions very different from an ordinary empty stomach.
The problem is that many Malaysians apply the "ibuprofen rule" to all painkillers, and paracetamol has been caught in the crossfire.
It is also worth knowing that while paracetamol is gentle on the stomach, it is not without risk at high doses.
Taking more than the recommended amount can cause serious liver damage, and this risk is higher in people who drink alcohol regularly or have existing liver conditions.
The rule of thumb for paracetamol is not that you should eat before you take it, but do not take more than you need.
Sources:
1. https://www.nhs.uk/medicines/paracetamol-for-adults/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564199/
3. https://link.springer.com/article/10.1007/s10787-006-1389-8
