Ingoiamo più paracetamolo possibile, vince chi va in ospedale» – Giornale di Brescia

The Italian Medicines Agency (AIFA) has issued a formal alert regarding a disturbing trend of intentional paracetamol overdoses among adolescents. The regulatory body is warning that some teenagers are consuming excessive amounts of the common analgesic not for the purpose of self-harm in a traditional sense, but as part of a competitive social challenge.

Reporting from the Giornale di Brescia highlights a specific and dangerous mindset driving this behavior, characterized by the phrase Ingoiamo più paracetamolo possibile, vince chi va in ospedale, which translates to Let’s swallow as much paracetamol as possible, the winner is whoever goes to the hospital.

This trend transforms a widely available over-the-counter medication into a tool for a high-stakes game, where the goal is to induce a medical emergency. AIFA has urged healthcare providers, parents, and pharmacists to remain vigilant to prevent severe liver damage or death among youth who may not fully comprehend the physiological consequences of such actions.

Paracetamol, known as acetaminophen in some regions, is one of the most frequently used medications globally for pain and fever. Because it is available without a prescription in many formats, it is easily accessible to minors, making it a primary target for this type of intentional misuse.

The danger of paracetamol overdose lies in its specific metabolic pathway in the liver. Under normal therapeutic doses, the drug is processed safely. However, when taken in excessive quantities, the liver’s primary detoxification pathways become saturated.

This saturation forces the body to use an alternative metabolic route that produces a highly reactive and toxic byproduct called N-acetyl-p-benzoquinone imine (NAPQI). Normally, a substance called glutathione neutralizes NAPQI, but an overdose depletes these glutathione stores, allowing the toxin to cause widespread death of liver cells, known as centrilobular hepatic necrosis.

Medical professionals warn that the onset of symptoms can be deceptive. In the first 24 hours following a massive ingestion, a patient may experience only mild nausea, vomiting, or general malaise, or they may exhibit no symptoms at all. This silent window can lead adolescents to believe they have won the challenge without suffering harm, while irreversible liver failure is already beginning to develop.

Severe liver failure typically manifests several days after the overdose, characterized by jaundice, coagulation disorders, and hepatic encephalopathy, which can lead to a coma. Without rapid intervention, the result is often fatal or requires an emergency liver transplant.

AIFA has emphasized the necessity of correct usage and the strict adherence to maximum daily dosages. The agency’s alert serves as a call to action for pharmacists to monitor unusual purchasing patterns among young people and to educate consumers on the risks of toxicity.

Pharmacists in Italy have reported an increase in concern regarding how these medications are marketed and accessed. The ease of obtaining multiple packs of paracetamol from different pharmacies or supermarkets allows adolescents to accumulate the quantities necessary for an intentional overdose without triggering immediate suspicion.

To mitigate these risks, public health experts suggest several preventative measures:

• Securely storing medications out of the reach of children and adolescents.
• Educating youth on the specific biological dangers of liver toxicity, emphasizing that the absence of immediate symptoms does not mean the drug is harmless.
• Encouraging pharmacists to question the purchase of excessive quantities of analgesics by minors.
• Increasing awareness among school counselors and parents about social media challenges that encourage the misuse of medications.

For those who have ingested an overdose, medical intervention is most effective when administered early. N-acetylcysteine (NAC) serves as the primary antidote by replenishing glutathione stores and neutralizing NAPQI, but its efficacy decreases significantly if treatment is delayed beyond the first eight to twenty-four hours.

The current situation in Italy reflects a broader public health challenge where medications are viewed as harmless tools for social validation. AIFA continues to monitor the data to determine if this trend is localized or represents a wider systemic issue among the adolescent population.