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The Info List - Paracetamol


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7.21 g/kg (0 °C)[8] 8.21 g/kg (5 °C)[8] 9.44 g/kg (10 °C)[8] 10.97 g/kg (15 °C)[8] 12.78 g/kg (20 °C)[8] ~14 mg/mL (20 °C)

SMILES

CC(=O)Nc1ccc(O)cc1

InChI

InChI=1S/C8H9NO2/c1-6(10)9-7-2-4-8(11)5-3-7/h2-5,11H,1H3,(H,9,10) Y

Key:RZVAJINKPMORJF-UHFFFAOYSA-N Y

  (verify)

Paracetamol, also known as acetaminophen or APAP, is a medicine used to treat pain and fever.[1] It is typically used for mild to moderate pain relief.[1] Evidence for its use to relieve fever in children is mixed.[11][12] It is often sold in combination with other medications, such as in many cold medications.[1] In combination with opioid pain medication, paracetamol is also used for severe pain such as cancer pain and pain after surgery.[13] It is typically used either by mouth or rectally but is also available intravenously.[1][14] Effects last between two and four hours.[14] Paracetamol
Paracetamol
is generally safe at recommended doses.[15] Serious skin rashes may rarely occur, and too high a dose can result in liver failure.[1] It appears to be safe during pregnancy and when breastfeeding.[1] In those with liver disease, it may still be used, but in lower doses.[16] Paracetamol
Paracetamol
is classified as a mild analgesic.[14] It does not have significant anti-inflammatory activity and how it works is not entirely clear.[17] Paracetamol
Paracetamol
was discovered in 1877.[18] It is the most commonly used medication for pain and fever in both the United States and Europe.[19] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[20] Paracetamol
Paracetamol
is available as a generic medication with trade names including Tylenol and Panadol among others.[21] The wholesale price in the developing world is less than 0.01 USD per dose.[22] In the United States it costs about 0.04 USD per dose.[23]

Contents

1 Medical uses

1.1 Fever 1.2 Pain

1.2.1 Osteoarthritis 1.2.2 Low back pain 1.2.3 Headaches 1.2.4 Postoperative pain 1.2.5 Dental use 1.2.6 Other

1.3 Patent
Patent
ductus arteriosus

2 Adverse effects

2.1 Liver
Liver
damage 2.2 Skin reactions 2.3 Asthma 2.4 Other factors 2.5 Overdose 2.6 Pregnancy 2.7 Cancer

3 Mechanism of action 4 Pharmacokinetics 5 Chemistry

5.1 Chemical properties 5.2 Synthesis

5.2.1 Original (Boots) method 5.2.2 Green(er) synthesis 5.2.3 Direct synthesis

5.3 Reactions

6 History 7 Society and culture

7.1 Naming 7.2 Available forms 7.3 Controversy

8 Veterinary use

8.1 Cats 8.2 Dogs 8.3 Snakes

9 References 10 External links

Medical uses[edit] Fever[edit] Paracetamol
Paracetamol
is used for reducing fever in people of all ages.[24] The World Health Organization
World Health Organization
(WHO) recommends that paracetamol be used to treat fever in children only if their temperature is higher than 38.5 °C (101.3 °F).[25] The efficacy of paracetamol by itself in children with fevers has been questioned[26] and a meta-analysis showed that it is less effective than ibuprofen.[27] Paracetamol
Paracetamol
does not have significant anti-inflammatory effects. Pain[edit] Paracetamol
Paracetamol
is used for the relief of mild to moderate pain. The use of the intravenous form for pain of sudden onset in people in the emergency department is supported by limited evidence.[28] Osteoarthritis[edit] The American College of Rheumatology recommends paracetamol as one of several treatment options for people with arthritis pain of the hip, hand, or knee that does not improve with exercise and weight loss.[29] A 2015 review, however, found it provided only a small benefit in osteoarthritis.[30] Paracetamol
Paracetamol
has relatively little anti-inflammatory activity, unlike other common analgesics such as the NSAIDs aspirin and ibuprofen, but ibuprofen and paracetamol have similar effects in the treatment of headache. Paracetamol
Paracetamol
can relieve pain in mild arthritis, but has no effect on the underlying inflammation, redness, and swelling of the joint.[31] It has analgesic properties comparable to those of aspirin, while its anti-inflammatory effects are weaker. It is better tolerated than aspirin due to concerns about bleeding with aspirin. Low back pain[edit] Based on a systematic review, paracetamol is recommended by the American College of Physicians
American College of Physicians
and the American Pain
Pain
Society as a first-line treatment for low back pain.[32][33] In contrast, other systematic reviews have concluded that evidence for its efficacy is lacking.[30][34][35] Headaches[edit] A joint statement of the German, Austrian, and Swiss headache societies and the German Society of Neurology recommends the use of paracetamol in combination with caffeine as one of several first line therapies for treatment of tension or migraine headache.[36] In the treatment of acute migraine, it is superior to placebo, with 39% of people experiencing pain relief at one hour compared with 20% in the control group.[37] Postoperative pain[edit] Paracetamol
Paracetamol
combined with NSAIDs may be more effective for treating postoperative pain than either paracetamol alone or NSAIDs alone.[38] Dental use[edit] NSAIDs such as ibuprofen, naproxen, diclofenac are more effective than paracetamol for controlling dental pain or pain arising from dental procedures; combinations of NSAIDs and paracetamol are more effective than either alone.[39] Paracetamol
Paracetamol
is particularly useful when NSAIDs are contraindicated due to hypersensitivity or history of gastrointestinal ulceration or bleeding.[40] It can also be used in combination with NSAIDs when these are ineffective in controlling dental pain alone.[41] The Cochrane review of preoperative analgesics for additional pain relief in children and adolescents shows no evidence of benefit in taking paracetamol before dental treatment to help reduce pain after treatment for procedures under local anaesthetic, however the quality of evidence is low.[42] Other[edit] The efficacy of paracetamol when used in combination with weak opioids (such as codeine) improved for approximately 50% of people but with increases in the number experiencing side effects.[43][44] Combination drugs of paracetamol and strong opioids like morphine improve analgesic effect.[45] The combination of paracetamol with caffeine is superior to paracetamol alone for the treatment of common pain conditions including dental pain, postpartum pain, and headache.[46] Patent
Patent
ductus arteriosus[edit] Paracetamol
Paracetamol
is used to treat patent ductus arteriosus, a condition that affects newborns when a blood vessel used in developing the lungs fails to close as it normally does, but evidence for the safety and efficacy of paracetamol for this purpose is lacking.[47][48] Nonsteroidal anti-inflammatory drugs (NSAID), particularly indomethacin and ibuprofen, have also been used but the evidence for them is also not strong.[47] The condition appears to be caused in part by overactive prostaglandin E2 (PGE2), signalling primarily through its EP4 receptor but possibly also through its EP2 and EP3 receptors.[47] Adverse effects[edit] Healthy adults taking regular doses of up to 4,000 mg a day show little evidence of toxicity (although some researchers disagree). They are more likely to have abnormal liver function tests, but the significance of this is uncertain.[30] Liver
Liver
damage[edit] Acute overdoses of paracetamol can cause potentially fatal liver damage. In 2011 the U.S. Food and Drug Administration
U.S. Food and Drug Administration
launched a public education program to help consumers avoid overdose, warning: "Acetaminophen can cause serious liver damage if more than directed is used."[49][50][51] In a 2011 Safety Warning the FDA immediately required manufacturers to update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury and required that such combinations contain no more than 325 mg of acetaminophen.[52][53] Overdoses are frequently related to high-dose recreational use of prescription opioids, as these opioids are most often combined with acetaminophen.[54] The overdose risk may be heightened by frequent consumption of alcohol. Paracetamol toxicity
Paracetamol toxicity
is the foremost cause of acute liver failure in the Western world
Western world
and accounts for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand.[55][56][57][58] According to the FDA, in the United States there were "56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths per year related to acetaminophen-associated overdoses during the 1990s. Within these estimates, unintentional acetaminophen overdose accounted for nearly 25% of the emergency department visits, 10% of the hospitalizations, and 25% of the deaths."[59] Paracetamol
Paracetamol
is metabolised by the liver and is hepatotoxic; side effects are multiplied when combined with alcoholic drinks, and are very likely in chronic alcoholics or people with liver damage.[60][61] Some studies have suggested the possibility of a moderately increased risk of upper gastrointestinal complications such as stomach bleeding when high doses are taken chronically.[62] Kidney damage
Kidney damage
is seen in rare cases, most commonly in overdose.[63] Skin reactions[edit] On August 2, 2013, the U.S. Food and Drug Administration
U.S. Food and Drug Administration
(FDA) issued a new warning about paracetamol. It stated that the drug could cause rare and possibly fatal skin reactions such as Stevens–Johnson syndrome and toxic epidermal necrolysis. Prescription-strength products will be required to carry a warning label about skin reactions, and the FDA has urged manufacturers to do the same with over-the-counter products.[64] Asthma[edit] There is an association between paracetamol use and asthma, but whether this association is causal is still debated as of 2017.[65] Certain evidence suggests that this association likely reflects confounders[66] rather than being truly causal.[67] A 2014 review found that among children the association disappeared when respiratory infections were taken into account.[68] As of 2014, the American Academy of Pediatrics
American Academy of Pediatrics
and the National Institute for Health and Care Excellence (NICE) continue to recommend paracetamol for pain and discomfort in children,[69][70][71][72][73][74] but some experts have recommended that paracetamol use by children with asthma or at risk for asthma should be avoided.[75][76] Other factors[edit] In contrast to aspirin, paracetamol does not prevent blood from clotting (it is not an antiplatelet), and thus may be used in people who have concerns with blood coagulation. Additionally it does not cause gastric irritation.[77] However, paracetamol does not help reduce inflammation, while aspirin does.[78] Compared with ibuprofen—whose side effects may include diarrhea, vomiting and abdominal pain—paracetamol has fewer adverse gastrointestinal effects.[79] Unlike aspirin, paracetamol is generally considered safe for children, as it is not associated with a risk of Reye's syndrome in children with viral illnesses.[80] If taken recreationally with opioids, there is weak evidence suggesting that it may cause hearing loss.[81] Overdose[edit] Main article: Paracetamol
Paracetamol
toxicity Untreated paracetamol overdose results in a lengthy, painful illness. Signs and symptoms of paracetamol toxicity may initially be absent or non-specific symptoms. The first symptoms of overdose usually begin several hours after ingestion, with nausea, vomiting, sweating, and pain as acute liver failure starts.[82] People who take overdoses of paracetamol do not fall asleep or lose consciousness, although most people who attempt suicide with paracetamol wrongly believe that they will be rendered unconscious by the drug.[83] The process of dying from an overdose takes from 3–5 days to 4–6 weeks. Paracetamol
Paracetamol
hepatotoxicity is by far the most common cause of acute liver failure in both the United States and the United Kingdom.[58][84] Paracetamol
Paracetamol
overdose results in more calls to poison control centers in the US than overdose of any other pharmacological substance.[85] Toxicity of paracetamol is believed to be due to its quinone metabolite.[86] Untreated overdose can lead to liver failure and death within days. Treatment is aimed at removing the paracetamol from the body and replenishing glutathione.[86] Activated charcoal
Activated charcoal
can be used to decrease absorption of paracetamol if the person comes to the hospital soon after the overdose. While the antidote, acetylcysteine (also called N-acetylcysteine
N-acetylcysteine
or NAC), acts as a precursor for glutathione, helping the body regenerate enough to prevent or at least decrease the possible damage to the liver, a liver transplant is often required if damage to the liver becomes severe.[55][87] NAC was usually given following a treatment nomogram (one for people with risk factors, and one for those without) but the use of the nomogram is no longer recommended as evidence to support the use of risk factors was poor and inconsistent, and many of the risk factors are imprecise and difficult to determine with sufficient certainty in clinical practice.[88] NAC also helps in neutralizing the imidoquinone metabolite of paracetamol.[86] Kidney failure
Kidney failure
is also a possible side effect. Until 2004, tablets were available (brand-name in the UK Paradote) that combined paracetamol with an antidote (methionine) to protect the liver in case of an overdose. One theoretical, but rarely if ever used, option in the United States is to request a compounding pharmacy to make a similar drug mix for people who are at risk. In June 2009, a U.S. Food and Drug Administration
U.S. Food and Drug Administration
(FDA) advisory committee recommended that new restrictions be placed on paracetamol usage in the United States to help protect people from the potential toxic effects. The maximum dosage at any given time would be decreased from 1000 mg to 650 mg, while combinations of paracetamol and opioid analgesics would be prohibited. Committee members were particularly concerned by the fact that the then present maximum dosages of paracetamol had been shown to produce alterations in hepatic function.[89] In January 2011, the FDA asked manufacturers of prescription combination products containing paracetamol to limit the amount of paracetamol to no more than 325 mg per tablet or capsule and began requiring manufacturers to update the labels of all prescription combination paracetamol products to warn of the potential risk of severe liver damage.[90][91][92][93] Manufacturers had three years to limit the amount of paracetamol in their prescription drug products to 325 mg per dosage unit.[91][93] In November 2011, the Medicines and Healthcare products Regulatory Agency revised UK dosing of liquid paracetamol for children.[94] Pregnancy[edit] Experimental studies in animals and cohort studies in humans indicate no detectable increase in congenital malformations associated with paracetamol use during pregnancy.[95] Additionally, paracetamol does not affect the closure of the fetal ductus arteriosus as NSAIDs can.[96] Paracetamol
Paracetamol
use by the mother during pregnancy is associated with an increased risk of childhood asthma.[97] It is also associated with an increase in ADHD
ADHD
but it is unclear whether the relationship is causal.[98] A 2015 review states that paracetamol remains a first-line recommended medication for pain and fever during pregnancy, despite these concerns.[99] Cancer[edit] Some studies have found an association between paracetamol and a slight increase in kidney cancer,[100] but no effect on bladder cancer risk.[101] Mechanism of action[edit]

AM404 – Metabolite of paracetamol

Anandamide – Endogenous cannabinoid

The mechanism of action of paracetamol is not completely understood. Unlike NSAIDs such as aspirin, paracetamol does not appear to inhibit the function of any cyclooxygenase (COX) enzyme outside the central nervous system, and this appears to be the reason why it is not useful as an anti-inflammatory.[102] It does appear to selectively inhibit COX
COX
activities in the brain, which may contribute to its ability to treat fever and pain.[102] This activity does not appear to be direct inhibition by blocking an active site, but rather by reducing COX, which must be oxidized in order to function.[102] It also appears that paracetamol might modulate the endogenous cannabinoid system in the brain through paracetamol's metabolite, AM404. AM404
AM404
appears to inhibit the reuptake of the endogenous cannabinoid/vanilloid anandamide by neurons, making it more available to reduce pain. AM404
AM404
also appears to be able to directly activate the TRPV1
TRPV1
(older name: vanilloid receptor), which also inhibits pain signals in the brain.[102] Pharmacokinetics[edit]

Main pathways of paracetamol metabolism (click to enlarge). Pathways shown in blue and purple lead to non-toxic metabolites; the pathway in red leads to toxic NAPQI.

After being taken by mouth it is rapidly absorbed by the gastrointestinal (GI) tract (although absorption through the stomach is negligible);[103] its volume of distribution is roughly 50 L.[104] The concentration in serum after a typical dose of paracetamol usually peaks below 30 µg/ml (200 µmol/L).[105] After four hours the concentration is usually less than 10 µg/mL (66 µmol/L).[105] Paracetamol
Paracetamol
is metabolised primarily in the liver, into toxic and non-toxic products. Three metabolic pathways are notable:[86]

Glucuronidation
Glucuronidation
(45-55%),[3] by UGT1A1 and UGT1A6;[101] Sulfation (sulfate conjugation) (20–30%)[3] by SULT1A1;[101] N-hydroxylation and dehydration, then glutathione conjugation, (less than 15%). The hepatic cytochrome P450 enzyme system metabolises paracetamol (mainly CYP2E1), forming a minor yet significant alkylating metabolite known as NAPQI
NAPQI
(N-acetyl-p-benzoquinone imine) (also known as N-acetylimidoquinone).[86][106] NAPQI
NAPQI
is then irreversibly conjugated with the sulfhydryl groups of glutathione.[106]

All three pathways yield final products that are inactive, non-toxic, and eventually excreted by the kidneys. In the third pathway, however, the intermediate product NAPQI
NAPQI
is toxic. NAPQI
NAPQI
is primarily responsible for the toxic effects of paracetamol; this constitutes an example of toxication.[107] Production of NAPQI
NAPQI
is due primarily to two isoenzymes of cytochrome P450: CYP2E1[101] and CYP3A4.[107] At usual doses, NAPQI
NAPQI
is quickly detoxified by conjugation with glutathione.[86][106] Chemistry[edit] Chemical properties[edit]

Paracetamol
Paracetamol
molecule polar surface area

Paracetamol
Paracetamol
electrostatic potential map

Paracetamol
Paracetamol
consists of a benzene ring core, substituted by one hydroxyl group and the nitrogen atom of an amide group in the para (1,4) pattern.[108] The amide group is acetamide (ethanamide). It is an extensively conjugated system, as the lone pair on the hydroxyl oxygen, the benzene pi cloud, the nitrogen lone pair, the p orbital on the carbonyl carbon, and the lone pair on the carbonyl oxygen are all conjugated. The presence of two activating groups also make the benzene ring highly reactive toward electrophilic aromatic substitution. As the substituents are ortho, para-directing and para with respect to each other, all positions on the ring are more or less equally activated. The conjugation also greatly reduces the basicity of the oxygens and the nitrogen, while making the hydroxyl acidic through delocalisation of charge developed on the phenoxide anion. Paracetamol
Paracetamol
is part of the class of drugs known as "aniline analgesics"; it is the only such drug still in use today.[109] It is not considered an NSAID
NSAID
because it does not exhibit significant anti-inflammatory activity (it is a weak COX
COX
inhibitor).[110][111] This is despite the evidence that paracetamol and NSAIDs have some similar pharmacological activity.[112] Synthesis[edit] Original (Boots) method[edit] The original method for production involves the nitration of phenol with sodium nitrate gives a mixture of two isomers, from which the wanted 4-nitrophenol
4-nitrophenol
(bp 279 °C) can easily be separated by steam distillation. In this electrophilic aromatic substitution reaction, phenol's oxygen is strongly activating, thus the reaction requires only mild conditions as compared to nitration of benzene itself. The nitro group is then reduced to an amine, giving 4-aminophenol. Finally, the amine is acetylated with acetic anhydride.[113] Industrially direct hydrogenation is used, but in the laboratory scale sodium borohydride serves.[114][115]

Green(er) synthesis[edit] An alternative industrial synthesis developed by Hoechst–Celanese involves direct acylation of phenol with acetic anhydride catalyzed by HF, conversion of the ketone to a ketoxime with hydroxylamine, followed by the acid-catalyzed Beckmann rearrangement
Beckmann rearrangement
to give the amide.[115][116]

Direct synthesis[edit] More recently (2014) a "one-pot" synthesis from hydroquinone has been described before the Royal Society of Chemistry.[117][118] The process may be summarized as follows:

Hydroquinone, ammonium acetate, and acetic acid were mixed in an argon atmosphere and heated slowly to 230 °C. The mixture was stirred at this temperature for 15 hours. After cooling the acetic acid was evaporated and the precipitate was filtered, washed with water and dried to give paracetamol as a white solid.

The authors go on to claim an 88% yield and 99% purity. Reactions[edit] 4-Aminophenol
4-Aminophenol
may be obtained by the amide hydrolysis of paracetamol. 4-Aminophenol
4-Aminophenol
prepared this way, and related to the commercially available Metol, has been used as a developer in photography by hobbyists.[119] This reaction is also used to determine paracetamol in urine samples: After hydrolysis with hydrochloric acid, 4-aminophenol reacts in ammonia solution with a phenol derivate, e.g. salicylic acid, to form an indophenol dye under oxidization by air.[120] History[edit]

Julius Axelrod
Julius Axelrod
(pictured) and Bernard Brodie demonstrated that acetanilide and phenacetin are both metabolised to paracetamol, which is a better tolerated analgesic.

Acetanilide
Acetanilide
was the first aniline derivative serendipitously found to possess analgesic as well as antipyretic properties, and was quickly introduced into medical practice under the name of Antifebrin
Antifebrin
by A. Cahn and P. Hepp in 1886.[121] But its unacceptable toxic effects, the most alarming being cyanosis due to methemoglobinemia, prompted the search for less toxic aniline derivatives.[109] Harmon Northrop Morse had already synthesised paracetamol at Johns Hopkins University
Johns Hopkins University
via the reduction of p-nitrophenol with tin in glacial acetic acid in 1877,[122][123] but it was not until 1887 that clinical pharmacologist Joseph von Mering
Joseph von Mering
tried paracetamol on humans.[109] In 1893, von Mering published a paper reporting on the clinical results of paracetamol with phenacetin, another aniline derivative.[124] Von Mering claimed that, unlike phenacetin, paracetamol had a slight tendency to produce methemoglobinemia. Paracetamol
Paracetamol
was then quickly discarded in favor of phenacetin. The sales of phenacetin established Bayer
Bayer
as a leading pharmaceutical company.[125] Overshadowed in part by aspirin, introduced into medicine by Heinrich Dreser in 1899, phenacetin was popular for many decades, particularly in widely advertised over-the-counter "headache mixtures", usually containing phenacetin, an aminopyrine derivative of aspirin, caffeine, and sometimes a barbiturate.[109] Paracetamol
Paracetamol
is the active metabolite of phenacetin and acetanilide, both once popular as analgesics and antipyretics in their own right.[104][126] However, unlike phenacetin, acetanilide and their combinations, paracetamol is not considered carcinogenic at therapeutic doses.[127] Von Mering's claims remained essentially unchallenged for half a century, until two teams of researchers from the United States analyzed the metabolism of acetanilide and paracetamol.[125] In 1947 David Lester and Leon Greenberg found strong evidence that paracetamol was a major metabolite of acetanilide in human blood, and in a subsequent study they reported that large doses of paracetamol given to albino rats did not cause methemoglobinemia.[128] In three papers published in the September 1948 issue of the Journal of Pharmacology and Experimental Therapeutics, Bernard Brodie, Julius Axelrod
Julius Axelrod
and Frederick Flinn confirmed using more specific methods that paracetamol was the major metabolite of acetanilide in human blood, and established that it was just as efficacious an analgesic as its precursor.[129][130][131] They also suggested that methemoglobinemia is produced in humans mainly by another metabolite, phenylhydroxylamine. A follow-up paper by Brodie and Axelrod in 1949 established that phenacetin was also metabolised to paracetamol.[132] This led to a "rediscovery" of paracetamol.[109] It has been suggested that contamination of paracetamol with 4-aminophenol, the substance von Mering synthesised it from, may be the cause for his spurious findings.[125] Paracetamol
Paracetamol
was first marketed in the United States in 1950 under the name Triagesic, a combination of paracetamol, aspirin, and caffeine.[123] Reports in 1951 of three users stricken with the blood disease agranulocytosis led to its removal from the marketplace, and it took several years until it became clear that the disease was unconnected.[123] Paracetamol
Paracetamol
was marketed in 1953 by Sterling-Winthrop Co. as Panadol, available only by prescription, and promoted as preferable to aspirin since it was safe for children and people with ulcers.[123][125][133] In 1955, paracetamol was marketed as Children's Tylenol Elixir by McNeil Laboratories.[134] In 1956, 500 mg tablets of paracetamol went on sale in the United Kingdom under the trade name Panadol, produced by Frederick Stearns & Co, a subsidiary of Sterling Drug Inc. In 1963, paracetamol was added to the British Pharmacopoeia, and has gained popularity since then as an analgesic agent with few side-effects and little interaction with other pharmaceutical agents.[123] Concerns about paracetamol's safety delayed its widespread acceptance until the 1970s, but in the 1980s paracetamol sales exceeded those of aspirin in many countries, including the United Kingdom. This was accompanied by the commercial demise of phenacetin, blamed as the cause of analgesic nephropathy and hematological toxicity.[109] In 1988 Sterling Winthrop was acquired by Eastman Kodak
Eastman Kodak
which sold the over the counter drug rights to SmithKline Beecham
SmithKline Beecham
in 1994.[135] Available without a prescription since 1959,[136] it has since become a common household drug.[137] Patents on paracetamol have long expired, and generic versions of the drug are widely available.[2][138] Society and culture[edit] Naming[edit] Acetaminophen is the name generally used in the United States (USAN), Japan (JAN), Canada[139] Venezuela, Colombia, and Iran; paracetamol is used in international venues (INN, AAN, BAN).[139][140][141] In some contexts, such as on prescription bottles of painkillers that incorporate this medicine, it is simply abbreviated as APAP, for acetyl-para-aminophenol. Both acetaminophen and paracetamol come from a chemical name for the compound: para-acetylaminophenol and para-acetylaminophenol. Available forms[edit] See also: Paracetamol
Paracetamol
brand names

Tylenol 500 mg capsules

Panadol 500 mg tablets

For comparison: The pure drug is a white crystalline powder.

Paracetamol
Paracetamol
is available in a tablet, capsule, liquid suspension, suppository, intravenous, intramuscular and effervescent forms.[142][143] In some formulations, paracetamol is combined with the opioid codeine, sometimes referred to as co-codamol (BAN) and Panadeine in Australia. In the U.S., this combination is available only by prescription, while the lowest-strength preparation is over the counter in Canada, and in other countries other strengths may be available over the counter.[citation needed] Paracetamol
Paracetamol
is also combined with other opioids such as dihydrocodeine, referred to as co-dydramol (BAN), oxycodone or hydrocodone. Another very commonly used analgesic combination includes paracetamol in combination with propoxyphene napsylate. A combination of paracetamol, codeine, and the calmative doxylamine succinate is also available. The efficacy of paracetamol/codeine combinations has been questioned by recent research.[45] Paracetamol
Paracetamol
is commonly used in multi-ingredient preparations for migraine headache, typically including butalbital and paracetamol with or without caffeine, and sometimes containing codeine. Paracetamol
Paracetamol
is sometimes combined with phenylephrine hydrochloride.[144] Sometimes a third active ingredient, such as ascorbic acid,[144][145] caffeine,[146][147] chlorpheniramine maleate,[148] or guaifenesin[149][150][151] is added to this combination. When marketed in combination with diphenhydramine hydrochloride, it is frequently given the label "PM" and is meant as a sleep aid. Diphenhydramine hydrochloride
Diphenhydramine hydrochloride
is known to have hypnotic effects and is non-habit forming. Unfortunately it has been implicated in the occasional development of restless leg syndrome.[152] Controversy[edit] In September 2013, an episode of This American Life
This American Life
titled "Use Only as Directed"[153] highlighted deaths from paracetamol overdose. This report was followed by two reports by ProPublica[154][155] alleging that the "FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson" and "McNeil, the maker of Tylenol, ... has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug." A report prepared by an internal FDA working group describes a history of FDA initiatives designed to educate consumers about the risk of paracetamol overdose and notes that one challenge to the Agency has been "identifying the appropriate message about the relative safety of acetaminophen, especially compared to other OTC pain relievers (e.g., aspirin and other NSAIDs)". The report notes that "Chronic use of NSAIDs is also associated with significant morbidity and mortality. NSAID
NSAID
gastrointestinal risk is substantial, with deaths and hospitalization estimated in one publication as 3200 and 32,000 per year respectively. Possible cardiovascular toxicity with chronic NSAID use has been a major discussion recently", finally noting that "The goal of the educational efforts is not to decrease appropriate acetaminophen use or encourage substitution of NSAID
NSAID
use, but rather to educate consumers so that they can avoid unnecessary health risks."[156] Veterinary use[edit] Cats[edit] Paracetamol
Paracetamol
is extremely toxic to cats, which lack the necessary UGT1 enzyme to break it down safely. Initial symptoms include vomiting, salivation, and discoloration of the tongue and gums. Unlike an overdose in humans, liver damage is rarely the cause of death; instead, methemoglobin formation and the production of Heinz bodies in red blood cells inhibit oxygen transport by the blood, causing asphyxiation (methemoglobemia and hemolytic anemia).[157] Treatment with N-acetylcysteine,[158] methylene blue or both is sometimes effective after the ingestion of small doses of paracetamol. Dogs[edit] Although paracetamol is believed to have no significant anti-inflammatory activity, it has been reported to be as effective as aspirin in the treatment of musculoskeletal pain in dogs.[159] A paracetamol-codeine product (trade name Pardale-V)[160] licensed for use in dogs is available for purchase under supervision of a vet, pharmacist or other qualified person.[160] It should be administered to dogs only on veterinary advice and with extreme caution.[160] The main effect of toxicity in dogs is liver damage, and GI ulceration has been reported.[158][161][162][163] N-acetylcysteine
N-acetylcysteine
treatment is efficacious in dogs when administered within two hours of paracetamol ingestion.[158][159] Snakes[edit] Paracetamol
Paracetamol
is also lethal to snakes, and has been suggested as a chemical control program for the invasive brown tree snake (Boiga irregularis) in Guam.[164][165] Doses of 80 mg are inserted into dead mice scattered by helicopter.[166] References[edit]

^ a b c d e f g "Acetaminophen". The American Society of Health-System Pharmacists. Archived from the original on 5 June 2016. Retrieved 16 September 2016.  ^ a b "International Listings for Paracetamol". Archived from the original on 6 January 2016. Retrieved 11 January 2016.  ^ a b c d e "Codapane Forte Paracetamol
Paracetamol
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Corporation  ^ Joncour, Roxan; Duguet, Nicolas; Métay, Estelle; Ferreira, Amadéo; Lemaire, Marc (2014). "Amidation of phenol derivatives: a direct synthesis of paracetamol (acetaminophen) from Hydroquinone". Green Chem. 16: 2997–3002. doi:10.1039/C4GC00166D.  ^ Joncour, Roxan; Duguet, Nicolas; Métay, Estelle; Ferreira, Amadéo; Lemaire, Marc. "Supplementary Information Amidation of phenol derivatives: a direct synthesis of paracetamol (acetaminophen) from hydroquinone" (PDF). Archived (PDF) from the original on 2015-09-24.  ^ Henney, K; Dudley B (1939). Handbook of Photography. Whittlesey House. p. 324.  ^ Novotny PE, Elser RC (1984). " Indophenol
Indophenol
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External links[edit]

Wikimedia Commons has media related to Paracetamol.

FDA: Safe Use of Over-the-Counter Pain
Pain
Relievers/ Fever
Fever
Reducers FDA: Consumer Update "Acetaminophen and Liver
Liver
Injury: Q and A for Consumers" (link) U.S. National Library of Medicine: Drug Information Portal–Paracetamol

v t e

Analgesics (N02A, N02B)

Opioids

Opiates/opium

Codeine# (+paracetamol, +aspirin) Morphine# (+naltrexone) Opium Laudanum Paregoric

Semisynthetic

Acetyldihydrocodeine Benzylmorphine Buprenorphine
Buprenorphine
(+naloxone) Desomorphine Diamorphine (heroin) Dihydrocodeine
Dihydrocodeine
(+paracetamol) Dihydromorphine Ethylmorphine Hydrocodone
Hydrocodone
(+paracetamol, +ibuprofen, +aspirin) Hydromorphinol Hydromorphone Nicocodeine Nicodicodeine Nicomorphine Oxycodone
Oxycodone
(+paracetamol, +aspirin, +ibuprofen, +naloxone, +naltrexone) Oxymorphone Thebacon

Synthetic

Alfentanil Alphaprodine Anileridine Butorphanol Carfentanil Dextromoramide Dextropropoxyphene Dezocine Fentanyl# (+fluanisone) Ketobemidone Levorphanol Lofentanil Meptazinol Methadone# Nalbuphine NFEPP Pentazocine Pethidine
Pethidine
(meperidine) Phenadoxone Phenazocine Piminodine Piritramide Propiram Remifentanil Sufentanil Tapentadol Tilidine Tramadol

Paracetamol-type

Acetanilide‡ Bucetin‡ Butacetin‡ Paracetamol
Paracetamol
(acetaminophen)# Parapropamol‡ Phenacetin‡ Propacetamol‡

NSAIDs

Propionates

Fenoprofen Flurbiprofen Ibuprofen# Ketoprofen Naproxen Oxaprozin

Oxicams

Meloxicam Piroxicam

Acetates

Diclofenac Indometacin Ketorolac Nabumetone Sulindac Tolmetin

COX-2 inhibitors

Celecoxib Etoricoxib Lumiracoxib Parecoxib Rofecoxib
Rofecoxib
Valdecoxib
Valdecoxib

Fenamates

Meclofenamic acid Mefenamic acid

Salicylates

Aspirin
Aspirin
(acetylsalicylic acid)# (+paracetamol/caffeine) Benorylate Diflunisal Ethenzamide Magnesium salicylate Salicin Salicylamide Salsalate Wintergreen
Wintergreen
(methyl salicylate)

Pyrazolones

Aminophenazone‡ Ampyrone Metamizole
Metamizole
(dipyrone) Nifenazone Phenazone Propyphenazone
Propyphenazone
(+paracetamol/caffeine)

Others

Glafenine

Cannabinoids

Cannabidiol Cannabis Nabilone Nabiximols Tetrahydrocannabinol
Tetrahydrocannabinol
(dronabinol)

Ion
Ion
channel modulators

Calcium
Calcium
blockers

Gabapentin Gabapentin
Gabapentin
enacarbil Pregabalin Ziconotide

Sodium blockers

Carbamazepine Lacosamide Local anesthetics (e.g., cocaine, lidocaine) Mexiletine Nefopam Tricyclic antidepressants (e.g., amitriptyline#)

Nav1.7/1.8-selective: DSP-2230§ Funapide§ PF-05089771§ Raxatrigine§

Potassium openers

Flupirtine

Myorelaxants

Carisoprodol Chlorzoxazone Cyclobenzaprine Mephenoxalone Methocarbamol Orphenadrine

Others

Analgesic
Analgesic
adjuvant Analgecine Camphor Capsaicin Clonidine Ketamine Menthol Methoxyflurane Nefopam Proglumide Tricyclic antidepressants (e.g., amitriptyline#)

#WHO-EM ‡Withdrawn from market Clinical trials:

†Phase III §Never to phase III

v t e

Cannabinoid
Cannabinoid
receptor modulators

Receptor (ligands)

CB1

Agonists (abridged; see here for more): 2-AG 2-AGE (noladin ether) 11-Hydroxy-THC α-Amyrin β-Amyrin AB-CHMINACA AM-1172 AM-1220 AM-1221 AM-1235 AM-2201 AM-2232 Anandamide Arvanil AZ-11713908 Cannabinol CB-13 CP 47,497 CP 55,940 Dimethylheptylpyran DEA ECG EGCG Epicatechin Gallocatechol
Gallocatechol
(gallocatechin) Honokiol HU-210 JWH-007 JWH-015 JWH-018 JWH-073 Kavain L-759,633 Levonantradol Menabitan Nabilone Nabitan NADA O-1812 Oleamide Pravadoline Serinolamide A THC (dronabinol) UR-144 WIN 55,212-2 Yangonin

Antagonists: AM-251 AM-6545 Cannabidiol Cannabigerol Drinabant Falcarinol
Falcarinol
(carotatoxin) Hemopressin Ibipinabant LY-320,135 MK-9470 NESS-0327 O-2050 Otenabant PF-514273 PipISB Rimonabant Rosonabant Surinabant Taranabant THCV TM-38837 VCHSR Virodhamine

Antibodies: Brizantin (Бризантин) Dietressa (Диетресса)

Unknown/unsorted: MAFP

CB2

Agonists: 2-AG 2-AGE (noladin ether) 3,3'-Diindolylmethane 4-O-Methylhonokiol α-Amyrin β-Amyrin A-796,260 A-834,735 A-836,339 AM-1172 AM-1221 AM-1235 AM-1241 AM-2232 Anandamide AZ-11713908 Cannabinol Caryophyllene CB-13 CBS-0550 CP-55,940 GW-405,833
GW-405,833
(L-768,242) GW-842,166X HU-308 JTE 7-31 JWH-007 JWH-015 JWH-018 JWH-73 JWH-133 L-759,633 L-759,656 Magnolol MDA-19 Nabitan NADA PF-03550096 S-444,823 SER-601 Serinolamide A UR-144 Tedalinab THC (dronabinol) THCV Tetrahydromagnolol Virodhamine

Antagonists: 4-O-Methylhonokiol AM-630 BML-190 Cannabidiol Honokiol JTE-907 SR-144,528 WIN 54,461 WIN 56,098

NAGly (GPR18)

Agonists: Abnormal cannabidiol ACPA AM251 Anandamide Cannabidiol NADGly THC (dronabinol) O-1602

Antagonists: CID-85469571 O-1918

GPR55

Agonists: 2-AGE (noladin ether) 2-ALPI Abnormal cannabidiol AM-251 CID1011163 CID1252842 CID1792579 CP 55,940 GSK-494581A Lysophosphatidylinositol ML-184 ML-185 ML-186 O-1602 Oleoylethanolamide Palmitoylethanolamide THC (dronabinol)

Antagonists: Cannabidiol CID-16020046 ML-191 ML-192 ML-193 O-1918 PSB-SB-487 PSB-SB-1202 PSB-SB-1203 Tetrahydromagnolol

GPR119

Agonists: 2-Oleoylglycerol Anandamide APD668 AR-231,453 AS-1269574 MBX-2982 N-Oleoyldopamine Oleoylethanolamide Olvanil PSN-375,963 PSN-632,408

Transporter (modulators)

eCBTs

Inhibitors: 5'-DMH-CBD AM-404 AM-1172 Arachidonoyl serotonin Arvanil Cannabidiol Guineensine LY-2183240 O-2093 OMDM-2 Paracetamol
Paracetamol
(acetaminophen) SB-FI-26 UCM-707 URB-597 VDM-11 WOBE490 WOBE491 WOBE492

Enzyme (modulators)

FAAH

Inhibitors: 4-Nonylphenylboronic acid AACOCF3 AM-404 Arachidonoyl serotonin BIA 10-2474 Biochanin A Genistein IDFP JNJ-1661010 JNJ-42165279 JZL-195 Kaempferol LY-2183240 MAFP Palmitoylisopropylamide Paracetamol
Paracetamol
(acetaminophen) PF-3845 PF-04457845 PF-750 SA-47 SA-57 TAK 21d TC-F 2 UCM710 URB-597

Activators: PDP-EA

MAGL

Inhibitors: ABX-1431 IDFP JJKK 048 JW 642 JZL-184 JZL-195 JZP-361 KML 29 MAFP MJN110 NAM Pristimerin URB-602

ABHD6

Inhibitors: JZP-169 JZP-430 KT182 KT185 KT195 KT203 LEI-106 ML294 ML295 ML296 UCM710 WWL-70

ABHD12

Inhibitors: Betulinic acid Maslinic acid MAFP Oleanolic acid Orlistat
Orlistat
(tetrahydrolipstatin) Ursolic acid

Others

Precursors: Phosphatidylethanolamine NAPE Diacylglycerol

Others: 2-PG (directly potentiates activity of 2-AG at CB1 receptor) ARN-272 (FAAH-like anandamide transporter inhibitor)

See also Receptor/signaling modulators Cannabinoids (cannabinoids by structure)

v t e

Prostanoid
Prostanoid
signaling modulators

Receptor (ligands)

DP (D2)

DP1

Agonists: Prostaglandin D2 Treprostinil

Antagonists: Asapiprant Laropiprant Vidupiprant

DP2

Agonists: Indometacin Prostaglandin D2

Antagonists: ADC-3680 AZD-1981 Bay U3405 Fevipiprant MK-1029 MK-7246 QAV-680 Ramatroban Setipiprant Timapiprant TM30089 Vidupiprant

EP (E2)

EP1

Agonists: Beraprost Enprostil Iloprost
Iloprost
(ciloprost) Latanoprost Lubiprostone Misoprostol Prostaglandin E1
Prostaglandin E1
(alprostadil) Prostaglandin E2
Prostaglandin E2
(dinoprostone) Sulprostone

Antagonists: AH-6809 ONO-8130 SC-19220 SC-51089 SC-51322

EP2

Agonists: Butaprost Misoprostol Prostaglandin E1
Prostaglandin E1
(alprostadil) Prostaglandin E2
Prostaglandin E2
(dinoprostone) Treprostinil

Antagonists: AH-6809 PF-04418948 TG 4-155

EP3

Agonists: Beraprost Carbacyclin Cicaprost Enprostil Iloprost
Iloprost
(ciloprost) Isocarbacyclin Latanoprost Misoprostol Prostaglandin D2 Prostaglandin E1
Prostaglandin E1
(alprostadil) Prostaglandin E2
Prostaglandin E2
(dinoprostone) Remiprostol Sulprostone

Antagonists: L-798106

EP4

Agonists: Lubiprostone Misoprostol Prostaglandin E1
Prostaglandin E1
(alprostadil) Prostaglandin E2
Prostaglandin E2
(dinoprostone) TCS-2510

Antagonists: Grapiprant GW-627368 L-161982 ONO-AE3-208

Unsorted

Agonists: 16,16-Dimethyl Prostaglandin E2 Aganepag Carboprost Evatanepag Gemeprost Nocloprost Omidenepag Prostaglandin F2α
Prostaglandin F2α
(dinoprost) Simenepag Taprenepag

FP (F2α)

Agonists: Alfaprostol Bimatoprost Carboprost Cloprostenol Enprostil Fluprostenol Latanoprost Prostaglandin D2 Prostaglandin F2α
Prostaglandin F2α
(dinoprost) Sulotroban Tafluprost Travoprost Unoprostone

IP (I2)

Agonists: ACT-333679 AFP-07 Beraprost BMY-45778 Carbacyclin Cicaprost Iloprost
Iloprost
(ciloprost) Isocarbacyclin MRE-269 NS-304 Prostacyclin
Prostacyclin
(prostaglandin I2, epoprostenol) Prostaglandin E1
Prostaglandin E1
(alprostadil) Ralinepag Selexipag Taprostene TRA-418 Treprostinil

Antagonists: RO1138452

TP (TXA2)

Agonists: Carbocyclic thromboxane A2 I-BOP Thromboxane A2 U-46619 Vapiprost

Antagonists: 12-HETE 13-APA AA-2414 Argatroban Bay U3405 BMS-180,291 Daltroban Domitroban EP-045 GR-32191 ICI-185282 ICI-192605 Ifetroban Imitrodast L-655240 L-670596 Linotroban Mipitroban ONO-3708 ONO-11120 Picotamide Pinane thromboxane A2 Ramatroban Ridogrel S-145 Samixogrel Seratrodast SQ-28,668 SQ-29,548 Sulotroban Terbogrel Terutroban TRA-418

Unsorted

Arbaprostil Ataprost Ciprostene Clinprost Cobiprostone Delprostenate Deprostil Dimoxaprost Doxaprost Ecraprost Eganoprost Enisoprost Eptaloprost Esuberaprost Etiproston Fenprostalene Flunoprost Froxiprost Lanproston Limaprost Luprostiol Meteneprost Mexiprostil Naxaprostene Nileprost Nocloprost Ornoprostil Oxoprostol Penprostene Pimilprost Piriprost Posaraprost Prostalene Rioprostil Rivenprost Rosaprostol Spiriprostil Tiaprost Tilsuprost Tiprostanide Trimoprostil Viprostol

Enzyme (inhibitors)

COX (PTGS)

Salicylic acids: Aloxiprin Aspirin
Aspirin
(acetylsalicylic acid) Benorilate
Benorilate
(benorylate) Carbasalate calcium Diflusinal Dipyrocetyl Ethenzamide Guacetisal Magnesium salicylate Mesalazine
Mesalazine
(5-aminosalicylic acid) Methyl salicylate Salacetamide Salicin Salicylamide Salicylate
Salicylate
(salicylic acid) Salsalate Sodium salicylate Triflusal; Acetic acids: Aceclofenac Acemetacin Aclofenac Amfenac Alclofenac Bendazac Bromfenac Bufexamac Bumadizone Cinmetacin Clometacin Diclofenac Difenpiramide Etodolac Felbinac Fenclofenac Fentiazac Glucametacin Indometacin
Indometacin
(indomethacin) Indometacin
Indometacin
farnesil Ketorolac Lonazolac Mofezolac Nabumetone Oxametacin Oxindanac Proglumetacin Sulindac Sulindac
Sulindac
sulfide Tolmetin Zidometacin Zomepirac; Propionic acids: Alminoprofen Benoxaprofen Bucloxic acid (blucloxate) Butibufen Carprofen Dexibuprofen Dexindoprofen Dexketoprofen Fenbufen Fenoprofen Flunoxaprofen Flurbiprofen Ibuprofen Ibuproxam Indoprofen Ketoprofen Loxoprofen Miroprofen Naproxen Naproxcinod Oxaprozin Pirprofen Pranoprofen Suprofen Tarenflurbil Tepoxalin Tiaprofenic acid
Tiaprofenic acid
(tiaprofenate) Vedaprofen; Anthranilic acids (fenamic acids): Etofenamic acid (etofenamate) Floctafenic acid (floctafenate) Flufenamic acid
Flufenamic acid
(flufenamate) Meclofenamic acid
Meclofenamic acid
(meclofenamate) Mefenamic acid
Mefenamic acid
(mefenamate) Morniflumic acid (morniflumate) Niflumic acid
Niflumic acid
(niflumate) Talinflumic acid (talinflumate) Tolfenamic acid
Tolfenamic acid
(tolfenamate); Pyrazolones: Azapropazone Dipyrone Isopyrin Oxyphenbutazone Phenylbutazone; Enolic acids (oxicams): Ampiroxicam Droxicam Enolicam Isoxicam Lornoxicam Meloxicam Piroxicam Tenoxicam; 4-Aminoquinolines: Antrafenine Floctafenine Glafenine; Quinazolines: Fluproquazone Proquazone; Aminonicotinic acids: Clonixeril Clonixin Flunixin; Sulfonanilides: Flosulide Nimesulide; Aminophenols (anilines): Acetanilide AM-404
AM-404
(N-arachidonoylaminophenol) Bucetin Paracetamol
Paracetamol
(acetaminophen) Parapropamol Phenacetin Propacetamol; Selective COX-2 inhibitors (coxibs): Apricoxib Celecoxib Cimicoxib Deracoxib Etoricoxib Firocoxib Lumiracoxib Mavacoxib Parecoxib Polmacoxib Robenacoxib Rofecoxib Tilmacoxib Valdecoxib; Others/unsorted: Anitrazafen Clobuzarit Curcumin DuP-697 FK-3311 Flumizole FR-122047 Glimepiride Hyperforin Itazigrel L-655240 L-670596 Licofelone Menatetrenone
Menatetrenone
(vitamin K2) NCX-466 NCX-4040 NS-398 Pamicogrel Resveratrol Romazarit Rosmarinic acid Rutecarpine Satigrel SC-236 SC-560 SC-58125 Tenidap Tiflamizole Timegadine Trifenagrel Tropesin

PGD2S

Retinoids Selenium
Selenium
(selenium tetrachloride, sodium selenite, selenium disulfide)

PGES

HQL-79

PGFS

Bimatoprost

PGI2S

Tranylcypromine

TXAS

Camonagrel Dazmegrel Dazoxiben Furegrelate Isbogrel Midazogrel Nafagrel Nicogrelate Ozagrel Picotamide Pirmagrel Ridogrel Rolafagrel Samixogrel Terbogrel U63557A

Others

Precursors: Linoleic acid γ-Linolenic acid (gamolenic acid) Dihomo-γ-linolenic acid Diacylglycerol Arachidonic acid Prostaglandin G2 Prostaglandin H2

See also Receptor/signaling modulators Leukotriene signaling modulators Nuclear receptor modulators

v t e

TRP channel modulators

TRPA

Activators

4-Hydroxynonenal 4-Oxo-2-nonenal 4,5-EET 12S-HpETE 15-Deoxy-Δ12,14-prostaglandin J2 α- Sanshool
Sanshool
(ginger, Sichuan and melegueta peppers) Acrolein Allicin
Allicin
(garlic) Allyl isothiocyanate
Allyl isothiocyanate
(mustard, radish, horseradish, wasabi) AM404 Bradykinin Cannabichromene
Cannabichromene
(cannabis) Cannabidiol
Cannabidiol
(cannabis) Cannabigerol
Cannabigerol
(cannabis) Cinnamaldehyde
Cinnamaldehyde
(cinnamon) CR gas
CR gas
(dibenzoxazepine; DBO) CS gas
CS gas
(2-chlorobenzal malononitrile) Curcumin
Curcumin
(turmeric) Dehydroligustilide (celery) Diallyl disulfide Dicentrine
Dicentrine
( Lindera
Lindera
spp.) Farnesyl thiosalicylic acid Formalin Gingerols (ginger) Hepoxilin A3 Hepoxilin B3 Hydrogen peroxide Icilin Isothiocyanate Ligustilide (celery, Angelica acutiloba) Linalool
Linalool
(Sichuan pepper, thyme) Methylglyoxal Methyl salicylate
Methyl salicylate
(wintergreen) N-Methylmaleimide Nicotine
Nicotine
(tobacco) Oleocanthal
Oleocanthal
(olive oil) Paclitaxel
Paclitaxel
(Pacific yew) Paracetamol
Paracetamol
(acetaminophen) PF-4840154 Phenacyl chloride Polygodial
Polygodial
(Dorrigo pepper) Shogaols (ginger, Sichuan and melegueta peppers) Tear gases Tetrahydrocannabinol
Tetrahydrocannabinol
(cannabis) Thiopropanal S-oxide
Thiopropanal S-oxide
(onion) Umbellulone
Umbellulone
(Umbellularia californica) WIN 55,212-2

Blockers

Dehydroligustilide (celery) Nicotine
Nicotine
(tobacco) Ruthenium red

TRPC

Activators

Adhyperforin
Adhyperforin
(St John's wort) Diacyl glycerol GSK1702934A Hyperforin
Hyperforin
(St John's wort) Substance P

Blockers

DCDPC DHEA-S Flufenamic acid GSK417651A GSK2293017A Meclofenamic acid N-(p-amylcinnamoyl)anthranilic acid Niflumic acid Pregnenolone sulfate Progesterone Pyr3 Tolfenamic acid

TRPM

Activators

ADP-ribose BCTC Calcium
Calcium
(intracellular) Cold Coolact P Cooling Agent 10 CPS-369 Eucalyptol
Eucalyptol
(eucalyptus) Frescolat MGA Frescolat ML Geraniol Hydroxycitronellal Icilin Linalool Menthol
Menthol
(mint) PMD 38 Pregnenolone sulfate Rutamarin (Ruta graveolens) Steviol glycosides (e.g., stevioside) (Stevia rebaudiana) Sweet tastants (e.g., glucose, fructose, sucrose; indirectly) Thio-BCTC WS-3 WS-12 WS-23

Blockers

Capsazepine Clotrimazole DCDPC Flufenamic acid Meclofenamic acid Mefenamic acid N-(p-amylcinnamoyl)anthranilic acid Nicotine
Nicotine
(tobacco) Niflumic acid Ruthenium red Rutamarin (Ruta graveolens) Tolfenamic acid TPPO

TRPML

Activators

MK6-83 PI(3,5)P2 SF-22

TRPP

Activators

Triptolide
Triptolide
(Tripterygium wilfordii)

Blockers

Ruthenium red

TRPV

Activators

2-APB 5',6'-EET 9-HODE 9-oxoODE 12S-HETE 12S-HpETE 13-HODE 13-oxoODE 20-HETE α- Sanshool
Sanshool
(ginger, Sichuan and melegueta peppers) Allicin
Allicin
(garlic) AM404 Anandamide Bisandrographolide (Andrographis paniculata) Camphor
Camphor
(camphor laurel, rosemary, camphorweed, African blue basil, camphor basil) Cannabidiol
Cannabidiol
(cannabis) Cannabidivarin
Cannabidivarin
(cannabis) Capsaicin
Capsaicin
(chili pepper) Carvacrol
Carvacrol
(oregano, thyme, pepperwort, wild bergamot, others) DHEA Diacyl glycerol Dihydrocapsaicin
Dihydrocapsaicin
(chili pepper) Estradiol Eugenol
Eugenol
(basil, clove) Evodiamine
Evodiamine
(Euodia ruticarpa) Gingerols (ginger) GSK1016790A Heat Hepoxilin A3 Hepoxilin B3 Homocapsaicin
Homocapsaicin
(chili pepper) Homodihydrocapsaicin
Homodihydrocapsaicin
(chili pepper) Incensole
Incensole
(incense) Lysophosphatidic acid Low pH (acidic conditions) Menthol
Menthol
(mint) N-Arachidonoyl dopamine N-Oleoyldopamine N-Oleoylethanolamide Nonivamide
Nonivamide
(PAVA) (PAVA spray) Nordihydrocapsaicin
Nordihydrocapsaicin
(chili pepper) Paclitaxel
Paclitaxel
(Pacific yew) Paracetamol
Paracetamol
(acetaminophen) Phorbol esters
Phorbol esters
(e.g., 4α-PDD) Piperine
Piperine
(black pepper, long pepper) Polygodial
Polygodial
(Dorrigo pepper) Probenecid Protons RhTx Rutamarin (Ruta graveolens) Resiniferatoxin
Resiniferatoxin
(RTX) (Euphorbia resinifera/pooissonii) Shogaols (ginger, Sichuan and melegueta peppers) Tetrahydrocannabivarin
Tetrahydrocannabivarin
(cannabis) Thymol
Thymol
(thyme, oregano) Tinyatoxin
Tinyatoxin
(Euphorbia resinifera/pooissonii) Tramadol Vanillin
Vanillin
(vanilla) Zucapsaicin

Blockers

α- Spinasterol
Spinasterol
( Vernonia
Vernonia
tweediana) AMG-517 Asivatrep BCTC Cannabigerol
Cannabigerol
(cannabis) Cannabigerolic acid (cannabis) Cannabigerovarin (cannabis) Cannabinol
Cannabinol
(cannabis) Capsazepine DCDPC DHEA DHEA-S Flufenamic acid GRC-6211 HC-067047 Lanthanum Meclofenamic acid N-(p-amylcinnamoyl)anthranilic acid NGD-8243 Niflumic acid Pregnenolone sulfate RN-1734 RN-9893 Ruthenium red SB-705498 Tivanisiran Tolfenamic acid

See also: Receptor/signaling modulators • Ion
Ion
channel modulators

Pharmacy and pharmacology port

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