Paracetamol During COVID-19, a Matter of Concern.

To the Editor, The recent contribution by Mattiuzzi and Lippi on this Journal reappraised the great concern of paracetamol consumption during COVID-19, as the authors highlighted, in their infodemiological survey, the need for monitoring pharmaceutical prescription in order to prevent any potential drug shortage.1 Yet, the majority of paracetamol packages were abused by home resident patients during pandemic. The consumption of paracetamol dropped down by 13.3% respect to 2020, because of a reduction in symptomatic individuals with SARS-CoV2 infections and due to controversial debates about the role of paracetamol in causing glutatione (GSH) depletion and increase in the COVID-19 hospitalization rate.2 Recent pharmaco-surveillance data from the Italian Agency of Medicines (AIFA) reported that while paracetamol has the 254th rank position in Germany, in Italy has the first position for expenditure in 2020. Moreover, as paracetamol is a pain relief drug, used to relieve symptoms, and is endowed with a slight anti-inflammatory potential, people recurring to paracetamol to treat SARS-CoV2 early symptomatology not necessarily undergo a proper therapy against COVID-19, so enhancing the overall number of packages used in the first treatment line of caregiving against COVID-19. A way to reduce the consumption of paracetamol packages may be suggested by improving its ability in working as a pain relief pharmaceutical. It is widely known that paracetamol lowers both plasma and intracellular availability of GSH in patients with fever, yet GSH depletion can be prevented by associating therapy with a sulfydryl donor such as N-acetyl-cysteine (NAC), even in case of paracetamol abuse.3 Ameliorating the efficacy of paracetamol, by accelerating the patient’s ability in restoring its health, may result in a reduced consumption of paracetamol packages. Moreover, the association with NSAIDs able to prevent the effect of paracetamol on glutathione, such as indomethacin, enhances the antipyretic effect of paracetamol and reduces the need to recur to further doses of the pharmaceutical.4 The rationalization of NSAIDs purchase and consumption, greatly depends on the optimal use of pharmaceuticals in home therapy and in hospitals. Pharmaceutical sciences should strengthen any effort to ameliorate the different therapy protocols used for inflammatory and infectious diseases, in order to reduce pharmaceutical abuse and promote a more sustainability also in pharmacy.