When should you take paracetamol for fever? Doctor explains

Fevers are uncomfortable to the human body, often accompanied with lethargy, mood changes and body ache. It is common for people to take over-the-counter (OTC) medications to manage symptoms.

While fevers are a source of discomfort and are alarming to the body, they play a role in fighting off infection.

It is not uncommon for people to think about popping a paracetamol at the earliest rise of the mercury, however, the question remains to be answered if one must suppress a fever or let it run its course.

As bodies react to the pathogenic microorganisms, the core temperature of the body rises. This is clinically understood as fever.

Sometimes, people can misunderstand the source of fever as coming from the infection, instead of taking it as a protective bodily defense.

Science behind fever

Any body temperature between 36 to 38 degrees Centigrade and above (98 to 100 degrees Fahrenheit) is considered as fever by most physicians.

Fever is a systemic rise in temperature of the body, usually in response to an infection. While it is accompanied with symptoms, it is a protective function rather than a disease itself.

It is distinct from other temporary rises in the body heat because of exercise or hot weather conditions.

Various studies have demonstrated that fever can help protect against infections by enhancing immune cell function. It is known to speed up and increase the appetite of white blood cells that fight against the pathogen. 

Some studies have shown high body heat can fasten ‘phagocytosis’ (an immune response where a protective immunity cell engulfs the pathogen).

It is also known to boost the function of interferons, chemicals alarming the healthy cells against pathogen invasion.

However, extremely high temperatures are associated with a cell’s reduced pH levels and cellular hypoxia (insufficient oxygen).

It can have types

As per experts, not all fevers are the same and differ as per their causes.

Speaking to DH, Dr Sarath Narayan, a consultant emergency physician at Baby Memorial hospital (Kannur, Kerala) said: “If you draw them on a graph, they could be continuous, intermittent (fluctuates between high and baseline), remittant (fluctuates but never touches the baseline) or relapsing (spikes again after a few days or weeks). Sometimes there could be intense, narrow spikes and then returning to baseline, resembling a picket fence on a chart. Other than that, we can also see them as high grade or low grade.”

Fevers can be caused by various reasons: bacterial infections, viral infections, yeast infections, autoimmune conditions, reaction to vaccines, allergic reactions, and even in some types of cancer.

The pattern of fever is often indicative of the type of condition causing it.

When to take paracetamol?

While antipyretics or fever medicines are given to treat the muscle strain and malaise caused by fever, some people take it in fear that a high temperature is dangerous itself.

While fever has protective functions, it becomes a concern if there is a risk of cellular damage caused by excessive heat.

In such cases, an attending physician will primarily focus on bringing down the temperature.

However, most experts agree on not treating fever right away unless the harm caused by it outweighs the benefits.

Speaking to DH, Dr Pankaj Khatana, a consultant in internal medicine at Marengo Asia Hospitals (Gurugram) said: “For mild or low grade fevers (between 99 and 101 degrees F) one must try to wait and monitor rather than popping the paracetamol right away. Let it run its course. Have lots of water and maybe rest for sometime. For high grade fevers, one must take medicine to reduce harm from body heat."

Most experts agree that antipyretics must be consumed in high grade fevers or those causing physical stress. For self limiting fevers, rest and hydration are the most suitable steps.

“Unless it causes significant physical distress like dizziness or burning sensation in eyes, one must allow the fever to run its course. If the temperature is 102 F or above, then it needs to be controlled. Any temperature above 104 F is an emergency in itself where a person can die from excessive bodily heat,” said Dr Narayan.

How many paracetamol can one take?

According to the NHS, paracetamol is a drug that helps with pain and high temperatures.

Paracetamol at recommended levels is not dangerous, however, if consumed too much can cause acute liver injury.

There must be a gap of at least four to six hours between the doses, experts have said.

“The maximum one can have in a day is 3000 mg. So, if a person is taking a 500mg tablet, it makes six doses,” said Dr Khatana. 

As per NHS, for 500 mg of a paracetamol, one must not take more than eight tablets in a day and for 1000mg, the limit should be four tablets a day.

As per experts, people have a tendency to take paracetamol to avoid discomfort rather than reducing temperature.

“Staying with fever is an unpleasant experience with chills and muscle pain. Some of my patients take paracetamol to get rid of the discomfort, not necessarily high temperature. Some take it out of fear for having high temperatures. However, among mothers I have found them to be more particular about the number of doses and the time gap in which the child must take the medicine,” said Dr Narayan.

As per experts, one must avoid taking paracetamol for more than 3 days unless the attending doctor asks one to do so.