Pharmacy Voice and the Royal Pharmaceutical Society (RPS) have called for tighter control of paracetamol sales, following research published in the British Medical Journal (BMJ) that suggested smaller pack sizes had reduced the number of suicides.

Pharmacy Voice called for better enforcement of MHRA guidance, which recommends that retailers only sell two packs of the medication in one transaction, after a study revealed that there were almost 800 fewer paracetamol-related deaths than forecast since pack sizes were reduced in 1998.

And the RPS went one step further, demanding the introduction of a law to prevent retailers selling multiple packets of paracetamol in one transaction.

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	The number of deaths from paracetamol overdose in England and Wales fell 43 per cent between October 1998 and the end of 2009, after packs were restricted to a maximum of 32 tablets in pharmacies and to 16 tablets for non-pharmacy sales, the study, published in the BMJ on February 7, found. The fall in deaths was calculated using forecasts based on figures dating back to 1993.

A similar reduction was found when accidental poisoning deaths were included and the registration for liver transplants related to paracetamol-induced hepatotoxicity also fell more than three fifths in the same period, although the number of transplants carried out remained the same.

Many patients taken to hospital following an overdose reported the act was impulsive and involved paracetamol that was already stored at home, the BMJ-published study said. "The continuing toll of deaths suggests, however, that further preventative measures should be sought," the authors concluded.

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Last year, the RPS and the MHRA criticised value retailer Poundland for selling three 16-tablet packs for £1, flouting the MHRA paracetamol guidelines, which also discourage multi-buy promotions.

The guidelines needed to be enforced with Poundland, Pharmacy Voice chief executive Rob Darracott told C+D this week.

But Poundland told C+D this week that it was a responsible retailer and its continuing policy of selling three packets of 16 tablets for £1 was "within operation of the law".

RPS president Martin Astbury said that the research showed it was time to change the law and "stop retailers like Poundland putting profits before patient safety". "The RPS believes this responsibility for medicines safety cannot be guaranteed merely through voluntary codes of conduct. These codes have been openly flouted," he added.

The MHRA said that, although it continued to monitor the safety of all marketed medicines, the benefits of paracetamol outweighed the risks of serious side effects. The legislation on pack sizes was introduced on recommendation from the UK Medicines Control Agency, now the MHRA, because of the high number of paracetamol overdoses.
		Paracetamol controls The law Packs are restricted to a maximum of 32 tablets in pharmacies and to 16 tablets for non-pharmacy sales. It is illegal to sell more than 100 tablets in one retail transaction. MHRA guidance Retailers should not be selling more than two packs in one transaction. Multiple sales and multi-buy promotions are strongly discouraged.

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