Controversies in management: Should methionine be added to every paracetamol tablet? (No: The risks are not well enough known)

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Abstract
In studies in Britain and America paracetamol was the commonest drug used in overdose, being taken in about 48% of overdoses in Oxford1 and 5% in America.2 Clinicians in general, and those working in liver transplant units in particular, are increasingly aware of the problems raised by the liver damage caused by paracetamol, and pressure is growing to find some preventive measure. Adding the antidote methionine3 to paracetamol tablets is attractive, but because most people who take overdoses act impulsively it would have to be added to every formulation to be of maximum value. The critical issue then is whether the vast numbers of responsible users of paracetamol should have no choice but to take it with methionine in order to protect the minority who take overdoses.

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