A narrative review of paracetamol-induced hypotension: Keeping the patient safe.

This is a narrative review, not a systematic review or meta-analysis, and the authors say they did not perform a comprehensive critical appraisal of each included study. Most included studies were observational, so they cannot prove that paracetamol alone caused the blood pressure changes. The evidence comes mostly from intensive care, emergency, perioperative, neonatal and paediatric settings, and the review notes no studies were performed outside closely monitored environments, so it does not tell you the risk on a general ward. Blood pressure monitoring methods and timing varied across studies, and some retrospective studies had episodic monitoring that may have missed the lowest blood pressure point. Many patients were febrile, septic, or receiving fluids and vasopressors, so illness progression or other treatments may have contributed to hypotension. The search was limited to English-language peer-reviewed articles and was last updated on 30 June 2020. Recommendations about monitoring and fluid correction are the authors' suggestions, not tested interventions.

The review author declared no conflict of interest. The review notes that one included study was funded by the same pharmaceutical company that produced the drug, and says this may create bias in that study's reassuring conclusion.

Do not read this as proof that paracetamol always causes dangerous hypotension in every patient. The review is based mainly on studies in febrile, critically ill, or closely monitored settings, uses heterogeneous observational data, and notes that no studies were performed outside closely monitored environments.