Easy access is a major issue—Dolo 650 can be bought without a prescription in most Indian pharmacies. Its popularity surged during the pandemic, driven by word-of-mouth, fuelling widespread misuse
Published May 01, 2025 | 7:00 AM ⚊ Updated May 01, 2025 | 7:00 AM
Synopsis: Dolo 650, a brand of paracetamol, is widely used to treat pain and fever. While safe when used correctly, overuse—especially without medical guidance—can severely harm the liver and kidneys. Globally, paracetamol overdose is a leading cause of acute liver failure, with major medical journals warning that it accounts for over half of such cases in some countries
If you’ve ever had a fever in India, chances are someone handed you a strip of Dolo 650 without blinking. It’s practically a household name now—and not just because it’s effective. Over the years, Dolo 650 has become India’s go-to pill, especially after the COVID-19 pandemic.
But its popularity hasn’t come without controversy.
Dr Palaniappan Manickam—known as “Dr Pal” on social media—recently summed it up in one viral post: “Indians take Dolo 650 like it’s Cadbury Gems.” And that pretty much captures the mood online, where memes, jokes, and hot takes have turned the pill into something of a pop culture phenomenon.
Indians take Dolo 650 like it’s cadbury gems
— Palaniappan Manickam (@drpal_manickam) April 14, 2025
Behind the humour, though, lies a growing concern among doctors—both in India and abroad—about just how casually this drug is being used.
Dolo 650 is simply a brand of paracetamol (also known as acetaminophen), a common painkiller and fever reducer. When taken properly, it’s safe and effective. But the key word here is properly. Overuse, especially without medical supervision, can be dangerous—particularly for the liver and kidneys.
In fact, paracetamol overdose is a leading cause of acute liver failure around the world.
A review in the World Journal of Hepatology puts it bluntly: “Paracetamol overdose… is the most common cause of drug-induced liver injury in the United States.” Similar warnings have been echoed in The New England Journal of Medicine, Expert Review of Clinical Pharmacology, and The Intensive Care Society in the UK, which noted that more than half of all acute liver failure cases in some countries are linked to paracetamol.
So why do people pop it like candy?
Part of the problem is accessibility. In India, you can walk into almost any pharmacy and buy Dolo 650 without a prescription. Add to that its word of mouth promotion —especially during the pandemic—and you’ve got a perfect storm for misuse.
Dr Naveen Polavarapu, senior gastroenterologist and liver specialist at Yashoda Hospital, explained it simply: “Paracetamol, like most medicines, is processed by the liver. In fact, the liver acts like the body’s main chemical factory—it breaks down most of the drugs we take.”
Now, paracetamol (or acetaminophen) is no exception. When taken in normal doses, it’s safe. But when someone takes too much—either all at once or repeatedly over several days—it can turn toxic.
“What happens is that paracetamol affects an enzyme in the liver called glutathione,” Dr Polavarapu told South First. “When the liver runs out of glutathione, toxic substances start to build up. These toxins damage liver cells, causing them to die—a process we call necrosis.”
This damage doesn’t just stay in the liver. “The toxins and free radicals that get released can travel through the bloodstream and start affecting other organs too,” he added.
“In India, it’s less common to see paracetamol used in suicide attempts,” Dr Polavarapu said. “But we often see people popping these tablets for back pain, fever, or body aches—without consulting a doctor. And when they do this for days in a row, they end up with what we call a staggered overdose. That can be just as harmful.”
He contrasted this with what he saw in the UK, where he trained. “Over there, paracetamol overdoses are one of the most common methods of attempted suicide. People would buy 20, 30, even 40 tablets over the counter and take them all at once.”
That kind of overdose can quickly lead to acute liver failure—and even death. “Anything over 8 grams a day—around 15 to 20 tablets of 650 mg—is potentially lethal,” he said.
Because of this, countries like the UK now limit how much paracetamol you can buy at one time—even without a prescription. “They introduced strict limits to cut down on suicide attempts,” he explained. “And it worked.”
Dr Naveen Polavarapu says the golden rule with paracetamol is simple: Don’t exceed the safe daily limit—and that limit depends on your body weight.
“For an average adult weighing around 60 to 70 kilos, the maximum safe dose is 4 grams per day,” he told South First. “That means you can take one 1-gram tablet every 6 hours—up to four times a day.”
But he’s quick to point out: That’s for adults. “If someone weighs less—like 30 or 40 kilos, or if it’s a child—the same adult dose can become an overdose. That’s when it turns dangerous.”
What happens when you exceed that limit?
“When people take too much—whether by mistake or on purpose—it can damage the liver very quickly,” Dr Polavarapu said. “In some cases, it can kill within 24 hours.”
The damage can be silent at first, but there are some warning signs to look out for:
“If your eyes or urine start turning yellow, that’s jaundice. If you have pain on the right side of your stomach, or if you start feeling drowsy—that’s serious. That means your liver is struggling.”
Such patients, he stressed, need urgent care at a specialized liver center.
His advice? “Don’t pop painkillers without a clear reason. Instead of treating the pain blindly, try to understand what’s causing it. Paracetamol isn’t something to take left, right, and center.”
So, is the rise in fatty liver disease somehow connected to increased paracetamol use?
“Not directly,” says Dr Polavarapu. “Fatty liver is mostly a result of our lifestyle—being sedentary, sitting at desks for hours, eating unhealthy, and so on. But there’s an indirect link.”
He explains: “People with sedentary jobs—especially in the IT sector—often complain of body pain. To manage that pain, they take paracetamol regularly instead of consulting a doctor. Over time, this repeated use, even in small amounts, can lead to accidental overdose and liver damage.”
However, fatty liver itself doesn’t cause acute liver failure. That only happens with paracetamol overdose. But the bigger concern is that fatty liver often goes unnoticed—and it can silently progress to cirrhosis (permanent liver damage), and even liver cancer.
“There’s a reason we call fatty liver a silent killer,” Dr Polavarapu warns. “You won’t see symptoms until the liver is already scarred. And by then, you’re looking at end-stage liver disease.”
According to recent studies, nearly 1 in 3 Indians now have fatty liver, and India’s high rates of diabetes are a major driver. On top of that, rising alcohol consumption and viral hepatitis are fuelling liver disease and liver cancer.
“Right now, liver cancer is the fastest growing cancer in the world—and in India, fatty liver is playing a big part in that,” he said.
With Dolo 650 making headlines for its massive use and alleged overuse, especially during the COVID-19 pandemic, many people are asking: Is it safe for the kidneys?
To get some clarity, South First spoke to Dr T Ravi Raju, senior nephrologist and former Vice Chancellor of NTR University of Health Sciences. Here’s what he had to say:
“Dolo 650 is just a brand name. What you’re really taking is paracetamol, and we’ve been using that for decades.”
According to Dr Raju, the 650 mg dose became popular during the pandemic. Typically, doctors would prescribe 500 mg, up to 2,000 mg a day. But during COVID, the 650 mg dose—taken up to 4 times a day—became the norm. It’s primarily used as an antipyretic (fever reducer), with only mild pain-relieving properties.
But what about the concerns being circulated online—that Dolo 650 could be harming kidneys?
“Paracetamol is metabolized by the liver, not the kidney. So by itself, it doesn’t usually cause kidney damage,” Dr Raju clarified.
He explained that most concerns around kidney issues are likely misattributed or exaggerated, especially when it comes to short-term or appropriate use.
However, problems can arise when paracetamol is taken in combination with other drugs, especially NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen or diclofenac.
“If someone takes 3 grams of paracetamol daily—about six tablets a day—along with NSAIDs, and continues this for years, that’s when you might start seeing chronic kidney damage. This condition is called analgesic nephropathy or renal papillary necrosis,” he warned.
But this isn’t typical for most people.
The real risk with paracetamol lies in liver toxicity, especially when taken in large doses. Dr Raju explained that if someone takes 10 to 12 grams in a day—either in a single large dose or spread across 24 hours—the liver may not be able to process it all, leading to acute liver damage or even multi-organ failure in extreme cases.
“It’s not that paracetamol is dangerous by default. It’s about the dose and the context,” he emphasised. So, should you be worried about taking a few Dolo 650 tablets when you have a fever?
Not really, as long as you stick to the recommended dosage and don’t mix it routinely with other painkillers without your doctor’s advice.
Medical experts aren’t saying Dolo 650 is bad. In fact, when used correctly, it’s a trusted and approved medicine for treating fever and mild pain. But like any drug, it’s not harmless if overused or misused—especially by people with liver or kidney conditions.
So the next time you reach for a Dolo 650, maybe don’t treat it like a candy-coated button. Treat it like the medicine it is.
(Edited by Ananya Rao)
