'It's not candy': US-based doctor says Indians take Dolo 650 'like Cadbury Gems'. What are the risks?

Despite its accessibility, misuse of paracetamol can have severe consequences.

A tweet by US-based gastroenterologist and stand-up comic Dr Palaniappan Manickam, better known online as Dr Pal, went viral this week after he drew attention to what he described as India’s casual overuse of the widely available painkiller Dolo 650.

“Indians take Dolo 650 like it’s Cadbury Gems,” Dr Pal posted on X (formerly Twitter), sparking a wave of reactions from amused netizens and health professionals. While the quip was delivered with humour, it struck a chord with thousands who admitted to turning to the paracetamol brand for a wide range of ailments—from fever and headache to general discomfort.

Indians take Dolo 650 like it's cadbury gems
Palaniappan Manickam (@drpal_manickam) April 14, 2025

The post rapidly gained traction, amassing thousands of likes and shares, and prompting memes, jokes, and confessions. “I can’t remember a time when I didn’t have a strip of Dolo at home,” one user wrote. Another quipped, “Dolo is the true Indian comfort drug. Bad day? Dolo. Fever? Dolo. Breakup? Dolo.”

Born in Madurai and now based in Sacramento, California, Dr Pal has built a loyal online following by blending medicine with humour. A practicing gastroenterologist, he has carved out a niche in what he refers to as “med-com”—medical comedy. With over a million followers across platforms, he gained prominence during the COVID-19 pandemic, when a rejected public awareness video—dismissed for being “too funny to be serious”—went viral after being uploaded to YouTube.

Since then, Dr Pal has embraced humour as a vehicle for health education. In 2023, he launched a live show titled "Fun with Fasting", combining comedy with science to discuss his own weight loss journey and the broader health benefits of intermittent fasting. “If I put up a PowerPoint, the last slide always had a joke,” he said in a previous interview. “Patients open up more when they’re laughing.”

However, behind the laughs, Dr Pal’s message regarding Dolo 650 carried serious implications. In a follow-up post, he clarified: “It’s not a candy. Frequent use can mask symptoms and delay proper diagnosis.”

Dolo 650, a brand name for paracetamol, has become a household staple across India, especially since the COVID-19 pandemic. Stocked in medicine cabinets, it is often the first line of defence for symptoms ranging from fever and body aches to headaches and post-vaccine discomfort.

Yet health experts have repeatedly warned against the unsupervised and excessive use of paracetamol. “Just like any other drug that comes with its own caveat, paracetamol too comes with advisories. Except that we ignore them and have the pill unsupervised, almost like taking a vitamin and mineral supplement,” said Dr Rakesh Gupta, Senior Consultant, Internal Medicine at Indraprastha Apollo Hospital, New Delhi.

“We do not even feel the need to ask a doctor about dosage since it is available easily over the counter. The fact is overuse can be toxic for key organs like the liver and kidneys and can lead to serious health complications.”

Paracetamol, though generally safe when used correctly, must be taken with caution. It is not an anti-inflammatory drug but is commonly prescribed to reduce fever and alleviate mild to moderate pain. It is available in 500 mg, 650 mg tablets and 1000 mg injectable forms. According to medical guidelines, the maximum permissible dose for adults is 4 grams (or 4000 mg) per day.

This means a person prescribed 500 mg tablets can safely take up to eight tablets in a 24-hour period, with a minimum four-hour interval between doses. Patients are advised not to consume paracetamol alongside other medications that contain the same compound, to avoid accidental overdose.

Importantly, paracetamol is considered safe for use during pregnancy and breastfeeding when prescribed by a doctor.

Despite its accessibility, misuse of paracetamol can have severe consequences. In cases of overdose, the liver—responsible for processing the drug—can become overwhelmed, leading to the release of toxic byproducts. These substances damage liver cells, potentially causing necrosis, and in extreme cases, acute liver failure.

“In one to two per cent of users with above-normal dosage, these toxins that the liver cannot neutralise lead to renal toxicity and damage the kidney’s filtering capacity,” noted Dr Gupta. “Sometimes, even internal bleeding can occur.”

Statistics from the UK’s Office for National Statistics (ONS) revealed the grave implications of paracetamol overuse. In 2021, England and Wales recorded 227 deaths from paracetamol overdose. This number increased to 261 in 2022.

Those with pre-existing liver or kidney issues, as well as individuals who consume more than 14 units of alcohol per week, are particularly at risk of severe side effects from even slightly excessive dosages.

Medical professionals emphasise that self-medicating with paracetamol should be limited to no more than two consecutive days. If fever or pain persists beyond this period, it may indicate an underlying condition requiring proper medical evaluation and alternative treatment.

“Temporary relief could be suppressing a condition instead of treating it as fast as needed,” Dr Gupta warned.