Dolo-650 and India’s pill-popping culture

A U.S.-based doctor’s viral tweet comparing Dolo-650 to Cadbury Gems has reignited debate on India’s casual use of paracetamol.

By HealthOdysseyHub Team | April 2025

In India, reaching for a Dolo-650 has become almost a reflex. Whether it’s for a mild headache, body ache, fever, or even general discomfort. But a recent tweet from a U.S.-based Indian-origin doctor has sparked national conversation around this “pill-popping” habit.

Dr. Palaniappan Manickam, a gastroenterologist practising in the United States, wrote on X (formerly Twitter), “Indians consume Dolo-650 like Cadbury Gems.”

Indians take Dolo 650 like it's cadbury gems

— Palaniappan Manickam (@drpal_manickam) April 14, 2025

This short tweet went viral, striking a nerve with many Indians who saw the humor but also the uncomfortable truth in the comparison. It was not just a witty remark, it was a public health warning.

What is Dolo-650 and why is it everywhere?

Dolo-650 is a brand of paracetamol (also known as acetaminophen), containing 650 mg per tablet, more than the standard 500 mg version. Manufactured by Micro Labs Limited, Dolo-650 became a household name during the COVID-19 pandemic, commonly prescribed to manage fever and body pain symptoms.

Over 350 crore tablets were reportedly sold during the pandemic, making it one of the most consumed medicines in Indian households. Its popularity has remained strong even in the post-pandemic era.

Why Dr. Manickam’s tweet struck a chord

While the tweet comparing Dolo-650 to Cadbury Gems drew laughter, it also highlighted a serious issue, particularly over-the-counter (OTC) drugs obsession.

Self-medication is deeply embedded in Indian culture. It’s not uncommon for people to skip medical consultation and go straight to the pharmacy to buy tablets for fever or pain.

“People need to stop treating paracetamol like candy,” said one user responding to Dr. Manickam’s tweet. Many showed concerns about the frequency with which Dolo-650 is taken, often without understanding dosage limits or risks.

Paracetamol is not risk-free

Though paracetamol is one of the most trusted medications worldwide, excessive use can lead to serious health problems.

Experts warn that if you exceed 4 grams per day, it can damage your liver. What many people don’t realise is that combination medications, like cold syrups or flu tablets, often also contain paracetamol, increasing the risk of an accidental overdose.

How much paracetamol is safe?

To prevent overdose, it’s crucial to follow proper dosage guidelines:

• Standard adult dose: 500–1000 mg every 4 to 6 hours
• Maximum daily dose: 4000 mg (i.e., 4 tablets of Dolo-650)
• Toxic dose: More than 7.5 to 10 grams in a day may lead to liver failure

People with liver conditions, alcohol dependency, or those on other medications that stress the liver should be especially cautious.

Unethical marketing

Dolo-650 came under scrutiny in 2022, when the Federation of Medical and Sales Representatives Association of India (FMRAI) filed a petition in the Supreme Court of India. The petition alleged that Micro Labs had distributed ₹1,000 crore worth of freebies to doctors to promote Dolo-650 during the pandemic.

Justice D.Y. Chandrachud raised concerns and asked the Centre to respond. While Micro Labs denied any wrongdoing, the case highlighted the deeper concern of how marketing may influence prescriptions.

Why Dolo-650 became India’s go-to medicine

Several factors contributed to its popularity:

• Higher dosage (650 mg): Perceived as more powerful than 500 mg
• Trusted brand: Familiar to doctors and patients alike
• COVID-19 reliance: Widely used during the pandemic
• Easy availability: Sold OTC without prescription
• Affordable: Cost-effective even for low-income groups

The danger of a casual mindset

When a medicine becomes part of daily life, its risks can be overlooked. Some of the dangers of frequent or high-dose paracetamol use include:

• Liver toxicity and failure
• Kidney damage, especially with dehydration
• Drug interactions, especially with alcohol or certain prescriptions
• Delayed medical attention, as symptoms are masked

Experts highlight that OTC does not mean risk-free. All medications carry potential side effects, and should be used responsibly.

What needs to change?

Dr. Manickam’s tweet, although brief, has triggered a conversation about safe medicine practices in India. Experts suggest the following steps:

• Public awareness campaigns on the risks of self-medication
• Clear dosage instructions in local languages
• Stronger pharmacist accountability when selling OTC medicines
• Mobile apps that alert users to overlapping drug ingredients

Paracetamol is one of the safest and most effective medications—when used correctly. But when overused or misunderstood, it can cause serious harm. Dolo-650 has its place in every Indian home, but treating it like candy, as Dr. Manickam noted, is a slippery slope.