Paracetamol (Acetaminophen)
Indications
Paracetamol (Acetaminophen) is used for:
Fever ans Mild to moderate pain such as osteoarthritis, rheumatoid arthritis, chronic low back pain, Renal stone pain, neuropathic pain, toothache, migraine, postoperative mild to moderate pain.
Adult Dose
Oral
Mild to moderate pain and fever
Tablet
Adult: 1 - 2 tablets every 4 to 6 hours up to a maximum of 4 g (8 tablets) daily
Extended Release (XR) Tablet
Adults: 2 tablets, swallowed whole, every 6 to 8 hours (maximum of 6 tablets in any 24 hours).
Syrup/Suspension:
Adults: 4-8 Measuring spoonful 3-4 times daily;
Rectal
Suppository
Adults: 500 mg-1 g every 4-6 hours to a maximum of 4 g daily.
Child Dose
Oral
Mild to moderate pain and fever
Tablet
Children (6 - 12 years) : 1/2 to 1 tablet 3 to 4 times daily
Extended Release (XR) Tablet
Children over 12 years: 2 tablets, swallowed whole, every 6 to 8 hours (maximum of 6 tablets in any 24 hours).
Syrup
Mild to moderate pain and fever
Children:
3 months - <1 year : 60 - 120 mg (1/2 - 1 measuring spoonful),
1 - 5 years : 1 - 2 measuring spoonful
6 - 12 years : 2 - 4 measuring spoonful
Children: 2 months: 60 mg (1/2 measuring spoonful) for post immunization pyrexia;
Paediatric Drops
Mild to moderate pain and fever
Children Up to 3 months: 0.5 ml (40 mg)
4 to 11 months: 1.0 ml (80 mg)
1 to <2 years: 1.5 ml (120 mg)
2 to 3 years: 2 ml (160mg)
4 to 5 years: 3 ml (240 mg)
Dose can be repeated, every 4 hours.
Rectal
Mild to moderate pain and fever
Suppository
Children: 3 months-<1 year: 60-125 mg
1-<5 years: 125-250 mg
5-12 years: 250-500 mg
These doses may be repeated every 4-6 hours as necessary (maximum 4 doses in 24 hours).
Children over 12 years: 500 mg-1 g every 4-6 hours to a maximum of 4 g daily.
Post-immunisation pyrexia
Child: 2-3 mth 60 mg. If necessary, a 2nd dose may be given after 4-6 hr.
Renal Dose
Administration
May be taken with or without food.
Contra Indications
Hypersensitivity.
Precautions
Patient w/ chronic alcoholism, known G6PD deficiency, severe hypovolaemia, chronic malnutrition. Renal and hepatic impairment. Pregnancy and lactation. Monitoring Parameters Monitor serum paracetamol levels esp when acute overdosage is suspected and w/ long-term use.
Pregnancy-Lactation
Interactions
May reduce serum levels w/ anticonvulsants (e.g. phenytoin, barbiturates, carbamazepine). May enhance the anticoagulant effect of warfarin and other coumarins w/ prolonged use. Accelerated absorption w/ metoclopramide and domperidone. May increase serum levels w/ probenecid. May increase serum levels of chloramphenicol. May reduce absorption w/ colestyramine w/in 1 hr of admin. May cause severe hypothermia w/ phenothiazine.
Adverse Effects
Side effects of Paracetamol (Acetaminophen) :
Thrombocytopenia, leucopenia, pancytopenia, neutropenia, agranulocytosis, pain and burning sensation at inj site. Rarely, hypotension and tachycardia.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, acute renal tubular necrosis and hepatotoxicity.
Mechanism of Action
Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.