1. Introduction
Paracetamol, also known as acetaminophen, is a widely used analgesic and antipyretic. It is effective for the relief of mild to moderate pain and fever. Paracetamol works by inhibiting the synthesis of prostaglandins in the central nervous system and has minimal anti-inflammatory effects. It is considered one of the safest analgesics when used appropriately.
2. Indications
- Mild to moderate pain (e.g., headaches, toothaches, muscle pain)
- Fever (pyrexia)
- Osteoarthritis pain (as a first-line option)
- Post-operative pain (as part of multimodal pain management)
- Pain relief during pregnancy
3. Dosage
Adults and Adolescents (≥12 years):
- Oral or rectal: 500–1000 mg every 4–6 hours as needed (maximum: 4000 mg/day).
- Intravenous (IV): 1 g every 6 hours or 650 mg every 4 hours as needed (maximum: 4 g/day).
Children (<12 years):
- Oral or rectal: 10–15 mg/kg per dose every 4–6 hours as needed (maximum: 60 mg/kg/day or 4 g/day, whichever is lower).
- Intravenous (IV): 15 mg/kg every 6 hours or 12.5 mg/kg every 4 hours (maximum: 75 mg/kg/day or 3 g/day, whichever is lower).
Elderly:
- Same as adult dosing; however, monitor closely in frail patients or those with liver disease.
4. Administration
- Tablets and liquids should be taken orally with water, with or without food.
- For IV administration, administer as an infusion over 15 minutes.
- Suppositories should be inserted rectally after ensuring the area is clean.
5. Forms Available
- Tablets: 500 mg, 1 g
- Liquid suspension: 120 mg/5 mL, 250 mg/5 mL
- Rectal suppositories: 125 mg, 250 mg, 500 mg, 1 g
- Intravenous infusion: 10 mg/mL (50 mL or 100 mL vials)
6. Side Effects
6.1 Common Side Effects:
- Nausea
- Vomiting
6.2 Less Common Side Effects:
- Skin rash or itching (allergic reactions)
6.3 Rare but Serious Side Effects:
- Liver toxicity (hepatotoxicity) with overdose or prolonged use
- Severe skin reactions (e.g., Stevens-Johnson syndrome)
- Blood disorders (e.g., thrombocytopenia, neutropenia)
7. Warnings
- Hepatotoxicity: Avoid exceeding the recommended dose, as it can cause severe liver damage. Patients with liver disease or chronic alcohol use should take lower doses.
- Overdose Risk: Accidental or intentional overdose may lead to acute liver failure. Immediate medical attention is required.
8. Precautions
- Use cautiously in patients with chronic liver disease, renal impairment, or alcohol dependence.
- Avoid concurrent use of multiple paracetamol-containing products to prevent overdose.
- Monitor liver function tests in patients on long-term or high-dose therapy.
9. Interactions
- Warfarin: Long-term use may enhance the anticoagulant effect; monitor INR closely.
- Rifampin, Carbamazepine, and Phenytoin: May increase the risk of hepatotoxicity by inducing liver enzymes.
- Alcohol: Increases the risk of liver damage when combined with paracetamol.
10. Monitoring Parameters
- Liver function tests, especially in patients on prolonged therapy or with liver disease.
- Assess for symptom relief (pain or fever reduction).
- Monitor for signs of overdose, such as nausea, vomiting, and abdominal pain.
11. Use in Children
- Safe for use in children when dosed according to weight (10–15 mg/kg per dose). Liquid suspensions are commonly used for ease of administration.
12. Use in Pregnancy
- Paracetamol is considered safe during all trimesters of pregnancy for short-term use in appropriate doses.
13. Use in Elderly
- Safe when used within the recommended dose range. Monitor closely in frail patients or those with hepatic or renal impairment.
14. Use in Kidney Disease
- Dose adjustments may be required in patients with severe renal impairment. Reduce the dosing frequency to every 6–8 hours.
15. Use in Liver Disease
- Use cautiously and at reduced doses (e.g., maximum 2–3 g/day) in patients with chronic liver disease or a history of alcohol abuse.
16. Patient Counselling Points
- Take only the recommended dose and avoid doubling doses.
- Check all medications for paracetamol to prevent unintentional overdose.
- Seek immediate medical attention if an overdose is suspected, even if there are no symptoms.
- Store medication out of reach of children.
- Do not consume alcohol while taking paracetamol.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Panadol | GSK | 500 mg Tablet | $5 (16 tablets) |
Tylenol | Johnson & Johnson | 500 mg Tablet | $6 (24 tablets) |
Generic Paracetamol | Various | 500 mg Tablet | $2 (16 tablets) |
Calpol | GSK | 120 mg/5 mL Suspension | $4 (100 mL) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Paracetamol used for?
Paracetamol is used to treat mild to moderate pain and fever.
2. How does Paracetamol work?
It inhibits prostaglandin synthesis in the central nervous system, reducing pain and fever.
3. What is the usual dose of Paracetamol for adults?
500–1000 mg every 4–6 hours as needed, not exceeding 4000 mg/day.
4. Is Paracetamol safe during pregnancy?
Yes, it is safe for short-term use during pregnancy when taken at recommended doses.
5. Can Paracetamol cause liver damage?
Yes, exceeding the recommended dose or prolonged use can cause liver toxicity.
6. Can children take Paracetamol?
Yes, it is safe for children when dosed according to weight (10–15 mg/kg per dose).
7. How long does Paracetamol take to work?
It typically takes 30–60 minutes to relieve pain or reduce fever.
8. Can I take Paracetamol with ibuprofen?
Yes, they can be taken together or alternated for pain or fever relief.
9. What should I do if I overdose on Paracetamol?
Seek immediate medical attention, as overdose can cause severe liver damage.
10. Can Paracetamol be taken on an empty stomach?
Yes, it can be taken with or without food.
11. Can Paracetamol interact with other medications?
Yes, but these interactions are not serious.
12. Is Paracetamol addictive?
No, Paracetamol is not addictive.
13. Can I drink alcohol while taking Paracetamol?
No, alcohol increases the risk of liver damage when combined with Paracetamol.
14. Can Paracetamol be used long-term?
Long-term use is generally not recommended due to potential liver toxicity.
15. Do I need a prescription for Paracetamol?
In most countries, Paracetamol is available over-the-counter, but some formulations may require a prescription.