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Indications

mild to moderate pain, pyrexia (pyrexia with discomfort in children)

Cautions

alcohol dependence; max. daily infusion dose 3 g in patients with hepatocellular insufficiency, chronic alcoholism, chronic malnutrition, or dehydration; before administering, check when paracetamol last administered and cumulative paracetamol dose over previous 24 hours; interactions: Appendix 1 (paracetamol)

Hepatic impairment

dose-related toxicity—avoid large doses; see also Cautions

Renal impairment

increase infusion dose interval to every 6 hours if eGFR less than 30 mL/minute/1.73 m²; note also sodium content of effervescent tablets (see under relevant preparation entry)

Pregnancy

not known to be harmful

Breast-feeding

amount too small to be harmful

Side-effects

side-effects rare, malaise, skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis; blood disorders including thrombocytopenia, leucopenia, neutropenia reported; hypotension, flushing, and tachycardia reported on infusion; important: liver damage (and less frequently renal damage) following overdosage, see Emergency Treatment of Poisoning

Dose

By mouth, 0.5–1 g every 4–6 hours to a max. of 4 g daily; CHILD 2–3 months 60 mg for post-immunisation pyrexia, repeated once after 4–6 hours if necessary; otherwise under 3 months see BNF for Children; 3–6 months 60 mg, 6 months–2 years 120 mg, 2–4 years 180 mg, 4–6 years 240 mg, 6–8 years 240–250 mg, 8–10 years 360–375 mg, 10–12 years 480–500 mg, 12–16 years 480–750 mg; these doses may be repeated every 4–6 hours when necessary (max. of 4 doses in 24 hours); postoperative pain in children see BNF for Children

By intravenous infusion over 15 minutes, ADULT and CHILD over 50 kg, 1 g every 4–6 hours, max. 4 g daily; ADULT and CHILD 10–50 kg, 15 mg/kg every 4–6 hours, max. 60 mg/kg daily; CHILD less than 10 kg see BNF for Children

By rectum, 0.5–1 g every 4–6 hours to a max. of 4 g daily; CHILD under 3 months see BNF for Children, 3 months–1 year 60–125 mg, 1–5 years 125–250 mg, 5–12 years 250–500 mg, 12–18 years 500 mg; these doses may be repeated every 4–6 hours as necessary (max. 4 doses in 24 hours); postoperative pain in children see BNF for Children

Sub-sections

Paracetamol (Non-proprietary)

Tablets (and caplets)¹, paracetamol 500 mg, net price 32–tab pack = 88p, 100-tab pack = £2.75. Label: 29, 30

Capsules¹, paracetamol 500 mg, net price 32-cap pack = £1.23, 100-cap pack = £3.84. Label: 29, 30

Soluble tablets (= Dispersible tablets), paracetamol 500 mg, net price 24-tab pack = £2.21, 100-tab pack = £9.21. Label: 13, 29, 30

Oral suspension 120 mg/5 mL, paracetamol 120 mg/5 mL, net price 100 mL = 74p, 500 mL = £3.05. Label: 30

Oral suspension 250 mg/5 mL, paracetamol 250 mg/5 mL, net price 100 mL = £1.26, 200 mL = £1.65. Label: 30

Oral suspension 500 mg/5 mL, paracetamol 500 mg/5 mL sugar-free, net price 150 mL = £20.00. Label: 30

Suppositories, paracetamol 60 mg, net price 10 = £11.95; 120 mg, 10 = £10.78; 125 mg, 10 = £13.80; 240 mg, 10 = £21.07; 250 mg, 10 = £27.60; 500 mg, 10 = £31.83; 1 g, 12 = £60.00. Label: 30

Panadol OA® (GSK)

Tablets, f/c, paracetamol 1 g, net price 100-tab pack = £3.45. Label: 30
Dose ADULT and CHILD over 12 years, 1 tablet up to 4 times daily, not more often than every 4 hours

With isometheptene mucate

Isometheptene mucate (in combination with paracetamol) is licensed for the treatment of acute attacks of migraine; other more effective treatments are available.

Midrid® (Manx)

Capsules, red, isometheptene mucate 65 mg, paracetamol 325 mg, net price 30-cap pack = £5.50. Label: 30, counselling, dosage
Dose migraine, 2 capsules at onset of attack, followed by 1 capsule every hour if necessary; max. 5 capsules in 12 hours; CHILD not recommended

With tramadol

For prescribing information on tramadol, see section 4.7.2

Tramacet® (Grünenthal)

Tablets, f/c, yellow, tramadol hydrochloride 37.5 mg, paracetamol 325 mg, net price 60-tab pack = £9.68. Label: 2, 25, 29, 30
Dose 2 tablets not more often than every 6 hours; max. 8 tablets daily; CHILD under 12 years not recommended

Effervescent tablets, pink, tramadol hydrochloride 37.5 mg, paracetamol 325 mg, net price 60-tab pack = £9.68. Label: 2, 13, 29, 30

Electrolytes Na⁺ 7.8 mmol/tablet

Dose 2 tablets not more often than every 6 hours; max. 8 tablets daily; CHILD under 12 years not recommended

With antiemetics

Paramax® (Zentiva)

Tablets, scored, paracetamol 500 mg, metoclopramide hydrochloride 5 mg, net price 42-tab pack = £9.64. Label: 17, 30
Dose acute migraine, ADULT over 18 years, 2 tablets at the onset of attack then repeat every 4 hours when necessary to max. 6 tablets in 24 hours

Sachets, effervescent powder, sugar-free, paracetamol 500 mg, metoclopramide hydrochloride 5 mg, net price 42-sachet pack = £12.52. Label: 13, 17, 30
Dose acute migraine, ADULT over 18 years, 2 sachets dissolved in a quarter tumblerful of water at onset of attack then repeat every 4 hours when necessary to max. 6 sachets in 24 hours

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PARACETAMOL