What are the recommended doses of Acetaminophen (Paracetamol)?

From the Guidelines

The recommended dose of paracetamol for children is 10 to 15 mg kg-1 every 6 hours, with a maximum daily dose of 60 mg/kg, as stated in the most recent guidance from the European Society for Paediatric Anaesthesiology 1.

Key Considerations

• For rectal administration, a single loading dose of 20 - 40 mg kg-1 (15 mg kg-1 if < 10 kg) can be used in association with anesthesia, considering the poor bioavailability from the rectal route 1.
• Intravenous paracetamol can be administered with a loading dose of 15 to 20 mg kg-1, followed by 10-15 mg kg-1 every 6-8 hours 1.
• It is crucial to carefully read medication labels, as paracetamol is found in many combination products, and taking multiple paracetamol-containing medications could lead to accidental overdose.

Important Notes

• The dose recommendations are based on the most recent and highest quality study available, which prioritizes the safety and efficacy of paracetamol use in children 1.
• The guidance from the European Society for Paediatric Anaesthesiology provides a comprehensive approach to postoperative pain management in children, including the use of paracetamol and other analgesics 1.
• While other studies, such as the North of England Evidence Based Guideline Development Project, provide recommendations for paracetamol use in adults with degenerative arthritis 1, the most recent and relevant guidance for pediatric use is from the European Society for Paediatric Anaesthesiology 1.

From the FDA Drug Label

Warnings Liver warning This product contains acetaminophen Severe liver damage may occur if: an adult takes more than 6 doses in 24 hours, or greater than 4000 mg of acetaminophen, the maximum daily amount a child takes more than 5 doses in 24 hours The recommended paracetamol doses are:

• No more than 6 doses in 24 hours for adults
• No more than 5 doses in 24 hours for children
• The maximum daily amount is 4000 mg of acetaminophen for adults 2

From the Research

Paracetamol Doses

• The appropriate use of paracetamol for paediatric pain in Italian emergency departments was very poor, with inappropriate doses used in 83% of cases 3.
• A study found that ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, tension-type headache, migraine, osteoarthritis, and rheumatoid arthritis 4.
• Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain, and is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety 5.
• A fixed-dose combination of paracetamol and tramadol was found to be no more effective than ibuprofen 400 mg in the acute setting, and had similar efficacy to tramadol alone at 112.5 mg in the chronic setting 6.
• A study comparing paracetamol with a combination of paracetamol, ibuprofen, and codeine for pain relief in acute minor musculoskeletal injuries found that combining oral paracetamol, ibuprofen, and codeine as the initial treatment was not superior to paracetamol alone for pain reduction at 60 minutes or need for rescue analgesia, with more adverse events in the combination group 7.

Dosage Recommendations

• The patient's age was a critical determinant of the correct analgesic dosage, with the probability of appropriate prescriptions rising 14.8% for every one-year increase in the patient's age 3.
• A dose reduction is recommended in patients with liver disease or malnourished 5.
• Genotyping may improve efficacy and safety of paracetamol 5.
• Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol 5.