Recommended Dosage of Paracetamol (Acetaminophen) Suppositories for Pediatric Patients
For pediatric patients, the recommended dose of paracetamol suppositories is 15-20 mg/kg per dose, with a maximum daily dose not exceeding 75 mg/kg/day.
Dosing Guidelines by Age Group
Infants and Children
- Standard dose: 15-20 mg/kg per dose
- Frequency: Every 4-6 hours as needed
- Maximum daily dose: 75 mg/kg/day (not to exceed for more than 2 consecutive days) 1
- Maximum doses per day: 4 doses in 24 hours
Neonates and Infants Under 3 Months
- Recommended dose: 10-15 mg/kg per dose
- Frequency: Every 6-8 hours as needed
- Maximum daily dose: 60-65 mg/kg/day 2
Efficacy Considerations
Research has shown that rectal administration of paracetamol at 15-20 mg/kg provides equivalent antipyretic effect to oral administration in children aged 3 months to 6 years 3. This makes suppositories a practical alternative when oral administration is not possible or appropriate.
Safety Considerations
Risk of Toxicity
- Liver injury can occur with repeated supratherapeutic dosing
- Consider potential toxicity when a child has received >75 mg/kg/day for ≥2 consecutive days 1
- Risk factors that increase susceptibility to paracetamol toxicity include:
- Malnutrition
- Dehydration
- Concurrent use of enzyme-inducing medications
- Pre-existing liver disease
Monitoring
- Monitor for signs of liver injury if higher doses have been used:
- Vomiting
- Right upper quadrant abdominal pain
- Jaundice
- Consider checking liver transaminases, coagulation factors, and paracetamol serum concentrations if toxicity is suspected
Practical Administration Tips
- Ensure accurate weight-based dosing
- Record all dose times carefully to avoid accidentally exceeding the maximum recommended dose
- Consider alternating with ibuprofen for enhanced fever control when appropriate (for children ≥6 months) 4
- For sustained therapeutic effect, ensure doses are given at regular intervals rather than on an as-needed basis
Common Pitfalls to Avoid
- Dosing errors: Always calculate dose based on accurate weight measurement
- Exceeding maximum daily dose: Studies show that 8% of children receive excessive paracetamol doses 4
- Inadequate dosing: Underdosing may result in poor symptom control
- Prolonged use: Avoid using maximum doses for more than 2-3 consecutive days without medical reassessment
- Failure to recognize toxicity: Be vigilant for early signs of liver injury with repeated dosing
By following these guidelines, paracetamol suppositories can be safely and effectively used for fever and pain management in pediatric patients when oral administration is not feasible.