Recommended Dosage of Paracetamol (Acetaminophen)
The standard recommended dose of paracetamol (acetaminophen) for adults is 1000 mg every 6-8 hours with a maximum daily dose of 3000-4000 mg, though 3000 mg daily is now preferred for safety. 1, 2, 3
Adult Dosing Guidelines
- Standard adult dose: 1000 mg per dose
- Dosing frequency: Every 6-8 hours as needed
- Maximum daily dose:
Special Population Considerations
Patients with Liver Disease
Elderly Patients
- Start at lower doses and titrate as needed
- No routine dose reduction required despite reduced clearance 4
Risk Factors for Toxicity
Severe liver damage may occur if:
- An adult takes more than 6 doses in 24 hours 1
- Total daily dose exceeds 4000 mg 1
- Taken with other drugs containing paracetamol 1, 5
- Taken with 3 or more alcoholic drinks daily 1, 3
Pediatric Dosing
- 15 mg/kg every 4 hours
- Maximum daily dose: 60 mg/kg/day 4
Safety Considerations
Warning Signs of Toxicity
- Monitor for signs of liver dysfunction:
- Elevated liver enzymes (ALT)
- A study by Watkins et al. showed that even therapeutic doses (4 g/day) can cause ALT elevations >3x normal in 31-41% of healthy adults 3
Precautions
- Avoid alcohol consumption while taking paracetamol 1, 2
- Be aware of paracetamol in combination products to prevent unintentional overdose 1, 5
- Check all medication labels for paracetamol/acetaminophen content 5
Efficacy
- Paracetamol provides effective analgesia for about 50% of patients with acute postoperative pain for approximately four hours 6
- For chronic pain conditions like hand osteoarthritis, efficacy is uncertain and likely small 3
Recent Changes in Recommendations
- Some manufacturers have voluntarily reduced the maximum daily dose from 4000 mg to 3000 mg 7
- The trend is toward more conservative dosing (3000 mg daily maximum) to improve safety margin 2, 7
Overdose Definition
- Acute ingestion: Excessive amount taken over less than 8 hours
- High-risk overdose: Greater than 500 mg/kg or 30 g (whichever is less) 8
In case of suspected overdose, immediate medical attention is critical, even if no symptoms are present. Contact Poison Control Center immediately (1-800-222-1222) 1.