What is the recommended dosage of acetaminophen (paracetamol) for adults and children?

Acetaminophen Dosing Guidelines for Adults and Children

For adults, the recommended dosage of acetaminophen is 1000 mg every 8 hours with a maximum daily dose of 3000 mg, while children's dosing should be weight-based according to age-appropriate guidelines. 1, 2

Adult Dosing

Standard Recommendations

• Adults: 1000 mg every 8 hours (3000 mg total daily) 1, 2
• Maximum single dose: 1000 mg
• Maximum daily dose: 3000-4000 mg, with more conservative guidelines recommending 3000 mg 1
• Administration: Take with water; swallow tablets whole without crushing, chewing, or splitting 2
• Duration: Do not use for more than 10 days unless directed by a doctor 2

Special Populations

• Patients with liver disease: Reduced dosing of 2000-3000 mg daily 1
• Elderly patients: Start with lower doses and titrate as needed 1

Children Dosing

Age-Based Recommendations

• Children under 12 years: Dosing should be weight-based, typically 10-15 mg/kg per dose 1
• Children 12 years and older: Adult dosing (2 caplets every 8 hours, not exceeding 6 caplets in 24 hours) 2

Safety Considerations

Risk Factors for Toxicity

• Exceeding the maximum daily dose of 3000-4000 mg
• Concurrent use of multiple acetaminophen-containing products
• Consumption of 3 or more alcoholic beverages daily
• Pre-existing liver disease 1

Warning Signs

• Severe liver damage may occur if:
  • Maximum daily dose is exceeded
  • Acetaminophen is taken with 3 or more alcoholic drinks daily
  • Multiple acetaminophen-containing products are used simultaneously 1

Clinical Pearls

• Acetaminophen is generally well-tolerated at recommended doses in healthy adults 3
• Despite being widely used, hepatotoxicity is rare among adults who use acetaminophen as directed 3
• No evidence supports routine dose reduction for older people without specific risk factors 3
• For sustained pain relief, the standard immediate-release formulation should be taken at regular intervals rather than as needed 4
• Many combination products (especially those with opioids) contain acetaminophen, which could lead to unintentional overdose 1

Common Pitfalls to Avoid

1. Dosing confusion: Different product strengths may have different maximum daily dose recommendations (e.g., 3000 mg for 500 mg tablets vs. 3250 mg for 325 mg tablets) 5
2. Inadequate dosing: Underdosing can lead to inadequate pain relief
3. Medication overlap: Failing to account for acetaminophen in combination products
4. Extended use: Using for longer than 10 days without medical supervision 2

Following these guidelines will help ensure safe and effective use of acetaminophen for both adults and children while minimizing the risk of adverse effects.