Recommended Dosage of Paracetamol (Acetaminophen) for Adults and Children
For adults, the recommended dose of paracetamol is 1000 mg every 6-8 hours with a maximum daily dose of 3000-4000 mg, while for children, dosing is weight-based and age-specific, ranging from 10-15 mg/kg every 4-6 hours with maximum daily limits based on age. 1, 2
Adult Dosing
- Standard adult dose: 1000 mg (1 gram) every 6-8 hours 1
- Maximum daily dose: 3000-4000 mg per day 1
- More conservative approach recommends 3000 mg maximum daily 1
- FDA-approved dosing: 650 mg every 4-6 hours, not to exceed 6 doses (3900 mg) in 24 hours 2
Special Populations
- Patients with liver disease: Reduce maximum daily dose to 2000-3000 mg 1
- Elderly patients: Start with lower doses and titrate as needed 1
- Patients with cirrhosis: 2-3 g daily maximum 1
Pediatric Dosing
According to FDA labeling 2:
| Age Group | Single Dose | Frequency | Maximum Daily Doses |
|---|---|---|---|
| 12 years and older | 650 mg | Every 4-6 hours | Not to exceed 6 doses (3900 mg) in 24 hours |
| 6 to under 12 years | 325 mg | Every 4 hours | Not to exceed 5 doses (1625 mg) in 24 hours |
| 4 to under 6 years | 240 mg | Every 4 hours | Not to exceed 5 doses (1200 mg) in 24 hours |
| 2 to under 4 years | 160 mg | Every 4 hours | Not to exceed 5 doses (800 mg) in 24 hours |
| Under 2 years | Consult a doctor | - | - |
Alternative weight-based dosing for children: 10-15 mg/kg every 4-6 hours, up to a total of 60 mg/kg/day 3
Administration Routes
- Oral route: Preferred for most patients; tablets, liquid formulations, and effervescent tablets available 3
- Effervescent tablets provide more rapid absorption than conventional tablets 3
- Rectal route: Higher doses (35-45 mg/kg) may be needed to achieve therapeutic plasma concentrations in adults 4
- Intravenous route: Used in hospital settings, particularly post-operatively 1, 3
Important Considerations
- Liver function: Monitor liver function with prolonged use, especially in high-risk patients 1
- Alcohol consumption: Avoid alcohol while taking paracetamol due to increased risk of hepatotoxicity 1
- Combination products: Be aware that many combination products (especially with opioids) contain paracetamol, which could lead to unintentional overdose 5
- Overdose risk: High-risk overdose is defined as greater than 500 mg/kg or 30 g (whichever is less) 1
Cautions
- Paracetamol is contraindicated in patients with hepatic insufficiency 3
- Therapeutic concentrations are typically 10-20 μg/ml 4
- Risk of accidental overdose: 8% of children in studies exceeded the maximum recommended number of doses in 24 hours 6
Remember that paracetamol dosing should be carefully monitored, especially in children, to avoid potential hepatotoxicity while ensuring adequate pain relief and fever reduction.