What is the appropriate dosage and usage of Dolo 650 (Paracetamol) for pain management and fever reduction?

Dolo 650 (Paracetamol) Dosage and Usage Guidelines

For pain management and fever reduction in adults, Dolo 650 (Paracetamol) should be administered as 650 mg every 4-6 hours, not exceeding 6 doses (3900 mg) in a 24-hour period. 1

Dosage Recommendations by Age

• Adults and children 12 years and older: 650 mg (one tablet) every 4-6 hours, maximum 6 doses (3900 mg) in 24 hours 1
• Children 6-12 years: 325 mg every 4 hours, maximum 5 doses in 24 hours 1
• Children 4-6 years: 240 mg every 4 hours, maximum 5 doses in 24 hours 1
• Children 2-4 years: 160 mg every 4 hours, maximum 5 doses in 24 hours 1
• Children under 2 years: Consult a doctor 1

Clinical Applications

Pain Management

Paracetamol is effective for mild to moderate pain, including:

• Musculoskeletal pain 2
• Osteoarthritis pain 3
• Post-operative pain 3
• Headache and other non-inflammatory conditions 4

Fever Reduction

• First-line antipyretic for both adults and children 5
• Onset of action is more rapid with effervescent tablets compared to conventional tablets 6

Special Populations

Elderly Patients

• Standard adult dosing (650 mg every 4-6 hours) is generally appropriate 7
• No routine dose reduction is necessary based solely on age 7
• Consider individual assessment in frail elderly patients 7

Patients with Comorbidities

• Liver Disease: Contraindicated in hepatic insufficiency; use with caution in patients with chronic, benign liver diseases 6, 7
• Kidney Disease: Preferred non-opiate analgesic in patients with chronic renal insufficiency; usually no dosage reduction necessary 6, 7
• Cardiovascular Disease: Safer option compared to NSAIDs for patients with cardiovascular risk factors 2, 7
• Gastrointestinal Disorders: Preferred over NSAIDs in patients with GI risk factors 2, 7

Combination Therapy

• Can be combined with NSAIDs for enhanced analgesic effect or to allow lower NSAID doses 6
• For post-operative pain, combining paracetamol with NSAIDs may reduce opioid requirements 3
• In children with fever, paracetamol can be alternated with ibuprofen when necessary, with careful recording of dosing times 8

Safety Considerations

Adverse Effects

• Generally well-tolerated at recommended doses 7, 4
• Rare serious side effects at therapeutic doses 4
• Safe during pregnancy and lactation 6

Overdose Risk

• Hepatotoxicity is the main concern in overdose 5, 4
• Single ingestions exceeding 10 times the recommended dose (>6500 mg) are potentially toxic 5
• Chronic overdosing (>140 mg/kg/day for several days) carries risk of serious toxicity 5
• N-acetylcysteine is an effective antidote if administered early 4

Drug Interactions

• Low risk of drug interactions due to minimal plasma protein binding 6
• Minimal interaction with anticoagulants 6

Monitoring Guidelines

• For short-term use (<14 days), routine monitoring is not required in healthy adults 7
• For long-term use, consider monitoring liver function tests, especially in patients with risk factors for hepatotoxicity 3
• Be vigilant for signs of liver toxicity: nausea, vomiting, right upper quadrant pain, or jaundice

Common Pitfalls to Avoid

• Exceeding the maximum daily dose of 4000 mg (6 tablets of Dolo 650)
• Combining with other paracetamol-containing products without accounting for total daily dose
• Inadequate dosing leading to insufficient pain relief
• Prolonged use without medical supervision
• Using in patients with severe liver disease

Paracetamol remains a first-line choice for treating mild to moderate pain and fever due to its favorable safety profile compared to NSAIDs and opioids when used at recommended doses 2, 4.