What formulation of paracetamol (acetaminophen) is suitable for a 23kg child?

Paracetamol (Acetaminophen) Formulation for a 23kg Child

For a 23kg child, the appropriate formulation of paracetamol is oral liquid suspension at a dose of 345mg (15mg/kg) every 4-6 hours, not exceeding 4 doses in 24 hours. 1, 2

Dosing Guidelines

• The recommended dose of paracetamol for children is 10-15mg/kg per dose 2, 3
• For a 23kg child, this equates to 230-345mg per dose 2, 4
• Maximum frequency is every 4-6 hours, with no more than 4 doses in 24 hours (maximum daily dose of 60mg/kg/day) 3, 5
• For optimal fever reduction and pain relief, the full 15mg/kg dose (345mg) is recommended 4

Available Formulations Suitable for This Child

• Oral liquid suspension (pediatric formulation): Most appropriate choice as it allows for precise weight-based dosing 1, 5

  • Available as 120mg/5mL or 250mg/5mL concentrations
  • For a 345mg dose, administer approximately 14.4mL of 120mg/5mL suspension or 6.9mL of 250mg/5mL suspension

• Chewable tablets: May be appropriate if the child can chew tablets 5

  • Available in 80mg and 160mg strengths
  • Two 160mg tablets plus one 80mg tablet would provide 400mg (slightly higher than ideal but within safe limits)

• Regular tablets: Less ideal as they would need to be split for accurate dosing 5

  • 500mg tablets would need to be split, which is difficult to do precisely

Administration Considerations

• Oral liquid formulation is preferred for accuracy and ease of administration 3, 4
• Use the measuring device provided with the medication for accurate dosing 4
• Can be given with or without food 1
• If treating fever, remember that paracetamol's maximum temperature reduction typically occurs around 3 hours after administration 4

Safety Considerations

• Avoid exceeding the recommended dose of 15mg/kg per dose or 60mg/kg/day 3, 5
• Single ingestions of more than ten times the recommended dose are potentially toxic 5
• Exposures greater than 140mg/kg/day for several days carry a risk of serious hepatotoxicity 5
• Record all dose times carefully to avoid accidentally exceeding the maximum recommended dose 6

Alternative Considerations

• For more severe pain, paracetamol can be alternated with ibuprofen (10mg/kg) if needed 6
• However, if using both medications, careful recording of administration times is essential to avoid overdosing 6