How to cool a fever with paracetamol (acetaminophen)?

Managing Fever with Paracetamol (Acetaminophen)

Paracetamol should be used to treat fever when patients have symptoms that antipyretics would help treat, not solely to reduce body temperature. 1

Appropriate Use of Paracetamol for Fever

• Paracetamol is considered first-line therapy for fever management in both adults and children 2
• The standard adult dose is 650-1000mg every 4-6 hours, not exceeding 4000mg in 24 hours 3
• For children, the recommended dose is 15mg/kg every 4-6 hours, with a maximum of 4 doses in 24 hours 2
• Higher doses of paracetamol (20mg/kg) in children have shown faster and longer antipyretic effects compared to standard doses (15mg/kg), with similar safety profile 4

Cooling Methods Beyond Medication

• Advise patients to drink fluids regularly to avoid dehydration (no more than 2 liters per day) 1
• For persistent high fever, tepid sponging can be used as a physical cooling method 5
• Encourage patients with fever to avoid lying on their back as this makes coughing ineffective if cough is present 1
• Monitor temperature regularly after administering antipyretics to assess response 5

When Paracetamol Is Insufficient

• If fever persists after paracetamol administration, consider adding an NSAID such as ibuprofen 5
• The combination of paracetamol and ibuprofen has shown superior fever control compared to either medication alone, providing an additional 2.5 hours without fever over 24 hours 6
• Paracetamol may be less effective for temperatures exceeding 38°C (100.4°F) 5
• Maximum antipyretic effect may take up to 4 hours to reach after administration 5

Important Cautions and Contraindications

• Liver warning: Severe liver damage may occur if an adult takes more than 6 doses in 24 hours or exceeds 4000mg daily 3
• Do not use paracetamol with any other drug containing acetaminophen (prescription or nonprescription) 3
• Paracetamol should be used with caution in patients with liver disease 3
• Paracetamol may cause severe skin reactions including reddening, blisters, and rash 3

When to Escalate Care

• If fever persists despite combined pharmacological and physical cooling methods 5
• If there are signs of clinical deterioration or development of complications 5
• If fever is accompanied by concerning symptoms such as altered mental status, severe headache, neck stiffness, or respiratory distress 5
• If fever persists for more than 3 days unless directed by a doctor 3

Special Considerations

• Recent evidence shows that when used at the appropriate dose (15 mg/kg for children), paracetamol is at least as effective as NSAIDs for fever management 2
• Treatment with paracetamol for the prevention of febrile convulsions has been proven ineffective 7
• There are indications that inhibiting fever through paracetamol can adversely affect the immune response 7
• In bacterial fever specifically, a combination of paracetamol and ibuprofen may be more effective than paracetamol alone in the first hour of treatment 8