Recommended Dosage of Paracetamol (Acetaminophen) for Adults and Children
The maximum single dose of paracetamol for adults is 1000 mg (1 gram), with a maximum daily dose not exceeding 4000 mg (4 grams) in a 24-hour period. 1
Adult Dosing Guidelines
- Adults and children 12 years and older should take 650 mg every 4 to 6 hours, not exceeding 6 doses (3900 mg) in a 24-hour period 2
- The optimal unit dose for adults is 1 gram, with analgesic effects typically lasting about 6 hours 3
- For elderly patients (≥60 years), the maximum daily dose should be reduced to 3000 mg or less per day to minimize risk of hepatotoxicity 4
- Exceeding the maximum recommended dose can lead to severe hepatotoxicity, liver failure, and potentially death 1
Pediatric Dosing Guidelines
Dosing for children is weight-based and age-dependent:
- Children 6 to under 12 years: 325 mg every 4 hours, not exceeding 5 doses in 24 hours 2
- Children 4 to under 6 years: 240 mg every 4 hours, not exceeding 5 doses in 24 hours 2
- Children 2 to under 4 years: 160 mg every 4 hours, not exceeding 5 doses in 24 hours 2
- Children under 2 years: Consult a doctor 2
- Weight-based dosing: 10-15 mg/kg every 4-6 hours is the recommended range for children 5, 6
Special Considerations
- Paracetamol is the first-line choice for both fever and pain treatment in children due to its favorable safety profile 6
- For very frail elderly patients or those with known liver impairment, starting at the lower end of the dosing range (e.g., 325 mg per dose) is advisable 4
- Patients should be cautious about taking multiple acetaminophen-containing products simultaneously to avoid unintentional overdose 1
- The FDA has required manufacturers to limit acetaminophen content in prescription combination products to 325 mg per dosage unit to reduce the risk of liver injury 1
Warning Signs of Toxicity
- Single ingestions of more than ten times the recommended dose (>10 g in adults) are potentially toxic 6
- Early signs of acetaminophen toxicity may include nausea, vomiting, and abdominal pain 1
- In children, exposures greater than 140 mg/kg/day for several days carry a risk of serious toxicity 6
- Avoid concurrent use of alcohol, as this increases the risk of hepatotoxicity even at therapeutic doses 4
Route of Administration
- Paracetamol can be administered via oral, intravenous, or rectal routes, with rectal administration showing slower and more irregular absorption 3
- With effervescent tablets, drug absorption and onset of action are more rapid than with conventional tablets 3
Remember that paracetamol is generally well-tolerated when used as directed, but careful attention to dosing is essential to prevent hepatotoxicity, particularly in vulnerable populations such as the elderly and those with liver impairment.