Recommended Dosing for Paracetamol (Acetaminophen)
The maximum recommended daily dose of paracetamol (acetaminophen) for adults is 4000 mg per day, administered in divided doses, with most guidelines suggesting not exceeding 3000-3250 mg daily for long-term use to minimize risk of hepatotoxicity. 1, 2
Adult Dosing
Standard Dosing
- The optimal unit dose for adults is 1 gram (1000 mg) per administration 3
- Maximum daily dose should not exceed 4000 mg in 24 hours 1
- Doses should be spaced at least 4-6 hours apart 3
- For chronic use, consider limiting to 3000 mg or less per day to reduce risk of hepatotoxicity 2
Special Populations
- Elderly patients: Standard dosing is generally appropriate without routine dose reduction, though individualized dosing may be considered based on clinical status 4
- Patients with liver disease: Use with caution; daily dose of 2-3 g is generally recommended for patients with liver cirrhosis due to risk of metabolic disorder and prolonged half-life 2
- Patients with chronic kidney disease: Paracetamol remains the non-opioid analgesic of choice, usually without need for dose reduction 3
Clinical Applications
Pain Management
- First-line therapy for mild pain (numerical pain score: 1-3) 2
- Effective for osteoarthritis and low back pain 2
- For moderate to severe pain, may be combined with other analgesics for enhanced effect 2
Safety Considerations
- FDA boxed warning highlights risk of severe liver injury with overdose 2
- Monitor for signs of liver toxicity with prolonged use 1
- Avoid concurrent use with other medications containing acetaminophen to prevent inadvertent overdose 1
- Caution patients about acetaminophen content in combination products (e.g., with opioids) 2
Warning Signs of Toxicity
- Liver toxicity is rare when used as directed, even in patients with cirrhotic liver disease 4
- Signs of potential toxicity include:
Common Pitfalls to Avoid
- Exceeding the maximum daily dose of 4000 mg 1
- Failing to account for acetaminophen in combination products 2
- Concurrent use with alcohol (3 or more drinks daily) increases risk of hepatotoxicity 1
- Repeated supratherapeutic ingestions (>4g/24h) can lead to hepatotoxicity, hepatic failure, and death 2
- Confusion about maximum daily dose due to different manufacturer recommendations (some recommend 3000-3250 mg) 6
Pediatric Dosing
- For children: 15 mg/kg every 4-6 hours, up to a total of 60 mg/kg/day 3
- Should not exceed 75 mg/kg/day to avoid risk of liver injury 5
- Consider evaluation for possible liver injury if doses exceed 75 mg/kg/day for more than 2 days 5
Paracetamol remains a safe and effective analgesic when used at appropriate doses, with a better safety profile than NSAIDs for many patients, particularly those with gastrointestinal, renal, or cardiovascular risk factors 4.