Paracetamol (Acetaminophen) Dosing for Pediatric Patients
The recommended paracetamol (acetaminophen) dosage for pediatric patients is 10-15 mg/kg every 4-6 hours, not to exceed 5 doses in a 24-hour period for children under 12 years of age. 1, 2, 3
Age-Based Dosing Guidelines
- Children under 2 years of age: Consult a doctor for appropriate dosing 1
- Children 2 to under 4 years: 5 mL (160 mg) every 4 hours, not to exceed 5 doses in a 24-hour period 1
- Children 4 to under 6 years: 7.5 mL (240 mg) every 4 hours, not to exceed 5 doses in a 24-hour period 1
- Children 6 to under 12 years: 10.15 mL (325 mg) every 4 hours, not to exceed 5 doses in a 24-hour period 1
- Children 12 years and older: 20.3 mL (650 mg) every 4 to 6 hours, not to exceed 6 doses in a 24-hour period 1
Weight-Based Dosing
- For more precise dosing, especially in infants and young children, weight-based dosing of 10-15 mg/kg is recommended 2, 3
- Clinical evidence supports that 15 mg/kg is more effective than lower doses for both fever and pain management 3
- Maximum daily dose should not exceed 60-65 mg/kg/day 4, 5
Administration Considerations
- Use an appropriate measuring device such as a 3-mL or 5-mL oral syringe for accurate measurement in infants and young children 6
- For faster onset of action, effervescent tablets provide more rapid absorption than conventional tablets in older children who can take this formulation 4
Special Populations
- For children with hepatic impairment, doses should be reduced and intervals extended to minimize the risk of hepatotoxicity 7
- For children with renal impairment, standard dosing can generally be used, but monitoring for accumulation is recommended in severe cases 7
Safety Considerations
- Single ingestions of more than ten times the recommended dose (>100-150 mg/kg) are potentially toxic 8
- Chronic overdosing at doses greater than 140 mg/kg/day for several days carries a risk of serious hepatotoxicity 8
- When used at the recommended dose of 15 mg/kg, paracetamol has a tolerability profile similar to placebo for short-term treatment 3
- Paracetamol shows a lower risk of adverse events compared to NSAIDs when used at repetitive doses for consecutive days 3
Clinical Efficacy
- At the appropriate dose of 15 mg/kg, paracetamol is significantly more effective than placebo and at least as effective as NSAIDs for fever and pain management 3
- Older studies using subtherapeutic doses (≤10 mg/kg) showed less efficacy compared to NSAIDs, highlighting the importance of using the correct therapeutic dose 3