Paracetamol Dosing for Teenagers
For teenagers aged 12 years and older, the recommended dose of paracetamol is 650-1000 mg every 4-6 hours, with a maximum daily dose of 4000 mg (4 grams) in 24 hours. 1
Standard Dosing Guidelines
Adolescents 12 years and older should receive:
- Single dose: 650 mg (20.3 mL of liquid) to 1000 mg every 4-6 hours 1, 2
- Maximum: 6 doses in 24 hours, not exceeding 4000 mg total daily 1, 3
- Minimum interval: 4 hours between doses 1, 3
The FDA-approved dosing for this age group treats teenagers as adults, using the same weight-independent dosing schedule. 1 This represents a shift from the weight-based pediatric dosing (10-15 mg/kg) used in younger children. 3, 4
Route-Specific Considerations
Oral Administration
- Standard oral dose: 10-15 mg/kg every 6 hours (maximum 60 mg/kg/day) for weight-based dosing if preferred 3
- Fixed adult dose: 650-1000 mg every 4-6 hours is more practical for teenagers 1, 2
Intravenous Administration (if applicable)
- Loading dose: 15-20 mg/kg 3
- Maintenance: 10-15 mg/kg every 6-8 hours 3
- Maximum daily dose: 60 mg/kg or 4000 mg, whichever is lower 3
Critical Safety Warnings
Hepatotoxicity risk increases significantly with:
- Any dose exceeding 4000 mg (4 grams) in 24 hours 1, 5
- Chronic exposures greater than 140 mg/kg/day for several days 5, 6
- Concurrent alcohol use, even at therapeutic doses 3
High-Risk Situations Requiring Dose Reduction
- Hepatic impairment: Reduce doses and extend intervals 5
- Chronic alcohol consumption: Consider limiting to 2-3 grams/day maximum 7
- Combination products: Exercise extreme caution to prevent duplicate dosing 5
The FDA has limited paracetamol content in prescription combination products to 325 mg per unit specifically to prevent accidental overdose. 5
Common Pitfalls to Avoid
Do not exceed the maximum recommended doses:
- Studies show that 8-11% of parents inadvertently exceed maximum dosing when using paracetamol, particularly when combining it with other medications. 8
- Always check all medications for hidden paracetamol content in combination cold/flu products 5
- Record all dose times carefully to prevent accidental overdosing 8
If paracetamol is ineffective:
- Consider ibuprofen (10 mg/kg every 8 hours) as second-line treatment 3, 5
- Combination therapy with ibuprofen may provide additional fever-free time (extra 2.5-4.4 hours over 24 hours), but increases complexity and overdose risk 8
Clinical Context
The European Society for Paediatric Anaesthesiology guidelines support these dosing recommendations for postoperative pain management in adolescents, confirming that paracetamol remains a cornerstone analgesic with an excellent safety profile when used appropriately. 3 The analgesic effect typically lasts 4-6 hours, which determines the dosing interval. 2