From the Guidelines
Paracetamol is a common over-the-counter pain reliever and fever reducer suitable for adults and children, with a standard adult dose of 500-1000mg every 4-6 hours, not exceeding 4000mg (4g) in 24 hours, as recommended by recent guidelines 1.
Important Considerations
- The maximum daily dose of paracetamol should not exceed 4000mg (4g) to avoid serious liver damage, as highlighted in a study published in the Annals of the Rheumatic Diseases 1.
- For children, dosing is weight-based and should follow package instructions carefully.
- Paracetamol is effective for mild to moderate pain and fever but does not reduce inflammation.
Administration and Side Effects
- Take paracetamol with or without food, and always follow the recommended dosage.
- Common side effects are rare but may include nausea and rash.
- Seek immediate medical attention if you experience symptoms of overdose such as nausea, vomiting, loss of appetite, or abdominal pain.
Special Precautions
- Paracetamol should be used cautiously if you have liver problems, regularly consume alcohol, or take other medications containing paracetamol to avoid accidental overdose, as advised in a study published in the Clinical and Molecular Hepatology 1.
- Patients with liver cirrhosis are at risk of metabolic disorder and prolonged half-life of paracetamol, and a daily dose of 2–3 g is generally recommended for acetaminophen, as reported in a study published in the British Journal of Cancer 1.
Mechanism of Action
- Paracetamol works by inhibiting prostaglandin production in the central nervous system, which helps reduce pain signals and reset the body's temperature regulation.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Paracetamol Leaflet Information
- Paracetamol is commonly recommended as first-line therapy for managing pain and/or fever in patients of all ages, including the elderly, children with viral illnesses, and patients with osteoarthritis, gastrointestinal conditions, bleeding disorders, cardiovascular disease, or renal disease 2.
- The use of paracetamol is often avoided in patients with chronic liver disease due to the perception of hepatotoxicity, but available studies have shown that it can be used safely in these patients at recommended doses 2, 3.
- Paracetamol is a suitable first-choice analgesic for mild to moderate acute pain in adults with liver, kidney, or cardiovascular disease, gastrointestinal disorders, asthma, or who are older, as it is generally well-tolerated at recommended doses (≤4 g/day) 3.
- The risk of hepatotoxicity is rare among adults who use paracetamol as directed, including people with cirrhotic liver disease, but serious liver disease before administration is an independent risk factor for acetaminophen-induced liver injury 4, 5.
- There is no evidence to support routine dose reduction for older people, but dosing for adults who are older and/or have decompensated cirrhosis, advanced kidney failure, or analgesic-induced asthma that is known to be cross-sensitive to paracetamol, should be individualized in consultation with their physician 3, 6.
- High-quality trials are not available to support the use of decreased acetaminophen doses in compensated cirrhosis patients, and acetaminophen can be a safe analgesic in patients with compensated hepatic dysfunction after careful analysis of patient-specific factors 6.