What is the recommended dosage for paracetamol (acetaminophen)?

Recommended Dosage for Paracetamol (Acetaminophen)

For adults, the standard dose is 650-1000 mg every 4-6 hours, with an absolute maximum of 4000 mg (4 grams) per 24 hours, though a more conservative limit of 3000 mg per day is increasingly recommended for chronic use to reduce hepatotoxicity risk. 1, 2

Standard Adult Dosing

• Single dose: 650-1000 mg every 4-6 hours as needed 3, 2
• Maximum daily dose: Do not exceed 4000 mg (4 grams) in 24 hours 1, 2
• Maximum frequency: Not more than 6 doses in 24 hours 2
• Minimum interval: Wait at least 4 hours between doses 2

Conservative Dosing for Chronic Use

For ongoing pain management beyond a few days, limit the maximum daily dose to 3000 mg rather than 4000 mg to significantly reduce liver toxicity risk. 1, 4

• The National Comprehensive Cancer Network recommends limiting chronic administration to 3 grams or less per day due to hepatotoxicity concerns 3, 1
• Recent evidence shows that even therapeutic doses of 4 grams/day for 14 days caused liver enzyme elevations (ALT >3 times normal) in 31-41% of healthy adults 5

High-Risk Populations Requiring Dose Reduction

Patients with the following risk factors should be limited to a maximum of 2000-3000 mg per day: 3, 5, 1

• Chronic liver disease or cirrhosis: Maximum 2-3 grams daily 6, 1
• Chronic alcohol consumption: (≥3 alcoholic drinks daily) - severe hepatotoxicity documented with doses as low as 4-5 grams/day 3, 5, 2
• Age ≥60 years: May require dose adjustment 3
• Concurrent use of other hepatotoxic medications 3

Critical Safety Warnings

Severe liver damage may occur if: 2

• An adult takes more than 6 doses in 24 hours or exceeds 4000 mg total daily
• Paracetamol is taken with other drugs containing acetaminophen (combination products)
• Taken with 3 or more alcoholic drinks daily while using this product

Common Pitfall: Hidden Acetaminophen Sources

Always check all medications for acetaminophen content before prescribing or taking additional doses. 1, 2

• Many prescription opioid combinations (hydrocodone, codeine, oxycodone) contain acetaminophen 5, 1
• Over-the-counter cold remedies, sleep aids, and multi-symptom products frequently contain acetaminophen 1
• The FDA now recommends limiting acetaminophen in combination products to ≤325 mg per dosage unit 1

Pediatric Dosing

For children, use weight-based dosing of 10-15 mg/kg every 4-6 hours: 7, 8, 9

• Optimal single dose: 15 mg/kg for effective fever and pain management 8
• Maximum daily dose: 60-75 mg/kg/day (not to exceed adult maximum of 4000 mg) 7, 10
• Minimum interval: 4 hours between doses 2
• Age-specific FDA dosing: 2
  • Ages 12+ years: 650 mg every 4-6 hours (adult dosing)
  • Ages 6-11 years: 325 mg every 4 hours (max 5 doses/24h)
  • Ages 4-5 years: 240 mg every 4 hours (max 5 doses/24h)
  • Ages 2-3 years: 160 mg every 4 hours (max 5 doses/24h)
  • Under 2 years: Consult a doctor

Intravenous Dosing

For IV paracetamol in adults: 6

• Standard dose: 1000 mg every 6 hours
• Maximum daily dose: 4000 mg in 24 hours
• Contraindicated in decompensated hepatic failure
• Consider reducing to 2-3 grams daily in compensated chronic liver disease

Duration Limitations

For self-medication without physician supervision: 2

• Do not use for more than 10 days for pain
• Do not use for more than 3 days for fever
• Stop and consult a doctor if symptoms persist or worsen

For chronic physician-supervised use: 1

• Use 3 grams/day or less rather than the 4-gram maximum for long-term management
• Monitor liver enzymes (AST/ALT) regularly when used chronically
• Reassess need frequently and reduce dose when appropriate

When to Seek Immediate Medical Attention

Stop use and get emergency help if: 2

• New symptoms occur
• Pain or fever persists or worsens after 3 days
• Redness or swelling is present
• Any signs of allergic reaction (skin reddening, blisters, rash)
• Suspected overdose (even without symptoms) - call Poison Control at 1-800-222-1222