Biogesic (Paracetamol) Dosing for Fever Management
For adults and children 12 years and older, administer paracetamol 650-1000 mg every 4-6 hours, not exceeding 4 grams in 24 hours, as this represents the safest and most effective first-line antipyretic therapy. 1
Adult Dosing
- Standard dose: 650-1000 mg every 4-6 hours 1, 2
- Maximum daily dose: 4 grams (4000 mg) in 24 hours 3, 1
- The optimum single dose for adults is 1000 mg, with analgesic activity typically lasting 6 hours 2
- Effervescent formulations provide more rapid absorption and faster onset of action compared to conventional tablets 2
Pediatric Dosing
Children should receive 15 mg/kg per dose every 4-6 hours, up to a maximum of 60 mg/kg/day or 5 doses in 24 hours. 4, 2, 5
Age-Based Dosing (FDA-Approved):
- Ages 12+ years: 650 mg every 4-6 hours (maximum 6 doses/24 hours) 1
- Ages 6-11 years: 325 mg every 4 hours (maximum 5 doses/24 hours) 1
- Ages 4-5 years: 240 mg every 4 hours (maximum 5 doses/24 hours) 1
- Ages 2-3 years: 160 mg every 4 hours (maximum 5 doses/24 hours) 1
- Under 2 years: Consult a physician 1
Weight-Based Dosing (Preferred):
The 15 mg/kg dose is significantly more effective than older recommendations of 10 mg/kg and demonstrates efficacy comparable to NSAIDs when used at this therapeutic level 5, 6
Special Populations
Elderly Patients:
- No dose reduction typically necessary despite reduced clearance 2
- Paracetamol is the preferred non-opioid analgesic in elderly persons due to superior safety profile 3, 2
Renal Impairment:
- Usually no dose adjustment required in chronic renal insufficiency 3, 2
- For severe impairment (creatinine clearance 10-30 mL/min): extend dosing interval to every 6 hours 3
Hepatic Impairment:
- Contraindicated in hepatic insufficiency 2
- Chronic liver disease patients require careful assessment before use 2
Clinical Considerations for Fever Management
Treatment Approach:
- Target discomfort and associated symptoms, not just temperature reduction 7
- Fever typically peaks around 5 days after infection exposure 7
- Maintain adequate hydration (maximum 2 liters/day in adults) 7
- Physical cooling methods may serve as adjunctive therapy, though evidence is limited 3, 7
Comparative Efficacy:
Recent evidence demonstrates that paracetamol 15 mg/kg is as effective as NSAIDs for fever reduction when used at appropriate doses, contrary to older studies using subtherapeutic doses of ≤10 mg/kg 5
Critical Safety Warnings
Overdose Risk:
- Single ingestions exceeding 10 times the recommended dose are potentially hepatotoxic 4
- Chronic exposures greater than 140 mg/kg/day for several days carry serious toxicity risk 4
- Parents must carefully record all dose times to avoid accidentally exceeding maximum daily limits 6
Drug Interactions:
- Low plasma protein binding results in minimal drug interactions 2
- Safe to use during pregnancy and lactation 2
When Paracetamol Fails:
If paracetamol is contraindicated or ineffective, ibuprofen is the superior alternative, providing longer duration of action and more effective fever reduction 8
For bacterial fever specifically, the combination of paracetamol 500 mg/ibuprofen 150 mg demonstrated superior efficacy at 1 hour compared to paracetamol alone (48.6% vs 33.6% achieving primary endpoint) 9