Is 250/5 ml of acetaminol (paracetamol) a suitable dose for a 6-month-old infant?

Paracetamol 250mg/5mL Dosing in a 6-Month-Old Infant

Yes, you can give paracetamol 250mg/5mL to a 6-month-old infant, but the dose must be calculated based on the infant's weight using 10-15 mg/kg per dose, not given as a fixed 250mg dose. The concentration of 250mg/5mL (50mg/mL) is appropriate for this age group, but the volume administered must be weight-based.

Recommended Dosing Algorithm

For a typical 6-month-old infant (approximately 7-8 kg):

• Calculate the dose: 10-15 mg/kg per dose 1, 2, 3
• For a 7 kg infant: 70-105 mg per dose (1.4-2.1 mL of the 250mg/5mL suspension)
• For an 8 kg infant: 80-120 mg per dose (1.6-2.4 mL of the 250mg/5mL suspension)
• Dosing interval: Every 4-6 hours as needed 1, 2
• Maximum daily dose: 60 mg/kg/day 1, 3

Step-by-Step Dosing Instructions

1. Weigh the infant accurately - this is essential for safe dosing 2

2. Calculate the single dose:

   • Multiply the infant's weight in kg by 15 mg/kg for optimal efficacy 2, 3
   • Example: 7 kg × 15 mg/kg = 105 mg per dose

3. Convert to volume using the 250mg/5mL concentration:

   • 250 mg = 5 mL, therefore 50 mg = 1 mL
   • For 105 mg: (105 ÷ 50) = 2.1 mL per dose

4. Administer every 4-6 hours as needed 1, 2

5. Calculate maximum daily doses:

   • Do not exceed 4 doses per 24 hours 1
   • Ensure total daily dose does not exceed 60 mg/kg/day 1, 3

Critical Safety Considerations

Common pitfalls to avoid:

• Never give a fixed 250mg (5mL) dose - this would be 31-36 mg/kg for a typical 6-month-old, which is excessive for a single dose and risks cumulative toxicity 4

• Avoid cumulative overdosing: Doses exceeding 90-95 mg/kg/day carry risk of hepatotoxicity 4, 5

• Be cautious with dosing intervals: While 4-hour intervals are traditional, 6-hour intervals may be safer in young infants to prevent cumulative toxicity 1, 5

• For infants under 3 months: Use lower doses (60-65 mg/kg/day total) as pharmacokinetics differ significantly in younger infants 4, 5

Age-Specific Pharmacokinetic Considerations

Why weight-based dosing is essential in infants:

• Paracetamol pharmacokinetics are age-dependent, with infants having different clearance rates than older children 3, 5
• The 10-15 mg/kg dosing range has been validated through clinical and pharmacokinetic studies to provide therapeutic concentrations while maintaining safety 2, 3
• Single doses in the 10-15 mg/kg range at 4-6 hour intervals are appropriate for infants 3 months and older 1, 2

Practical Example for a 7.5 kg Infant

• Single dose: 7.5 kg × 15 mg/kg = 112.5 mg (approximately 2.25 mL of 250mg/5mL suspension)
• Frequency: Every 4-6 hours as needed
• Maximum doses per day: 4 doses
• Maximum daily dose: 7.5 kg × 60 mg/kg = 450 mg/day (9 mL total per day)

1, 2, 3