Maximum Paracetamol Infusion Dose in Adolescents
For adolescents receiving intravenous paracetamol (acetaminophen), the maximum recommended dose is 15 mg/kg per dose (up to 1000 mg maximum per dose), administered every 6 hours, with a maximum daily dose not exceeding 60 mg/kg/day or 4000 mg/day, whichever is lower. 1
Weight-Based Dosing Algorithm
For adolescents (typically defined as ≥12 years or ≥40 kg):
- Per-dose calculation: 15 mg/kg (maximum 1000 mg per single dose) 2, 1
- Dosing interval: Every 6 hours (allowing up to 4 doses in 24 hours) 2, 1
- Maximum daily limit: 60 mg/kg/day OR 4000 mg/day, whichever is lower 2, 3, 4
Practical Dosing Examples
- Adolescent weighing 50 kg: 750 mg per dose (15 mg/kg), every 6 hours, maximum 3000 mg/day 1
- Adolescent weighing 70 kg or more: 1000 mg per dose (capped at adult maximum), every 6 hours, maximum 4000 mg/day 3
IV Administration Specifications
When using intravenous formulation:
- Standard IV dose: 7.5-10 mg/kg per dose for younger/smaller adolescents, up to 15 mg/kg for larger adolescents 1
- Concentration: Typically 10 mg/mL, can be diluted in 0.9% normal saline or 5% dextrose 1
- Infusion time: Administer over 15 minutes minimum to reduce risk of hypotension 1
Critical Safety Considerations
The most important pitfall is inadvertent overdosing from multiple sources. 1
- Verify that the adolescent is not receiving other acetaminophen-containing products (cold remedies, combination analgesics) 1
- Never exceed 60 mg/kg/day or 4000 mg/day - exceeding this threshold significantly increases hepatotoxicity risk 2, 3, 4
- In patients with hepatic insufficiency, paracetamol is contraindicated 3
- In chronic renal insufficiency, dosage reduction is usually not necessary despite reduced clearance 3
Comparison with Oral Dosing
The IV route provides more consistent absorption compared to rectal administration, which has erratic and unpredictable absorption patterns. 2, 3 Oral formulations are absorbed more rapidly than suppositories and provide more reliable therapeutic effect. 2, 3
Duration and Monitoring
- Standard treatment duration: Typically 48-72 hours for acute pain/fever management 5
- Extended use: If treatment extends beyond 3-5 days, reassess the underlying condition and consider hepatic function monitoring 4
- Document all dose times carefully to prevent accidental overdosing, particularly if alternating with other analgesics 5