Paracetamol Suppository Dosing for a 5-Year-Old Child
For a 5-year-old child, administer paracetamol suppositories at 15 mg/kg per dose every 4-6 hours, with a maximum daily dose of 60 mg/kg/day (not exceeding 5 doses in 24 hours). 1
Weight-Based Dosing Calculation
- Standard dose range: 10-15 mg/kg per dose, given every 4-6 hours 1, 2
- Optimal dosing: Use 15 mg/kg per dose for more consistent therapeutic effect 3, 4
- Maximum daily limit: 60 mg/kg/day total 1, 2
For example, if the child weighs 18 kg (typical for age 5):
- Single dose = 15 mg/kg × 18 kg = 270 mg per dose
- Maximum daily = 60 mg/kg × 18 kg = 1,080 mg per day
Critical Caveats About Rectal Administration
Rectal suppositories have significantly erratic absorption compared to oral formulations and should be used cautiously. 1
- Rectal bioavailability ranges from only 66-77% compared to oral tablets 5
- Absorption is markedly slower and more irregular with suppositories 3, 5
- Some children may receive inadequate analgesia while others risk accumulation with repeated dosing 1
Oral syrup formulation is absorbed more rapidly and provides more consistent response compared to suppositories and should be preferred whenever possible. 1
When to Use Rectal Route
Rectal administration is appropriate only in specific situations:
- Child is actively vomiting and cannot tolerate oral medication 1
- Perioperative situations where oral intake is restricted 1
Dosing Interval and Safety
- Frequency: Every 4-6 hours as needed 1, 2
- Never exceed: 5 doses in 24 hours 1
- Minimum interval: 4 hours between doses 2
Chronic overdosing (>140 mg/kg/day for several days) carries risk of serious hepatotoxicity, so careful tracking of total daily dose is essential. 2
Practical Suppository Strength Selection
Common suppository strengths are 125 mg, 250 mg, and 500 mg. For an 18 kg child needing 270 mg per dose:
- Use one 250 mg suppository (provides 13.9 mg/kg—within therapeutic range)
- Alternatively, use 125 mg + 125 mg = 250 mg total