Paracetamol

Paracetamol

[one tablet 17 cents; one IV dose $3.96]

ADMINISTRATION ROUTES:

  • PO, IV, PR

ALTERNATIVE NAMES:

  • Pamol, Panadol, Perfalgan

ICU INDICATIONS:

  1. analgesia
  2. antipyretic

PRESENTATION AND ADMINISTRATION:

  • IV:
    Perfalgan 10mg/mL solution contains 1gm of paracetamol in 100ml.
    Can also be diluted in compatible IV fluid. In this case, use the diluted solution within the hour following its preparation (infusion time included).
    Compatible in the following IV fluids: Normal saline, 5% dextrose
    As for all solutions for infusion presented in glass vials, it should be remembered that close monitoring is needed notably at the end of the infusion, regardless of the administration route. This monitoring at the end of the perfusion applies particularly for central route infusion, in order to avoid air embolism.
    It is recommended that for the administration of Perfalgan 10mg/mL solution for infusion a syringe or giving set with a diameter equal to or below 0.8mm should be used for solution sampling. In addition, it is recommended that the bung is pierced at the location specifically designed for needle introduction (where the thickness of the bung is the lowest). If these recommendations are not adhered to the likelihood of bung fragmentation or the bung being forced into the vial is increased.
    Store at room temperature
  • PO:
    Available in 500mg capsules, tablets, soluble tablets and suppositories

DOSAGE:

  • IV:
    1g 4 hourly (maximum 4g/24 hours)
  • PO:
    1g 4 hourly (maximum 4g/24 hours)

    Note: In patients with chronic or active hepatic disease, especially those with hepatocellular insufficiency, chronic alcoholism, chronic malnutrition (low reserves of hepatic glutathione), and dehydration the dose should not exceed 3g/day.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO / IV:
    20mg/kg stat, then 15mg/kg 4 hourly; usual daily maximum of 90mg/kg for 48 hours then 60mg/kg.
  • PR:
    40mg/kg stat then 30mg/kg 6 hourly (max 5gm/day)

CLINICAL PHARMACOLOGY:

  • Paracetamol is analgesic and antipyretic. The precise mechanism of the analgesic and antipyretic properties of paracetamol has yet to be established; it may involve central and peripheral actions.

CONTRAINDICATIONS:

  1. hypersensitivity to paracetamol
  2. fulminant hepatic failure

WARNINGS

  • Patients with hepatic insufficiency, chronic alcoholism, chronic malnutrition or dehydration may be at a higher risk of liver damage following administration of paracetamol.

PRECAUTIONS

  • General:
    Paracetamol should be used with caution in the following settings:
    Glucose 6 Phosphate Dehydrogenase (G6PD) deficiency (may lead to haemolytic anaemia), chronic alcoholism, excessive alcohol intake (3 or more alcoholic drinks every day), anorexia, bulimia or cachexia, chronic malnutrition (low reserves of hepatic glutathione)
  • Laboratory Tests: No tests indicated in addition to routine ICU tests
  • Drug/Laboratory Test Interactions:None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • None of note

ADVERSE REACTIONS

  • Neurological: Dizziness, headache, dystonia
  • Gastrointestinal: Vomiting, dry mouth, diarrhoea, constipation, nausea, dyspepsia, enlarged abdomen, transaminitis
  • Haematological: Anaemia

Critical Care Drug Manual

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