Paracetamol
ADMINISTRATION ROUTES:
PO, IV, PR
ALTERNATIVE NAMES:
Pamol, Panadol, Perfalgan
ICU INDICATIONS:
- Analgesia
- Antipyretic
PRESENTATION AND ADMINISTRATION:
IV:
Perfalgan 10 mg/mL solution contains 1 gm of paracetamol in 100 mL Administer by infusion over 15 minutes
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: 0.9% saline, 5% dextrose
As for all solution 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 10 mg/mL solution for infusion a syringe or giving set with a diameter equal to or below 0.8 mm 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 500 mg capsules, tablets, soluble tablets and suppositories
DOSAGE:
IV:
1 g 4 hourly
Maximum 4 g in 24 hours
PO/PR:
1 g 4 hourly
Maximum 4 g in 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 maximum daily dose is 3 g.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
PO / IV:
20 mg/kg stat then 15 mg/kg 4 hourly
Daily maximum of 90 mg/kg for 48 hours then 60 mg/kg
PR:
40 mg/kg stat then 30 mg/kg QID
Daily maximum 5 g in 24 hours
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:
- Hypersensitivity to paracetamol
- 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 IN ICU:
None of note
ADVERSE REACTIONS:
Neurological:
Dizziness, headache, dystonia
Gastrointestinal:
Vomiting, dry mouth, diarrhoea, constipation, nausea, dyspepsia, enlarged abdomen, transaminitis
Haematological:
Anaemia