Drug reference

Paracetamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 487, 488, 489

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Mild to moderate pain | Pyrexia ▶BY MOUTH ▶Adult: 0.5–1 g every 4–6 hours; maximum 4 g per day ▶BY INTRAVENOUS INFUSION ▶Adult (body-weight up to 50 kg): 15 mg/kg every 4–6 hours, dose to be administered over 15 minutes; maximum 60 mg/kg per day ▶Adult (body-weight 50 kg and above): 1 g every 4–6 hours, dose to be administered over 15 minutes; maximum 4 g per day ▶BY RECTUM ▶Adult: 0.5–1 g every 4–6 hours; maximum 4 g per day Mild to moderate pain in patients with risk factors for hepatotoxicity | Pyrexia in patients with risk factors for hepatotoxicity ▶BY INTRAVENOUS INFUSION ▶Adult (body-weight up to 50 kg): 15 mg/kg every 4–6 hours, dose to be administered over 15 minutes; maximum 60 mg/kg per day Nervous system ▶Adult (body-weight 50 kg and above): 1 g every 4–6 hours, dose to be administered over 15 minutes; maximum 3 g per day Pain | Pyrexia with discomfort ▶BY MOUTH ▶Child 3–5 months: 60 mg every 4–6 hours; maximum 4 doses per day ▶Child 6–23 months: 120 mg every 4–6 hours; maximum 4 doses per day ▶Child 2–3 years: 180 mg every 4–6 hours; maximum 4 doses per day ▶Child 4–5 years: 240 mg every 4–6 hours; maximum 4 doses per day ▶Child 6–7 years: 240–250 mg every 4–6 hours; maximum 4 doses per day ▶Child 8–9 years: 360–375 mg every 4–6 hours; maximum 4 doses per day ▶Child 10–11 years: 480–500 mg every 4–6 hours; maximum 4 doses per day ▶Child 12–15 years: 480–750 mg every 4–6 hours; maximum 4 doses per day ▶Child 16–17 years: 0.5–1 g every 4–6 hours; maximum 4 doses per day ▶BY RECTUM ▶Child 3–11 months: 60–125 mg every 4–6 hours as required; maximum 4 doses per day ▶Child 1–4 years: 125–250 mg every 4–6 hours as required; maximum 4 doses per day ▶Child 5–11 years: 250–500 mg every 4–6 hours as required; maximum 4 doses per day ▶Child 12–17 years: 500 mg every 4–6 hours Post-immunisation pyrexia in infants ▶BY MOUTH ▶Child 2–3 months: 60 mg for 1 dose, then 60 mg after 4–6 hours if required ▶Child 4 months: 60 mg for 1 dose, then 60 mg after 4–6 hours; maximum 4 doses per day Acute migraine ▶BY MOUTH ▶Adult: 1 g for 1 dose, to be taken as soon as migraine symptoms develop l UNLICENSED USE ▶In children Paracetamol oral suspension 500 mg/5 mL not licensed for use in children under 16 years. g Not licensed for use as prophylaxis of post-immunisation pyrexia following immunisation with meningococcal group B vaccine. l

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Cautions

Before administering, check when paracetamol last administered and cumulative paracetamol dose over previous 24 hours. body-weight under 50 kg. chronic alcohol consumption. chronic dehydration. chronic malnutrition. hepatocellular insufﬁciency. long-term use (especially in those who are malnourished) CAUTIONS, FURTHER INFORMATION g Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients. l g Co-administration of enzyme-inducing antiepileptic medications may increase toxicity; doses should be reduced. l

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Prescribing And Dispensing Information

BP directs that when Paediatric Paracetamol Oral Suspension or Paediatric Paracetamol Mixture is prescribed Paracetamol Oral Suspension 120 mg/5 mL should be dispensed.

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Exceptions To Legal Category

Paracetamol capsules or tablets can be sold to the public provided packs contain no more than 32 capsules or tablets; pharmacists can sell multiple packs up to a total quantity of 100 capsules or tablets in justiﬁable circumstances.

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Safety

Interactions

→Appendix 1: paracetamol

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Side Effects

GENERAL SIDE-EFFECTS ▶Rare or very rare Thrombocytopenia SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With rectal use Anorectal erythema ▶Rare or very rare Nervous system ▶With intravenous use Hypersensitivity. hypotension. leucopenia. malaise. neutropenia ▶With rectal use Angioedema. liver injury. skin reactions ▶Frequency not known ▶With intravenous use Flushing. skin reactions. tachycardia ▶With oral use Agranulocytosis. bronchospasm. hepatic function abnormal. rash. severe cutaneous adverse reactions (SCARs) ▶With rectal use Agranulocytosis. blood disorder. severe cutaneous adverse reactions (SCARs) Overdose Liver damage and less frequently renal damage can occur following overdose. Nausea and vomiting, the only early features of poisoning, usually settle within 24 hours. Persistence beyond this time, often associated with the onset of right subcostal pain and tenderness, usually indicates development of hepatic necrosis. For speciﬁc details on the management of poisoning, see Paracetamol, under Emergency treatment of poisoning p. 1430.

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Pregnancy

Not known to be harmful.

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Breast Feeding

Amount too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution (increased risk of toxicity).

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Renal Impairment

Dose adjustments ▶In adults Increase infusion dose interval to every 6 hours if eGFR less than 30 mL/minute/1.73 m2. ▶In children Increase infusion dose interval to every 6 hours if estimated glomerular ﬁltration rate less than 30 mL/minute/1.73 m2.

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Dose and formulations

Directions For Administration

▶With intravenous use For intravenous infusion (Perfalgan ®), give in Glucose 5% or Sodium Chloride 0.9%; dilute to a concentration of not less than 1 mg/mL and use within an hour; may also be given undiluted. For children under 33 kg, use 50 mL-vial.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution, suppository, powder Tablet CAUTIONARY AND ADVISORY LABELS 29(500 mg tablets in adults), ▶Paracetamol (Non-proprietary) Paracetamol 500 mg Paracetamol 500mg caplets | 100 tablet P £3.05 DT = £2.41 Paracetamol 500mg tablets | 100 tablet P £2.41 DT = £2.41 | 1000 tablet P £24.10 Paracetamol 1 gram Paracetamol 1g tablets | 100 tablet P £2.49 DT = £2.49 ▶Mandanol (M & A Pharmachem Ltd) Paracetamol 500 mg Mandanol 500mg caplets | 100 tablet P £1.34 DT = £2.41 Mandanol 500mg tablets | 100 tablet P £1.34 DT = £2.41 ▶Paravict (Ecogen Europe Ltd) Paracetamol 500 mg Paravict 500mg tablets | 100 tablet P £1.62 DT = £2.41 Suppository CAUTIONARY AND ADVISORY LABELS 30 ▶Paracetamol (Non-proprietary) Paracetamol 80 mg Paracetamol 80mg suppositories | 10 suppository p £10.00 DT = £10.00 Paracetamol 120 mg Paracetamol 120mg suppositories | 10 suppository p £12.39 DT = £12.39 Paracetamol 125 mg Paracetamol 125mg suppositories | 10 suppository p £15.00 DT = £13.80 Paracetamol 240 mg Paracetamol 240mg suppositories | 10 suppository p £22.01 DT = £22.01 Paracetamol 250 mg Paracetamol 250mg suppositories | 10 suppository p £33.38 DT = £27.60 Paracetamol 500 mg Paracetamol 500mg suppositories | 10 suppository p £36.50 DT = £36.50 Paracetamol 1 gram Paracetamol 1g suppositories | 10 suppository p £60.00 DT = £59.50 ▶Alvedon (Intrapharm Laboratories Ltd) Paracetamol 60 mg Alvedon 60mg suppositories | 10 suppository p £11.95 DT = £11.95 Paracetamol 125 mg Alvedon 125mg suppositories | 10 suppository p £13.80 DT = £13.80 Paracetamol 250 mg Alvedon 250mg suppositories | 10 suppository p £27.60 DT = £27.60 Oral suspension CAUTIONARY AND ADVISORY LABELS 30 ▶Paracetamol (Non-proprietary) Paracetamol 24 mg per 1 ml Paracetamol 120mg/5ml oral suspension paediatric | 100 ml p £1.25–£1.70 | 500 ml p £6.23 DT = £6.23 Paracetamol 120mg/5ml oral suspension paediatric sugar-free | 100 ml p £1.83 DT = £1.37 sugar-free | 200 ml p £2.72–£3.20 sugar-free | 500 ml p £8.00 sugar-free | 1000 ml p £10.48 Paracetamol 50 mg per 1 ml Paracetamol 250mg/5ml oral suspension | 100 ml p £2.00–£2.40 DT = £2.06 | 500 ml p £10.00– £12.00 Paracetamol 250mg/5ml oral suspension sugar-free | 100 ml p £1.35–£1.89 sugar-free | 200 ml p £2.96 DT = £2.69 sugar-free | 500 ml p £6.67–£6.73 sugar-free | 1000 ml p £13.35 Paracetamol 100 mg per 1 ml Paracetamol 500mg/5ml oral suspension sugar-free | 150 ml P £24.00 DT = £24.00 ▶Calpol (McNeil Products Ltd) Paracetamol 24 mg per 1 ml Calpol Infant 120mg/5ml oral suspension | 200 ml p £3.78 Calpol Infant 120mg/5ml oral suspension sugar-free | 200 ml p £3.78 Paracetamol 50 mg per 1 ml Calpol Six Plus 250mg/5ml oral suspension | 200 ml p £4.40 Calpol Six Plus 250mg/5ml oral suspension sugar-free | 100 ml p £2.64 sugar-free | 200 ml p £4.40 DT = £2.69 Effervescent tablet CAUTIONARY AND ADVISORY LABELS 13, 29(500 mg tablets in adults), 30 ▶Paracetamol (Non-proprietary) Paracetamol 500 mg Paracetamol 500mg soluble tablets | 100 tablet P s DT = £6.25 Paracetamol 500mg effervescent tablets | 24 tablet P £1.64– £2.18 | 60 tablet P £4.10 | 100 tablet P £6.83 DT = £6.83 ▶Altridexamol (TriOn Pharma Ltd) Paracetamol 1 gram Altridexamol 1000mg effervescent tablets sugar-free | 50 tablet P £6.59 DT = £6.59 Solution for infusion ▶Paracetamol (Non-proprietary) Paracetamol 10 mg per 1 ml Paracetamol 500mg/50ml solution for infusion bottles | 10 bottle P £11.00 (Hospital only) Paracetamol 500mg/50ml solution for infusion vials | 10 vial P £15.10 Paracetamol 1g/100ml solution for infusion bottles | 10 bottle P s Paracetamol 1g/100ml solution for infusion vials | 10 vial P £12.00 DT = £12.00 (Hospital only) | 10 vial P £16.40 DT = £12.00 | 20 vial P £24.00 (Hospital only) Paracetamol 100mg/10ml solution for infusion ampoules | 20 ampoule P £12.00 ▶Perfalgan (Bristol-Myers Squibb Pharmaceuticals Ltd) Paracetamol 10 mg per 1 ml Perfalgan 1g/100ml solution for infusion vials | 12 vial P £14.96 Perfalgan 500mg/50ml solution for infusion vials | 12 vial P £13.60 Oral solution CAUTIONARY AND ADVISORY LABELS 30 ▶Paracetamol (Non-proprietary) Paracetamol 24 mg per 1 ml Paracetamol 120mg/5ml oral solution paediatric sugar-free | 2000 ml p £23.80 DT = £23.80 Paracetamol 100 mg per 1 ml Paracetamol 500mg/5ml oral solution sugar-free | 150 ml P £24.00 sugar-free | 200 ml P £18.00 DT = £18.00 Powder ▶Paracetamol (Non-proprietary) Paracetamol 650 mg Boots Cold & Flu Relief 650mg oral powder sachets | 10 sachet G s Value Health Cold Relief Powders Lemon Flavour | 5 sachet G s Capsule CAUTIONARY AND ADVISORY LABELS 29, 30 ▶Paracetamol (Non-proprietary) Paracetamol 500 mg Paracetamol 500mg capsules | 100 capsule P £3.85 DT = £3.16 Orodispersible tablet CAUTIONARY AND ADVISORY LABELS 30 ▶Calpol Fastmelts (McNeil Products Ltd) Paracetamol 250 mg Calpol Six Plus Fastmelts 250mg tablets sugar- free | 24 tablet p £4.12 DT = £4.12 Combinations available: Co-codamol, p. 474. Dihydrocodeine with paracetamol, p. 478. Tramadol with paracetamol, p. 494 ANALGESICS › NON-OPIOID, CENTRALLY ACTING

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Clinical care

Patient And Carer Advice

Medicines for Children leaflet: Paracetamol for mild-to-moderate pain www.medicinesforchildren.org.uk/paracetamol-mild- moderate-pain l PROFESSION SPECIFIC INFORMATION Dental practitioners’ formulary Paracetamol Tablets may be prescribed. Paracetamol Soluble Tablets 500 mg may be prescribed. Paracetamol Oral Suspension may be prescribed.

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Dose text by age group

Adult

0.5–1 g every 4–6 hours; maximum 4 g per day

First-line fragment. Read the complete Indications and Dose section above.

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Adult (body-weight up to 50 kg)

15 mg/kg every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight 50 kg and above)

1 g every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult

0.5–1 g every 4–6 hours; maximum 4 g per day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight up to 50 kg)

15 mg/kg every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight 50 kg and above)

1 g every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult

1 g for 1 dose, to be taken as soon as migraine

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Paracetamol

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 487, 488, 489

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 487

Cautions

PDF page 487

Prescribing And Dispensing Information

BP directs that when Paediatric Paracetamol Oral Suspension or Paediatric Paracetamol Mixture is prescribed Paracetamol Oral Suspension 120 mg/5 mL should be dispensed.

PDF page 488

Exceptions To Legal Category

PDF page 488

Safety

Interactions

→Appendix 1: paracetamol

PDF page 487

Side Effects

PDF page 488

Pregnancy

Not known to be harmful.

PDF page 488

Breast Feeding

Amount too small to be harmful.

PDF page 488

Hepatic Impairment

Manufacturer advises caution (increased risk of toxicity).

PDF page 488

Renal Impairment

PDF page 488

Dose and formulations

Directions For Administration

PDF page 488

Medicinal Forms

PDF pages 488, 489

Clinical care

Patient And Carer Advice

PDF page 488

Dose text by age group

Adult

0.5–1 g every 4–6 hours; maximum 4 g per day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight up to 50 kg)

15 mg/kg every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight 50 kg and above)

1 g every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult

0.5–1 g every 4–6 hours; maximum 4 g per day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight up to 50 kg)

15 mg/kg every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult (body-weight 50 kg and above)

1 g every

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Adult

1 g for 1 dose, to be taken as soon as migraine

First-line fragment. Read the complete Indications and Dose section above.

PDF page 487

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.