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Paracetamol Generic Name: paracetamol (oral/rectal) (par RA cet a MOL) Alternate Name: acetaminophen (a SEET a MIN oh fen) Medically reviewed by Judith Stewart, BPharm. Last updated on Feb 16, 2021. Uses Warnings What to avoid Side effects Dosage Interactions FAQ What is paracetamol ? Paracetamol (acetaminophen) is a pain reliever and a fever reducer. The exact mechanism of action of is not known. Paracetamol is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint. Paracetamol may also be used for other purposes not listed in this medication guide. Drugs A to Z Acetaminophen Dosage PrintSave Acetaminophen Dosage Medically reviewed by Drugs.com. Last updated on Jan 28, 2021. Applies to the following strengths: 160 mg; 80 mg/0.8 mL; 160 mg/5 mL; 500 mg; 650 mg; 80 mg; 325 mg; 500 mg/15 mL; 120 mg; 120 mg/5 mL; 325 mg/10.15 mL; 650 mg/20.3 mL; 10 mg/mL; 80 mg/5 mL; 650 mg/25 mL; 80 mg/mL; 500 mg/5 mL; 48 mg/mL Usual Adult Dose for: Fever Pain Usual Pediatric Dose for: Pain Fever Additional dosage information: Renal Dose Adjustments Liver Dose Adjustments Dose Adjustments Precautions Dialysis Other Comments Usual Adult Dose for Fever Doses may be given as a single or repeated dose as follows: Parenteral: Weight 50 kg or greater: 1000 mg IV every 6 hours OR 650 mg IV every 4 hours Maximum Single Dose: 1000 mg Minimum Dosing Interval: every 4 hours Maximum Dose: 4000 mg per 24 hours Weight less than 50 kg: 15 mg/kg IV every 6 hours OR 12.5 mg/kg IV every 4 hours Maximum Single Dose: 15 mg/kg Minimum Dosing Interval: every 4 hours Maximum Dose: 75 mg/kg per 24 hours Oral: Immediate-release: 325 mg to 1 g orally every 4 to 6 hours Minimum Dosing Interval: every 4 hours Maximum Single Dose: 1000 mg Maximum Dose: 4 g per 24 hours Extended-Release: 1300 mg orally every 8 hours Maximum dose: 3900 mg per 24 hours Rectal: 650 mg rectally every 4 to 6 hours Maximum dose: 3900 mg per 24 hours Comments: -Maximum daily dose is based on all routes of administration and all products containing acetaminophen. -Maximum daily dose and dosing recommendations may differ by product; some manufacturers have decreased the maximum daily dose to protect consumers from inadvertent overdoses. -For IV administration, verify the dose in mg and mL to ensure the dose is correct; verify that infusion pumps are properly programmed Uses: -For the management of mild to moderate pain and the management of moderate to severe pain with adjunctive opioid analgesics. -For the reduction of fever. Usual Adult Dose for Pain Doses may be given as a single or repeated dose as follows: Parenteral: Weight 50 kg or greater: 1000 mg IV every 6 hours OR 650 mg IV every 4 hours Maximum Single Dose: 1000 mg Minimum Dosing Interval: every 4 hours Maximum Dose: 4000 mg per 24 hours Weight less than 50 kg: 15 mg/kg IV every 6 hours OR 12.5 mg/kg IV every 4 hours Maximum Single Dose: 15 mg/kg Minimum Dosing Interval: every 4 hours Maximum Dose: 75 mg/kg per 24 hours Oral: Immediate-release: 325 mg to 1 g orally every 4 to 6 hours Minimum Dosing Interval: every 4 hours Maximum Single Dose: 1000 mg Maximum Dose: 4 g per 24 hours Extended-Release: 1300 mg orally every 8 hours Maximum dose: 3900 mg per 24 hours Rectal: 650 mg rectally every 4 to 6 hours Maximum dose: 3900 mg per 24 hours Comments: -Maximum daily dose is based on all routes of administration and all products containing acetaminophen. -Maximum daily dose and dosing recommendations may differ by product; some manufacturers have decreased the maximum daily dose to protect consumers from inadvertent overdoses. -For IV administration, verify the dose in mg and mL to ensure the dose is correct; verify that infusion pumps are properly programmed Uses: -For the management of mild to moderate pain and the management of moderate to severe pain with adjunctive opioid analgesics. -For the reduction of fever. Usual Pediatric Dose for Pain Doses may be given as a single or repeated dose as follows: PARENTERAL: 2 to 12 years: 12.5 mg/kg IV every 4 hours OR 15 mg/kg IV every 6 hours Maximum Single Dose: 15 mg/kg; not to exceed 750 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 75 mg/kg in 24 hours; not to exceed 3750 mg 13 years or older; weight less than 50 kg: 12.5 mg/kg IV every 4 hours OR 15 mg/kg IV every 6 hours Maximum Single Dose: 15 mg/kg; not to exceed 750 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 75 mg/kg in 24 hours; not to exceed 3750 mg 13 years or older; weight 50 kg or greater: 650 mg IV every 4 hours OR 1000 mg IV every 6 hours Maximum Single Dose: 1000 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 4000 mg in 24 hours ORAL: 10 to 15 mg/kg orally every 4 to 6 hours as needed not to exceed 5 doses in 24 hours -Alternatively, use weight first, then age: 2.7 to 5.3 kg (0 to 3 months): 40 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 5.4 to 8.1 kg (4 to 11 months): 80 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 8.2 to 10.8 kg (12 to 23 months): 120 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 10.9 to 16.3 kg (2 to 3 years): 160 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 16.4 to 21.7 kg (4 to 5 years): 240 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 21.8 to 27.2 kg (6 to 8 years): 320 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 27.3 to 32.6 kg (9 to 10 years): 400 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 32.7 to 43.2 kg (11 to 12 years): 480 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 12 years or older: Immediate-release: 325 mg to 1 g orally every 4 to 6 hours Minimum Dosing Interval: every 4 hours Maximum Single Dose: 1000 mg Maximum Dose: 4 g per 24 hours Extended-Release: 1300 mg orally every 8 hours Maximum dose: 3900 mg per 24 hours RECTAL: 6 to 11 months: 80 mg rectally every 6 hours up to a maximum of 4 doses in 24 hours 12 to 36 months: 80 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 3 to 6 years: 120 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 6 to 12 years: 325 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 12 years or older: 650 mg rectally every 4 to 6 hours up to a maximum of 6 doses in 24 hours Comments: -Maximum daily dose is based on all routes of administration and all products containing acetaminophen. -Maximum daily dose and dosing recommendations may differ by product; some manufacturers have decreased the maximum daily dose to protect consumers from inadvertent overdoses. -For IV administration, verify the dose in mg and mL to ensure the dose is correct; verify that infusion pumps are properly programmed. Uses: -For the management of mild to moderate pain and for the management of moderate to severe pain when used with adjunctive opioid analgesics. Usual Pediatric Dose for Fever Doses may be given as a single or repeated dose as follows: PARENTERAL: Neonates (premature neonates born at least 32 weeks gestational age up to 28 days chronological age): 12.5 mg/kg IV every 6 hours Minimum Dosing Interval: 6 hours Maximum Daily Dose: 50 mg/kg/day Infants (29 days to 2 years old): 15 mg/kg every 6 hours Minimum Dosing Interval: 6 hours Maximum Daily Dose: 60 mg/kg/day 2 to 12 years: 12.5 mg/kg IV every 4 hours OR 15 mg/kg IV every 6 hours Maximum Single Dose: 15 mg/kg; not to exceed 750 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 75 mg/kg in 24 hours; not to exceed 3750 mg 13 years or older; weight less than 50 kg: 12.5 mg/kg IV every 4 hours OR 15 mg/kg IV every 6 hours Maximum Single Dose: 15 mg/kg; not to exceed 750 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 75 mg/kg in 24 hours; not to exceed 3750 mg 13 years or older; weight 50 kg or greater: 650 mg IV every 4 hours OR 1000 mg IV every 6 hours Maximum Single Dose: 1000 mg Minimum Dosing Interval: every 4 hours Maximum Daily Dose: 4000 mg in 24 hours ORAL: 10 to 15 mg/kg orally every 4 to 6 hours as needed not to exceed 5 doses in 24 hours -Alternatively, use weight first, then age: 2.7 to 5.3 kg (0 to 3 months): 40 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 5.4 to 8.1 kg (4 to 11 months): 80 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 8.2 to 10.8 kg (12 to 23 months): 120 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 10.9 to 16.3 kg (2 to 3 years): 160 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 16.4 to 21.7 kg (4 to 5 years): 240 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 21.8 to 27.2 kg (6 to 8 years): 320 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 27.3 to 32.6 kg (9 to 10 years): 400 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 32.7 to 43.2 kg (11 to 12 years): 480 mg orally every 4 hours as needed not to exceed 5 doses in 24 hours 12 years or older: Immediate-release: 325 mg to 1 g orally every 4 to 6 hours Minimum Dosing Interval: every 4 hours Maximum Single Dose: 1000 mg Maximum Dose: 4 g per 24 hours RECTAL: 6 to 11 months: 80 mg rectally every 6 hours up to a maximum of 4 doses in 24 hours 12 to 36 months: 80 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 3 to 6 years: 120 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 6 to 12 years: 325 mg rectally every 4 to 6 hours up to a maximum of 5 doses in 24 hours 12 years or older: 650 mg rectally every 4 to 6 hours up to a maximum of 6 doses in 24 hours Comments: -Maximum daily dose is based on all routes of administration and all products containing acetaminophen. -Maximum daily dose and dosing recommendations may differ by product; some manufacturers have decreased the maximum daily dose to protect consumers from inadvertent overdoses. -For IV administration, verify the dose in mg and mL to ensure the dose is correct; verify that infusion pumps are properly programmed. Use: For the reduction of fever. Renal Dose Adjustments Severe renal impairment (CrCl less than 30 mL/min): Longer dosing intervals and a reduced total daily dose may be warranted Liver Dose Adjustments Parenteral: Severe hepatic impairment, severe active hepatic disease: Use is contraindicated Mild to moderate hepatic impairment, mild to moderate active hepatic disease: Use with caution; a reduced total daily dose may be warranted Over the counter products must contain labeling that states: This product contains acetaminophen. Severe liver damage may occur if: -Adult takes more than maximum daily dose in 24 hours -Child takes more than 5 doses in 24 hours -More than 3 alcoholic drinks are consumed per day while using this product. Dose Adjustments Use caution in patients with alcoholism, chronic malnutrition, severe hypovolemia (e.g. due to dehydration or blood loss); A reduced daily dose may be warranted. Suspected Overdose: -If an overdose is suspected, obtain a serum drug level as soon as possible, but no sooner than 4 hours after oral ingestion. -Liver function studies should be obtained and repeated at 24-hour intervals. -The antidote, N-acetylcysteine (NAC) should be administered as soon as possible according to NAC protocols. Precautions US BOXED WARNING: RISK OF MEDICATION ERRORS Take care when prescribing, preparing, and administering IV acetaminophen injection to avoid dosing errors which could result in accidental overdose and death. In particular, be careful to ensure that - the dose in milligrams (mg) and milliliters (mL) is not confused; - the dosing is based on weight for patients under 50 kg; - infusion pumps are properly programmed; -the total daily dose of acetaminophen from all sources does not exceed maximum daily limits. US BOXED WARNING: HEPATOTOXICITY: This drug has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed the maximum daily limits, and often involve more than 1 acetaminophen-containing product. US OVER THE COUNTER LABELING: Adults only: This product contains acetaminophen. Severe liver damage may occur if: -More than maximum daily dose is taken in 24 hours -This product is taken with other drugs containing acetaminophen -Three or more alcoholic drinks are consumer every day while using this product. US OVER THE COUNTER LABELING: Adults and children under 12 years of age: This product contains acetaminophen. Severe liver damage may occur if: -Adult takes more than maximum daily dose in 24 hours -Child takes more than 5 doses in 24 hours -This product is taken with other drugs containing acetaminophen -Persons consume 3 or more alcoholic drinks per day while using this product. Safety and efficacy for the treatment of acute pain have not been established in patients younger than 2 years. Consult WARNINGS section for additional precautions. Dialysis Children: Intermittent hemodialysis or peritoneal dialysis: Administer every 8 hours CRRT: No adjustments necessary Adults: Intermittent hemodialysis or peritoneal dialysis: No adjustment necessary CRRT: Administer every 8 hours