BMA Concise Guide to Medicine & Drugs

Paracetamol

Brand names Alvedon, Anadin Paracetamol, Calpol, Disprol, Hedex, Panadol, and many others

Used in the following combined preparations Anadin Extra, Migraleve, Panadeine, Paradote, Solpadol, Tylex, and others

QUICK REFERENCE

Drug group Non-opioid analgesic

Overdose danger rating High

Dependence rating Low

Prescription needed No

Available as generic Yes

GENERAL INFORMATION

One of a group of drugs known as the non-opioid analgesics, paracetamol is kept in the home to relieve occasional bouts of mild pain and to reduce fever. It is suitable for children as well as adults.

One of the primary advantages of paracetamol is that it does not cause stomach upset or bleeding problems. This makes it a particularly useful alternative for people who suffer from peptic ulcers or those who cannot tolerate aspirin. The drug is also safe for occasional use by those who are being treated with anticoagulants.

Although safe when used as directed, paracetamol is dangerous when it is taken in overdose, and it is capable of causing serious damage to the liver and kidneys. Even a small excess dose of paracetamol may be toxic if you regularly drink more than the recommended allowance of alcohol.

INFORMATION FOR USERS

Follow instructions on the label. Call your doctor if symptoms worsen.

How taken/used Tablets, capsules, liquid, suppositories.

Frequency and timing of doses Every 4–6 hours as necessary, but not more than 4 doses per 24 hours in children.

Dosage range Adults 500mg–1g per dose up to 4g daily. Children 60mg (2 months for fever following immunization; 2 doses only); 60–120mg per dose (3 months–1 year); 120–250mg per dose (1–5 years); 250–500mg per dose (6–12 years).

Onset of effect Within 15–60 minutes.

Duration of action Up to 6 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember if required to relieve pain. Otherwise do not take the missed dose, and take a further dose only when you are in pain.

Stopping the drug Can be safely stopped as soon as you no longer need it.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if nausea, vomiting, or stomach pain occur.

POSSIBLE ADVERSE EFFECTS

Paracetamol has rarely been found to produce any side effects when taken as recommended, although nausea may sometimes occur. If you develop a rash, stop taking the drug and contact your doctor promptly.

INTERACTIONS

Anticoagulants such as warfarin may need dosage adjustment if paracetamol is taken regularly in high doses.

Carbamazepine may increase the rate at which paracetamol is metabolized.

Colestyramine reduces the absorption of paracetamol and may reduce its effectiveness.

Metoclopramide and domperidone These drugs increase the rate at which paracetamol is absorbed by the body.

Imatinib may interact with paracetamol, which should be used at a reduced dosage or avoided altogether if taking imatinib.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before using this drug if:

· You have liver or kidney problems.

· You have cystic fibrosis.

· You have an eating disorder.

· You are taking other medicines.

Pregnancy Not known to be harmful.

Breast-feeding The drug passes into the breast milk but only in amounts too small to be harmful.

Infants and children Usually only given to infants under 3 months on doctor’s advice except for relief of fever following vaccination at 2 months. Reduced dose necessary up to 12 years.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol Small amounts of alcohol are probably safe but regularly exceeding your daily alcohol allowance can increase the risk of liver damage from paracetamol.

PROLONGED USE

Do not take paracetamol for longer than 48 hours except on the advice of your doctor. If the drug is taken long-term as recommended, there is relatively little evidence of harm.