Introduction of Paracetamol

Paracetamol, known as acetaminophen in the United States and Canada, is a widely used over-the-counter (OTC) medication known for its effectiveness in relieving pain and reducing fever. This comprehensive guide will provide you with essential information about paracetamol, including its uses, dosages, safety precautions, and potential side effects.

Indication

Provides relief from mild to moderate pain, including headaches, muscle aches, arthritis pain, toothaches, menstrual cramps, and pain caused by colds, flu, sprains, and other conditions. Reduces fever.

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Doses of Paracetamol

Adult doses 

Oral

 Mild to moderate pain and fever

Tablet: 1 – 2 tablets every 4 to 6 hours up to a maximum of 4g( 8 tables) daily

Extended release(xr) tablets: 2 Tablets, Swallowed whole, every 6 to 8 hours( maximum of 6 tablets in any 24 hours).

Syrup/suspension: 4-8 Measuring spoonful 3-4 times daily.

Rectal suppository: 500 mg- 1g every 4-6 hours to a maximum of 4g daily.

Child doses

Oral

Mild to moderate pain and fever

Tablet: Children( 6-12 years) : ½ to 1 tablet 3 to 4 times daily

Extended release (xr) tablet: Children over 12 years: 2 tablets, Swallowed whole, every 6 to 8 hours( maximum of 6 tablets in any 24 hours )

Syrup

Mild to moderate pain and fever

Children: 3 months-< 1 year: 60 – 120 mg( ½ – 1 measuring spoonful)

1-5 years: 1 – 2 measuring spoonful

6 – 12 years: 2-4 measuring spoonful

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Administration

May be taken with and without food.

Contraindications of Paracetamol

Hypersensitivity to paracetamol (acetaminophen).

Liver Conditions: Individuals with liver diseases or damage should avoid paracetamol due to the risk of exacerbating liver issues.

Alcohol Consumption: Combining paracetamol with alcohol can increase the risk of liver damage; individuals should limit alcohol intake while using this medication.

Allergies: Those allergic to paracetamol or any of its components should refrain from using it to prevent adverse reactions.

Pediatric Age: Children with certain health conditions or under specific age groups should follow pediatric-specific guidelines, as indicated by healthcare providers.

Pregnancy and Breastfeeding: Pregnant or breastfeeding individuals should consult healthcare professionals before using paracetamol to ensure it’s safe for them and their baby.

Site effect of Paracetamol

Serious side effects of Paracetamol

Allergic reactions, which may be severe and include:

Skin rashes, itching or hives

Swelling of the throat, tongue or face

Shortness of breath or wheezing

Skin rash or peeling, or mouth ulcers

Breathing problems. This is more likely if you have experienced them before when taking other painkillers such as ibuprofen and aspirin

Unexplained bruising or bleeding or becoming unusually tired. Getting more infections than usual.

Liver problems. Nausea, sudden weight loss, loss of appetite and yellowing of the eyes and skin can occur

If you get any of the rare side effects listed above, stop taking the medicine and contact your doctor immediately.

Common side effect of paracetamol suppositories include:

Redness or soreness in or around the rectum

Everyday, long-term use (several months or more) of paracetamol can cause liver or kidney damage. People taking this medication in the usual way for shorter periods of time have not had these problems.

Get emergency help immediately if any of the following symptoms of overdose occur while taking acetaminophen:

Symptoms of overdose

Diarrhea

increased sweating

loss of appetite

nausea or vomiting

stomach cramps or pain

swelling, pain, or tenderness in the upper abdomen or stomach area

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Precautions and Warnings

Patient w/ chronic alcoholism, known G6PD deficiency, severe hypo volaemia, chronic malnutrition. Renal and hepatic impairment. Pregnancy and lactation. Monitoring parameters monitor serum paracetamol levels esp when acute over dosage is suspected and w/ long-term use.

Pregnancy and Lactation

Pregnancy category – B

Animal reproduction to studies have failed to demonstrate a risk to the  fetus and there are no adequate and well- controlled studies in pregnant women or animal studies have shown an adverse effect. But adequate and well- controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Pregnancy

  Drug crosses placenta and can be detected in cord blood, newborn serum and urine  immediately after delivery.

Increased risk of teratogenic effect not reported following maternal use of drug during pregnancy.

 Use of normal dosage during pregnancy not associated with increased risk of miscarriage or still birth. However, increase in fatal death or spontaneous abortion may be seen with maternal overdose if treatment delayed.

 Wheezing and Asthma in early childhood associated with frequent maternal use of drug during pregnancy.

Lactation

Drug is excreted in milk; in general, breastfeeding is generally acceptable if relative infant dose(RID) is< 10%; avoid breastfeeding when RID> 25%. 

Paracetamol Mode of action

According to its FDA labeling, acetaminophen’s exact mechanism of action has not been fully establish Label – despite this, it is often categorize alongside NSAIDs (nonsteroidal anti-inflammatory drugs) due to its ability to inhibit the cyclooxygenase (COX) pathways. It is thought to exert central actions which ultimately lead to the alleviation of pain symptoms.

One theory is that acetaminophen increases the pain threshold by inhibiting two isoforms of cyclooxygenase, COX-1 and COX-2, which are involved in prostaglandin (PG) synthesis. Prostaglandins are responsible for eliciting pain sensations. Acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, therefore, has no peripheral anti-inflammatory effects.

Though acetylsalicylic acid (aspirin) is an irreversible inhibitor of COX and directly blocks the active site of this enzyme, studies have shown that acetaminophen (paracetamol) blocks COX indirectly. Studies also suggest that acetaminophen selectively blocks a variant type of the COX enzyme that is unique from the known variants COX-1 and COX-2.6 This enzyme has been refer to as COX-3. The antipyretic actions of acetaminophen are likely attribute to direct action on heat-regulating centers in the brain, resulting in peripheral vasodilation, sweating, and loss of body heat. The exact mechanism of action of this drug is not fully understate at this time, but future research may contribute to deeper knowledge.

Drug interaction of Acetaminophen

Tell your doctor or pharmacist about all the medicines you take, including prescription and OTC medicines, vitamins, and herbal supplements before taking this medication. Especially tell your doctor if you take:

  1. Blood thinning medications (anticoagulants) such as warfarin and you need to take a pain reliever daily. Occasional doses of paracetamol can be take with anticoagulants
  2. Flucloxacillin (antibiotic), due to a serious risk of blood and fluid abnormality (high anion gap metabolic acidosis) that must have urgent treatment, and which may occur particularly in case of severe renal impairment, sepsis (when bacteria and their toxins circulate in the blood leading to organ damage), malnutrition, chronic alcoholism, and if the maximum daily doses of paracetamol are use.
  3. Medications to treat high cholesterol (cholestyramine)
  4. Medications to treat epilepsy (lamotrigine)
  5. Medications to treat tuberculosis (isoniazide)
  6. Medication to treat fever or mild pain (aspirin, salicylamide)
  7. Barbiturate and tricyclic antidepressants to treat depression (amitriptyline)
  8. A medication to treat gout called probenecid
  9. A medication used to treat bacterial infections called chloramphenicol
  10. A medication used in HIV infections and AIDS called zidovudine
  1. Medications to help relieve nausea (metoclopramide or domperidone)

Paracetamol may affect the results of laboratory tests for uric acid and blood sugar levels.

Paracetamol can be taken with oral contraceptives, but it may not work as well to lower your pain or fever.

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Popular FAQ of Paracetamol

What temperature is consider a fever?

A fever is define as a body temperature of 38°C (100.4°F) or higher. Normal body temperature is usually 37°C (98.6°F), although it can be about a half degree Celsius higher or lower for some people and that’s normal for them.

Can you take tramadol with paracetamol, ibuprofen, or aspirin?

Yes, it is safe for most people to take tramadol with paracetamol, ibuprofen, or aspirin if they are old enough (aspirin is not recommend for children less than 16 years and tramadol should not be taken by children under the age of 12).

What is paracetamol / panadol call in the US?

Paracetamol is known as acetaminophen in the U.S. Acetaminophen relieves mild-to-moderate pain, headache and fever. It’s available over-the-counter as brand names such as Tylenol, Mapap or Panadol, and also as generics and store-specific brands. There are no differences in the chemical or therapeutics uses of acetaminophen and paracetamol, although recommended doses or available products may differ between countries.

Advil (ibuprofen) & Tylenol (paracetamol) together, is it safe?

Yes, it is safe to take ibuprofen (Advil) and paracetamol (Tylenol) together if you need to for extra pain relief, such as for a dental extraction. Taking ibuprofen and paracetamol together works better to relieve pain than taking ibuprofen and paracetamol separately. This is because they work in different ways with few side effects.

paracetamol vs Ibuprofen: Which is better?

Paracetamol is only effective at relieving pain and fever, while ibuprofen relieves inflammation in addition to pain and fever.

In the safe duration of using paracetamol (also known as acetaminophen) for a person?

Paracetamol is generally consider safe when used as directed. However, it’s important to follow the recommended dosage and duration specified on the packaging or as advised by a healthcare professional.

If you have a specific medical condition or if you’re unsure about the appropriate duration for using paracetamol, it’s crucial to consult with a healthcare professional. Prolonged or excessive use of paracetamol can lead to adverse effects, including liver damage.

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