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Analgesic / Antipyretic Pregnancy: A

Paracetamol (Elderly)

Brand names: Panadol, Calpol

Adult dose

Dose: 500 mg–1 g every 4–6 hours; frail elderly: 500 mg every 6 hours
Route: oral, IV, rectal
Frequency: every 4–6 hours (max 4 doses/24h)
Max: 4 g/day (standard adult); 2–3 g/day (frail elderly <50 kg, hepatic risk)
First-line analgesia in elderly — no NSAID-related cardiovascular/renal/GI risks; reduce maximum dose in frail elderly; check for hidden paracetamol in combination products

Paediatric dose

Dose: 15 mg/kg
Route: oral or rectal
Frequency: every 4–6 hours
Max: 60 mg/kg/day (max 4 g/day)
Concentration: 120 mg/5 mL (2–5 years), 250 mg/5 mL (6–11 years), 500 mg tablet mg/ml
1–3 months: 30–60 mg every 8 hours; 3–12 months: 60–120 mg every 4–6h; 1–5 years: 120–250 mg; 6–12 years: 250–500 mg every 4–6h

Dose adjustments

Renal

No dose adjustment required (max 3 g/day if eGFR <30 ml/min)

Hepatic

Avoid or use max 2 g/day in severe hepatic impairment, alcoholism, or malnutrition

Paediatric weight-based calculator

1–3 months: 30–60 mg every 8 hours; 3–12 months: 60–120 mg every 4–6h; 1–5 years: 120–250 mg; 6–12 years: 250–500 mg every 4–6h

Clinical pearls

  • BEERS/AGS guidelines: preferred analgesic for musculoskeletal pain in elderly over NSAIDs
  • Paracetamol-containing combination products (co-codamol, cold/flu remedies) — ALWAYS check total dose
  • IV paracetamol: weight <50 kg: 15 mg/kg (max 75 mg/kg/day); >50 kg: 1 g every 4–6h (max 4 g/day)

Contraindications

  • Severe hepatic impairment (Child-Pugh C)
  • Known hypersensitivity

Side effects

  • Hepatotoxicity (overdose)
  • Rare: hypersensitivity
  • Elevated LFTs (chronic use)

Interactions

  • Warfarin (prolonged regular use increases INR)
  • Alcohol (hepatotoxicity)
  • Colestyramine (reduces absorption)
  • Metoclopramide (increased absorption)

Monitoring

  • LFTs (if prolonged high-dose use)
  • Effective pain control assessment

Reference: BNFc; BNF 86; AGS guidelines; NICE NG193. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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