Paracetamol (Elderly)

How it works

Its analgesic and antipyretic actions are thought to involve central inhibition of prostaglandin synthesis and modulation of pain pathways, with little peripheral anti-inflammatory effect.

Prescribing in practice

• In frail, low-body-weight or chronically malnourished older people, and in those with hepatic impairment or chronic high alcohol intake, a reduced total daily dose may be appropriate to limit hepatotoxicity risk.
• Account for paracetamol contained in combination analgesics and over-the-counter products to avoid inadvertent excess.
• It is preferred over NSAIDs in older people because it avoids gastrointestinal, renal and cardiovascular NSAID hazards.

Monitoring

Routine monitoring is not required, but review cumulative intake and consider hepatic status in frail or low-weight older patients.

Counselling the patient

• Do not take other products that also contain paracetamol at the same time.
• Take regularly rather than only when pain is severe for steadier control.

Evidence & guidelines

NICE guidance positions paracetamol as a first-line analgesic, and it is generally favoured over NSAIDs in older adults because of its safer organ profile.