Analgesia
Pregnancy: Safe at standard doses — first-line analgesic in pregnancy; use minimum effective dose
Paracetamol
Brand names: Panadol, Calpol
Adult dose
Dose: 500 mg–1 g
Route: Oral / IV
Frequency: Every 4–6 hours
Max: 4 g/24h (2 g/24h in hepatic impairment or low body weight <50 kg)
First-line analgesic throughout all trimesters; safe in breastfeeding. IV route for post-operative analgesia (e.g. post-caesarean section). Reduce dose in hepatic impairment.
Paediatric dose
Dose: 15 mg/kg mg/kg
Route: Oral / IV
Frequency: Every 4–6 hours
Max: 60 mg/kg/day (max 4 g/day in children ≥50 kg)
BNFc: neonates 20 mg/kg loading dose then 10–15 mg/kg every 6–8 hours
Dose adjustments
Renal
Increase dosing interval to minimum 6 hours if eGFR <30 mL/min/1.73m²
Hepatic
Avoid or reduce dose — maximum 2 g/24h in hepatic impairment
Paediatric weight-based calculator
BNFc: neonates 20 mg/kg loading dose then 10–15 mg/kg every 6–8 hours
Clinical pearls
- First-line analgesic in pregnancy — safe at standard doses in all trimesters
- Epidemiological associations between prolonged prenatal paracetamol use and neurodevelopmental outcomes remain under investigation; use minimum effective dose for shortest duration
- IV paracetamol 1 g TDS is standard post-caesarean multimodal analgesia
- Safe in breastfeeding — maternal plasma levels are low in breast milk
- Overdose: NAC is safe in pregnancy and must not be withheld
Contraindications
- Hypersensitivity to paracetamol
- Severe hepatic impairment
Side effects
- Hepatotoxicity in overdose
- Rash (rare)
- Thrombocytopenia (rare)
Interactions
- Warfarin — INR elevation with regular paracetamol use; monitor
- Alcohol — increased hepatotoxicity risk
Monitoring
- Hepatic function in prolonged use or overdose
- LFTs
Reference: BNFc; BNF 90; BNFc; RCOG (2022) Obstetric Analgesics guidance; NICE CG190. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.