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Analgesic / Antipyretic — First-Line Pain and Fever in Children Pregnancy: Safe throughout pregnancy — first-line analgesic/antipyretic in pregnancy

Paracetamol (Paediatric)

Brand names: Calpol, Medinol, Panado

Adult dose

Dose: Standard adult dose: 500–1000 mg every 4–6 hours
Route: Oral, rectal or IV
Frequency: Every 4–6 hours
Max: 4 g/day
Adult dosing included for reference — see paediatric dose section for weight-based child dosing

Paediatric dose

Dose: 15 mg/kg mg/kg
Route: Oral (suspension), rectal (suppository), or IV (Perfalgan)
Frequency: Every 4–6 hours
Max: 60 mg/kg/day or 4 g/day (whichever is less); IV: 15 mg/kg every 6 hours (max 60 mg/kg/day up to 3 g/day for <50 kg)
BNFc: oral suspension 120 mg/5 mL (Calpol) for children under 6 years; 250 mg/5 mL for older children. Neonates: 28–32 weeks gestation — 10–15 mg/kg every 8–12 hours; >32 weeks — 10–15 mg/kg every 6–8 hours. IV Perfalgan: <10 kg: 7.5 mg/kg every 4–6 hours (max 30 mg/kg/day); 10–50 kg: 15 mg/kg every 4–6 hours (max 60 mg/kg/day). Do not exceed maximum daily dose — paracetamol hepatotoxicity remains most common cause of paediatric liver failure in UK.

Dose adjustments

Renal

CrCl <30 mL/min: extend dosing interval to every 6 hours minimum

Hepatic

Avoid in severe hepatic impairment; caution in Gilbert's syndrome (relative)

Paediatric weight-based calculator

BNFc: oral suspension 120 mg/5 mL (Calpol) for children under 6 years; 250 mg/5 mL for older children. Neonates: 28–32 weeks gestation — 10–15 mg/kg every 8–12 hours; >32 weeks — 10–15 mg/kg every 6–8 hours. IV Perfalgan: <10 kg: 7.5 mg/kg every 4–6 hours (max 30 mg/kg/day); 10–50 kg: 15 mg/kg every 4–6 hours (max 60 mg/kg/day). Do not exceed maximum daily dose — paracetamol hepatotoxicity remains most common cause of paediatric liver failure in UK.

Clinical pearls

  • Antidote for overdose: N-acetylcysteine (NAC) IV — replenishes glutathione; use Rumack-Matthew nomogram for risk assessment; contact NPIS (UK Poisons Information Service) for guidance
  • Paracetamol is weight-based in children — Calpol 120 mg/5 mL (infant/junior) vs 250 mg/5 mL (six-plus) — parents must use correct strength; overdose risk if wrong formulation used
  • Fever management: paracetamol and ibuprofen are equally effective antipyretics; alternating is common practice (evidence limited — PITCH trial showed no clinical benefit of alternating over single agent)
  • Neonatal analgesia: paracetamol reduces opioid requirements post-surgery and for minor procedures; oral/IV superior to rectal in neonates (variable rectal absorption)

Contraindications

  • Hepatic impairment (severe)
  • Hypersensitivity to paracetamol

Side effects

  • Hepatotoxicity (overdose — most feared; N-acetylcysteine antidote)
  • Rash (rare)
  • Thrombocytopaenia (rare)
  • Neutropenia (rare)

Interactions

  • Warfarin — enhanced anticoagulant effect at regular doses
  • Metoclopramide — increases absorption rate
  • Phenytoin/phenobarbital — increase metabolism of paracetamol (hepatotoxicity risk in overdose)

Monitoring

  • Paracetamol levels if overdose suspected (4-hour post-ingestion level)
  • LFTs (overdose)
  • INR (overdose — surrogate of hepatic synthetic function)

Reference: BNF for Children; NICE CG160 (Fever in Under 5s); MHRA Paracetamol Safety Review; NPIS UK. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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