Page 83 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness
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References:
Ashley C, Currie A, eds. The renal drug handbook, 3rd ed. Oxford, Radcliffe Publishing, 2009.
Drugdex in Micromedex Healthcare Series [Internet]. New York, NY, Thomson Reuters, 1974–2010 (http://
micromedex.hcn.net.au/mdx-full/, accessed 18 August 2011).
Hodding JH, Kraus DM, Taketomo CK. Pediatric dosage handbook, 16th ed. Hudson, OH, Lexicomp, 2009.
MIMS Online. Sydney, UBM Medica, 2009 (http://www.mimsonline.com.au/Search/Search.aspx, accessed 10 February
2010).
Paediatric Formulary Committee. British national formulary for children 2009. London, BMJ Group RBS Publishing,
2009.
Twycross R, Wilcock A, eds. Palliative care formulary, 3rd ed. Nottingham, palliativedrugs.com, 2007.
A1.8 Paracetamol
ATC code: N02BE01
Oral liquid: 25 mg/ml.
Suppository: 100 mg.
Tablet: 100–500 mg.
also referred to as acetaminophen.
Indications: mild pain.
Precautions: hepatic impairment, renal impairment, overdose.
Dose:
Oral or rectal:
• neonate – 10 mg/kg every 6–8 hours as necessary; maximum dose is 4 doses in 24 hours;
• infant or child – 15 mg/kg, up to 1 g, every 4–6 hours as necessary; maximum dose is 4 doses,
or 4 g, in 24 hours.
Hepatic impairment: dose-related toxicity; do not exceed the daily recommended dose.
Adverse effects:
• rare – rash, pruritus, urticaria, hypersensitivity, anaphylactic reactions, neutropenia,
thrombocytopenia, pancytopenia.
Hepatotoxicity (and less frequently renal damage) can occur after paracetamol overdose and can
even occur at standard doses in children with the conditions described above.
Interactions with other medicines:
• carbamazepine – increased potential hepatotoxicity to paracetamol;
• metoclopramide – increased absorption of paracetamol;
• phenobarbital – increased potential hepatotoxicity to paracetamol;
• phenytoin – increased potential hepatotoxicity to paracetamol;
• warfarin – prolonged regular use of paracetamol possibly enhances anticoagulant effect.
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