PARACETAMOL. DESCRIPTION. Non-narcotic analgesic and antipyretic.
Paracetamol is rapidly absorbed by mouth and widely distributed in the body.
ROYAL HOSPITAL FOR WOMEN
Approved by Neonatal Clinical Committee
CLINICAL POLICIES AND PROCEDURES NEWBORN USE ONLY GIVEN ON DOCTORS ORDER ONLY
PARACETAMOL DESCRIPTION
Non-narcotic analgesic and antipyretic. Paracetamol is rapidly absorbed by mouth and widely distributed in the body. Extensively metabolized in the liver, primarily by sulfation with a small amount by glucuronidation
PHARMACOKINETICS Metabolites and unchanged drug are excreted by the kidney. Elimination half-life is approximately 3 hours in term neonates, 5 hours up to 11 hours in preterm neonates. Elimination is prolonged in patients with liver dysfunction. Optimum pain relief occurs over an hour after the blood level peaks. IV paracetamol is a more effective analgesic compared to oral paracetamol, offering faster onset of action, higher peak plasma concentration and longer duration of action. USE
Analgesia
PRESENTATION
ORAL 100mg/ml syrup IV 500mg/50ml (10mg/ml) vial
DOSE
7.5 mg/kg/dose 6 hourly
MAXIMUM OF FOUR DOSES DAILY WITH A MAXIMUM OF 30 MG/KG/DAY!
Warning! review dose and indications if IV paracetamol is needed for more then 3 days! ROUTE
IV
used for post-operative analgesia where oral route is contraindicated or unavailable NBM> 24 hrs High nasogastric output Vomiting due to prolonged ileus Short gut
ORAL RECTAL
NOT recommended as rectal absorption is unreliable
ADMINISTRATION
IV ORAL RECTAL
Administer undiluted over 15minutes via syringe driver.
MONITORING
Hepatic and renal function
ADVERSE EFFECT 1. 2. 3. 4. 5. 6.
Pain at the injection site Vomiting Rash, neutropenia, leucopoenia, thrombocytopenia Neurological disorders, hypersensitivity, anaphylaxis Hepatotoxicity as higher peak plasma levels achieved Rare occurrence of elevated liver transaminases
ROYAL HOSPITAL FOR WOMEN
Approved by Neonatal Clinical Committee
CLINICAL POLICIES AND PROCEDURES NEWBORN USE ONLY GIVEN ON DOCTORS ORDER ONLY PARACETAMOL cont PRECAUTIONS 1. 2. 3. 4. CONTRAINDICATIONS 1. 2.
Hepatic or renal impairment Dehydration Chronic malnutrition Hypotension
Hypersensitivity to paracetamol. Active liver disease.
SOLUTION COMPATIBILITY
0.9%sodium chloride, 5% dextrose
INCOMPATABILITY
IV Paracetamol should not be mixed with any other intravenous fluids or medications!
REFERENCE 1. 2.
Neonatal Formulary 5, Drug use in Pregnancy and First Year of Life, 2007, Blackwell Publishing Personal communication with The Royal Children’s hospital, Neonatal Department and Pharmacy, Parkville, Melbourne, Vic.
3. MIMS (No dosing schedule for preterm). 4. Bristol-Myers Squibb Australia Pty Ltd Information 23.05.2012
