Acetaminophen, (Paracetamol)
Abenol , A’Cenol, Acephen, Anacin-3, Anuphen, APAP, Atasol ,
Campain , Dolanex, Exdol , Halenol, Liquiprin, Ofirmev, Panadol, Pedric,
Robigesic , Rounox, Tapar, Tempra, Tylenol, Tylenol Arthritis, Valadol
Classifications: NONNARCOTIC ANALGESIC, ANTIPYRETIC
Therapeutic: NONNARCOTIC ANALGESIC; ANTIPYRETIC
Suppository; tablet/caplet; extended release tablet/capsule;
liquid; injection
ACTION & THERAPEUTIC EFFECT
Produces analgesia by unknown mechanism, but it is centrally
acting in the CNS by increasing the pain threshold by inhibiting
cyclooxygenase. Reduces fever by direct action on hypothalamus heat-regulating
center with consequent peripheral vasodilation, sweating, and dissipation of
heat. It provides temporary analgesia for mild to moderate pain. In
addition, acetaminophen lowers body temperature in individuals with a fever.
Fever reduction. Temporary relief of mild to moderate pain. Generally
as substitute for aspirin when the latter is not tolerated or is contraindicated.
Hypersensitivity to acetaminophen or phenacetin. Acute liver
failure has been associated with doses that exceed 4000 mg per day.
Repeated administration to patients with anemia, G6PD deficiency,
renal or hepatic disease; arthritic or rheumatoid conditions affecting children
younger than 12 y; alcoholism; malnutrition; thrombocytopenia; bone marrow
depression, immunosuppression; pregnancy
Mild to Moderate Pain, Fever
PO 325–650 mg q4–6h (max: 4 g/day) PR 650 mg
q4–6h (max: 4 g/day) IV 1000 mg q6h or 650 q4h prn
PO 10–15 mg/kg q4–6h PR 2–5 y: 120 mg q4–6h (max:720
mg/day); 6–12 y: 325 mg q4–6h (max:
2.6 g/day)
IV 15 mg/ kg/dose q6h or 12.5 mg/kg/dose q4h prn
Neonate:
PO 10–15 mg/kg q6–8h
- Ensure that extended release tablets are not crushed or chewed. These
must be swallowed whole.
- Chewable tablets should be thoroughly chewed and wetted before they
are swallowed.
- Do not coadminister with a high carbohydrate meal; absorption rate
may be significantly retarded.
- Store in light-resistant containers at room temperature,
preferably between 15°–30° C (59°–86° F).
- Insert suppositories beyond the rectal sphincter.
Intermittent: For adults and adolescents
weighing 50 kg (110 lb) or more, give without dilution by attaching a vented IV
set directly to the 100 mL (1000 mg) vial. For patients weighing less than 50
kg (110 lb), withdraw the needed dose from a sealed 1000mg vial and place in an
empty sterile container (e.g., plastic IV bag, syringe) for infusion.
Intermittent: Infuse over 15 min. For
small volume pediatric doses up to 60 mL, use a syringe pump to administer over
15 min. Store at controlled temperature and use within 6 h after opening.
Body as a Whole: Negligible with recommended
dosage; rash. Acute poisoning: Anorexia, nausea, vomiting, dizziness,
lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea; onset of
hepatotoxicity: elevation of serum transaminases (ALT, AST) and bilirubin;
hypoglycemia, hepatic coma, acute renal failure (rare).
Chronic ingestion: Neutropenia, pancytopenia,
leukopenia, thrombocytopenic purpura, hepatotoxicity in alcoholics, renal
damage.
DIAGNOSTIC TEST INTERFERENCE
False increases in urinary 5-HIAA (5-hydroxyindoleacetic
acid) byproduct of serotonin; false decreases in blood glucose (by
glucose oxidase–peroxidase procedure); false increases in urinary
glucose (with certain instruments in glucose analyses); and false increases in serum
uric acid (with phosphotungstate method). High doses or
long-term therapy: hepatic, renal, and hematopoietic function (periodically).
Drug: Cholestyramine may decrease
acetaminophen absorption. With chronic coadministration, BARBITURATES, carbamazepine,
phenytoin, and rifampin may increase potential for chronic hepatotoxicity.
Chronic, excessive ingestion of alcohol will increase risk of
hepatotoxicity.
Absorption: Rapid and almost complete
absorption (PO) less complete absorption from rectal suppository. Peak: 0.5–2
h. Duration: 3–4 h. Distribution: In all body fluids; crosses
placenta.
Metabolism: Extensively in liver.
Elimination: 90–100% of drug excreted as
metabolites in urine; excreted in breast milk. Half-Life: 1–3 h.
Black
Box WarningDoses in excess of 4000 mg/day have been associated with acute liver
failure.
Assessment & Drug Effects
- Monitor for S&S of: Hepatotoxicity, even with moderate
acetaminophen doses, especially in individuals with poor nutrition or who have
ingested alcohol (3 or more alcoholic drinks daily) over prolonged periods;
poisoning, usually from accidental ingestion or suicide attempts; potential
abuse from psychological dependence (withdrawal has been associated with restless
and excited responses).
Patient & Family Education
- Do not take other medications (e.g., cold preparations) containing
acetaminophen without medical advice; overdosing and chronic use can cause
liver damage and other toxic effects.
- Do not self-medicate adults for pain more than 10 days (5 days in
children) without consulting a prescriber.
- Do not use this medication without medical direction for: Fever persisting
longer than 3 days, fever over 39.5° C (103° F), or recurrent fever.
- Do not give children more than 5 doses in 24 h unless prescribed by
prescriber.
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