Acetaminophen

Oral
Intravenous
Rectal
Class
Antipyretics
Subclass
Anilides
Substance name
Acetaminophen, paracetamol
Brand names
Tylenol®, Feverall®
Common formulations
Film-coated tablet
See also
Acetaminophen ER (Tylenol 8hr®)
Contained in
Acetaminophen / caffeine / dihydrocodeine (Trezix®)
Acetaminophen / oxycodone (Percocet®)
Benzhydrocodone / acetaminophen (Apadaz®)
Butalbital / acetaminophen (Allzital®, Bupap®, Tencon®)
Butalbital / acetaminophen / caffeine (Esgic®, Fioricet®)
Hydrocodone / acetaminophen (Hycet®, Lortab®, Norco®, Xodol®, Zamicet®, Zydone®)
Tramadol / acetaminophen (Ultracet®)
Dosage and administration
Adults patients
Symptomatic relief
Fever
•
Maintenance: 650 mg PO q4-6h PRN
•
Maximum: 3,250 mg per day
Alternative
•
Maintenance: 1,000 mg PO QID PRN
•
Maximum: 3,000 mg per day
Pain • Mild-to-moderate
•
Maintenance: 650 mg PO q4-6h PRN
•
Maximum: 3,250 mg per day
Alternative
•
Maintenance: 1,000 mg PO QID PRN
•
Maximum: 3,000 mg per day
Treatment
Treatment of migraine attacks • Off-label
•
1,000 mg PO once
Pediatric patients
Fever
Weight < 60 kg
•
Maintenance: 10-15 mg/kg PO q4-6h PRN
•
Maximum: 100 mg/kg per day
Pain • Mild-to-moderate
Weight < 60 kg
•
Maintenance: 10-15 mg/kg PO q4-6h PRN
•
Maximum: 100 mg/kg per day
Weight ≥ 60 kg
•
Maintenance: 650 mg PO q4-6h PRN
•
Maximum: 3,250 mg per day
Indications for use
Labeled indications
Adults
•
Symptomatic relief of fever
•
Symptomatic relief of pain (mild-to-moderate)
Children
•
Symptomatic relief of fever
•
Symptomatic relief of fever (in patients ≤ 1 year)
•
Symptomatic relief of pain
•
Symptomatic relief of pain (in patients ≤ 1 year) (mild-to-moderate)
•
Symptomatic relief of pain (mild-to-moderate)
Off-label indications
Adults
•
Treatment of migraine attacks
Safety risks
Boxed warnings
Hepatotoxicity
•
Use extreme caution when using large doses. Do not use doses larger than 4,000 mg per day.
Contraindications
Hypersensitivity to acetaminophen or its components
Severe hepatic impairment or severe active liver disease
Warnings and precautions
ALF
•
Use extreme caution in patients with underlying liver disease or using alcohol while taking acetaminophen.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Child-Pugh A (mild)
•
Use with caution.
Child-Pugh B (moderate)
•
Use with caution.
Child-Pugh C (severe)
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Generally acceptable for use.
Breastfeeding
Acceptable for use during breastfeeding.
Undetectable levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Nausea
Common 1-10%
•
Constipation, dizziness, dyspepsia, facial sweating, headache, somnolence, vomiting
Uncommon < 1%
•
Pruritus
Unknown frequency
•
Acute liver failure, ↑ liver enzymes
Interactions
Drug(s)
Check Interactions
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