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Paracetamol Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Reduce dose in patients weighing less than 50kg (see 'Dose' overleaf for details)
- Pharmacy DO NOT endorse any intravenous dose in excess of 1gram
- Paracetamol for infusion is 10mg/1ml. Fatalities have been reported where patients have been dosed in ml instead of mg (potential 10-fold overdose). Always prescribe total dose in mg and ml. e.g 500mg/50ml.
- A single dose of paracetamol should never exceed 100ml
- Overdose algorithm is different for the INTRAVENOUS formulation. Advise contact National Poisons Centre
- Check whether paracetamol is also being given by other routes - to avoid inadvertant overdose - eg po Solpadol, Panadeine, Paracetamol
- Consider IV to PO or PR switch as soon as possible
- The maximum daily dose is 3g in patients with risk factors for hepatotoxicity
- see under 'Dose' re: renal impairment
Available preparations
Paracetamol 1g per 100ml bag (Macopharm) or Ecoflac (Braun)
Paracetamol 500mg per 50ml infusion bottle (Fresenius Kabi)
Reconstitution
Already in solution
Infusion fluids
Not required - product ready for infusion
Methods of intravenous administration
Intermittent intravenous infusion
- Administer over 15 minutes
If using glass bottles : Glass bottle precautions as follows: (ref 1)
- Precautions need to be taken during administration to prevent possible air embolism - particularly in central line administration.
- Bottles must be vented in one of two ways· Directly by means of a filter needle into the bottle which goes through the rubber stopper and opens into the air, or · Direct air vent on the air inlet of the administration set, located between the drip chamber and piercing pin, it is covered with a bacterial retentive filter to reduce the chance of contamination
Dose in adults
Patient weight | Dose | Frequency | Maximum daily dose | Comment |
---|---|---|---|---|
Greater than 50kg | 1g | Four to six hourly | 4g in 24 hours | Important: The maximum daily dose is 3g in patients with risk factors for hepatotoxicity |
Greater than 33kg, up to or equal to 50kg | 15mg per kg | Four to six hourly |
60mg/kg/24 hours max 3g (24 hours) |
Calculate the dose in mg. NOTE: some drug will need to be discarded eg. required dose is 650mg (65ml)- remove and discard 350mg (35ml) from 1000mg bag |
Less than or equal to 33kg | 15mg per kg | Four to six hourly |
60mg/kg/24 hours max 2g (24 hours) |
Use the 500mg in 50ml preparation Calculate the dose in mg Note: some drug will need to be discarded eg. required dose is 400mg (40ml), remove and discard 100mg (10ml) from 500mg bottle |
Important: The maximum daily dose is 3g in patients with risk factors for hepatotoxicity
Renal impairment
- Use with caution where eGFR is less than or equal to 30ml/min/1.73m2
- Minimum interval between doses is six hours for patients with eGFR less than or equal to 30ml/min/1.73m2
Hepatic impairment
- The manufacturer's contraindicate its use in patients with severe hepatic impairment
- Maximum daily dose is 3g
Further information
- Numerous over-the-counter and prescription products contain paracetamol as an ingredient e.g. Panadol, Paramol, Solpadeine, Solpadol, Lemsip etc. Avoid prescribing more than one paracetamol-containing product at a time as local experience suggests that maximum doses may be exceeded.
Storage
- Store below 250C
- Keep the vial in the outer carton in order to protect from light
References
SPC (B Braun) November 2019