Note: The article you are reading is only for the purpose of raising awareness and is not a substitute for a doctor's advice. To take medicine, to know about side effects, drug interaction and other related matters, you must visit a specialist doctor.

 

Acetaminophen or paracetamol or tylenol or panadol is an analgesic, anti-inflammatory and anti-pyretic drug that is not included in corticosteroid drugs. It is used for back pain, toothache and unusual headaches such as migraine and other cases without any special side effects.

In all medical articles and books, this drug is known as a well-tolerated type of drug. This drug is prescribed in most doctors' prescriptions from a simple cold to a certain type of disease, but why is it the main cause of immediate liver poisoning in the world, especially in the West?

Every year, many people die in connection with this drug or even other drugs due to lack or lack of awareness. In the United States, England and Australia, this issue is seen more severely than in other countries.

Suitable dose for adults with normal liver and kidney function:

(Oral) 325 to 650 mg every 4 to 6 hours or 1 gram every 6 hours with a maximum dose of 4 grams per day.

Intravenous (IV)
If the weight is more than 50 kg: 650 mg every 4 hours or 1 gram every 6 hours (maximum 1 gram per dose) and with a maximum dose of 4 grams per day.
If the weight is less than 50 kg: 12.5 mg per kg of body weight every 4 hours or 15 mg per kg of body weight every 6 hours (maximum 750 mg per dose) with a maximum dose of less than 75 milligrams per kilogram of body weight per day.(less than 3.75 grams per day)

Rectal:325 to 650 mg every 4 to 6 hours with a maximum dose of 3.9 g per day.

Appropriate dosage for adults with renal dysfunction: Oral and Rectal, similar to those without renal dysfunction. There is no need to adjust the dose in patients with renal function.

Intravenous (IV)
In case of GFR more than 15: there is no need to adjust the dose.

In case of GFR less than 15: there is usually no need to adjust the dose, however, it is recommended to reduce the amount of medicine in each dose and increase the interval between doses.

Appropriate dosage for adults with liver disorders:

Acetaminophen should be used with caution in people with liver disease.In patients who have chronic liver disease and their disease has already been compensated, the maximum dose should be limited to 2 to 3 grams per day.

It should be emphasized to the patient that the use of other drugs that are dangerous for the liver, such as alcohol or some medicinal plants, as well as malnutrition, severe weight loss, and fasting can increase the risk of acetaminophen hepatotoxicity.

Therefore, the oral use of acetaminophen in these patients should be restricted and should not be used if safe.

The use of the drug by intravenous injection is prohibited in those with advanced liver failure.

Appropriate dosage for children with normal liver and kidney function:


Warning: Acetaminophen is mainly used as an oral syrup in children. These syrups have different medicinal concentrations, so you should pay attention to this point before use.

The maximum dose of medicine in children is less than 75 mg per kilogram of weight per day and generally less than 4 grams per day. It is better to take less than 5 times a day.

 

Intravenous (IV): Infants and children under 2 years of age: 7.5 to 15 mg per kilogram of body weight every 4 to 6 hours up to a maximum of 60 mg per kilogram of body weight daily.

Children older than 2 years:

If you weigh more than 50 kg: 15 mg per kg of body weight every 6 hours or 12.5 mg per kg of body weight every 4 hours (maximum 1 g in one dose) up to a maximum of 75 mg per kg  Body weight per day should not exceed 4 grams per day.

If the weight is less than 50 kg: 15 mg per kg of body weight every 6 hours or 12.5 mg per kg of body weight every 4 hours (maximum 750 mg in one dose) up to a maximum of 75 mg per  kg of body weight so that it does not exceed 3750 mg daily.

Teenagers:

If the weight is more than 50 kg: 1000 mg every 6 hours or 650 mg every 4 hours (maximum 1 gram in one dose) up to a maximum of 4 grams daily.


If the weight is less than 50 kg: 15 mg per kg of body weight every 6 hours or 12.5 mg per kg of body weight every 4 hours (maximum 750 mg in one dose) up to a maximum of 75 mg per kg of body weight so that it does not exceed 3750 mg daily.

Rectal:

There is no complete information in this field.  However, the dose of 40 mg per kilogram of body weight up to a maximum of 1 gram per dose has been used the most, and no dose-related complications have been observed.

 20 to 25 mg per kilogram of body weight every 6 hours for 2 to 3 days is recommended as a maintenance dose for pain in children.

Please discuss with your doctor for more certainty.

 

Appropriate dosage for children with renal dysfunction:

In children with kidney disease, there is no need to adjust the dose of acetaminophen and the drug can be used with the usual dose.

Appropriate dosage for children with liver dysfunction:

It is better not to use acetaminophen in children who have liver diseases.

The risk of taking acetaminophen in pregnancy:

It is true that research has shown that occasional use of acetaminophen is unlikely to harm the mother or fetus, but long-term use of acetaminophen during pregnancy is not recommended.

The permissible dose of acetaminophen is very important in pregnancy, and excessive consumption of acetaminophen (more than 4000 mg in 24 hours) at one time can lead to severe liver damage and harm the fetus.

A drug that kills tens of thousands of people every year!!!

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Sources examined:

1/Katzong's basic and clinical pharmacology

2/Evidence-based pharmacotherapy book series

3/Dipiro's pharmacotherapy handbook

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