Cetamol

# Cetamol ## Overview - **Classification**: Analgesic, Antipyretic - **Mechanism**: Thought to inhibit prostaglandin synthesis primarily in the central nervous system, leading to analgesic and antipyretic effects. It has weak anti-inflammatory activity. ## Primary Indications 1. **Mild to Moderate Pain** - e.g., headache, muscle ache, toothache, dysmenorrhea. 2. **Fever Reduction** - Associated with various conditions like colds, flu, vaccinations. 3. **Osteoarthritis Pain** - As a first-line agent for mild to moderate pain. ## Adult Dosing ### Standard Dosing **Mild to Moderate Pain / Fever** - **Dose**: **325 mg** to **1000 mg** - **Frequency**: Every **4-6 hours** as needed - **Route**: Oral, Rectal, IV - **Maximum Dose**: **4000 mg** per **24 hours** (some sources recommend **3000 mg** for chronic use) ### Dose Adjustments - **Renal Impairment**: - CrCl **<50 mL/min**: Extend dosing interval to every **6 hours**. - CrCl **<10 mL/min**: Extend dosing interval to every **8 hours**. - **Hepatic Impairment**: Reduce dose and/or extend interval. Max **2000 mg/day**. Avoid in severe hepatic disease. - **Elderly Patients**: Generally, no specific adjustment needed beyond renal/hepatic considerations. May be more susceptible to adverse effects. ## Pediatric Dosing ### Neonates (0-28 days) - **Indication**: Pain or Fever (often used in hospital settings for post-surgical pain). - **Dose**: **10-15 mg/kg** - **Frequency**: Every **6-8 hours** - **Maximum**: **60 mg/kg/day** - **Special Notes**: Use with caution. Oral solution preferred. Consider prolonged half-life. ### Infants (1-12 months) - **Indication**: Pain or Fever - **Dose**: **10-15 mg/kg** - **Frequency**: Every **4-6 hours** - **Maximum**: **75 mg/kg/day** (not to exceed **4000 mg/day**) ### Children (1-12 years) - **Indication**: Pain or Fever - **Dose**: **10-15 mg/kg** - **Frequency**: Every **4-6 hours** - **Maximum**: **75 mg/kg/day** (not to exceed **4000 mg/day**) - **Formulation**: Oral suspension is common for accurate dosing. ### Adolescents (13-18 years) - **Indication**: Pain or Fever - **Dose**: Follow **adult dosing** of **325-1000 mg** - **Frequency**: Every **4-6 hours** - **Maximum**: **4000 mg** per **24 hours** ## Safety Information ### Contraindications - **Absolute**: Severe hepatic impairment or active liver disease. - **Absolute**: Known hypersensitivity to Cetamol or excipients. ### Common Adverse Effects - **Very Common (>10%)**: Generally well-tolerated at therapeutic doses. - **Common (1-10%)**: Nausea, vomiting, insomnia, constipation (with IV). - **Serious but Rare**: Hepatotoxicity (overdose), severe skin reactions (SJS, TEN, AGEP), blood dyscrasias. ### Key Drug Interactions - **Warfarin**: May increase INR and bleeding risk, especially with doses >**2000 mg/day** for >1 week. Monitor INR. - **Alcohol**: Chronic heavy alcohol use increases risk of hepatotoxicity. Advise moderation. - **Isoniazid, Rifampin, Phenytoin**: May increase risk of hepatotoxicity due to enzyme induction. - **Other Paracetamol-containing products**: Risk of accidental overdose. Advise patients to check all labels. ## Monitoring & Follow-up - **Before Treatment**: Baseline liver function tests (LFTs) if patient has pre-existing liver disease or chronic alcohol use. - **During Treatment**: Monitor for signs/symptoms of liver injury (jaundice, dark urine, abdominal pain). - **Clinical Signs**: Watch for effectiveness (pain/fever reduction) and any signs of overdose (nausea, vomiting, diaphoresis, malaise). ## Clinical Pearls - 💡 **Max Dose Caution**: Emphasize **daily maximum doses** for all patients to prevent overdose and liver damage. - 💡 **Formulation Accuracy**: Always use appropriate measuring devices for liquid pediatric formulations. - 💡 **Combination Products**: Counsel patients to avoid taking multiple products containing Cetamol simultaneously. - 💡 **Antidote Availability**: N-acetylcysteine (NAC) is the antidote for Cetamol overdose; timely administration is critical. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.