Panadol

# Panadol (Acetaminophen / Paracetamol) ## Overview - **Classification**: Analgesic and Antipyretic (non-opioid) - **Mechanism**: Inhibits prostaglandin synthesis in the central nervous system (CNS), reducing pain and modulating the hypothalamic heat-regulating center. ## Primary Indications 1. **Mild to Moderate Pain**: Management of headache, muscle ache, and musculoskeletal pain. 2. **Fever/Pyrexia**: Reduction of elevated body temperature associated with various conditions. 3. **Osteoarthritis**: Used as a first-line agent, especially in mild cases. ## Adult Dosing ### Standard Dosing **Pain/Fever Management** - **Dose**: **325 mg** to **1000 mg** - **Frequency**: Every 4 to 6 hours as needed (PRN) - **Route**: Oral, Rectal (Suppository), or IV (Injection) - **Maximum Daily Dose**: **4000 mg** (4 g) in healthy adults ### Dose Adjustments - **Renal Impairment (CrCl 10-50 mL/min)**: Dosing interval often extended to every **6 hours**. - **Renal Impairment (CrCl <10 mL/min)**: Dosing interval often extended to every **8 hours**. - **Hepatic Impairment**: **Contraindicated** in severe disease; consider maximum dose of **2000 mg** per day in chronic stable disease. - **Elderly Patients**: Use caution; often recommended max dose of **3000 mg** per day due to potential polypharmacy or decreasing hepatic reserve. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **10-15 mg/kg/dose** - **Frequency**: Every 6 to 8 hours - **Maximum**: 60 mg/kg/day total - **Special Notes**: Use lowest effective dose; liquid formulation essential; monitor for strict adherence to weight-based dosing. ### Infants (1-12 months) - **Dose**: **10-15 mg/kg/dose** - **Frequency**: Every 4 to 6 hours - **Maximum**: **75 mg/kg/day** total, not to exceed **4000 mg** per day. ### Children (1-12 years) - **Dose**: **10-15 mg/kg/dose** - **Frequency**: Every 4 to 6 hours - **Maximum**: **75 mg/kg/day** total, not to exceed **4000 mg** per day. ### Adolescents (13-18 years) - **Dose**: Approach adult dosing, typically **650-1000 mg** per dose. - **Maximum**: **4000 mg** per 24 hours. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to acetaminophen. - **Absolute**: Severe active liver disease or acute liver failure. ### Common Adverse Effects - **Very Common (>10%)**: None specific to recommended doses. - **Common (1-10%)**: Nausea, vomiting, insomnia (rare). - **Serious but Rare**: **Hepatotoxicity** (dose-dependent), Anaphylaxis, Severe cutaneous reactions (SJS/TEN). ### Key Drug Interactions - **Warfarin**: May increase INR; monitor closely, especially with consistent high doses (>2000 mg/day). - **Ethanol (Alcohol)**: Increases risk of hepatotoxicity; advise minimal or no alcohol use. - **Isoniazid, Phenytoin, Carbamazepine**: May increase acetaminophen's metabolism, increasing risk of harmful metabolites and hepatotoxicity. ## Monitoring & Follow-up - **Before Treatment**: Baseline AST/ALT is generally unnecessary unless pre-existing liver disease is suspected. - **During Treatment**: Monitor for signs of hepatic injury (jaundice, nausea, fatigue), especially with chronic use or overdose. - **Clinical Signs**: Assess pain relief (VAS scores) or temperature reduction within 1-2 hours of administration. ## Clinical Pearls - 💡 **Tip 1**: Overdose treatment is **N-acetylcysteine (NAC)**; treatment should be started rapidly, ideally within 8 hours. - 💡 **Tip 2**: Counsel patients to check all OTC products for acetaminophen content to avoid inadvertent overdose (e.g., cold/flu remedies). - 💡 **Tip 3**: The **maximum daily dose of 4000 mg** should be reduced to **3000 mg or less** in chronic users, malnourished patients, or those with underlying liver concerns. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.