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Paracetamol.

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VOL: 101, ISSUE: 04, PAGE NO: 29

Generic/proprietary names

- Paracetamol.

- There is a large variety of prescription-only and over-the-counter medications that contain paracetamol alone or in combination with other ingredients.

Action

- Paracetamol is a non-opioid analgesic.

- It inhibits prostaglandin synthesis.

- Paracetamol is effective at reducing pain and fever.

- It is sometimes used to relieve cancer pain.

Indications

- Mild to moderate pain.

- Pyrexia. 

- Post-vaccination fever from two months of age.

Cautions

- Decreased kidney function.

- Decreased liver function.

- Alcohol dependence.

Side-effects

- Side-effects are rare and include skin rashes and blood disorders.

- In overdose, hepatocellular necrosis or less frequently renal tubular necrosis.

Interactions

- Increased INR may occur with patients taking warfarin.

- Cholestyramine may reduce the absorption of paracetamol from the gut.

- Metoclopramide and domperidone may increase the absorption of paracetamol from the gut.

Administration

- Liquid paracetamol is flavoured to make it more palatable. It is available in a variety of concentrations.

- Tablets are available in traditional and soluble form.

- Suppositories are also available.

- Administer as required four times a day, every 4-6 hours.

- Do not give more than four doses in 24 hours.

Nursing considerations

- Check that the patient is not taking any other medication containing paracetamol.

- For children who may refuse medicine off a spoon try using a medicine syringe to squirt liquid slowly into the side of the child’s mouth or use soluble paracetamol mixed with a drink.

- Some children may be happy to take one paracetamol product but dislike the taste of another.

- There are no known harmful effects when used during pregnancy.

- Small amounts may pass into breast milk. However, there are no known harmful effects when used by breastfeeding mothers.

- Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistent heavy drinkers and in people with alcoholic liver disease.

- Evaluate therapeutic response.

Patient teaching

- If symptoms persist for more than three days, patients should consult the prescribing practitioner.

- Patients should be cautioned not to take any other products containing paracetamol and they should read the label of all other medication carefully to ensure that it does not contain paracetamol.

- Make sure patients are aware they must not exceed the recommended dose.

- Immediate medical advice should be sought in the event of an overdose, even if patients feel well, because of the risk of delayed, serious liver damage.

- Paracetamol for children comes in different strengths. Parents should take care they give their child the correct dose.

- Paracetamol can be taken on an empty stomach.

- Do not drink excessive quantities of alcohol while taking paracetamol.

- Keep all paracetamol well out of the reach of children.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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