[See also Paracetamol Monograph.]
Description and indication for use
Guideline for Intravenous Paracetamol (Perfalgan) Dosing
in RCH NNU.
Paracetamol is an effective analgesic in
the newborn / post-operative period.
Despite its widespread use, it carries
significant risks with respect to the side-effect profile, most specifically
having potential to cause irreversible liver damage.
There is little data upon which to guide Paracetamol
dosing in the perinatal period. There is no data regarding oral dosing, and a
paucity of data for the use of Paracetamol under 32 weeks’ gestation.
Dosing of IV Paracetamol is as follows:
|
Infants
gestational age equivalent at the time of dosing
|
Paracetamol
dose (mg/kg)
|
Dosing
interval
|
Maximum
dosing per day (mg/kg)
|
|
<
32 weeks
|
10
|
8 hourly
|
30
|
|
32
- < 44weeks
|
10
|
6 hourly
|
40
|
|
≥
44 weeks
|
15
|
6 hourly
|
60
|
Paracetamol should
be administered undiluted. Administer over 15 minutes. Administer alone.
Paracetamol
should be avoided or administered in reduced frequency and/or doses than in the
above guideline if any of the following exist:
Hyperbilirubinaemia requiring
phototherapy.
- Other severe liver disease.
- Prolonged fasting (not
receiving TPN)/severe malnutrition-intrauterine growth retardation.
- If paracetamol is required for
more than 48 hours, the ongoing need
for paracetamol should be reviewed by a consultant.
- The decision to continue should
be based upon:
The infant’s medical condition
and expected course.
Assessment of liver function.
Need for ongoing analgesia
based on pain scoring.
Alternative analgesic options
available for the infant’s treatment.
References:
1. Palmer GM, Atkins M,
Anderson BJ, Smith KR, Culnane TJ, McNally CM, Perkins EJ, Chalkiadis G and
Hunt RW. Intravenous paracetamol
(acetaminophen) pharmacokinetics in neonates following multiple doses. Br J Anaesth 2008 Oct;101(4): 523-530. PMID:
18628265.
2. Allegaert K, Palmer GM,
Anderson BJ. The pharmacokinetics of IV
paracetamol in neonates: size matters. Eur
J Clin Pharmacol. 2004 May;60(3): 191-7. PMID: 15071761.