ACETAMINOPHEN, PARACETAMOL Pr

(a-seat-a-mee’noe-fen)

Abenol , A’Cenol, Acephen, Anacin-3, Anuphen, APAP, Atasol

, Campain , Dolanex, Exdol , Halenol, Liquiprin, Ofi mev,
Panadol, Pedric, Robigesic , Rounox , Tapar, Tempra,
Tylenol, Tylenol Arthritis, Valadol

Classifications: NONNARCOTIC ANALGESIC, ANTIPYRETIC

Therapeutic: NONNARCOTIC ANALGESIC; ANTIPYRETIC

Pregnancy Category: B

Availability: 80 mg, 120 mg, 125 mg, 300 mg, 325 mg, 650 mg
suppositories; 80 mg, 160 mg, 325 mg, 500 mg tablets/caplets; 650 mg
extended release tablets/capsules; 80 mg/0.8 mL, 80 mg/2.5 mL,
80 mg/5 mL, 120 mg/5 mL, 160 mg/5 mL, 500 mg/5 mL liquid

Action & Therapeutic Effect: Produces analgesia by unknown

mechanism, but it is centrally acting in the CNS by increasing the pain
threshold by inhibiting cyclooxygenase. Reduces fever by direct action
on hypothalamus heat-regulating center with consequent peripheral
vasodilation, sweating, and dissipation of heat. It provides temporary
analgesia for mild to moderate pain. In addition, acetaminophen
lowers body temperature in individuals with a fever.

Uses: Fever reduction. Temporary relief of mild to moderate pain.

Generally as substitute for aspirin when the latter is not tolerated or is
contraindicated.

Contraindications: Hypersensitivity to acetaminophen or phenacetin;

use with alcohol.

Cautious Use: Repeated administration to patients with anemia,

G6PD deficiency, renal or hepatic disease; arthritic or rheumatoid
conditions affecting children younger than 12 y; alcoholism;
malnutrition; thrombocytopenia; bone marrow depression,
immunosuppression; pregnancy (category B).

Common adverse effects in italic, life-threatening effects underlined; generic names

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Acetaminophen, Paracetamol. In Pearson
Nurse’s Drug Guide 2012 (pp. 9–11). Upper Saddle River, NJ: Prentice Hall. 1
in bold; classifications in SMALL CAPS; Canadian drug name; Pr Prototype drug
Route & Dosage

Mild to Moderate Pain, Fever

Adult: PO 325–650 mg q4–6h (max: 4 g/day) PR 650 mg q4–6h

(max: 4 g/day) IV 1000 mg q6h or 650 q4h prn

Child: PO 10–15 mg/kg q4–6h PR 2–5 y, 120 mg q4–6h

(max: 720 mg/day); 6–12 y, 325 mg q4–6h (max: 2.6 g/day)

Child (2 y or more): IV 15 mg/kg/dose q6h or 12.5 mg/kg/dose q4h

prn

Neonate: PO 10–15 mg/kg q6–8h

Administration

Oral
• Ensure that extended release tablets are not crushed or chewed.
These must be swallowed whole.
• Chewable tablets should be thoroughly chewed and wetted
before they are swallowed.
• Do not coadminister with a high carbohydrate meal; absorption
rate may be significantly retarded.
• Store in light-resistant containers at room temperature,
preferably between 15°–30° C (59°–86° F).

Rectal
• Insert suppositories beyond the rectal sphincter.

Intravenous

Prepare: Intermittent: For adults and adolescents weighing 50 kg

(110 lb) or more, give without dilution by attaching a vented IV set
directly to the 100 mL (1000 mg) vial. For patients weighing less than
50 kg (110 lb.), withdraw the needed dose from a sealed 1000 mg vial
and place in an empty sterile container (e.g., plastic IV bag, syringe)
for infusion.

Administer: Intermittent: Infuse over 15 min. For small volume

pediatric doses up to 60 mL, use a syringe pump to administer over 15
min. Store at controlled temperature and use within 6h after opening.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Acetaminophen, Paracetamol. In Pearson
2 Nurse's Drug Guide 2012 (pp. 9–11). Upper Saddle River, NJ: Prentice Hall.
Adverse Effects (≥1%): Body as a Whole: Negligible with
recommended dosage; rash. Acute poisoning: Anorexia, nausea,
vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or
abdominal pain, diarrhea; onset of hepatotoxicity: elevation of serum
transaminases (ALT, AST) and bilirubin; hypoglycemia, hepatic coma,
acute renal failure (rare). Chronic ingestion: Neutropenia,
pancytopenia, leukopenia, thrombocytopenic purpura, hepatotoxicity in
alcoholics, renal damage.

Diagnostic Test Interference: False increases in urinary 5-HIAA

(5-hydroxyindoleacetic acid) byproduct of serotonin; false decreases in
blood glucose (by glucose oxidase–peroxidase procedure); false
increases in urinary glucose (with certain instruments in glucose
analyses); and false increases in serum uric acid (with
phosphotungstate method). High doses or long-term therapy:
hepatic, renal, and hematopoietic function (periodically).

Interactions: Drug: Cholestyramine may decrease acetaminophen

absorption. With chronic coadministration, BARBITURATES,
carbamazepine, phenytoin, and rifampin may increase potential
for chronic hepatotoxicity. Chronic, excessive ingestion of alcohol will
increase risk of hepatotoxicity.

Pharmacokinetics: Absorption: Rapid and almost complete

absorption (PO) less complete absorption from rectal suppository.
Peak: 0.5–2 h. Duration: 3–4 h. Distribution: In all body fluids;
crosses placenta. Metabolism: Extensively in liver. Elimination: 90–
100% of drug excreted as metabolites in urine; excreted in breast
milk. Half-Life: 1–3 h.

Nursing Implications

Assessment & Drug Effects

• Monitor for S&S of: Hepatotoxicity, even with moderate
acetaminophen doses, especially in individuals with poor
nutrition or who have ingested alcohol (3 or more alcoholic
drinks daily) over prolonged periods; poisoning, usually from
accidental ingestion or suicide attempts; potential abuse from
psychological dependence (withdrawal has been associated with
restless and excited responses).

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Acetaminophen, Paracetamol. In Pearson
Nurse’s Drug Guide 2012 (pp. 9–11). Upper Saddle River, NJ: Prentice Hall. 3
Patient & Family Education
• Do not take other medications (e.g., cold preparations)
containing acetaminophen without medical advice; overdosing
and chronic use can cause liver damage and other toxic effects.
• Do not self-medicate adults for pain more than 10 days (5 days
in children) without consulting a prescriber.
• Do not use this medication without medical direction for: Fever
persisting longer than 3 days, fever over 39.5° C (103° F), or
recurrent fever.
• Do not give children more than 5 doses in 24 h unless prescribed
by prescriber.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Acetaminophen, Paracetamol. In Pearson
4 Nurse's Drug Guide 2012 (pp. 9–11). Upper Saddle River, NJ: Prentice Hall.