Acetaminophen (Paracetamol) - Drug Information - UpToDate

13/10/22, 18:17 Acetaminophen (paracetamol): Drug information - UpToDate
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Acetaminofén (paracetamol): información sobre medicamentos
Copyright 1978-2022 Lexicomp, Inc. Todos los derechos reservados.
Divulgaciones de contribuyentes
(Para obtener información adicional, consulte "Acetaminofén (paracetamol): información sobre medicamentos para el paciente" y consulte "Acetaminofeno
(paracetamol): información sobre medicamentos pediátricos" ).
Para abreviaturas, símbolos y definiciones de grupos de edad utilizados en Lexicomp ( ver tabla )
ALERTA: Advertencia en caja de EE. UU.

Riesgo de errores de medicación y hepatotoxicidad (inyección):
Tenga cuidado al recetar, preparar y administrar la inyección de paracetamol para evitar errores de dosificación que podrían
provocar una sobredosis accidental y la muerte. En particular, tenga cuidado de asegurarse de lo siguiente: no se confunda la dosis
en miligramos y mililitros; la dosificación se basa en el peso para pacientes de menos de 50 kg; las bombas de infusión están
correctamente programadas; y la dosis diaria total de paracetamol de todas las fuentes no excede los límites diarios máximos.
El acetaminofén se ha asociado con casos de insuficiencia hepática aguda, que a veces resulta en trasplante de hígado y muerte. La
mayoría de los casos de daño hepático están asociados con el uso de acetaminofén en dosis que superan los límites máximos
diarios y, a menudo, implican más de 1 producto que contiene acetaminofén.
Nombres de marca: EE. UU.
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7T Gummy ES [DSC];
analgésico de 8 horas [de venta libre];
Acetaminofén 8 horas [OTC];
Acetaminofeno Extra Fuerte [OTC];
aminofeno
[de venta libre] [DSC];
Apra [de venta libre];
Alivio del dolor de la artritis [OTC];
Aurophen Childrens [de venta libre] [DSC];
BetaTemp para
niños [de venta libre];
Acetaminofén para niños [OTC];
APAP para niños [OTC];
sin aspirina para niños [de venta libre];
Silapap para niños
[de venta libre];
niños táctiles [OTC] [DSC];
Ed-APAP [de venta libre];
ElixSure fiebre/dolor [de venta libre];
FiebreTodos los adultos [OTC];
FiebreTodos los niños [OTC];
FeverAll Infants [OTC];
FeverAll Junior Strength [OTC];
GoodSense Pain & Fever Child [de venta libre];
GoodSense Pain & Fever Infants [de venta libre];
GoodSense Pain Relief Extra St [de venta libre];
Alivio del dolor GoodSense [de venta
libre] [DSC];
Healthy Mama Shake That Ache [OTC];
Alivio del dolor líquido [OTC];
M-PAP [de venta libre];
Mapap Acetaminophen Extra Str
[OTC];
Dolor de artritis Mapap [OTC];
Mapap Childrens [OTC];
Mapap extrafuerte [OTC] [DSC];
mapap [de venta libre];
Fuerza extra sin
aspirina [OTC];
Analgésico sin aspirina [OTC] [DSC];
Non-Aspirin [OTC];
Nortemp Infants [OTC] [DSC];
Nortemp [OTC] [DSC];
Ofirmev
[DSC];
Pain & Fever Childrens [OTC] [DSC];
Pain & Fever Extra Strength [OTC] [DSC];
Pain & Fever Infants [OTC] [DSC];
Pain & Fever [OTC]
[DSC];
Pain Relief Childrens [OTC];
Pain Relief Extra Strength [OTC];
Pain Relief Regular Strength [OTC];
Pain Relief [OTC];
Panadol
Childrens [OTC];
Panadol Extra Strength [OTC];
Panadol Infants [OTC];
Pharbetol Extra Strength [OTC];
Pharbetol [OTC];
Tactinal Extra
Strength [OTC] [DSC];
Tactinal [OTC] [DSC];
Triaminic Fever Reducer [OTC];
Tylenol 8 Hour Arthritis Pain [OTC];
Tylenol 8 Hour [OTC];
Tylenol Childrens Chewables [OTC];
Tylenol Childrens Pain + Fever [OTC];
Tylenol Childrens [OTC];
Tylenol Dissolve Packs [OTC];
Tylenol
Extra Strength [OTC];
Tylenol for Children + Adults [OTC];
Tylenol Infants Pain+Fever [OTC];
Tylenol [OTC]
Pharmacologic Category
Analgesic, Nonopioid
Dosing: Adult
Note: Safety: Acetaminophen-induced hepatotoxicity, which can be life threatening, has been associated with doses >4 g/day. Although
doses up to 4 g/day are generally well tolerated (Ref), hepatotoxicity has been reported rarely at this dose limit (Ref). Due to this risk,
some experts recommend a lower maximum dose of 3 g/day in adults with normal liver function, particularly when used for longer
durations (eg, >7 days) for pain (Ref). Heavy alcohol use, malnutrition, fasting, low body weight, advanced age, febrile illness, select liver
disease, and use of drugs that interact with acetaminophen metabolism may increase risk of hepatotoxicity; a lower total daily dose (eg,
2 g/day) or avoidance may be preferred (Ref). When calculating total daily dose, confirm that all sources (eg, prescription, OTCs,
combinations) are included.
Pain and/or fever 
Pain (mild to moderate) and/or fever (monotherapy or as an adjunct):
Oral: 325 to 650 mg every 4 to 6 hours as needed or 1 g every 6 hours as needed; maximum dose: 4 g/day (Ref). See "Note:
Safety" above regarding maximum dose.
OTC labeling (patient-guided therapy): Note: Dosage recommendations, including maximum doses, vary among OTC
manufacturers.
Immediate release:
Regular strength (325 mg/tablet): 2 tablets (650 mg) every 4 to 6 hours as needed; maximum daily dose: 10
tablets/day (3.25 g/day).
Extra strength (500 mg/tablet): 2 tablets (1 g) every 6 hours as needed; maximum daily dose: 6 tablets/day (3
g/day).
Extended release (650 mg/tablet): 2 tablets (1.3 g) every 8 hours as needed; maximum daily dose: 6 tablets/day (3.9
g/day).
IV:
≥50 kg: 650 mg every 4 hours or 1 g every 6 hours; maximum single dose: 1 g/dose; maximum daily dose: 4 g/day.
<50 kg: 12.5 mg/kg every 4 hours or 15 mg/kg every 6 hours; maximum single dose: 15 mg/kg/dose (≤750 mg/dose);
maximum daily dose: 75 mg/kg/day (≤3.75 g/day). Note: Some experts recommend this reduced dosing if used in
patients with chronic alcoholism, malnutrition, or dehydration regardless of weight (Ref).
Rectal: 325 to 650 mg every 4 to 6 hours as needed (Ref); maximum daily dose: 3.9 g/day. Note: Absorption is irregular;
bioavailability may be reduced by ~10% to 20% relative to oral administration (Ref).
Dosing: Kidney Impairment: Adult
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce
Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
IV, Oral, Rectal:
Mild to severe impairment: No dosage adjustment likely to be necessary. The manufacturer's labeling for IV acetaminophen
states that longer dosing intervals and a reduced total daily dose may be warranted in patients with severe kidney impairment
(CrCl ≤30 mL/minute); however, acetaminophen concentrations and half-life are increased but similar to those in patients with
normal renal function (Ref). Glucuronide and sulfate conjugate metabolites accumulate in renal impairment, but the clinical
effects are unknown (Ref).
Hemodialysis, intermittent (thrice weekly): Acetaminophen and its conjugates are readily dialyzable (Ref): No dosage
adjustment necessary (Ref).
Peritoneal dialysis: Not dialyzed (Ref): No dosage adjustment necessary (Ref).
CRRT: Dialyzed (Ref): No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
Dosing: Hepatic Impairment: Adult
Oral: Use with caution and consider dosage adjustment or avoiding use, depending on degree of hepatic impairment and other
patient-specific factors. Although limited data exist, low-dose therapy (maximum: ≤2 to 3 g/day) is usually well tolerated in patients
with chronic liver disease or cirrhosis, provided patients are not actively drinking alcohol; however, the presence of other factors
increasing the risk of acetaminophen-induced hepatoxicity (eg, malnutrition, fasting, low body weight, advanced age, febrile illness,
concurrent use of drugs that interact with acetaminophen metabolism) must also be taken into consideration (Ref). Some experts
would limit the maximum dose to ≤2 g/day in any patient with advanced chronic liver disease or cirrhosis (provided the patient is not
actively drinking alcohol) and would avoid use in any patient with severe alcoholic hepatitis or acute liver injury. Avoiding use is also
recommended by some experts in patients with advanced chronic liver disease or cirrhosis who are actively drinking alcohol,
malnourished, not eating, or receiving a concomitant interacting medication. For short-term or one-time use, a maximum of ≤4
g/day may be considered in lower risk patients with chronic liver disease or early-stage compensated cirrhosis who are not actively
drinking alcohol (Ref).
IV:
Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling. Use with caution; a
reduced total daily dosage may be warranted.
Severe impairment: Use is contraindicated.
Dosing: Pediatric
(For additional information see "Acetaminophen (paracetamol): Pediatric drug information")

Note: Oral liquids are available in multiple concentrations (eg, 160 mg/5 mL, 500 mg/5 mL, 500 mg/15 mL); precautions should be taken
to verify and avoid confusion between the different concentrations; dose should be clearly presented as "mg."
Collapse All
Pain or fever 
Pain (mild to moderate) or fever: Note: All sources of acetaminophen (eg, prescription, OTC, combination products) should be
considered when evaluating a patient's maximum daily dose. To lower the risk for hepatotoxicity, limit daily dose to ≤75
mg/kg/day (maximum of 5 daily doses), not to exceed 4,000 mg/day; while recommended doses are generally considered safe,
hepatotoxicity has been reported (rarely) even with doses below recommendations (Ref).
Oral:
Weight-directed dosing: Infants, Children, and Adolescents: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Ref); do
not exceed 5 doses in 24 hours; maximum daily dose: 75 mg/kg/day not to exceed 4,000 mg/day.
Fixed dosing:
Oral suspension, chewable tablets: Infants and Children <12 years: Consult specific product formulations for
appropriate age groups. See table; use of weight to select dose is preferred; if weight is not available, then use age;
doses may be repeated every 4 hours; maximum: 5 doses/day.
Acetaminophen Dosing (Oral)
Weight (preferred)A Dosage

Age
kg lbs (mg)
2.7 to 5.3 6 to 11 0 to 3 mo 40
5.4 to 8.1 12 to 17 4 to 11 mo 80
8.2 to 10.8 18 to 23 1 to 2 y 120
10.9 to 16.3 24 to 35 2 to 3 y 160
16.4 to 21.7 36 to 47 4 to 5 y 240
21.8 to 27.2 48 to 59 6 to 8 y 320 to 325
27.3 to 32.6 60 to 71 9 to 10 y 325 to 400
32.7 to 43.2 72 to 95 11 y 480 to 500
AManufacturer’s recommendations are based on weight in pounds (OTC labeling); weight in kg listed here is derived from pounds and rounded; kg weight listed also is
adjusted to allow for continuous weight ranges in kg. OTC labeling instructs consumer to consult with physician for dosing instructions in infants and children under 2 years
of age.
Immediate-release solid dosage formulations: Note: Actual OTC dosing recommendations may vary by product
and/or manufacturer:
Children 6 to 11 years: 325 mg every 4 to 6 hours; maximum daily dose: 1,625 mg/day; Note: Do not use more
than 5 days unless directed by a physician.
Children ≥12 years and Adolescents:
Regular strength: 650 mg every 4 to 6 hours; maximum daily dose: 3,250 mg/day unless directed by a
physician; under physician supervision daily doses ≤4,000 mg may be used.
Extra strength: 1,000 mg every 6 hours; maximum daily dose: 3,000 mg/day unless directed by a physician;
under physician supervision daily doses ≤4,000 mg may be used.
Extended release: Children ≥12 years and Adolescents: 1,300 mg every 8 hours; maximum daily dose: 3,900 mg/day.
IV:
Infants and Children <2 years:
Manufacturer’s labeling: Fever: 15 mg/kg/dose every 6 hours; maximum daily dose: 60 mg/kg/day.
Alternate dosing: Limited data available: Pain and fever: 7.5 to 15 mg/kg/dose every 6 hours; maximum daily dose: 60
mg/kg/day (Ref).
Children ≥2 years (Ref):
<50 kg: 15 mg/kg/dose every 6 hours or 12.5 mg/kg/dose every 4 hours; maximum single dose: 15 mg/kg up to 750
mg; maximum daily dose: 75 mg/kg/day not to exceed 3,750 mg/day.
≥50 kg: 15 mg/kg/dose every 6 hours or 12.5 mg/kg/dose every 4 hours; maximum single dose: 15 mg/kg up to 1,000
Adolescents:
≥50 kg: 1,000 mg every 6 hours or 650 mg every 4 hours; maximum single dose: 1,000 mg; maximum daily dose:
4,000 mg/day.
Rectal:
Weight-directed dosing: Limited data available: Infants and Children <12 years: 10 to 20 mg/kg/dose every 4 to 6 hours as
needed; do not exceed 5 doses in 24 hours (Ref); maximum daily dose: 75 mg/kg/day not to exceed 1,625 mg/day.
Fixed dosing:
Infants 6 to 11 months: 80 mg every 6 hours; maximum daily dose: 320 mg/day.
Infants and Children 12 to 36 months: 80 mg every 4 to 6 hours; maximum daily dose: 400 mg/day.
Children >3 to 6 years: 120 mg every 4 to 6 hours; maximum daily dose: 600 mg/day.
Children >6 up to 12 years: 325 mg every 4 to 6 hours; maximum daily dose: 1,625 mg/day.
Children ≥12 years and Adolescents: 650 mg every 4 to 6 hours; maximum daily dose: 3,900 mg/day.
Pain; peri-/postoperative management; adjunct to opioid therapy 
Pain; peri-/postoperative management; adjunct to opioid therapy:
IV:
Infants and Children <2 years: Limited data available: 7.5 to 15 mg/kg/dose every 6 hours; maximum daily dose: 60
mg/kg/day (Ref).
Children ≥2 years (Ref):
≥50 kg: 15 mg/kg/dose every 6 hours or 12.5 mg/kg/dose every 4 hours; maximum single dose: 15 mg/kg up to 1,000
Adolescents:
≥50 kg: 1,000 mg every 6 hours or 650 mg every 4 hours; maximum single dose: 1,000 mg; maximum daily dose:
4,000 mg/day.
Rectal: Limited data available: Children:
Loading dose: 40 mg/kg for 1 dose, in most trials, the dose was administered postoperatively (Ref); a maximum dose of
1,000 mg was most frequently reported. However, in one trial evaluating 24 older pediatric patients (all patients ≥25 kg;
mean age: ~13 years), the data suggested that a dose of 1,000 mg does not produce therapeutic serum concentrations
(target for study: >10 mcg/mL) compared to a 40 mg/kg dose (up to ~2,000 mg); the resultant Cmax was: 7.8 mcg/mL
(1,000 mg dose group) vs 15.9 mcg/mL (40 mg/kg dose group). Note: Therapeutic serum concentrations for analgesia
have not been well-established (Ref).
Maintenance dose: 20 to 25 mg/kg/dose every 6 hours as needed for 2 to 3 days has been suggested if further pain
control is needed postoperatively; maximum daily dose: 100 mg/kg/day not to exceed 4,000 mg/day; therapy longer than
5 days has not been evaluated (Ref).
Note: In the majority of trials, suppositories were not divided due to unequal distribution of drug within suppository;
doses were rounded to the nearest mg amount using 1 or 2 suppositories of available product strengths.
Dosing: Kidney Impairment: Pediatric
Altered kidney function:
Infants, Children, and Adolescents:
Oral, rectal: Mild to severe impairment: There are no dosage adjustments provided in the manufacturer's labeling; based on
adult pharmacokinetic studies, dosage adjustment may not be necessary for short courses. In adult pharmacokinetic
studies, plasma concentrations of acetaminophen did not differ in renal impairment patients when compared to healthy
patients for short courses of treatment (ie, 3 days); however, accumulation of the glucuronide and sulfate conjugate
metabolites in renal impairment has been described following a single dose of acetaminophen up to repeat dosing for 10
days; the clinical significance of this finding is unknown (Ref).
IV:
Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer's labeling.
Severe impairment (CrCl <30 mL/minute): The manufacturer's labeling for IV acetaminophen states that longer dosing
intervals and a reduced total daily dose may be warranted in patients with severe kidney impairment; use with caution.
Hemodialysis, intermittent: Acetaminophen and its conjugates are readily dialyzable (Ref): No dosage adjustment necessary when
used for mild to moderate pain (Ref).
Peritoneal dialysis: Not dialyzed (Ref): No dosage adjustment necessary when used for mild to moderate pain (Ref).
Dosing: Hepatic Impairment: Pediatric

Use with caution. Limited, low-dose therapy is usually well-tolerated in hepatic disease/cirrhosis; however, cases of hepatotoxicity at daily
acetaminophen dosages <4,000 mg/day have been reported. Avoid chronic use in hepatic impairment.
Dosing: Older Adult
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Pain (acute) or fever: Oral, IV: Refer to adult dosing.
Persistent pain (off-label): Adults ≥75 years: Oral:
Initial: 325 to 500 mg every 4 hours or 500 to 1,000 mg every 6 hours
Maximum: ≤4,000 mg/day. In older adults with hepatic impairment or history of alcohol abuse being treated for persistent pain,
do not exceed a maximum of 2,000 to 3,000 mg/day (Ref).
Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] =
Discontinued product
Capsule, Oral:
Mapap: 500 mg [aspirin free; contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Tylenol: 325 mg [aspirin free; contains fd&c red #40, soybeans (glycine soja)]
Elixir, Oral:
Apra: 160 mg/5 mL (120 mL, 240 mL, 480 mL, 3840 mL) [contains alcohol, usp]
Pain Relief Childrens: 160 mg/5 mL (118 mL [DSC], 237 mL [DSC], 473 mL) [alcohol free, aspirin free; contains fd&c red #40,
polyethylene glycol (macrogol), saccharin sodium, sodium benzoate, sorbitol]
Generic: 160 mg/5 mL (473 mL [DSC])
Gel, Oral:
ElixSure Fever/Pain: 160 mg/5 mL (120 mL) [alcohol free, aspirin free; contains butylparaben, carbomer 934p, polyethylene
glycol (macrogol); bubble-gum flavor]
glycol (macrogol); cherry flavor]
glycol (macrogol); grape flavor]
Liquid, Oral:
Acetaminophen Extra Strength: 500 mg/15 mL (237 mL [DSC]) [alcohol free, aspirin free; contains brilliant blue fcf (fd&c blue #1),
fd&c yellow #10 (quinoline yellow), polyethylene glycol (macrogol), saccharin sodium, sodium benzoate]
Childrens Silapap: 160 mg/5 mL (118 mL, 237 mL, 473 mL) [alcohol free, sugar free; contains fd&c red #40, methylparaben,
propylene glycol, saccharin sodium, sodium benzoate; cherry flavor]
Ed-APAP: 160 mg/5 mL (236 mL) [alcohol free; contains fd&c red #40, saccharin sodium, sodium benzoate; cherry flavor]
Liquid Pain Relief: 160 mg/5 mL (473 mL [DSC]) [contains fd&c red #40, polyethylene glycol (macrogol), saccharin sodium,
sodium benzoate; cherry flavor]
Liquid Pain Relief: 160 mg/5 mL (473 mL) [alcohol free, aspirin free; contains fd&c red #40, methylparaben, polyethylene glycol
(macrogol), propylene glycol, propylparaben]
M-PAP: 160 mg/5 mL (120 mL, 473 mL) [alcohol free, aspirin free, sugar free; contains fd&c red #40, polyethylene glycol
(macrogol), saccharin sodium, sodium benzoate; cherry flavor]
Mapap: 160 mg/5 mL (118 mL [DSC], 473 mL [DSC]) [alcohol free, aspirin free; contains benzoic acid, fd&c red #40, polyethylene
glycol (macrogol), propylene glycol, sodium benzoate]
Mapap Acetaminophen Extra Str: 500 mg/15 mL (237 mL) [contains fd&c red #40, polyethylene glycol (macrogol), propylene
glycol, saccharin sodium, sodium benzoate; cherry flavor]
Pain Relief: 500 mg/15 mL (237 mL) [alcohol free, aspirin free; contains fd&c red #40, methylparaben, polyethylene glycol
(macrogol), propylene glycol, propylparaben]
Generic: 160 mg/5 mL (118 mL, 473 mL)
Packet, Oral:
Tylenol Childrens Pain + Fever: 160 mg (18 ea, 30 ea) [aspirin free, ibuprofen free; wild berry flavor]
Tylenol Dissolve Packs: 500 mg (12 ea, 32 ea) [berry flavor]
Solution, Intravenous:
Generic: 10 mg/mL (50 mL, 100 mL); 1000 mg/100 mL (100 mL)
Solution, Intravenous [preservative free]:
Ofirmev: 10 mg/mL (100 mL [DSC])
Generic: 10 mg/mL (100 mL)
Solution, Oral:
Pain & Fever Childrens: 160 mg/5 mL (118 mL [DSC], 473 mL [DSC]) [alcohol free, aspirin free, sugar free; contains fd&c red #40,
polyethylene glycol (macrogol), propylene glycol, sodium benzoate]
Generic: 160 mg/5 mL (5 mL, 10.15 mL, 20.3 mL, 118 mL, 473 mL); 325 mg/10.15 mL (10.15 mL); 650 mg/20.3 mL (20.3 mL)
Suppository, Rectal:
FeverAll Adults: 650 mg (50 ea) [contains polysorbate 80]
FeverAll Childrens: 120 mg (6 ea, 50 ea) [contains polysorbate 80]
FeverAll Infants: 80 mg (1 ea, 6 ea, 50 ea) [contains polysorbate 80]
FeverAll Junior Strength: 325 mg (6 ea, 50 ea) [contains polysorbate 80]
Suspension, Oral:
Aurophen Childrens: 160 mg/5 mL (118 mL [DSC]) [alcohol free, aspirin free, gluten free, ibuprofen free; contains butylparaben,
fd&c red #40, propylene glycol, sodium benzoate; cherry flavor]
BetaTemp Childrens: 160 mg/5 mL (118 mL) [contains butylparaben, fd&c red #40, propylene glycol, sodium benzoate]
Childrens Acetaminophen: 160 mg/5 mL (5 mL) [alcohol free, aspirin free; contains butylparaben, fd&c red #40, polysorbate 80,
propylene glycol, sodium benzoate]
Childrens Acetaminophen: 160 mg/5 mL (5 mL) [alcohol free, aspirin free; contains butylparaben, fd&c red #40, polysorbate 80,
propylene glycol, sodium benzoate; strawberry flavor]
Childrens Non-Aspirin: 160 mg/5 mL (118 mL)
GoodSense Pain & Fever Child: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, dye free, gluten free, ibuprofen free; contains
propylene glycol, propylparaben, sodium benzoate, sorbitol]
GoodSense Pain & Fever Child: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, gluten free, ibuprofen free; contains brilliant
blue fcf (fd&c blue #1), butylparaben, propylene glycol, sodium benzoate, sorbitol; grape flavor]
GoodSense Pain & Fever Child: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, gluten free, ibuprofen free; contains
butylparaben, fd&c red #40, propylene glycol, sodium benzoate, sorbitol]
GoodSense Pain & Fever Child: 160 mg/5 mL (118 mL) [alcohol free, aspirin free, gluten free, ibuprofen free; contains
butylparaben, fd&c red #40, propylene glycol, sodium benzoate, sorbitol; cherry flavor]
GoodSense Pain & Fever Infants: 160 mg/5 mL (30 mL) [alcohol free, aspirin free, gluten free, ibuprofen free; contains brilliant
blue fcf (fd&c blue #1), butylparaben, propylene glycol, sodium benzoate, sorbitol]
GoodSense Pain & Fever Infants: 160 mg/5 mL (30 mL) [alcohol free, aspirin free, gluten free, ibuprofen free; contains
butylparaben, fd&c red #40, propylene glycol, sodium benzoate, sorbitol]
Mapap Childrens: 160 mg/5 mL (118 mL [DSC]) [contains butylparaben, fd&c red #40, propylene glycol, sodium benzoate]
Nortemp: 160 mg/5 mL (118 mL [DSC]) [alcohol free, aspirin free; contains butylparaben, fd&c red #40, polysorbate 80,
propylene glycol, sodium benzoate; cotton candy flavor]
Nortemp Infants: 80 mg/0.8 mL (30 mL [DSC]) [alcohol free, aspirin free, sugar free; contains fd&c yellow #6 (sunset yellow),
methylparaben, propylene glycol, saccharin sodium, sodium benzoate]
Pain & Fever Childrens: 160 mg/5 mL (118 mL [DSC]) [alcohol free, aspirin free, dye free, gluten free, ibuprofen free; contains
butylparaben, propylene glycol, sodium benzoate; cherry flavor]
Pain & Fever Infants: 160 mg/5 mL (59 mL [DSC]) [alcohol free, aspirin free, ibuprofen free; contains butylparaben, fd&c red #40,
propylene glycol, sodium benzoate, sorbitol]
Pain Relief Childrens: 160 mg/5 mL (118 mL) [cherry flavor]
Panadol Childrens: 160 mg/5 mL (118 mL) [aspirin free, ibuprofen free; contains benzoic acid, fd&c red #40, polyethylene glycol
(macrogol), propylene glycol, saccharin sodium; raspberry flavor]
Panadol Infants: 160 mg/5 mL (54.7 mL) [aspirin free, ibuprofen free; contains benzoic acid, fd&c red #40, polyethylene glycol
(macrogol), propylene glycol, saccharin sodium; raspberry flavor]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free; cherry flavor]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, dye free, ibuprofen free]
Tylenol Childrens: 160 mg/5 mL (120 mL, 240 mL) [alcohol free, aspirin free, dye free, ibuprofen free; cherry flavor]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, ibuprofen free; contains brilliant blue fcf (fd&c blue #1),
sodium benzoate; grape flavor]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, ibuprofen free; contains butylparaben, fd&c red #40,
propylene glycol, sodium benzoate; strawberry flavor]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, ibuprofen free; contains fd&c red #40, sodium benzoate]
Tylenol Childrens: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, ibuprofen free; contains sodium benzoate, sorbitol; grape
flavor]
Tylenol Childrens Pain + Fever: 160 mg/5 mL (120 mL) [alcohol free, aspirin free, ibuprofen free; bubble-gum flavor]
Tylenol for Children + Adults: 160 mg/5 mL (240 mL) [alcohol free, aspirin free, dye free, ibuprofen free, paraben free; cherry
flavor]
Tylenol Infants Pain+Fever: 160 mg/5 mL (60 mL) [alcohol free, aspirin free, dye free, ibuprofen free]
Tylenol Infants Pain+Fever: 160 mg/5 mL (30 mL) [alcohol free, aspirin free, dye free, ibuprofen free; cherry flavor]
Tylenol Infants Pain+Fever: 160 mg/5 mL (60 mL) [alcohol free, aspirin free, ibuprofen free; contains brilliant blue fcf (fd&c blue
#1), butylparaben, propylene glycol, sodium benzoate, sorbitol]
Tylenol Infants Pain+Fever: 160 mg/5 mL (30 mL) [alcohol free, aspirin free, ibuprofen free; contains brilliant blue fcf (fd&c blue
#1), butylparaben, propylene glycol, sodium benzoate, sorbitol; grape flavor]
Tylenol Infants Pain+Fever: 160 mg/5 mL (60 mL) [alcohol free, aspirin free, ibuprofen free; contains butylparaben, fd&c red #40,
propylene glycol, sodium benzoate, sorbitol; cherry flavor]
Generic: 160 mg/5 mL (5 mL, 10.15 mL, 20.3 mL, 59 mL, 118 mL); 650 mg/20.3 mL (20.3 mL)
Syrup, Oral:
Triaminic Fever Reducer: 160 mg/5 mL (59 mL, 118 mL) [alcohol free, aspirin free, ibuprofen free; contains benzoic acid, edetate
(edta) disodium, fd&c red #40, polyethylene glycol (macrogol); bubble-gum flavor]
Triaminic Fever Reducer: 160 mg/5 mL (59 mL, 118 mL) [alcohol free, aspirin free, ibuprofen free; contains brilliant blue fcf (fd&c
blue #1), edetate (edta) disodium, fd&c red #40, polyethylene glycol (macrogol), sodium benzoate; grape flavor]
Tablet, Oral:
Acetaminophen Extra Strength: 500 mg
Acetaminophen Extra Strength: 500 mg [scored]
Acetaminophen Extra Strength: 500 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Acetaminophen Extra Strength: 500 mg [contains corn starch]
Acetaminophen Extra Strength: 500 mg [contains fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake]
Acetaminophen Extra Strength: 500 mg [aspirin free]
Acetaminophen Extra Strength: 500 mg [scored; aspirin free]
Acetaminophen Extra Strength: 500 mg [aspirin free; contains corn starch]
Acetaminophen Extra Strength: 500 mg [aspirin free, sodium free]
Aminofen: 500 mg [DSC]
Aminofen: 325 mg [DSC] [antihistamine free, caffeine free, salt free, sugar free]
GoodSense Pain Relief Extra St: 500 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #6 (sunset yellow)]
GoodSense Pain Relief Extra St: 500 mg [DSC] [gluten free; contains corn starch, edetate (edta) disodium, fd&c red #40
aluminum lake, fd&c yellow #10 aluminum lake]
GoodSense Pain Relief Extra St: 500 mg [gluten free; contains fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake]
Healthy Mama Shake That Ache: 500 mg
Mapap: 325 mg [DSC], 500 mg [DSC]
Mapap Extra Strength: 500 mg [DSC] [aspirin free; contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Non-Aspirin: 325 mg
Non-Aspirin: 325 mg, 500 mg [contains corn starch]
Non-Aspirin Extra Strength: 500 mg
Non-Aspirin Pain Reliever: 325 mg [DSC] [contains methylparaben, propylparaben]
Pain & Fever: 325 mg [DSC]
Pain & Fever Extra Strength: 500 mg [DSC]
Pain & Fever Extra Strength: 500 mg [DSC] [scored]
Pain Relief Extra Strength: 500 mg
Pain Relief Extra Strength: 500 mg [contains corn starch]
Pain Relief Extra Strength: 500 mg [DSC] [contains methylparaben, propylparaben]
Pain Relief Extra Strength: 500 mg [aspirin free]
Pain Relief Extra Strength: 500 mg [aspirin free; contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Pain Relief Regular Strength: 325 mg [contains methylparaben, propylparaben]
Panadol Extra Strength: 500 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #10 aluminum
lake]
Pharbetol: 325 mg
Pharbetol Extra Strength: 500 mg [aspirin free]
Tactinal: 325 mg [DSC] [scored/varied; aspirin free]
Tactinal Extra Strength: 500 mg [DSC] [aspirin free]
Tylenol: 325 mg [scored]
Tylenol: 325 mg [contains corn starch, fd&c red #40 aluminum lake]
Tylenol: 325 mg [DSC] [contains fd&c red #40 aluminum lake]
Tylenol Extra Strength: 500 mg
Tylenol Extra Strength: 500 mg [contains brilliant blue fcf (fd&c blue #1), butylparaben, edetate (edta) calcium disodium, fd&c
red #40, fd&c yellow #10 (quinoline yellow), methylparaben, polysorbate 80, propylparaben]
Tylenol Extra Strength: 500 mg [contains brilliant blue fcf (fd&c blue #1), butylparaben, edetate (edta) calcium disodium, fd&c
red #40, fd&c yellow #10 (quinoline yellow), methylparaben, propylparaben]
Tylenol Extra Strength: 500 mg [contains corn starch, fd&c red #40 aluminum lake]
Tylenol Extra Strength: 500 mg [contains fd&c red #40 aluminum lake]
Tylenol Extra Strength: 500 mg [contains fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake]
Generic: 325 mg, 500 mg

Tablet Chewable, Oral:
Childrens APAP: 80 mg [scored; contains aspartame, fd&c yellow #6 aluminum lake; fruit flavor]
Childrens Non-Aspirin: 80 mg
Childrens Tactinal: 80 mg [DSC] [aspirin free, ibuprofen free]
Mapap Childrens: 80 mg [aspirin free, ibuprofen free; contains fd&c blue #1 aluminum lake; grape flavor]
Mapap Childrens: 160 mg [scored; aspirin free, ibuprofen free; bubble-gum flavor]
7T Gummy ES: 500 mg [DSC] [aspirin free, ibuprofen free]
Tylenol Childrens Chewables: 160 mg [aspirin free, ibuprofen free]
Tylenol Childrens Chewables: 160 mg [aspirin free, ibuprofen free; contains brilliant blue fcf (fd&c blue #1)]
Generic: 160 mg, 325 mg
Tablet Extended Release, Oral:
8 Hour Pain Reliever: 650 mg
Acetaminophen 8 Hour: 650 mg [aspirin free; contains corn starch]
Arthritis Pain Relief: 650 mg
GoodSense Pain Relief: 650 mg [DSC] [contains fd&c red #40 aluminum lake]
Mapap Arthritis Pain: 650 mg [gluten free]
Tylenol 8 Hour: 650 mg
Tylenol 8 Hour Arthritis Pain: 650 mg

Generic: 650 mg
Generic Equivalent Available: US

May be product dependent
Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 10 mg/mL (100 mL)
Administration: Adult
Oral: May administer without regard to food; may administer with food to decrease possible GI upset; shake drops and suspension
well before use; do not crush or chew ER products.
Bariatric surgery: Caplet and tablet, extended release: Some institutions may have specific protocols that conflict with these
recommendations; refer to institutional protocols as appropriate. Switch to IR formulation (tablet or adult strength liquid). Avoid
children's liquid formulation due to sugar content and volume needed to achieve adult doses.
Injection: For IV infusion only. Administer undiluted over 15 minutes. Attach an administration set in accordance with the
manufacturer’s recommendations; may vary by product. If dose to be administered (eg, 650 mg) is not equivalent to an available
formulation (eg, 500 mg per 50 mL or 1,000 mg per 100 mL) then withdraw appropriate dose and place into separate empty, sterile
container (eg, glass bottle, plastic IV container, syringe) for administration.
Rectal: Remove wrapper; insert suppository well up into the rectum.
Administration: Pediatric
Oral: Administer with food to decrease GI upset; shake drops and suspension well before use; do not crush or chew extended
release products
Parenteral: For IV infusion only. May administer undiluted over 15 minutes. Use within 6 hours of opening vial or transferring to
another container. Discard any unused portion; single-use vials only.
Rectal: Remove wrapper; insert suppository well up into the rectum.
Use: Labeled Indications
Fever: Temporary reduction of fever.
Pain:
Injection: Management of mild to moderate pain in patients ≥2 years of age; management of moderate to severe pain when
combined with opioid analgesia in patients ≥2 years.
Oral, Rectal: Temporary relief of minor aches, pains, and headache.
Medication Safety Issues

Sound-alike/look-alike issues:
Acephen may be confused with AcipHex
Acetaminophen may be confused with acetazolamide
FeverALL may be confused with Fiberall
Triaminic Children's Fever Reducer Pain Reliever may be confused with Triaminic cough and cold products
Tylenol may be confused with atenolol, timolol, Tylenol PM, Tylox
Infusion bottles of ropivacaine and IV acetaminophen look similar. Potentially fatal mix-ups have been reported in which a glass
bottle of Naropin was mistaken for Ofirmev in perioperative areas.
Other safety concerns:
Duplicate therapy issues: This product contains acetaminophen, which may be a component of combination products. Do not
exceed the maximum recommended daily dose of acetaminophen.
Infant concentration change: All children’s and infant acetaminophen products are available as 160 mg/5 mL. Some remaining
infant concentrated solutions of 80 mg/0.8 mL and 100 mg/mL may still be available on pharmacy shelves or in patient homes.
Check concentrations closely prior to administering or dispensing and verify concentration available to patients prior to
recommending a dose (November 2011).
Injection: Reports of 10-fold overdose errors using the parenteral product have occurred in the U.S. and Europe; calculation of
doses in "mg" and subsequent administration of the dose in "mL" using the commercially available concentration of 10 mg/mL
contributed to these errors. Expressing doses as mg and mL, as well as pharmacy preparation of doses, may decrease error
potential (Dart, 2012; ISMP, 2012).
International issues:
Depon [Greece] may be confused with Depen brand name for penicillamine [US]; Depin brand name for nifedipine [India]; Dipen
brand name for diltiazem [Greece]
Duorol [Spain] may be confused with Diuril brand name for chlorothiazide [US, Canada]
Paralen [Czech Republic] may be confused with Aralen brand name for chloroquine [US, Mexico]
Adverse Reactions (Significant): Considerations

Hepatotoxicity
Acute hepatotoxicity may result from intentional or unintentional overdose in adult and pediatric patients. In pediatric patients,
unintentional overdose can be a result of accidental ingestion, supratherapeutic dosing, more frequent administration than
recommended, and use of multiple acetaminophen-containing products; hepatotoxicity has also been rarely reported with
recommended dosages (Ref).
Spontaneous resolution occurs with or without treatment in ~65% of cases, although some cases may progress to acute liver
failure leading to liver transplantation or death (Ref); a mortality of ~0.4% has been reported (Ref). Acetaminophen is one of the
most commonly reported products causing drug-induced liver injury (Ref), with ~50% of cases of acute hepatic failure in the
US attributed to acetaminophen (Ref). Minor increased alanine aminotransferase (ALT) and increased aspartate
aminotransferase (AST) may occur during chronic acetaminophen therapy that are rarely symptomatic; resolution generally
occurs with discontinuation or dose reduction, but may also occur with continuation of the same dose (Ref).
Mechanism: Dose-related; direct toxic effect through formation of toxic metabolite, N-acetyl-p-benzoquinoneimine (NAPQI) that
binds to cellular proteins, including mitochondrial proteins. Toxic free radicals, including peroxynitrite, may also cause damage
inside the mitochondria (Ref).
Onset: Rapid; usually starts 24 to 72 hours after ingestion with marked elevations in serum ALT and AST, followed at 48 to 96
hours by clinical symptoms (Ref).
Risk factors:
• Dose:
ο Pediatric: Toxicity is likely to occur with single ingestions >150 mg/kg or when the maximum daily acetaminophen
dose is >75 mg/kg/day (maximum of 5 daily doses) up to 4,000 mg/day from all sources (Ref).
ο Adult: Toxicity is likely to occur with single ingestions >250 mg/kg or >12,000 mg over a 24-hour period (Ref).
Asymptomatic elevation of ALT may occur following maximal therapeutic doses of acetaminophen (4,000 mg/day) for
≥4 days (Ref).
• Multiple acetaminophen-containing products: An unintentional overdose may occur in adult and pediatric patients who
take multiple acetaminophen or acetaminophen-containing combination products (Ref).
• Chronic alcohol ingestion: Chronic alcoholics who take therapeutic doses of acetaminophen are NOT at an increased risk
of hepatotoxicity (Ref). In contrast, chronic alcoholics who ingest repeated supratherapeutic doses of acetaminophen are at
an increased risk for hepatotoxicity (Ref).
• Concomitant medications and herbal products: Although use of products that induce CYP2E1 enzymes (eg,
carbamazepine, phenobarbital, phenytoin, isoniazid, rifampin) have been postulated to predispose to acetaminophen
hepatotoxicity by enhanced production of NAPQI, there is little evidence, aside from case reports, that drug interactions
increase the risk of liver injury (Ref).
• Nutritional status: Malnutrition and fasting may increase the risk (Ref)
• Age: Pediatric patients are less susceptible, whereas elderly patients are at a higher risk (Ref)
• Delay to treatment with N-acetylcysteine (NAC): Most patients with acetaminophen overdose who receive treatment with
NAC within 8 hours of ingestion will not develop hepatotoxicity (Ref)
Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Oral, Rectal: Frequency not defined:
Dermatologic: Erythema of skin, skin blister, skin rash
Otic: Hearing loss
IV:
>10%: Gastrointestinal: Nausea (adults: 34%; neonates, infants, children, and adolescents: ≥5%), vomiting (adults: 15%;
neonates, infants, children, and adolescents: ≥5%)
1% to 10%:
Cardiovascular: Hypertension, hypotension, peripheral edema (adults)
Dermatologic: Pruritus (neonates, infants, children, and adolescents: ≥5%)
Endocrine & metabolic: Hypoalbuminemia (neonates, infants, children, and adolescents), hypokalemia, hypomagnesemia
(neonates, infants, children, and adolescents), hypophosphatemia (neonates, infants, children, and adolescents)
Gastrointestinal: Constipation (neonates, infants, children, and adolescents: ≥5%), diarrhea (neonates, infants, children, and
adolescents)
Genitourinary: Oliguria (neonates, infants, children, and adolescents)
Hematologic & oncologic: Anemia
Hepatic: Increased serum aspartate aminotransferase (Watkins 2006)
Local: Infusion-site pain, pain at injection site
Nervous system: Agitation (neonates, infants, children, and adolescents), anxiety (adults), fatigue (adults), headache,
insomnia (adults: 7%), trismus (adults)
Neuromuscular & skeletal: Muscle spasm (≥1%)
Respiratory: Abnormal breath sounds (adults), atelectasis (neonates, infants, children, and adolescents), dyspnea (adults),
pleural effusion (neonates, infants, children, and adolescents), pulmonary edema (neonates, infants, children, and
adolescents), stridor (adults), wheezing (adults)
Postmarketing (all formulations):

Dermatologic: Acute generalized exanthematous pustulosis (FDA 2016), Stevens-Johnson syndrome (FDA 2016), toxic epidermal
necrolysis (Watanabe 2016; FDA 2016)
Hepatic: Acute hepatic failure, hepatotoxicity (Ramachandran 2019, Yoon 2016), increased serum alanine aminotransferase
(Watkins 2006)
Hypersensitivity: Anaphylaxis (Ho 2008, Numata 2016), hypersensitivity reaction (Thomspon 2019)
Contraindications
Injection: Hypersensitivity to acetaminophen or any component of the formulation; severe hepatic impairment or severe active liver
disease
OTC labeling: When used for self-medication, do not use with other drug products containing acetaminophen or if allergic to
acetaminophen or any of the inactive ingredients
Warnings/Precautions
Disease-related concerns:
• G6PD deficiency: Use with caution in patients with known G6PD deficiency.
• Hepatic impairment: Use with caution in patients with hepatic impairment or active liver disease; use of the IV formulation is
contraindicated in patients with severe hepatic impairment or severe active liver disease.
• Hypovolemia: Use the IV formulation with caution in patients with severe hypovolemia (eg, due to dehydration or blood loss).
Dosage form specific issues:
• Aspartame: Some products may contain aspartame, which is metabolized to phenylalanine and must be avoided (or used with
caution) in patients with phenylketonuria.
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol and/or sodium benzoate/benzoic acid; benzoic
acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a
potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory
distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and
cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein
binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol and/or benzyl alcohol derivative with caution
in neonates. See manufacturer's labeling.
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a
delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain
individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and
hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade
1986; CDC 1984). See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been
associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
Other warnings/precautions:
• Dosage limit: Limit acetaminophen dose from all sources (prescription, OTC, combination products) and all routes of
administration (IV, oral, rectal) to <4 g/day (adults).
• Self-medication (OTC use): When used for self-medication, patients should be instructed to contact health care provider if
symptoms get worse or new symptoms appear, redness or swelling is present in the painful area, fever lasts >3 days (all ages),
or pain (excluding sore throat) lasts longer than: Children ≥12 years, Adolescents, and Adults: 10 days; Infants and Children <12
years: 5 days. When treating children with sore throat, if sore throat is severe, persists for >2 days, or is followed by fever, rash,
headache, nausea, or vomiting, consult health care provider immediately.
Warnings: Additional Pediatric Considerations
Prophylactic use of acetaminophen to reduce fever and discomfort associated with vaccination is not recommended by the Advisory
Committee on Immunization Practices (ACIP). Additionally, the ACIP does not recommend prophylactic acetaminophen to reduce risk of
febrile seizure in infants and children with or without a history of febrile seizures. Antipyretics have not been shown to prevent febrile
seizures (NCIRD/ACIP 2011). One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to
vaccination decreased the immune response of some vaccines; in the trial evaluating 459 infants (including 226 who received
acetaminophen), antibody geometric mean concentrations (GMCs) for targeted vaccine immune response markers were lower in
significantly more infants in the acetaminophen group compared with control. Before the booster dose, children who received
prophylactic acetaminophen had lower antibody GMCs for all vaccine serotypes than children in the control group; this effect persisted
after boosting even in the absence of additional acetaminophen doses. The clinical significance of this reduction in immune response
has not been established (Prymula 2009). Antipyretics may be used to treat fever or discomfort following vaccination (NCIRD/ACIP 2011).
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg,
>3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal
failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures,
and respiratory depression; use caution (AAP 1997; Shehab 2009).
Metabolism/Transport Effects
Substrate of CYP1A2 (minor), CYP2A6 (minor), CYP2C9 (minor), CYP2D6 (minor), CYP2E1 (major), CYP3A4 (minor), UGT1A1, UGT1A6,
UGT1A9, UGT2B15; Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Drug Interactions
(For additional information: Launch drug interactions program)
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4
Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management
recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alcohol (Ethyl): May enhance the hepatotoxic effect of Acetaminophen. Risk C: Monitor therapy
Busulfan: Acetaminophen may increase the serum concentration of Busulfan. Risk C: Monitor therapy
CarBAMazepine: May increase the metabolism of Acetaminophen. This may 1) diminish the effect of acetaminophen; and 2) increase
the risk of liver damage. Risk C: Monitor therapy
Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy
Dasatinib: Acetaminophen may enhance the hepatotoxic effect of Dasatinib. Dasatinib may increase the serum concentration of
Acetaminophen. Management: Avoid coadministration of acetaminophen and dasatinib if possible. If coadministration is
unavoidable, monitor for signs/symptoms of hepatotoxicity, particularly in patients with greater acetaminophen exposure. Risk D:
Consider therapy modification
Flucloxacillin: May enhance the adverse/toxic effect of Acetaminophen. Specifically, the risk for high anion gap metabolic acidosis
may be increased. Risk C: Monitor therapy
Fosphenytoin-Phenytoin: May decrease the serum concentration of Acetaminophen. Specifically, serum concentrations of
acetaminophen may be decreased (leading to decreased efficacy), but the formation of the toxic N-acetyl-p-benzoquinone imine
(NAPQI) metabolite may be increased (leading to increased hepatotoxicity). Risk C: Monitor therapy
Imatinib: Acetaminophen may enhance the hepatotoxic effect of Imatinib. Risk C: Monitor therapy
Immune Checkpoint Inhibitors: Acetaminophen may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C:
Monitor therapy
Isoniazid: May enhance the hepatotoxic effect of Acetaminophen. Isoniazid may increase the metabolism of Acetaminophen.
Specifically, formation of the hepatotoxic NAPQI metabolite may be increased. Risk C: Monitor therapy
LamoTRIgine: Acetaminophen may decrease the serum concentration of LamoTRIgine. Risk C: Monitor therapy
Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically,
the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Lorlatinib: May decrease the serum concentration of Acetaminophen. Risk C: Monitor therapy
MetyraPONE: May increase the serum concentration of Acetaminophen. More importantly, by inhibiting the conjugative metabolism
of acetaminophen, metyrapone may shift the metabolism towards the oxidative route that produces a hepatotoxic metabolite. Risk
X: Avoid combination
Mipomersen: Acetaminophen may enhance the hepatotoxic effect of Mipomersen. Risk C: Monitor therapy
Mitapivat: May decrease the serum concentration of UGT1A1 Substrates. Risk C: Monitor therapy
Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may
increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
PHENobarbital: May increase the metabolism of Acetaminophen. Specifically, formation of the hepatotoxic NAPQI metabolite may
be increased. Risk C: Monitor therapy
Phenylephrine (Systemic): Acetaminophen may increase the serum concentration of Phenylephrine (Systemic). Risk C: Monitor
therapy
Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these
agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of
methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with
development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy
Primidone: May increase the metabolism of Acetaminophen. Specifically, formation of the hepatotoxic NAPQI metabolite may be
increased. Risk C: Monitor therapy
Probenecid: May increase the serum concentration of Acetaminophen. Probenecid may also limit the formation of at least one major
non-toxic metabolite, possibly increasing the potential for formation of the toxic NAPQI metabolite. Management: Consider limiting
acetaminophen use in combination with probenecid. Probenecid may reduce clearance of acetaminophen to one of its non-toxic
metabolities, increasing the risk for acetaminophen toxicity, even a lower doses. Risk D: Consider therapy modification
RifAMPin: May enhance the hepatotoxic effect of Acetaminophen. RifAMPin may decrease the serum concentration of
Acetaminophen. Risk C: Monitor therapy
Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of
these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
SORAfenib: Acetaminophen may enhance the hepatotoxic effect of SORAfenib. SORAfenib may increase the serum concentration of
Acetaminophen. Management: Avoid coadministration of acetaminophen and sorafenib if possible. If coadministration is
unavoidable, monitor for signs/symptoms of hepatotoxicity, particularly in patients with greater acetaminophen exposure. Risk D:
Consider therapy modification
Vaccines: Acetaminophen may diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use
of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers
and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Acetaminophen may enhance the anticoagulant effect of Vitamin K Antagonists. This appears
most likely with daily acetaminophen doses exceeding 1.3 or 2 g/day for multiple consecutive days. Risk C: Monitor therapy
Food Interactions
Rate of absorption may be decreased when given with food. Management: Administer without regard to food.
Pregnancy Considerations
Acetaminophen crosses the placenta (Naga Rani 1989).
Based on epidemiological data, an increased risk of major congenital malformations has not been observed following maternal use of
acetaminophen during pregnancy. Although not considered a major birth defect, an association between maternal acetaminophen use
and cryptorchidism (undescended testis) has been observed (Fisher 2016; Jensen 2010; Kristensen 2011; Snijder 2012). The use of
acetaminophen in normal doses during pregnancy is not associated with an increased risk of miscarriage or still birth; however, an
increase in fetal death or spontaneous abortion may be seen following maternal overdose if treatment is delayed (Li 2003; Rebordosa
2009; Riggs 1989). Prenatal constriction of the ductus arteriosus has been noted in case reports following maternal use during the third
trimester (Allegaert 2019); although this association was not confirmed in a large observational study (Dathe 2019), acetaminophen has
been evaluated for the treatment of a persistent patent ductus arteriosus in preterm neonates (Terrin 2016). Additional adverse events
such as wheezing and asthma in early childhood and adverse neurodevelopmental effects such as ADHD following in utero
acetaminophen exposure have been evaluated in multiple studies; outcome information is inconclusive, and a causal association has not
been established (Cheelo 2014; Fan 2017; Lourido-Cebreiro 2017; Scialli 2010; SMFM 2017). It should be noted that maternal fever is also
associated with adverse fetal outcomes, including neural tube defects, oral clefts, and congenital heart defects. Treatment of maternal
fever with an antipyretic may reduce these risks (Drier 2014).
Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of acetaminophen may be altered. Dose adjustments
are not recommended (Kulo 2014). Acetaminophen is considered appropriate for the treatment of pain and fever in pregnancy (SMFM
2017). Acetaminophen may be used as part of a multimodal approach to pain relief following cesarean delivery (ACOG 209 2019), for the
treatment of acute migraine in pregnant patients (Burch 2019; Hamilton 2019a; Marmura 2015) and is recommended for the treatment
of fever in pregnant women diagnosed with influenza (ACOG 753 2018). Acetaminophen is recommended to be used at the lowest
effective dose for the shortest duration of time to effectively treat the mother and protect the health of the fetus (Kilcoyne 2017).
Breastfeeding Considerations
Acetaminophen is present in breast milk (Notarianni 1987).
The relative infant dose (RID) of acetaminophen is 3.98% when calculated using the highest breast milk concentration located and
compared to an infant therapeutic dose of 60 mg/kg/day.
In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).
The RID of acetaminophen was calculated using a milk concentration of 15.9 mcg/mL providing an estimated daily infant dose via breast
milk of 2.385 mg/kg/day. This milk concentration was obtained following a single maternal dose of oral acetaminophen 1,000 mg given
to 11 women, 3 to 9 days' postpartum (Hurden 1980).
Following a single oral maternal dose of acetaminophen 650 mg, the half-life of acetaminophen is 1.35 to 3.5 hours in breast milk (Berlin
1980). Acetaminophen can be detected in the urine of breastfeeding infants (Notarianni 1987). Except for a single case report of a rash
(Matheson 1985), adverse reactions have generally not been observed in breastfeeding infants (Ito 1993).
Nonopioid analgesics are preferred for breastfeeding females who require pain control peripartum or for surgery outside of the
postpartum period (ABM [Martin 2018]; ABM [Reece-Stremtan 2017]; Sachs 2013). Acetaminophen is one of the preferred non-narcotic
agents (Sachs 2013) and is considered compatible with breastfeeding when used in usual recommended doses (WHO 2002).
Dietary Considerations
Some products may contain phenylalanine and/or sodium.
Monitoring Parameters
Serum acetaminophen levels: Where acute overdose suspected and with long-term use in patients with hepatic disease; relief of pain or
fever
Mechanism of Action
Although not fully elucidated, the analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathways
in the CNS. Interactions with other nociceptive systems may be involved as well (Smith 2009). Antipyresis is produced from inhibition of
the hypothalamic heat-regulating center.
Pharmacokinetics
Note: With the exception of half-life, the pharmacokinetic profile in pediatric patients (0-18 years) is similar to adult patients.
Onset of action:
Oral: <1 hour
IV: Analgesia: 5 to 10 minutes; Antipyretic: Within 30 minutes
Peak effect: IV: Analgesic: 1 hour
Duration:
IV, Oral: Analgesia: 4 to 6 hours
IV: Antipyretic: ≥6 hours
Absorption: Primarily absorbed in small intestine (rate of absorption dependent upon gastric emptying); minimal absorption from
stomach; varies by dosage form
Distribution: ~1 L/kg at therapeutic doses
Protein binding: 10% to 25% at therapeutic concentrations; 8% to 43% at toxic concentrations
Metabolism: At normal therapeutic dosages, primarily hepatic metabolism to sulfate and glucuronide conjugates, while a small
amount is metabolized by CYP2E1 to a highly reactive intermediate, N-acetyl-p-benzoquinone imine (NAPQI), which is conjugated
rapidly with glutathione and inactivated to nontoxic cysteine and mercapturic acid conjugates. At toxic doses (as little as 4 g daily)
glutathione conjugation becomes insufficient to meet the metabolic demand causing an increase in NAPQI concentrations, which
may cause hepatic cell necrosis. Oral administration is subject to first pass metabolism.
Half-life elimination: Prolonged following toxic doses
Neonates: 7 hours (range: 4 to 10 hours)
Infants: ~4 hours (range: 1 to 7 hours)
Children: 3 hours (range: 2 to 5 hours)
Adolescents: ~3 hours (range: 2 to 4 hours)
Adults: ~2 hours (range: 2 to 3 hours); may be slightly prolonged in severe renal insufficiency (CrCl<30 mL/minute): 2 to 5.3
hours
Time to peak, serum: Oral: Immediate release: 10 to 60 minutes (may be delayed in acute overdoses); IV: 15 minutes
Excretion: Urine (<5% unchanged; 60% to 80% as glucuronide metabolites; 20% to 30% as sulphate metabolites; ~8% cysteine and
mercapturic acid metabolites)
Pharmacokinetics: Additional Considerations
Hepatic function impairment: The half-life may increase 2-fold or more in patients with liver disease.
Pricing: US
Capsules (Tylenol Oral)
325 mg (per each): $0.20
Chewable (Acetaminophen Oral)
160 mg (per each): $6.29
325 mg (per each): $6.79
Chewable (Mapap Childrens Oral)
80 mg (per each): $0.08
160 mg (per each): $0.09
Chewable (Tylenol Childrens Chewables Oral)
160 mg (per each): $0.29
Gel (ElixSure Fever/Pain Oral)
160 mg/5 mL (per mL): $0.04
Liquid (Acetaminophen Oral)
160 mg/5 mL (per mL): $0.06
Liquid (Mapap Acetaminophen Extra Str Oral)
500 mg/15 mL (per mL): $0.02
Pack (Tylenol Childrens Pain + Fever Oral)
160 mg (per each): $0.38
Pack (Tylenol Dissolve Packs Oral)
500 mg (per each): $0.36
Solution (Acetaminophen Childrens Oral)
160 mg/5 mL (per mL): $0.02
Solution (Acetaminophen Intravenous)
10 mg/mL (per mL): $0.11 - $0.45
Solution (Acetaminophen Oral)
160 mg/5 mL (per mL): $0.18 - $0.45
Suppository (FeverAll Adults Rectal)
650 mg (per each): $0.66

Suppository (FeverAll Childrens Rectal)
120 mg (per each): $0.80
Suppository (FeverAll Infants Rectal)
80 mg (per each): $0.80
Suppository (FeverAll Junior Strength Rectal)
325 mg (per each): $0.80
Suspension (Acetaminophen Oral)
160 mg/5 mL (per mL): $0.22
Suspension (Panadol Childrens Oral)
160 mg/5 mL (per mL): $0.05
Suspension (Panadol Infants Oral)
160 mg/5 mL (per mL): $0.08
Suspension (Tylenol Childrens Oral)
160 mg/5 mL (per mL): $0.06
Suspension (Tylenol Childrens Pain + Fever Oral)
160 mg/5 mL (per mL): $0.06
Suspension (Tylenol for Children + Adults Oral)
160 mg/5 mL (per mL): $0.05

Suspension (Tylenol Infants Pain+Fever Oral)
160 mg/5 mL (per mL): $0.16
Syrup (Triaminic Fever Reducer Oral)
160 mg/5 mL (per mL): $0.08
Tablet, controlled release (Acetaminophen ER Oral)
650 mg (per each): $0.07 - $0.10
Tablet, controlled release (Tylenol 8 Hour Arthritis Pain Oral)
650 mg (per each): $0.13
Tablet, controlled release (Tylenol 8 Hour Oral)
650 mg (per each): $0.18
Tablets (Acetaminophen Oral)
325 mg (per each): $0.01 - $0.06
500 mg (per each): $0.02 - $0.08
Tablets (Healthy Mama Shake That Ache Oral)
500 mg (per each): $0.06
Tablets (Panadol Extra Strength Oral)
500 mg (per each): $0.14
Tablets (Pharbetol Extra Strength Oral)

500 mg (per each): $0.03
Tablets (Pharbetol Oral)
325 mg (per each): $0.02
Tablets (Tylenol Extra Strength Oral)
500 mg (per each): $0.12
Tablets (Tylenol Oral)
325 mg (per each): $0.05
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided
when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine
the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate
any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer.
Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to
accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or
consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Brand Names: International

A-Mol (TH);
Acamol (CL, IL, LI);
Acamol To-Go (IL);
Acamoli Baby (IL);
Acamoli Forte suppositories for Kids (IL);
Accelio (JP);
Acemol (VN);
ACET suppositories (SG);
Acetab (VN);
Acetalgan (EG);
Acetalgin (CH);
Acetamol (IT);
Acicur-P (PY);
Actimol (MY);
Adinol (CR, DO, GT, HN,
MX, NI, SV);
Adol (BH, EG, ET, JO, KW, LB, QA, SA);
Adolin (PA);
Adorem (CO);
Afebrin (HK);
Afebryl (LU);
Agap Fast (PL);
Agomol (TZ);
Alcocin
(IN);
Alginox (EC);
Alvedon (SE);
Amadol (AU);
Ametrex (CO);
Amol (AE, CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE);
Analgiser (AE, BH,
CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE);
Analphen (MX);
Angela (TH);
Antalgic (ZW);
Antamol (JO);
Apacet (LI);
Apap (LI);
Apimol
(ZW);
Aptamol (IN);
Arfen (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW);
Atamel (PE);
Avadol (MY);
Axcel (MY);
Ben-U-Ron (CH, PT);
ben-u-ron (HU);
Benuron (JP);
Betamol (ZW);
Biogesic (SG);
Biogesic Suspension
(HK);
Biopain (PH);
Blimol (UA);
Calapol (ID);
Calonal (JP);
Calpol (AE, BF, BJ, CI, CY, EG, ET, GH, GM, GN, IE, IQ, IR, JO, JP, KE, KW, LB, LK, LR,
LY, MA, ML, MR, MT, MU, MW, NE, NG, OM, PR, QA, SA, SC, SD, SI, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW);
Causalon (AR);
Cemol (TH);
Cetal
(ET);
Cetapain (ID);
Cetapyrin (LK);
Cetta (TH);
Champ Syrup (KR);
Children's Bufferin (CN);
Children's S Tylenol (KR);
Christamol (HK);
Claradol (MA);
Cotemp (TH);
Croix Blanche (LU);
Curpol (LU);
Dafalgan (BE, LU);
Dafalgan odis (LU);
Dailyal (LV);
Daleron (HR, SI);
Demneq
(NL);
Den-U-Ron (CN);
Denamol (TH);
Depon (TR);
Dirox (AR);
Dismifen (MX);
Dol-Stop (LU);
Dolan Infantil (GT, HN, NI, SV);
Dolex (UY);
Dolgesic (ES);
Doliprane (FR, IN, LB, MA);
Dolitabs (FR);
Dolomol (AE, CY, EG, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE);
Dolorol (ZA);
Dolprone (LU);
Doluvital (MX);
Dolviran (MX);
Dumin (LK);
Efermol (PY);
Efferalgan (HR, HU, LT, LU, LV, UA);
Efferalgan 500 (CR, DO, EE, GT,
HN, NI, PA, SV);
Efferalganodis (FR);
Elgan (UA);
Eneffa (BH);
Enelfa (LU);
Eterfix (ID);
Europain (HK);
Fast (BD);
Fbridol (ET);
Febridol (AU);
Febrile Free (PH);
Fervex (BR);
Fevadol (BH, QA);
Fibralgin (HR);
Filanc (MX);
Fortolin (CN, HK);
Gelocatil (ES);
Geluprane 500 (FR);
Hapacol
(MY);
Hapacol Jr (MY);
Hedex (IE);
Hoemal (MY);
Hoemal Junior (MY);
Influgan (UA);
Kelvin (ET, LK);
Lekadol (HR);
Lemgrip (BE, LU);
Lonarid
mono (LU);
Lotemp (TH);
Lupocet (HR);
Maccabimol (IL);
Mafidol (PE);
Medipyrin (SK);
Mejoralito Junior (MX);
Mejoralito Pediátrico (MX);
Meldol (ZW);
Metagesic (PH);
Mexalen (AT, CZ, HU);
Minopan (KR);
Momentum (LU);
Mypara (TH);
Napafen (EC);
Napamol (ZA);
Napaton
(TW);
Napran (PH);
Naprex (ID);
NEBS (JP);
Neuridon (LU);
Nordinet Infantil (MX);
Normotemp (EC);
Novadol (ZW);
Nufadol (ID);
Omnipap
(PL);
Omol (QA);
Pacemol (KR);
Padolieve (IE);
Pamol (DK, JO, NZ);
Pamol 650 (SG);
Panadol (AE, AU, BE, BF, BG, BJ, CH, CI, CL, CN, CY, CZ,
EE, EG, ES, ET, FI, FR, GB, GH, GM, GN, GR, HK, HU, ID, IE, IL, IQ, IR, IT, JO, KE, KR, KW, LB, LK, LR, LU, LV, LY, MA, ML, MR, MT, MU, MW, NE,
NG, NL, NZ, OM, PE, PK, PL, PT, QA, RO, RU, SA, SC, SD, SG, SK, SL, SN, SY, TH, TN, TW, TZ, UA, UG, YE, ZM, ZW);
Panadol Actifast (MY, SG);
Panadol Extend (SG);
Panadol for Children (SG);
Panadon (HR);
Panadrex (BH, ET);
Panamax (AU);
Panodil (DK, NO, SE);
Para-IV (PH);
Paracet (IS, NO, ZW);
Paracetamol (HR);
Paracetamol Pharmavit (HU);
Paracetamol-ratiopharm (LU);
Paracetol (LK);
Paracil (MY);
Paracip
(LV);
Paragin (TH);
Paralgin (AU);
Paralief (IE);
Paramol (IL, LB, RO, TW);
Paramol Kat Drops (IL);
Parapaed (DE);
Parapaed Junior (NZ);
Parapaed Six Plus (NZ);
Parapane (AU);
Paratabs (IS);
Parcemol (HK);
Parcemol Forte (HK);
Parmol (HK);
Paromon (HK);
Parvid (PH);
Paximol (SG);
Pe-Tam (LU);
Pedipan (KR);
Penral-Night (KR);
Perdolan Mono (LU);
Perfalgan (AE, AT, BG, BH, CH, CZ, DE, DK, EE, EG, ES, FI,
FR, GB, GR, HR, IE, IL, IN, IS, IT, JO, KR, KW, LB, LT, MT, NZ, PL, PT, QA, RO, RU, SA, SE, SI, SK, TR, VN, ZA);
Pharmacen-M (MX);
Pinex (NO);
Pireta (ID);
Plicet (HR);
Poro (ID, MY, PH, SG, TH);
Portem (CR, DO, GT, HN, NI, PA, SV);
Prest (NL);
Progesic (HK);
Raperon (KR);
Rapidene
(LK);
Rapidol (CL);
Reliv (SE);
Remedol (MT, PR, TR);
Revanin (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL,
SN, TN, TZ, UG, ZM, ZW);
Rhinapen elixir (KR);
Rubophen (HU);
Salzone (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG,
SC, SD, SL, SN, TN, TZ, UG, ZM, ZW);
Sanmol (PH);
Sanmol Infusion (ID);
Saridon (CO);
Sedalito (MX);
Sedalmerck (CR, DO, GT, HN, NI, PA,
SV);
Selegesic (PH);
Sensamol (IL);
Setamol (HK);
Setopain (KR);
Setopain ER (KR);
Sinebriv (PL);
Sinedol (DO, MX);
Strimol (ZW);
Supadol
mono (LU);
Suspen ER (KR);
Tafirol (PE);
Tamin (TZ);
Tamoliv (ID);
Tasmen (KR);
Tempol (MY);
Tempra (ID, JP, LU, MX);
Tempte (TW);
Teramol
(PH);
Teramol Forte (PH);
Tipol (IE);
Toniker (TW);
Turpan (ID);
Tylenol (BR, CH, DE, JP, KR, MX, NL, PH, PT, QA, TH, VE);
Tylenol 8-hour (TH);
Tylenol Acetaminophen Extended Relief (CN);
Tylenol ER (KR);
Tylenol Extra Fuerte (PY);
Tylenol Forte (AE, CY, EG, IQ, IR, JO, KW, LB, LY,
OM, QA, SA, SY, YE);
Tylex (BB, BM, BS, BZ, CR, DO, GT, GY, HN, JM, MX, NI, PA, SR, SV, TT);
Umbral (EC);
Winadol (CO, VE);
Xcel (BD);
Xebramol (TH);
XL-Dol Infantil (MX);
Z-Mol (PY)
For country abbreviations used in Lexicomp ( show table)
Use of UpToDate is subject to the Terms of Use.
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13/10/22, 18:17 Acetaminophen (paracetamol): Drug information - UpToDate

Reimpresión oficial de UpToDate ®

Acetaminofén (paracetamol): información sobre medicamentos

Copyright 1978-2022 Lexicomp, Inc. Todos los derechos reservados.

ALERTA: Advertencia en caja de EE. UU.

Nombres de marca: EE. UU.

Pain and/or fever 

Pain (mild to moderate) and/or fever (monotherapy or as an adjunct):

Dosing: Kidney Impairment: Adult

IV, Oral, Rectal:

Peritoneal dialysis: Not dialyzed (Ref): No dosage adjustment necessary (Ref).

CRRT: Dialyzed (Ref): No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

Severe impairment: Use is contraindicated.

(For additional information see "Acetaminophen (paracetamol): Pediatric drug information")

Acetaminophen Dosing (Oral)

Weight (preferred)A Dosage

8.2 to 10.8 18 to 23 1 to 2 y 120

10.9 to 16.3 24 to 35 2 to 3 y 160

16.4 to 21.7 36 to 47 4 to 5 y 240

21.8 to 27.2 48 to 59 6 to 8 y 320 to 325

27.3 to 32.6 60 to 71 9 to 10 y 325 to 400

32.7 to 43.2 72 to 95 11 y 480 to 500

Children ≥12 years and Adolescents:

Infants and Children <2 years:

Children ≥2 years (Ref):

Infants 6 to 11 months: 80 mg every 6 hours; maximum daily dose: 320 mg/day.

Pain; peri-/postoperative management; adjunct to opioid therapy 

Pain; peri-/postoperative management; adjunct to opioid therapy:

Children ≥2 years (Ref):

Rectal: Limited data available: Children:

Dosing: Kidney Impairment: Pediatric

Altered kidney function:

Infants, Children, and Adolescents:

Dosing: Hepatic Impairment: Pediatric

Dosing: Older Adult

Pain (acute) or fever: Oral, IV: Refer to adult dosing.

Persistent pain (off-label): Adults ≥75 years: Oral:

Initial: 325 to 500 mg every 4 hours or 500 to 1,000 mg every 6 hours

Generic: 160 mg/5 mL (473 mL [DSC])

Generic: 160 mg/5 mL (118 mL, 473 mL)

Tylenol Dissolve Packs: 500 mg (12 ea, 32 ea) [berry flavor]

Solution, Intravenous [preservative free]:

Ofirmev: 10 mg/mL (100 mL [DSC])

Generic: 10 mg/mL (100 mL)

FeverAll Adults: 650 mg (50 ea) [contains polysorbate 80]

FeverAll Childrens: 120 mg (6 ea, 50 ea) [contains polysorbate 80]

FeverAll Infants: 80 mg (1 ea, 6 ea, 50 ea) [contains polysorbate 80]

FeverAll Junior Strength: 325 mg (6 ea, 50 ea) [contains polysorbate 80]

Childrens Non-Aspirin: 160 mg/5 mL (118 mL)

Pain Relief Childrens: 160 mg/5 mL (118 mL) [cherry flavor]

Acetaminophen Extra Strength: 500 mg

Acetaminophen Extra Strength: 500 mg [scored]

Acetaminophen Extra Strength: 500 mg [contains corn starch]

Acetaminophen Extra Strength: 500 mg [aspirin free]

Acetaminophen Extra Strength: 500 mg [scored; aspirin free]

Acetaminophen Extra Strength: 500 mg [aspirin free; contains corn starch]

Acetaminophen Extra Strength: 500 mg [aspirin free, sodium free]