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12E. ANALGESICS & ANTI-INFLAMMATORY DRUGS in 12. MUSCULOSKELETAL DISORDERS & PAIN
PARACETAMOL
NSAID | ANALGESIC & ANTI-PYRETIC
PK: A: Rapid D: Extensive M: Hepatic E: Urine (as glucuronide & sulfate conjugates)

Indications & Dose: FEVER PO/RECTAL Adult 325-650mg q4-6h or 1g 3-4 times/day, max 4g/day Child 0-3 month: 40mg, 4-11 months: 80mg, 1-2 yr: 120mg, 2-3 yr: 160mg, 4-5 yr: 240mg, 6-8 yr: 320mg, 9-10 yr: 400mg, 11 yr: 480mg | IV Adult <50 kg: 15mg/kg q6h or 12.5mg/kg q4h, max single dose: 750mg/dose, max daily dose: 75mg/kg/day (<3.75g/day), >50 kg: 650mg q4h or 1g q6h, max single dose 1g/dose, max daily dose 4g/day Child 2-12 yr: 15mg/kg q6h or 12.5mg/kg q4h, max single dose: 15mg/kg/dose, max daily dose: 75mg/kg/day (<3.75 g/day), >12 yr: Same as adult dose | PAIN Mild-to-moderate PO/RECTAL Adult 325-650mg q4-6h or 1g 3-4 times/day, max 4g/day Child 0-3 months: 40mg, 4-11 months: 80mg, 1-2 yr: 120mg, 2-3 yr: 160mg, 4-5 yr: 240mg, 6-8 yr: 320mg, 9-10 yr: 400mg, 11 yr: 480mg | IV Adult <50 kg: 15mg/kg q6h or 12.5mg/kg q4h, max single dose: 750mg/dose, max daily dose: 75mg/kg/day (<3.75g/day), >50 kg: 650mg q4h or 1g q6h, max single dose 1g/dose, max daily dose 4g/day Child 2-12 yr: 15mg/kg q6h or 12.5mg/kg q4h, max single dose: 15mg/kg/dose, max daily dose: 75mg/kg/day (<3.75 g/day), >12 yr: Same as adult dose | POST-IMMUNIZATION PYREXIA PO Child 2–3 month: 60mg, followed by a second dose after 4-6h if needed (seek medical advice if pyrexia persists after the second dose)

Contra: Hypersensitivity, severe hepatic impairment

Precautions: Anemia, mild-to-moderate hepatic disease, renal disease, elderly, children <2 yrs, alcohol dependence

ADR: Serious: Hematological reactions, hepatotoxicity, hypoglycemia, hypersensitivity reactions, edema, periorbital edema, hypoalbuminemia/hypokalemia/hypomagnesemia/hypophosphatemia, hypotension, tachycardia, Others: insomnia, atelectasis, wheezing, hypervolemia, nausea, vomiting, Rash

DDI: Serious Busulfan clearance reduces (IV) by drug, Diflunisal increases drug level, Phenobarbital/Carbamazepine/Phenytoin/Primidone/Rifampicin increases metabolism of drug, Isoniazid increases toxicity of drug, Alcohol leads to severe liver damage, Colestyramine reduces drug absorption, Probenecid reduces drug clearance

Diet: With food

Monitor: Relief of pain/fever

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