The exact mechanism of action of paracetamol is not fully understood, but it is believed to exert its therapeutic effects through multiple pathways. Its key mechanisms include:

1. Inhibition of Prostaglandin Synthesis:
   • Paracetamol inhibits cyclooxygenase (COX) enzymes, particularly COX-2, in the central nervous system (CNS).
   • This reduces the production of prostaglandins, which are involved in pain and fever.
2. Central Nervous System Effects:
   • Paracetamol acts on the CNS to reduce pain perception and fever by modulating the hypothalamic heat-regulating center.
3. Weak Anti-Inflammatory Effects:
   • Unlike nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol has minimal anti-inflammatory effects, making it less effective for inflammatory conditions.

Paracetamol is approved for a variety of clinical conditions, including:

1. Pain Relief:
   • Management of mild to moderate pain, such as headaches, dental pain, musculoskeletal pain, and postoperative pain.
2. Fever:
   • Reduction of fever in adults and children.
3. Off-Label Uses:
   • Adjunctive therapy for osteoarthritis (when NSAIDs are contraindicated).
   • Management of pain and fever in pregnancy (under medical supervision).

The dosage of paracetamol varies depending on the indication, patient age, and formulation. The following dosing guidelines are based on the British National Formulary (BNF) and clinical pharmacology references:

1. Adults:
   • Oral: 500–1000 mg every 4–6 hours as needed, not exceeding 4000 mg daily.
   • Intravenous (IV): 1000 mg every 4–6 hours, not exceeding 4000 mg daily.
2. Children:
   • Oral: 10–15 mg/kg every 4–6 hours as needed, not exceeding 60 mg/kg daily.
   • IV: 7.5–15 mg/kg every 4–6 hours, not exceeding 60 mg/kg daily.

Important Considerations:

• Paracetamol is available in oral tablets, capsules, suspensions, suppositories, and intravenous formulations.
• Dose adjustments may be necessary for patients with hepatic impairment. Avoid use in severe hepatic impairment.

Paracetamol should not be taken with other medications containing paracetamol to avoid overdose

Paracetamol is generally well-tolerated when used at recommended doses, but it is associated with a range of side effects, particularly with overdose. Common side effects include:

1. Gastrointestinal:
   • Nausea and vomiting (rare at therapeutic doses).
2. Hepatic:
   • Hepatotoxicity (with overdose or prolonged use).
3. Other:
   • Hypersensitivity reactions (rare).

Serious Side Effects:

• Hepatotoxicity: Liver damage, including acute liver failure, can occur with overdose or prolonged use of high doses.
• Skin Reactions: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) (rare).

Paracetamol requires careful monitoring and adherence to specific precautions to ensure patient safety:

1. Hepatic Risk:
   • Use with caution in patients with hepatic impairment. Avoid use in severe hepatic impairment.
   • Educate patients about the risk of hepatotoxicity with overdose.
2. Pregnancy and Lactation:
   • Paracetamol is considered safe for use during pregnancy and breastfeeding when taken at recommended doses.
3. Elderly Patients:
   • No dose adjustment is required, but caution is advised due to potential comorbidities.
4. Overdose:
   • Paracetamol overdose can cause severe liver damage. Immediate medical attention is required for suspected overdose. N-acetylcysteine (NAC) is the antidote for paracetamol overdose.
5. Alcohol Use:
   • Chronic alcohol use increases the risk of hepatotoxicity. Patients should avoid excessive alcohol consumption while taking paracetamol.

Paracetamol has a low potential for drug interactions, but key interactions include:

1. Warfarin:
   • Long-term use of high doses of paracetamol may enhance the anticoagulant effects of warfarin, increasing the risk of bleeding.
2. Isoniazid:
   • Concurrent use with isoniazid may increase the risk of hepatotoxicity.
3. Other Interactions:
   • Cholestyramine: Reduces the absorption of paracetamol.
   • Metoclopramide and domperidone: Increase the absorption of paracetamol.

Paracetamol is the generic name for this medication. It is marketed under various brand names, depending on the country and manufacturer. Some examples include:

• Panadol (a well-known brand in the United Kingdom and other regions).
• Tylenol (a well-known brand in the United States and other regions).
• Calpol (a pediatric formulation).
• Paracetamol Accord.

Paracetamol Mylan