Introduction and Audit of Intravenous Paracetamol at a Tertiary Paediatric Teaching Hospital

Abstract

Intravenous (IV) paracetamol (Perfalgan ®) is an patients unable to tolerate the oral form when 'nil by mouth', vomiting or with no absorptive capacity. suggests that in comparison to the oral route it has superior pharmacokinetics 1 1-3 sparing ability (50% vs. oral 30%) 1,4. However, there is little information on the new IV paracetamol 5,6. The IV form's with greater potential for error, particularly in 5 particularly the risk of hepatotoxicity, as well as IV on their formulary. representatives. When a new formulary application is However, when the agent is more costly, has potential

Safety and Efficacy of Off-label and Unlicensed Medicines in Children

“…Therefore, we included dopamine in the list of off-labeled/unlicensed drugs in the present study. Additionally, the use of intravenous propacetamol in neonates and children has gained popularity,1617 and it has been widely used for postoperative pain control and as an antipyretic in Korea. In US, intravenous acetaminophen is approved in children aged > 2 years.…”

Use of Intravenous Acetaminophen (Paracetamol) in a Pediatric Patient at the End of Life: Case Report

“…3 The majority of data on the use of intravenous acetaminophen involve postoperative analgesia, 4-6 although in the past several years increasing evidence has accumulated regarding the safety and efficacy of intravenous acetaminophen in pediatric populations, including neonates. [7][8][9] The standard dosing of intravenous acetaminophen in pediatric patients is the same as for oral acetaminophen (15 mg/kg every 4-6 hours with a maximum of 60 mg/kg per day or 4 g/d) with each dose being run over 15 minutes. Noninferiority trials in pediatric patients have shown that in terms of analgesic and antipyretic effects, intravenous acetaminophen is no less effective than a comparable dose of intravenous propacetamol.…”

Best Practice for Fever Management With Intravenous Acetaminophen in Pediatric Oncology

“…This exact scenario, while the cause for many documented errors in the United Kingdom, does not necessarily equate increased toxicity to the liver, because of its first-pass metabolism (Candiotti et al, 2010;Dart & Rumack, 2012;). Palmer et al (2007) looked at the use of acetaminophen in pediatric hospitals and noted that the IV form may also have a different dosing schedule than its oral equivalent, which allows room for error (Palmer et al, 2007). Fortunately, because of its predictable and reliable plasma concentrations, an overdose could, in fact, be managed more accurately and appropriately than an oral or rectal overdose, which can have variable uptake and absorption (Babl et al, 2011;Zuppa et al, 2011).…”

“…This study also found drug interactions with probenacid and oral anticoagulants, suggesting a decreased dose when on probenacid, and frequent monitoring of the international normalized ratio, which was seen to have variations. Palmer et al (2007) associated greater risk for liver toxicity in patients concurrently receiving total parenteral nutrition. This observation may have been because of confounding patient characteristics such as a higher acuity of illness, being in a longer fasting state, and receiving IV acetaminophen over a prolonged duration, making it difficult to deduce the drug's precise impact on liver function (Palmer et al, 2007).…”

“…Palmer et al (2007) associated greater risk for liver toxicity in patients concurrently receiving total parenteral nutrition. This observation may have been because of confounding patient characteristics such as a higher acuity of illness, being in a longer fasting state, and receiving IV acetaminophen over a prolonged duration, making it difficult to deduce the drug's precise impact on liver function (Palmer et al, 2007). Nevertheless, it would be beneficial to consider these factors in pediatric oncology patients sharing similar conditions.…”