Paracetamol administration is associated with hypotension in the critically ill

Boyle, M.; Hundy, S.; Torda, T. A.

doi:10.1016/s1036-7314(97)70414-4

Cited by 47 publications

(24 citation statements)

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“…Three other reports of paracetamol-induced hypotension in ICU patients were found in the literature [15][16][17]. Boyle and colleagues [16] found a significant reduction in MAP within 15 min of oral paracetamol administration, which persisted for 90 min. Based on the published results so far, the occurrence of paracetamolinduced hypotension seems thus independent of route of administration or formulation.…”

Section: Discussionmentioning

confidence: 94%

“…Mean arterial pressure (MAP) dropped significantly in these patients, requiring active intervention (initiation or increase of noradrenaline or a fluid bolus) in 33% of the events [14]. Three other reports of paracetamol-induced hypotension in ICU patients were found in the literature [15][16][17]. Boyle and colleagues [16] found a significant reduction in MAP within 15 min of oral paracetamol administration, which persisted for 90 min.…”

Section: Discussionmentioning

confidence: 99%

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Paracetamol for intravenous use in medium- and intensive care patients: pharmacokinetics and tolerance

Maat

Tijssen

Brüggemann

et al. 2010

Eur J Clin Pharmacol

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Purpose We studied the pharmacokinetics of paracetamol and determine the incidence of hypotension after intravenous administration in medium-(MCU) and intensive care (ICU) patients. Methods All patients on the ICU/MCU starting with paracetamol i.v. were included, yielding 38 patients. Blood samples were collected at predetermined time points to determine paracetamol serum concentration. The number of patients with a clinically relevant reduction in systolic blood pressure (SBP) and the number of patients that needed intervention to regain an acceptable blood pressure level were assessed. Results Overall, pharmacokinetic data were roughly comparable with earlier publications, but differences were noted in the subgroup ICU patients. Also, there was a trend to a larger peak serum concentration (p=0.052) and a significantly smaller volume of distribution (p=0.033) in MCU patients compared with ICU patients. Twenty-two percent (22%) and 33% of patients had a clinically relevant reduction in systolic blood pressure (SBP) 15 and 30 min after start of paracetamol infusion, respectively. In six patients (16%), an intervention was needed to correct blood pressure. Overall, SBP was significantly reduced at T=15 min and 30 min postinfusion (p<0.003 at both time points) when compared with SBP at the start of paracetamol infusion. Conclusions Further research on differences in paracetamol pharmacokinetics between ICU and MCU patients is warranted, as these differences might result in differences in efficacy. Furthermore, administration of paracetamol i.v. as potential cause of hypotension in the critically ill patient must not be overlooked.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Paracetamol for intravenous use in medium- and intensive care patients: pharmacokinetics and tolerance

Maat

Tijssen

Brüggemann

et al. 2010

Eur J Clin Pharmacol

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“…In a study of critically ill patients, a single 1-gram dose of paracetamol did not raise, but rather lowered, blood pressure more than 30%. 12 …”

Section: Clinical Correlationsmentioning

confidence: 99%

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

Egan

2002

Hypertension

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sion in US Women" 1 presents epidemiological observations that are intriguing and have potentially important public health and clinical implications. The high prevalence and incidence of hypertension in this comparatively healthy (nurses) cohort of middle-aged and older women 44 to 69 years of age was substantial. The prevalence of hypertension at baseline was 32%. The incidence of hypertension among the women who were normotensive in 1990 and followed an average of Ϸ7.4 years (381 078 person yr/51,630 persons) was an impressive 20.5% (51 630/10 579) or Ϸ2.8% annually. The relatively high incidence of hypertension occurred despite the fact that 50% of these women had a reported body mass index of Յ24 kg/m 2 , whereas Ϸ60% of Americans in this age range have a body mass index Ͼ25 kg/m 2 . The high rate of analgesic use was also noteworthy. Eighty-five percent of women provided information on their use of 1 of 3 analgesics, including aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Seventy percent of the sample reported using at least 1 of these 3 analgesics 1 or more days monthly. Self-reported use on a monthly basis was of similar magnitude for aspirin (44%), acetaminophen (43%), and NSAIDs (37%).A striking and novel observation in this report is the positive and consistent association between the frequency of use for all 3 classes of analgesics and the relative risk of hypertension after controlling for multiple confounders in the multivariate model. The Table represents one clinician's attempt to put the risks in simple quantitative terms for the individual, as well as for the population of women in this age range. The multivariate relative risks, taken from Table 2 of the authors' original paper, 1 and the calculated absolute risks (per 1000) to the individual associated with a given frequency of use for each analgesic are shown in the third column of the Table in this commentary. The population-attributable risk (PAR/1000) of developing hypertension among middle-aged women associated with analgesic use is shown in the fourth column.In the absence of analgesic use, Ϸ25.5 women/1000 (2.55%) in this cohort developed hypertension annually. Given the prevalence and frequency of analgesic use reported and the risk of incident hypertension associated with that use, Ϸ4.5 additional women/1000 (0.45%) develop hypertension annually, ie, the sum of the PARs for the 3 analgesics. These data suggest that Ϸ15% (4.5/[25.5ϩ4.5]) of the hypertension developing in middle-aged women is associated with analgesic use.Epidemiological association between frequency of analgesic use and incident hypertension does not establish a pathogenetic relationship. Therefore, it may be useful to examine the implications of the report from various perspectives. Epidemiological ValidityThe Nurses' Health Study is a well-known cohort of 121 700 women that began in 1976. Although the data are based on self-reports from questionnaires, nurses are credible historians. One additional point is that this cohort of nurses was ...

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“…Paracetamol is associated with a reduction in blood pressure in critically-ill adults [1][2][3][4][5] . The reported decrease ranges between 7 and 15% from baseline and occurs over the first 2 hours.…”

Section: Introductionmentioning

confidence: 99%

“…The hyperthermia of fever is produced by an increase in metabolic rate, and a reduction in surface heat loss, through peripheral vasoconstriction. Paracetamol resets this central 'set-point': this opposes heat-conserving vasoconstriction, explaining a fall in both 4 SVR and blood pressure. However the haemodynamic impact of paracetamol may be complex given that heart rate also increases with temperature 10 .…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic changes with paracetamol in critically-ill children

Ray

Brick

Raman

et al. 2017

Journal of Critical Care

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Purpose: Paracetamol has been associated with a reduction in blood pressure, especially in febrile, critically-ill adults. We hypothesised that blood pressure would fall following administration of paracetamol in critically-ill children and this effect would be greater during fever and among children with a high body surface area to weight ratio. Methods:A 12-month prospective observational study of children (0-16 years) admitted to paediatric intensive care, who underwent pulse contour analysis and received paracetamol concurrently. Results:Mean arterial blood pressure decreased significantly by 4.7% from baseline (95% CI 1.75-8.07%) in 31 children following 148 doses of paracetamol. The nadir was 2-hours postdose. The effect was pronounced in children with fever at baseline (6.4%, 95% CI 2.8-10%), although this was not statistically significant. There was no simple relationship between this effect and body surface area to weight ratio. The association between a change in blood pressure and changes in heart rate or measured stroke volume was poor; therefore it was likely that a change in the systemic vascular resistance contributes most to this effect. Conclusion:There is a significant but modest reduction in blood pressure post-paracetamol in critically-ill children. This is likely related to a change in systemic vascular resistance.

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Paracetamol administration is associated with hypotension in the critically ill

Cited by 47 publications

References 1 publication

Paracetamol for intravenous use in medium- and intensive care patients: pharmacokinetics and tolerance

Paracetamol for intravenous use in medium- and intensive care patients: pharmacokinetics and tolerance

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

Haemodynamic changes with paracetamol in critically-ill children

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