What dose of paracetamol for older people?

Abstract

Paracetamol, on its own or in combination with other analgesics, is widely used to treat pain associated with acute and chronic conditions. It is considered safe enough to have a general sales licence (GSL) for use by "adults, elderly and children over 16 years" and has few listed cautions or contraindications.1,2 However, recently the effectiveness and safety of paracetamol for some conditions have been challenged, 3,4 and there are published case reports of liver failure associated with therapeutic doses.5-9 Here, we review the use of paracetamol, its pharmacokinetics, the mechanisms by which it can cause liver damage and consider whether frail older people are at greater risk of adverse effects. We also discuss if dose reduction should be considered in some circumstances.

Highly Variable Paracetamol Pharmacokinetics After Multiple Oral Dosing in Frail Older People: A Population Pharmacokinetic Analysis

“…Both in clinical practice as well as in literature, a discussion is ongoing whether to administer paracetamol in a dose of 1000 mg q6h or q8h to the older population because of efficacy as well as safety issues [5]. Here we provide the pros and cons of the administration of paracetamol 1000 mg q6h vs q8h in relation to our analysis.…”

“…Paracetamol (acetaminophen) is a commonly used analgesic [3]. It is registered for pain treatment in adults with a dose of 1000 mg q6h (maximum daily dose of 4000 mg) and for adults with a bodyweight ≤ 50 kg with a dose of 15 mg/ kg/dose (maximum daily dose of 60 mg/kg or 3000 mg) [4,5]. A maximum dose of 3000 mg daily is suggested for individuals with additional risk factors for paracetamol toxicity, such as old age itself and frailty [4].…”

An Updated Review on the Metabolite (AM404)-Mediated Central Mechanism of Action of Paracetamol (Acetaminophen): Experimental Evidence and Potential Clinical Impact

“…Paracetamol represents an effective and safe analgesic option; however, its use in the elderly with chronic pain is still questionable. 102 …”

What dose of paracetamol for people with low bodyweight?

“…In an article published in 2018, we reviewed the pharmacokinetics of paracetamol, the mechanisms by which it can cause liver damage and discussed whether frail older people are at greater risk of adverse effects 5. The article noted, ‘Old age is not a risk factor in itself and older people who are in good health and weigh over 50kg are unlikely to need a dose reduction.…”