Analgesic
Antipyretic
EMR: Mild to moderate pain (PO only)
PCP: Mild to moderate pain
PCP: Severe pain in a multimodal approach
PCP: Symptomatic pyrexia (PO/IV)
Caution:
See → CPG E08: Pain Management for additional guidance
EMR: Analgesia
PCP: Analgesia and antipyresis(Consider in symptomatic fever greater than 38°C (myalgias, chills, rigors))
Intravenous and oral doses are equivalent on a mg-to-mg basis.
Oral administration of acetaminophen is the preferred route of adminsitration where possible.
In severe pain, IV route is a reasonable consideration if rapid analgesia is required.
PCP: Analgesia and antipyresis (Consider in symptomatic fever greater than 38°C (myalgias, chills, rigors))
| Weight | ACP | PCP |
| 50 kgs or greater | 1000 mg IV q6h prn | 1000 mg IV q6h prn |
| <50 kgs | 15 mg/kg IV q6h prn | NOT AUTHORIZED |
Infuse 1000 mg/100 mL bag undiluted over 15 minutes using a standard 10 gtts/mL IV set (66 gtts/min)
Do not add other medications to the acetaminophen bag.
ACP Mixing Instructions:
EMR: Analgesia
PCP: Analgesia and antipyresis (Consider in symptomatic fever greater than 38°C (fussiness, irritability, inability to soothe, etc))
| Weight | PCP/ACP |
| Less than 30 kg | 15 mg/kg PO (liquid) |
| 30-50 kg | 500 mg PO (liquid or tablet) |
| Greater than 50 kg | 500-1000 mg PO |
PCP: Analgesia and antipyresis (Consider in symptomatic fever greater than 38°C (fussiness, irritability, inability to soothe, etc))
| Weight and Age | ACP | PCP |
| 12-17 and >50 kgs | 1000 mg IV q6h prn | 1000 mg IV q6h prn |
| Age 2-11 and < 50 kgs | 15 mg/kg IV q6h prn (see dosing chart below) | NOT AUTHORIZED |
ACP Mixing Instructions:
Table 1. Intravenous acetaminophen infusion dosing (15 mg/kg infused over 15 minutes)
| Patient Age & Weight | Dose (15 mg/kg) | VOLUME to be infused | drip rate (10 gtts admin set over 15 minutes) |
| 2 years - 12 kg | 180 mg | 18 mL | 12 gtts/min |
| 3 years - 15 kg | 225 mg | 22.5 mL | 15 gtts/min |
| 4 years - 18 kg | 270 mg | 27 mL | 18 gtts/min |
| 6 years - 20 kg | 300 mg | 30 mL | 20 gtts/min |
| 8 years - 25 kg | 375 mg | 37.5 mL | 25 gtts/min |
| 10 years - 30 kg | 450 mg | 45 mL | 30 gtts/min |
| 12 years - 40 kg | 600 mg | 60 mL | 40 gtts/min |
Caution:Verify dosing in milligrams (mg) with volume in milliliters (mL) to ensure accuracy. There is a potential for a ten-fold dosing error.
DO NOT add other medications to the acetaminophen bag.
Acetaminophen inhibits prostaglandin synthetase in the central nervous system, reducing pain and pyrexia.
Oral:
Intravenous:
Adverse reactions are uncommon with short-term use of acetaminophen. Nausea and vomiting can occur with IV formulation.
Hypotension has been reported with IV infusion, particularly in critically ill patients. Monitor baseline BP and then q15min x 3.
Rash and hives are rarely reported, but can occur.
Toxicity may occur after a single dose of more than 7.5 g (adults) or 150 mg/kg (pediatrics). Clinical findings of toxicity include nausea, vomiting, and/or right upper quadrant pain.
Acetaminophen is the leading cause of serious liver injury in Canada. Patients with pre-existing liver disease (regardless of underlying cause), chronic users of acetaminophen, and pediatrics are at most risk. Acetaminophen is a component of many over-the-counter medications and patients may inadvertently be consuming much higher doses than expected. Paramedics must ensure that a complete medication history is obtained prior to the administration of acetaminophen, including over-the-counter preparations.
Alcohol may potentiate acetaminophen’s hepatoxic effects. Chronic acetaminophen use can impact INR levels, potentially affecting patients taking warfarin.