Paracetamol
The first-choice painkiller and fever medicine. 1 g every 4–6 hours in adults, 15 mg/kg in children, never more than 4 g a day.
Common brands in Pakistan: Panadol, Calpol. Brand availability changes; check with your pharmacy.
On this page
Uses
Adult dose
| Route | Dose | Maximum |
|---|---|---|
| Oral | 500 mg–1 g every 4–6 hours | 4 g in 24 hours |
| IV, weight 50 kg or more | 1 g every 6 hours over 15 minutes | 4 g in 24 hours |
| IV, weight under 50 kg | 15 mg/kg every 6 hours | 60 mg/kg in 24 hours |
| Rectal | 500 mg–1 g every 4–6 hours | 4 g in 24 hours |
Children's dose
| Age or weight | Oral dose | Maximum |
|---|---|---|
| Over 3 months | 15 mg/kg every 4–6 hours | 4 doses (60 mg/kg) in 24 hours |
| Neonates and infants under 3 months | 10–15 mg/kg, less often | Specialist advice |
| IV (child 10–50 kg) | 15 mg/kg every 6 hours | 60 mg/kg in 24 hours |
Use the paracetamol syrup calculator to convert mg to mL. Check the syrup strength every time: 120 mg/5 mL and 250 mg/5 mL are both common in Pakistan.
Kidney and liver
- Liver disease, heavy alcohol use, malnutrition or weight under 50 kg: use a lower maximum (often 3 g a day or less) and longer gaps between doses.
- Severe kidney impairment (creatinine clearance under 10–30 mL/min): give at least 6 hours apart.
Pregnancy and breastfeeding
Paracetamol is the preferred painkiller and fever treatment in pregnancy and breastfeeding at normal doses.
Side effects and cautions
- Side effects are rare at normal doses.
- Hidden double dosing is common: many cough and cold syrups and combination tablets also contain paracetamol. Ask what else the patient is taking.
- IV paracetamol can cause low blood pressure if given too fast.
Overdose
Overdose causes liver failure, often with no symptoms for the first day. Take a level at 4 hours or later and use the treatment line to decide on acetylcysteine. See overdose and poisoning.
Frequently asked questions
What is the maximum dose of paracetamol in 24 hours?
4 g in 24 hours for adults over 50 kg (for example 1 g four times a day), and 60 mg/kg in 24 hours for children. Use less in liver disease and low body weight.
How much paracetamol syrup can I give a child?
15 mg/kg per dose, up to 4 times in 24 hours. For a 12 kg child that is 180 mg: 7.5 mL of 120 mg/5 mL syrup or 3.6 mL of 250 mg/5 mL syrup.
Can paracetamol be given in dengue?
Yes. Paracetamol is the recommended painkiller in dengue, within the normal maximum dose. Avoid NSAIDs and aspirin.
Used in these guides
- A patient has fallen
- Acute abdominal pain
- Acute diverticulitis
- Acute pancreatitis
- Acute sinusitis
- Ankle and foot injuries
- Appendicitis
- Bronchiolitis
- Burns
- Chickenpox
- Cough and chest infection in OPD
- Dengue fever
- Dental pain and dental infection
- Earache
- Elbow injuries
- Eye injuries
- Fever in a well-looking child
- Fever in adults
- Fractures and dislocations: the essentials
- Gallstone disease: colic, cholecystitis, cholangitis
- Guillain–Barré syndrome
- Head injury
- Headache in OPD
- Headache in the emergency department
- High blood pressure on the ward
- Hip (neck of femur) fracture
- Insect bites, stings and scorpions
- Knee injuries
- Lumbar puncture
- Minor head injury
- Neck injuries
- Nosebleed (epistaxis)
- Ovarian torsion
- Pneumothorax
- Post-operative complications
- Renal colic (kidney stones)
- Rib injuries
- Shingles (herpes zoster)
- Shoulder injuries
- Skin abscess
- Snake bite
- Sore throat
- Temperature spike on the ward
- The febrile child
- The limping child
- Typhoid (enteric fever)
- Urinary tract infection (cystitis)
- Wrist injuries
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Paracetamol is covered in our textbook chapter Analgesics and NSAIDs, with practice MCQs.