Update: October 2018
Paracetamol is a drug from the group of anilides,
with significant antipyretic and analgesic effect and
less pronounced anti-inflammatory effect. Everywhere
used in the treatment of adult patients and in pediatrics (see all
antipyretics for children).
Paracetamol is the main metabolite of phenacetin –
substances previously widely used in the treatment of pain and
hyperthermic syndrome but prohibited due to dangerous
toxic effects on the kidneys and
The main advantage of paracetamol is low toxicity and
low risk of methemoglobin formation. However, long-term use
high doses of paracetamol can cause adverse reactions in the form of
nephrotoxic and hepatotoxic effects. Paracetamol is on the list
WHO’s most important drugs, as well as a list of the most important and essential
preparations of the Government of the Russian Federation.
Farmgroup: Anilides. Included in the group of NSAIDs.
Pharmacotherapeutic group: antipyretic and analgesics.
The international name of the drug: paracetamol.
The composition of the drug, release form, price
The drug is available in the following forms: tablets, syrup,
suspension for children, candles
Paracetamol 500 or 200 mg
|120 mg of paracetamol in five ml of syrup or 2.4 g of paracetamol per
100 ml of the drug.
|120 mg of paracetamol in five ml of suspension or 2.4 g of paracetamol
на 100 ml of the drug.
|Paracetamol 100 or 500 mg|
Potato starch, calcium sterate, polyvinylpyrrolidone
|Propylene glycol, ethyl alcohol 96%, glycerin, sorbitol,
propyl parahydroxybenzoate, methyl parahydroxybenzoate, water
purified, food flavor raspberry, ponso 4R
|Methyl parahydroxybenzoate, glycerol, sorbitol, liquid, gum
xanthan, strawberry flavor, dye azorubine, sucrose,
|Solid fat base to obtain a candle|
Pills белого или кремового цвета плоские с фаской
|Transparent viscous liquid, pink color,
|Viscous pinkish liquid with strawberry flavor||White-cream suppositories|
Ten tablets per cell pack, in carton packs No.
|On 50 or 100 ml in a bottle glass or polymeric with measured
spoon, in a carton box
On 100, 200 ml of suspension in bottles or bottles from dark
|5 suppositories in polyethylene cell packaging, 2 each
100 ml: 44 rub.
Paracetamol blocks two forms (TSOG1 and TSOG2) of the enzyme
cyclooxygenase and thereby inhibits prostaglandin synthesis.
The main action is implemented in the central nervous system, where paracetamol acts
on pain and thermoregulation centers. In peripheral tissues
paracetamol action is neutralized by cox effect
cellular peroxidase, so the anti-inflammatory effect is
Lack of activation of prostaglandins in peripheral tissues
determines the absence of the negative effect of paracetamol on
gastrointestinal mucosa and water-salt balance. There is an assumption
that paracetamol selectively blocks TSOG3, which is only in
The central nervous system, and the COX enzymes located outside the brain are not
influences, which explains such a pronounced antipyretic and
analgesic effect. Therapeutic plasma concentration
paracetamol is achieved at a dosage of 10-15 mg / kg.
It is characterized by high absorption. Maximum effective
concentration in the bloodstream 5-20 mcg / ml is reached over
30-120 minutes after ingestion. The drug penetrates through the BBB in the head
Up to 97% of paracetamol is metabolized by the liver. About 80% of them
is involved in the reaction of biosynthesis with sulfates and glucuronic
acid, resulting in synthesized inactive metabolites:
paracetamol sulfate and glucuronide. Up to 17% paracetamol
subjected to hydroxylation reactions, leading to the formation of 8
metabolites with activity and conjugating with glutathione with
further synthesis of already inactive metabolites. Disadvantage
glutathione in the liver leads to the fact that active metabolites
paracetamol begin to block the enzyme systems of the liver cells
and lead to their necrosis.
Elimination half-life: from 1 to 4 hours. Displayed as
inactive metabolites (97%) through the urinary system,
about 3% of the drug is displayed in its original form.
Indications for use
Paracetamol is intended purely for symptomatic therapy,
reduce the severity of pain and inflammatory reactions at the time
of use. Does not affect disease progression.
- Fever amid infections (see how to reduce the temperature without
- Vaccine-induced hyperthermia;
- Pain syndrome of different degrees of severity (moderate and
weak): arthralgia, neuralgia, myalgia, migraine, etc .;
- Toothache and headache;
- Algomenorrhea (see painful periods)
- erosions and ulcers of the digestive tract;
- stomach bleeding;
- inflammatory gastrointestinal tract diseases;
- chronic alcoholism;
- a combination of nasal and sinus polyposis, as well as bronchial asthma with
intolerance to aspirin and other NSAIDs;
- severe renal failure;
- progressive kidney disease;
- severe liver failure;
- active liver disease;
- rehabilitation period after coronary artery
- hypersensitivity to paracetamol and its components;
- children up to 1 month;
- 3 trimester of pregnancy.
The time interval between doses of paracetamol should
be at least 4 hours. Use no more than three days as
antipyretic and no more than five days to achieve pain medication
It should be taken orally after meals with water. Adults
и подростки массой тела> 60 кг: по 0,5 гр до 4 раз в течение
days. The maximum single dose of paracetamol can be increased.
up to 1 g, maximum daily dose – no more than 4 g.
- Children 6-12 years: 0.2-0.5 g paracetamol.
- Children 1-5 years: 0.12-0.25 gr.
- Children from 3-12 months: 60-120 mg.
- Children 1-3 months: from 10 mg / kg.
Children’s Paracetamol Syrup
For internal reception to food, frequency rate – 3-4 times a day.
Shake before use.
- Children 6 months-3 years: 60 (half a spoon) – 120 mg (tea
- Children 12 months-3 years: 120 (tea boat) – 180 mg (one and a half
- Children 3-6 years: 180 (one and a half teaspoons) – 240 mg (2 tea
- Children 6-12 years old: 240 (2 tsp.) – 360 mg (3 tsp.).
- Children from 12 years old: 360 (3 tsp.) – 600 mg (5 tsp.).
Suspension парацетамол для детей
For oral administration before eating. Before use suspension
need to shake. Single dose – no more than 10-15 mg per kilogram
body weight, the maximum daily – 60 mg / kg body weight. Multiplicity
– three times-four times a day.
- Children 1-3 months: ~ 50 mg paracetamol (2 ml suspension).
- Children 3-12 months: 60-120 mg paracetamol (2.5-5 ml
- Children 12 months-6 years old: 120-240 mg of paracetamol (5-10 ml
- Дети 6-14 лет: 240-480 мг (10-20 мл suspensions).
For rectal administration. Multiplicity: два-четыре раза в сутки.
The average single dose: 10-12 mg / kg paracetamol, the maximum
daily up to 60 mg / kg.
- Children 6-12 months: 0.5-1 suppository (50-100 mg paracetamol).
- Children 12 months-3 years: 1-1,5 candles (100-150 mg).
- Children 3-5 years: 1.5-2 candles (150-200 mg).
- Children 5-10 years: 2.5-3.5 candles (250-350 mg).
- Children 10-12 years old: 3.5-5 candles (350-500 mg).
- The digestive system: dyspeptic symptoms in
rare cases. Long-term therapy in high doses leads to
- Blood system. Rarely develop: leukopenia,
thrombocytopenia, pancytopenia, neutropenia, agranulocytosis.
- Hypersensitivity reactions: rarely develop skin rash,
Groups of drugs and some drugs
|Inductors of microsomal liver enzymes, agents with
|Strengthening the hepatotoxic effect of paracetamol|
|Anticholinergics||Decreased Paracetamol Absorption|
|Oral contraceptives||Acceleration of paracetamol elimination, its decrease
|Urikozurichesky means||Reducing the effectiveness of this group|
|Sorbents||Decreased Paracetamol Bioavailability|
|Diazepam||Decreased excretion of diazepam|
|Zidovudine||Strengthening myelodepressive effect of this drug|
|Isoniazid||Increased toxic effect of paracetamol|
|Phenytoin, Carbamazepine, Phenobarbital, Primidone||Reducing the effectiveness of paracetamol|
|Lamotrigine||Acceleration of the excretion of the drug|
|Metoclopramide||Increased paracetamol absorption|
|Probenecid||Reduced clearance of paracetamol|
|Rifampicin, Sulfinpyrazon||Increased clearance of paracetamol|
|Ethinyl Estradiol||Acceleration of Paracetamol Absorption|
Caution should be used in the treatment of patients with
benign hyperbilirubinemia, disorders of the liver and
kidney and elderly people. Long treatment
paracetamol should be under the control of the picture
peripheral blood and liver conditions. When appointing a child
paracetamol instruction must be strictly followed – exceed
The recommended duration of treatment is not allowed!
Toxic doses of paracetamol that can lead to necrosis
liver, make up 10-15 grams.
Pregnancy and lactation
Paracetamol passes through the placental barrier. Negative
effects of the drug on the fetus (teratogenic, mutagenic and
ambiotoxic) is not marked. Paracetamol penetrates the chest
milk (about 1% of a single dose) and is excreted with it in
concentration of 0.04-0.23%.
In this way, possible use of paracetamol in period 1 and 2
trimester of pregnancy and lactation period with careful
the attending physician weighs the expected benefit of the treatment and
potential risk to the baby or fetus.
Panadol, Flutabs, Strymol, Paracetamol-Hemofarm,
Paracetamol-extract, Cifécon, Efferalgan, Calpol, Daleron.
|Cifekon||Efferalgan syrup||Efferalgan candles||Daleron|
Автор: врач-гигиенист, эпидемиолог