Paracetamol: updated dosing for children to be introduced
Updated dosing for paediatric paracetamol liquids has been developed to ensure children receive the optimum dose for their age.
Article date: July 2011
Background
The current recommended doses consist of wide age bands with the option to receive 5 mL or 10 mL within each dose range. As a result, children who are light for their age and receive the maximum recommended dose will receive an amount per kg bodyweight that differs from older, heavier children taking the lower recommended dose within that age band. Consequently, lighter children may currently be receiving a higher dose than needed for an effective therapeutic result, if the parent or carer decides to use the larger dosing option.
To address this, the dosing for liquid paracetamol products for children has been revised to one that is based on narrower age bands with a single dosing option per band. Although dosing for children on a mg/kg bodyweight is standard practice in hospitals, this is not always practical for parents to manage at home. The new posology retains dosing by age bands and the familiar 2.5 mL and 5.0 mL increments.
The changes to paediatric paracetamol dosing have not altered the dose of paracetamol recommended for the treatment of post-vaccination symptoms in children age 2–3 months.
Implementation of updated paediatric paracetamol dosing
The new dosage instructions for paediatric paracetamol will be on products entering the market by the end of 2011. In the meantime, parents and carers should follow the advice currently on the packaging. There is no need to remove any products from shelves. The new packs will also be supplied with a suitable measuring device to assist accurate administration.
The updated dosing will apply equally to prescribed paracetamol for children, and the BNF will be updated accordingly.
Advice for healthcare professionals:
- Parents and carers should be advised to follow the advice on the packaging.
- The new dosing will be supplied with a revised patient information leaflet and packaging (entering the market by end 2011).
- All products will be supplied with an administration device to ensure accurate administration.
- Doctors may use the new dosing immediately for prescribed paracetamol products.
New dosing tables
For paracetamol infant suspension (120 mg/5 mL):
| Age: 2–3 months | Dose | |
|---|---|---|
| 1. Post-vaccination fever | 2.5 mL If necessary, after 4–6 hours, give a second 2.5 mL dose | |
| 2. Other causes of pain and fever if your baby weighs over 4 kg and was born after 37 weeks |
Do not give to babies less than 2 months of age. Do not give more than 2 doses. Leave at least 4 hours between doses. If further doses are needed, talk to your doctor or pharmacist.
| Child’s age | How much | How often (in 24 hours) | ||
|---|---|---|---|---|
| 3–6 months | 2.5 mL | 4 times | ||
| 6–24 months | 5 mL | 4 times | ||
| 2–4 years | 7.5 mL | 4 times | ||
| 4–6 years | 10 mL | 4 times |
Do not give more than 4 doses in any 24-hour period. Leave at least 4 hours between doses. Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist.
For paracetamol six plus suspension (250 mg/5 mL):
| Child’s age | How much | How often (in 24 hours) | ||
|---|---|---|---|---|
| 6–8 years | 5 mL | 4 times | ||
| 8–10 years | 7.5 mL | 4 times | ||
| 10–12 years | 10 mL | 4 times |
Do not give more than 4 doses in any 24-hour period. Leave at least 4 hours between doses. Do not give this medicine to your child for more than 3 days without speaking to your doctor or pharmacist. Do not give to children under the age of 6 years.
Dose for children age 12–16 years: 10–15 mL up to 4 times a day.
Dose for adults and children over 16 years: 10–20 mL up to 4 times a day.
Article citation: Drug Safety Update July 2011, vol 12 issue 4: A2.