Paracetamol B. Braun (Paracetamol)

• Paracetamol acts on the cyclooxygenase pathway to provide analgesic and antipyretic effects.
• Pain: provides analgesic relief in acute and chronic pain conditions.
• Fever: reduces elevated body temperature in febrile states.
• Post‑operative pain: offers rapid analgesia after surgical procedures when oral administration is not feasible.
• Headache: alleviates tension‑type and migraine‑associated headache pain.
• Musculoskeletal pain: eases discomfort from sprains, strains, and inflammatory conditions.

• Paracetamol exerts its effect primarily by inhibiting cyclooxygenase (COX) enzymes, particularly COX‑2, within the central nervous system. This inhibition reduces the synthesis of prostaglandins that mediate pain and fever signaling. Unlike non‑steroidal anti‑inflammatory drugs, its peripheral anti‑inflammatory activity is minimal, allowing analgesic and antipyretic actions without significant impact on platelet function. The drug’s central action also modulates the hypothalamic heat‑regulation center, contributing to its antipyretic effect.

Paracetamol administered intravenously may be associated with several adverse reactions, ranging from mild to severe.

Common Side Effects

• Nausea: mild nausea may occur during or after infusion.
• Vomiting: occasional vomiting post‑administration.
• Injection site discomfort: transient pain or irritation at the IV site.
• Headache: mild headache reported in some patients.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Stevens‑Johnson syndrome: rare severe skin reaction.
• Hepatotoxicity: elevated liver enzymes or liver injury, especially with overdose.
• Hypotension: sudden drop in blood pressure during infusion.

When using intravenous paracetamol, several precautions should be observed to ensure patient safety.

• Renal function: assess renal function and adjust use in patients with severe impairment.
• Hepatic function: avoid or use with caution in patients with significant liver disease.
• Allergy history: discontinue immediately if signs of hypersensitivity or rash develop.
• Concomitant hepatotoxic drugs: review other medications that may increase liver risk.
• Pregnancy and lactation: use only if potential benefit justifies potential risk to fetus or infant.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Paracetamol can interact with other medicines; awareness of major and moderate interactions helps prevent adverse outcomes.

Major Interactions (Avoid)

• Concomitant hepatotoxic agents: avoid use with other drugs that can damage the liver, such as high‑dose ibuprofen or certain antitubercular agents.
• Alcohol: chronic alcohol consumption increases risk of liver injury.
• Warfarin: may enhance anticoagulant effect and increase bleeding risk.
• Other paracetamol‑containing products: risk of overdose when combined with additional paracetamol sources.

Moderate Interactions (Monitor Closely)

• CYP450 inducers: drugs like rifampicin may reduce paracetamol plasma levels.
• High‑dose aspirin: may increase risk of renal impairment when used together.