Paracetamol solution is indicated in the management of pain and fever associated with such conditions as the common cold, influenza and headache.

For patients who are unable to tolerate solid dose formulations or lower strength preparations of paracetamol containing products.

Posology:

Recommended Doses and Dosage Schedules

Adults and young persons 16 years and over:

The Optimal dosage range is 500mg (5ml) to 1000mg (10ml) up to three to four times a day, as required, to a maximum of 4 g paracetamol/ day (40 ml paracetamol oral solution).

The dose should not be repeated more frequently than every four hours, and not more than four doses should be taken in any 24 hour period.

Elderly:

In older people, the rate and extent of paracetamol absorption is normal but plasma half-life is longer and paracetamol clearance is lower than in young adults.

Paediatric Population

Do not use this medicine in children and adolescents under 16 years.

Method of administration

For oral administration only.

It is important to shake the bottle for at least 10 seconds well before use.

Hypersensitivity to paracetamol or any of the excipients listed in section 6.1.

Patients with severe hepatic dysfunction.

Do not use this medicine in children and adolescents under 16 years.

Care is advised in the administration of paracetamol to patients with severe renal or severe hepatic impairment. The hazards of overdose are greater in those with (non-cirrhotic) alcoholic liver disease.

Do not take with any other paracetamol-containing products.

Caution is advised when paracetamol is administered concomitantly with flucloxacillin due to increased risk of high anion gap metabolic acidosis (HAGMA), particularly in patients with severe renal impairment, sepsis, malnutrition and other sources of gluthione deficiency (e.g. chronic alcoholism), as well as those using maximum daily doses of paracetamol. Close monitoring, including measurement of urinary 5-oxoproline, is recommended.

Talk to a doctor at once if you take too much of this medicine, even if you feel well. This is because too much paracetamol can cause delayed, serious liver damage.

Do not exceed the recommended dose.

Keep out of the sight and reach of children.

Excipient warnings:

This product contains the following excipients:

Parahydroxybenzoates: these may cause allergic reactions (possibly delayed).

Propylene glycol: this medicine contains 1530 mg propylene glycol in each 5ml. Therefore, this medicine should be used with caution in pregnancy, breastfeeding, liver or kidney disease.

Glycerol: may cause headache, stomach upset and diarrhoea.

This medicine contains 4.25mg/5ml (0.18 mmol) of sodium which is essentially 'sodium free'.

The hepatotoxicity of Paracetamol, particularly after overdosage, may be increased by drugs which induce liver microsomal enzymes such as barbiturates, tricyclic antidepressants and alcohol.

Alcohol can increase the hepatotoxicity of paracetamol overdosage.

The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by cholestyramine.

The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding; occasional doses have no significant effect.

Antivirals: Regular use of Paracetamol possibly reduces metabolism of Zidovudine (increased risk of neutropenia).

Caution should be taken when paracetamol is used concomitantly with flucloxacillin as concurrent intake has been associated with high anion gap metabolic acidosis, especially in patients with risk factors. (See section 4.4).

Pregnancy:

Epidemiological studies in human pregnancy have shown no ill effects due to paracetamol used in the recommended dosage, but patients should follow the advice of their doctor regarding its use.

A large amount of data on pregnant women indicate neither malformative, nor feto/neonatal toxicity. Epidemiological studies on neurodevelopment in children exposed to paracetamol in utero show inconclusive results. If clinically needed, paracetamol can be used during pregnancy however it should be used at the lowest effective dose for the shortest possible time and at the lowest possible frequency.

Breast-feeding:

Paracetamol is excreted in breast milk but not in clinically significant amount. Available published data do not contraindicate breast feeding.

Fertility:

There are no data on the effects of this medicine on human fertility.

None known

The information below lists reported adverse reactions, ranked using the following frequency classification:

Very common (≥ 1/10); common (≥ 1/100 to <1/10); uncommon (≥ 1/1,000 to <1/100); rare (≥ 1/10,000 to <1/1,000); very rare (<1/10,000), not known (cannot be estimated from the available data).

¹But these were not necessarily causally related to Paracetamol.

²Paracetamol has been widely used and reports of adverse reactions are rare, and are generally associated with overdosage.

³Nephrotoxic effects are uncommon and have not been reported in association with therapeutic doses, except after prolonged administration.

Reporting of suspected adverse reactions:

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Liver damage is possible in adults who have taken 10g or more of paracetamol. Ingestion of 5g or more of paracetamol may lead to liver damage if the patient has the risk factors.

Risk Factors:

If the patient

a) Is on long term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes.

OR

b) Regularly consumes ethanol in excess of recommended amounts.

OR

c) Is likely to be glutathione deplete e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.

Symptoms:

Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. Hyperglycaemia has been reported. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.

Management

Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see BNF overdose section.

Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol; however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote however declines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who represent with serious hepatic dysfunction beyond 24h ingestion should be discussed with the NPIS or a liver unit.

Pharmacotherapeutic group: Other analgesics and antipyretics; Anilides

ATC Code: N02B E01

Mechanism of action:

The site and mechanism of the analgesic effect of paracetamol is unclear. Paracetamol reduces fever by a direct action on the hypothalamic heat-regulating centers, which increases dissipation of body heat (via vasodilation and sweating). The action of endogenous pyrogen on heat-regulating centers is inhibited.

Paracetamol is almost as potent as aspirin in inhibiting prostaglandin synthetase in the CNS but its peripheral inhibition of prostaglandin synthesis is minimal, which may account for its lack of clinically significant anti-rheumatic or anti-inflammatory effects.

Paracetamol dose not inhibit platelet aggregation, affect prothrombin response or produce GI ulceration.

Data in the literature on toxic doses and serum levels of Paracetamol is limited, but Paracetamol is relatively non-toxic in therapeutic doses.

Paracetamol toxicity may result from a single toxic dose or from long term ingestion of the drug. It has been reported in the literature that children may be less susceptible to acute Paracetamol poisoning than adults. Hepatic necrosis is dose dependent and is the most serious acute toxic effect associated with over dosage. It is potentially fatal, and nausea, vomiting and abdominal pain usually occur within 2-3 hours after ingestion of toxic doses of the drug.

Acute toxic doses of Paracetamol in laboratory animals produce animals produce death from liver and renal damage.

Conventional studies using the currently accepted standards for the evaluation of toxicity to reproduction and development are not available.

Citric acid monohydrate

Erythrosine (E127)

Glycerol (E 422)

Macrogol 400

Propylene Glycol (E 1520)

Methyl parahydroxybenzoate (E 218)

Propyl parahydroxybenzoate (E 216)

Raspberry flavor No.1

Saccharin Sodium

Sodium citrate

Purified Water

Not relevant.

Do not store above 25° C.

Do not refrigerate or freeze.

Store in the original container.

Do not use 3 months after you first open it. Take it back to the pharmacy.

Amber glass bottle with LD-polyethylene, tamper evident and child resistant cap. The bottle is packed in an outer carton.

A polypropylene syringe with 10ml measure along with adaptor is supplied with this pack.

Pack size: 300ml and 200ml

Not all pack sizes may be marketed.

No special instruction