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Pregnancy Category B
Drug classes
Antipyretic
Analgesic (nonopioid)
Therapeutic actions
Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center
to cause vasodilation and sweating, which helps dissipate heat.
Analgesic: Site and mechanism of action unclear.
Indications
• Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances,
bleeding diatheses, upper GI disease, gouty arthritis
• Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks
clinically significant antirheumatic and anti-inflammatory effects)
• Common cold, flu, other viral and bacterial infections with pain and fever
• Unlabeled use: prophylactic for children receiving DPT vaccination to reduce
incidence of fever and pain
Available forms
Suppositories—80, 120, 125, 300, 325, 650 mg; chewable tablets—80 mg; tablets—160,
325, 500, 650 mg; caplets—160, 500, 650 mg; gelcaps—650 mg; capsules—325,
500 mg; elixir—80 mg/2.5 mL, 80 mg/5 mL, 120 mg/5 mL, 160 mg/5 mL; liquid—
160 mg/5 mL, 500 mg/15 mL; solution—80 mg/1.66 mL, 100 mg/mL; drops—80 mg/0.8
mL; sprinkle capsules—80, 160 mg
Dosages
ADULTS
PO or PR
By suppository, 325–650 mg q 4–6 hr or PO, 1,000 mg tid to qid. Do not exceed 4 g/day.
PEDIATRIC PATIENTS
PO or PR
Doses may be repeated 4–5 times/day; do not exceed five doses in 24 hr; give PO or by
suppository.
Pharmacokinetics
Route Onset Peak Duration
Oral Varies 0.5–2 hr 3–4 hr
Adverse effects
• CNS: Headache
• CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are
ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr
• GI: Hepatic toxicity and failure, jaundice
• GU: Acute kidney failure, renal tubular necrosis
• Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria,
anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
• Hypersensitivity: Rash, fever
Interactions
Drug-drug
• Increased toxicity with long-term, excessive ethanol ingestion
• Increased hypoprothrombinemic effect of oral anticoagulants
• Increased risk of hepatotoxicity and possible decreased therapeutic effects with
barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone
• Possible delayed or decreased effectiveness with anticholinergics
• Possible reduced absorption of acetaminophen with activated charcoal
• Possible decreased effectiveness of zidovudine
Drug-lab test
• Interference with Chemstrip G, Dextrostix, and Visidex II home blood glucose
measurement systems; effects vary
Nursing considerations
Assessment
• History: Allergy to acetaminophen, impaired hepatic function, chronic
alcoholism, pregnancy, lactation
• Physical: Skin color, lesions; T; liver evaluation; CBC, liver and renal function
tests
Interventions
• Do not exceed the recommended dosage.
• Consult physician if needed for children < 3 yr; if needed for longer than 10 days;
if continued fever, severe or recurrent pain occurs (possible serious illness).
• Avoid using multiple preparations containing acetaminophen. Carefully check all
OTC products.
• Give drug with food if GI upset is noted.
• Discontinue drug if hypersensitivity reactions occur.
• Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should
be available as a specific antidote; basic life support measures may be necessary.
Teaching points
• Do not exceed recommended dose; do not take for longer than 10 days.
• Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
• Avoid the use of other over-the-counter preparations. They may contain
acetaminophen, and serious overdosage can occur. If you need an over-the-
counter preparation, consult your health care provider.
• Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in
voiding patterns.
Adverse effects in Italics are most common; those in Bold are life-threatening.