Paracetamol

Synonym(s)

Acetaminophen

Definition
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Very frequently used, suitable analgesic (basic analgesic) and antipyretic. Paracetamol is one of the weak peripheral analgesics which are not organ-damaging if dose limits are observed and which have a more favourable side effect profile in comparison with other non-opioids (see below anti-inflammatory, non-steroidal; COX-2 inhibitors see below Coxibe, Metamizole). Due to the favourable ratios of benefit and tolerability, it is therefore to be regarded as a non-opioid of first choice.

Pharmacodynamics (Effect)
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The active metabolite is acetaminophen. Fever-reducing and pain-inhibiting effect, presumably by inhibition of the prostaglandin synthesis. The enhancement of the effect of coumarins is also being discussed (the mechanism is not yet fully known).

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Dermatology

Lip carcinoma

Squamous cell carcinoma(spinocellular carcinoma) of the red of the lips

Indication
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Slight to moderate pain, fever.

Dosage and method of use
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Depending on age and body weight, usually 10-15 mg/kg bw as single dose, up to 50 mg/kg bw as total daily dose.

Undesirable effects
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Rarely drug exanthema, angioneurotic edema. Muscle pain, headache, hyperhidrosis, nausea, bronchospasm in predisposed patients, rarely hypotension, thombo- or leucopenia.

Isolated, severe cases of Stevens-Johnson syndrome and TEN resulting in death have been reported (according to the FDA report, 67 hospitalizations and 12 deaths occurred between 1969 and 2012).

Acute overdose (> 10 g in adults) may cause severe liver damage. Chronic ingestion may lead to kidney damage.

Contraindication
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Known genetic glucose-6-phosphate dehydrogenase deficiency, paragroup allergy: hypersensitivity to para-hydroxy-benzoic acid esters.

Preparations
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Ben-u-ron, Captin, Mono Praecimed, Paedialgon, Paracetamol-ratiopharm, Perfalgan

Note(s)
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Remember! Antidote for overdose / intoxication is acetylcysteine in high doses.

Literature
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Jage J (2009) Key questions on the therapy of postoperative pain. Georg Thieme Publishing House, Stuttgart S.16-21
Panorama (dermatologist) 2013: Dangerous skin reactions to paracetamol. Dermatologist 64: 633
Suwarsa O et al(2016) Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013 Asia Pac Allergy6: 43-47.