Parenteral Manual

Acetaminophen

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Classification: 
Analgesic, antipyretic
Original Date: 
May 2020
Indications: 
  • Post operative pain management: to reduce opioid consumption.
  • Neonatatology: Closure of PDA if oral route unavailable and usual medication management with ibuprofen or indomethacin is ineffective or contraindicated.
Reconstitution and Stability: 
  • Available as a 10 mg/ml solution. (1000 mg/100 mL bag)
  • Clear and colorless to off-white/yellow
  • Protect from light
  • Syringe stability: 24 hours room temp
  • Bag stability: 6 hours once punctured
Compatibility: 

-Solutions Compatible: 0.9% NaCl, D5-0.9%NaCL

-Drugs Compatible: buprenorphine, dexamethasone, diphenhydramine, fentanyl, granisetron, heparin, hydrocortisone, hydromorphone, hydroxyzine, ketorolac, lidocaine, lorazepam, mannitol, meperidine, methylprednisolone, metoclopramide, midazolam, morphine, nalbuphine, ondansetron, KCL, prochlorperazine.

-Incompatible: acyclovir, chlorpromazine HCL, diazepam

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

YES

Usual dilution: undiluted

Infusion time: 15 minutes

IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric

  • Children < 2 years old: 15 mg/kg/dose Q6H (maximum 60 mg/kg/day)
  • Children > 2 years old: 15 mg/kg/dose Q6H or 12.5 mg/kg/dose Q4H (maximum 75 mg/kg/day or 4000 mg/day)

Adult: 1000 mg Q6H or 650 mg Q4H (maximum 4000 mg/day)

Renal Impairment:

  • CrCl > 30 mL/min: no dosage adjustment necessary
  • CrCl < 30 mL/min: caution in this population. Consider extending interval and decreasing total daily doses

 

Potential hazards of parenteral administration: 
  • Ensure total daily dose of all forms of acetaminophen (PO, IV, PR) does not exceed total daily maximum
  • Potential hematologic side effects: neutropenia, thrombocytopenia, leukopenia

 

Notes: 
  • Contraindicated in patients with severe hepatic impairment or severe active liver disease
  • Non medicinal ingredients: mannitol, povidone K12, sodium dihydrogen phosphate dihydrate, sodium hydroxide (pH adjustment), water
  • Pediatric Considerations for children < 2 years of age : ACETAMINOPHEN INJECTION contains low molecular weight povidone (povidone K12) and there is limited data supporting its safe use in neonates and infants. Povidone is an inactive compound which is not metabolized prior to its renal elimination primarily through glomerular filtration. Although the potential for povidone accumulation is unknown, there is a possibility in the neonates and very young children where the glomerular filtration is immature

References: 
  • Pediatric and Neonatal Lexi-Drugs
  • Health Canada drug product monograph
  • Kwiatkowski JL, Johnson CE, Wagner DS. Extended stability of IV acetaminophen in syringes and opened vials. Am J Health Syst Pharm. 2012 Nov 15;69(22):1999-2001
  • Trissel's 2 Clinical Pharmaceutics Database (created by Lawrence A Trissel)

 

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