acetaminophen (Tylenol®)

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

acetaminophen (Tylenol®)

Indication

  • Antipyretic and analgesic for mild to moderate pain
  • Treatment of symptomatic patent ductus arteriosus (PDA) 
  • Perioperative Neonatal GI surgery patients

Dosage Guidelines

Analgesic or antipyretic

Oral

  • 10–15 mg/kg/dose q4-6 hours prn

Rectal

  • 30–33 weeks: 20 mg/kg/dose q12 hours (max 40 mg/kg/day)
  • 34–39 weeks: 25 mg/kg/dose q8 hours (max 75 mg/kg/day)
  • 40 weeks or greater: 30 mg/kg/dose q6 hours (max 120 mg/kg/day)

Intravenous (for Perioperative Neonatal GI surgery patients)

  • Greater than 23 to less than 32 weeks: 10 mg/kg/dose IV x 1 pre-op, then 7.5 mg/kg/dose IV q6 hours x 48 hours
  • 32 weeks or greater: 20 mg/kg/dose IV x 1 pre-op, then 10 mg/kg/dose IV q6 hours x 48 hours

Treatment of PDA

15 mg/kg/dose oral or IV** q6 hours x 7 days

**IV acetaminophen for PDA treatment is restricted to patients who have feeding intolerance or are NPO due to surgical conditions

Administration

  • Oral
  • Rectal
  • IV intermittent slow infusion over 15 minutes

Adverse Effects

  • Relatively free of adverse effects when given as indicated 
  • Overdose may cause hepatotoxicity

Comments

  • Regular dosing of acetaminophen can mask manifestations of infection (e.g. fever, fussiness, crying, irritability) possibly causing a delay in treatment. Caregivers should monitor infants with extra care during the period when acetaminophen is given
  • Use with caution in neonates with hepatic dysfunction
  • Considered safe in G6PD deficiency when used in therapeutic doses
  • Monitor NPASS score as per protocol when used for analgesia
  • Liver Function Tests (LFTs) should be drawn prior to or within 24 hours of initiation for PDA treatment in patients with prior hepatic dysfunction or at risk of dysfunction. All patients who receive acetaminophen for PDA treatment should have LFTs drawn at the end of treatment

Supplied As

80 mg/mL oral drops

Suppository 30 mg, 40 mg, 60 mg

10 mg/mL IV syringe prepared by Pharmacy

References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal