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