Table 26

Paracetamol orodispersible or rectal

Paracetamol orodispersible or rectal
What is it?Non-opioid analgesic
Mechanism of actionWeak COX2 and peroxidase inhibitor
Starting dose500 mg–1000 mg, maximum four times a day
Time to onset of effectUncertain (15–30 min with oral route)17
FormulationParacetamol FasTab 250 mg oradispersible tablets (2–4 tablets per dose, dependent on weight and liver function)
Paracetamol suppositories 1 g; n.b. bioavailability is 60% compared with oral administration3
IndicationPain, fever
Common adverse effectsRectal ‘anorectal erythema’ with rectal preparation16
ContraindicationsSevere liver dysfunction, 500 mg four times a day maximum if weight less than 50 kg
CautionOld age, poor nutritional state, fasting, anorexia, weight <50 kg, chronic alcohol use17
LicencingBoth are licensed formulation
BenefitsTransmucosal alternatives for managing fever
RisksEnsuring correct number of orodispersible are used; ensuring that dose is reduced to 500 mg four times a day if weight less than 50 kg or liver function tests severely deranged
Cost£4.12 for 24×250 mg orodispersible tablets (Fastmelts—would need four tablets per 1 g dose); £59.50 for 10×1 g suppositories