PARACETAMOL TABLETS BP 500mg

Each tablet contains 500mg Paracetamol PhEur.

For a full list of excipients, see 6.1

White uncoated tablets.

Paracetamol has analgesic and antipyretic actions similar to those of aspirin and hence is a suitable alternative for patients sensitive to aspirin.

1) For the relief of mild to moderate pain and febrile conditions, eg headache, toothache, colds, influenza, rheumatic pain and dysmenorrhoea.

Posology

Adults including elderly and children over 12 years: One to two tablets every 4-6 hours as required, to a maximum of 8 tablets daily in divided doses.

Children 6-12 years: Half to one tablet every 4-6 hours as necessary, to a maximum of 4 tablets daily in divided doses.

Children under 6 years: Not recommended for children under 6 years of age. Alternative presentations of paracetamol are recommended for paediatric usage in order to obtain suitable doses of less than 250mg.

Method of Administration

For oral administration.

• Known hypersensitivity to paracetamol or other constituents in the tablets.

Care is advised in the administration of paracetamol to patients with alcohol dependency (see section 4.9), severe renal or severe hepatic impairment. The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.

Label Warnings:

Do not exceed the recommended dose

If symptoms persist consult your doctor

Keep out of the reach and sight of children

Do not take with any other paracetamol-containing products.

Immediate medical advice should be sought in the event of an overdose, even if you feel well, because of the risk of delayed, serious liver damage.

or if leaflet present:

Immediate medical advice should be sought in the event of an overdose, even if you feel well.

• Anticoagulants - the effect of warfarin and other coumarins may be enhanced by prolonged regular use of paracetamol with increased risk of bleeding. Occasional doses have no significant effect.

• Metoclopramide – may increase speed of absorption of paracetamol.

• Domperidone – may increase speed of absorption of paracetamol.

• Colestyramine – may reduce absorption if given within one hour of paracetamol.

• Imatinib - restriction or avoidance of concomitant regular paracetamol use should be taken with imatinib.

Epidemiological studies in human pregnancy have shown no effects due to paracetamol used in the recommended dosage. However, paracetamol should be avoided in pregnancy unless considered essential by the physician.

Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding.

None known.

Adverse effects of Paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including, thrombocytopenia, neutropenia, pancytopenia, leukopenia and agranulocytosis, but these were not necessarily causality related to Paracetamol.

Liver damage is possible in adults who have taken 10g or more of Paracetamol. Ingestion of 5g or more of Paracetamol may lead to liver damage if the patient has risk factors (see below).

Risk Factors:

If the patient

a, Is on long term treatment with carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St John's Wort or other drugs than induce liver enzymes.

Or

B, Regularly consumes ethanol in excess of recommended amounts.

Or

C, Is likely to be glutathione depleted e.g. eating disorders, cystic fibrosis, HIV, starvation, cachexia.

Symptoms

Symptoms of Paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisioning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.

Management

Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention.

Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see BNF overdose section.

Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of Paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote decines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24h from ingestion should be discussed with the NPIS or a liver unit.

ATC code N02B E01

Paracetamol has analgesic and antipyretic properties but it has no useful anti-inflammatory properties.

Paracetamol's effects are thought to be related to inhibition of prostaglandin synthesis.

Absorption: paracetamol is readily absorbed from the gastrointestinal tract.

Distrubution: peak plasma concentrations occur about 10 to 60 minutes after oral doses. Paracetamol is distributed into most body tissues. It crosses the placenta and is present in breast milk. Plasma-protein binding is negligible at usual therapeutic concentrations but increases with increasing concentrations.

Metabolism: It is metabolised in the liver. A minor hydroxylated metabolite which is usually produced in very small amounts by mixed-function oxidases in the liver and which is usually detoxified by conjugation with liver glutathione may accumulate following paracetamol overdosage and cause tissue damage.

Elimination: It is excreted in the urine, mainly as the glucuronide and sulphate conjugates. The elimination half-life varies from about 1 to 4 hours.

Not applicable.

Also contains: maize starch, stearic acid.

None known.

Shelf-life

Three years for PE tablet containers.

Five years for blisters and PP tablet containers.

Shelf-life after dilution/reconstitution

Not applicable.

Shelf-life after first opening

Not applicable.

Store below 25°C in a dry place. Protect from light.

Child-resistant blister pack: (i) 250µm white rigid PVC (ii) 9µm soft aluminium / 35g/m² glassine paper. Compliant with BS8404.

Pack sizes:

GSL: 16.

P: 20, 30, 32.

POM: 100.

PE tablet container with a child-resistant PP closure. Compliant with ISO8317.

Pack sizes:

GSL: 16.

P: 30, 32.

POM: 100.

PP tablet container with a PE closure for supply to nursing homes.

Pack sizes: 100, 1000.

Product may also be supplied in bulk hospital packs for reassembly, in polybags contained in tins, skillets or polybuckets filled with suitable cushioning material.

Not applicable.

Name or style and permanent address of registered place of business of the holder of the Marketing Authorisation:

Actavis UK Limited

(Trading style: Actavis)

Whiddon Valley

BARNSTAPLE

N Devon EX32 8NS

PL 0142/5554 R

10.11.80 / 26.10.05

(Product Licence of Right issued: Pre 1974)

February 2007

IF APPLICABLE

IF APPLICABLE