POM: Prescription only medicine
This information is intended for use by health professionals
PARACETAMOL TABLETS BP 500mg
Each tablet contains 500mg Paracetamol PhEur.
For the full list of excipients, see section 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.
Adults including the elderly and children over 16 years: One to two tablets every 4-6 hours as required, to a maximum of 8 tablets daily in divided doses.
Children 10-15 years: One tablet every 4-6 hours as necessary to a maximum of 4 doses in 24 hours.
Children under 10 years: Not recommended for children under 10 years of age. Alternative presentations of paracetamol are recommended for paediatric usage in order to obtain suitable doses of less than 500mg.
Method of Administration
For oral administration.
• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Where analgesics are used long-term (>3 months) with administration every two days or more frequently, headache may develop or worsen. Headache induced by overuse of analgesics (MOH medication-overuse headache) should not be treated by dose increase. In such cases, the use of analgesics should be discontinued in consultation with the doctor.
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.
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.
A large amount of data on pregnant women indicate neither malformative, nor feto/neonatal toxicity. Epidemiological studies on neurodevelopment in children exposed to paracetamol in utero show inconclusive results. If clinically needed, paracetamol can be used during pregnancy however it should be used at the lowest effective dose for the shortest possible time and at the lowest possible frequency.
Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding.
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
Very rare cases of serious skin reactions have been reported.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme; website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
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).
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.
B, Regularly consumes ethanol in excess of recommended amounts.
C, Is likely to be glutathione depleted e.g. eating disorders, cystic fibrosis, HIV, starvation, cachexia.
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.
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.
Pharmacotherapeutic group: Other analgesics and antipyretics, Anilides
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.
Paracetamol is readily absorbed from the gastrointestinal tract.
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.
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.
It is excreted in the urine, mainly as the glucuronide and sulfate conjugates. The elimination half-life varies from about 1 to 4 hours.
Conventional studies using the currently accepted standards for the evaluation of toxicity to reproduction and development are not available.
Pregelatinised Maize Starch
Three years for PE tablet containers.
Five years for blisters and PP tablet containers.
Shelf-life after dilution/reconstitution
Shelf-life after first opening
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.
20, 30, 32.
PE tablet container with a child-resistant PP closure. Compliant with ISO8317.
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.
(Trading style: Accord)
PL 0142/5554 R
10.11.80 / 26.10.05
(Product Licence of Right issued: Pre 1974)