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Medicines Q&As
Q&A 361.2
What is the evidence to support the use of IV paracetamol for the
short-term treatment of moderate to severe pain?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Date prepared: December 2012
Summary
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Intravenous (IV) paracetamol is licensed for the short-term treatment of moderate pain,
especially following surgery, and for the short-term treatment of fever, when administration by
the IV route is clinically justified by an urgent need to treat pain or hyperthermia and/or when
other routes of administration are not possible.
The main advantages of IV paracetamol are: when GI motility is reduced in the immediate
post -operative period or when rapid establishment of analgesia is required. Studies have
shown a reduction in morphine/opioid requirements; however sedation and post-operative
nausea and vomiting are not reduced
IV paracetamol has been shown to achieve therapeutic plasma concentrations well above the
therapeutic range within 40 minutes of administration, whereas early plasma concentrations
following oral administration of paracetamol may vary, and in some cases may remain
subtherapeutic, unless a loading dose has been given. Absorption of paracetamol following
rectal administration is slower and more variable than with IV or oral administration therefore
this is not a suitable alternative if the oral route is not appropriate
A large proportion of the efficacy data on IV paracetamol is derived from studies of IV
propacetamol, a pro-drug of paracetamol. 2g IV propacetamol has been shown to be
therapeutically equivalent to 1g IV paracetamol.
There are several studies of the use of IV paracetamol in patients with severe pain postsurgery as an opioid-sparing agent and a number of systematic reviews have assessed the
effectiveness of adding paracetamol to (PCA) morphine for pain relief and reduction of
morphine-related side effects following surgery. IV paracetamol was used in most of the
included studies. Paracetamol reduced the mean 24 hour morphine consumption by 6 to 9mg,
but overall there was no statistically significant reduction in post-operative nausea and
vomiting. Paracetamol was well tolerated, compared to NSAIDs and COX-2 inhibitors.
Caution must be used when IV paracetamol is given to children or adults weighing less than
50kg, as the dose has to be adjusted according to body weight. The dose should also be
reduced in patients with hepatocellular insufficiency, chronic alcoholism, chronic malnutrition,
or dehydration. Failure to reduce the dose appropriately may result in paracetamol-induced
liver toxicity. This could lead to hepatic failure and death.
IV paracetamol has been shown to be effective and well-tolerated in the management of
moderate pain immediately after surgery, but care must be taken to dose according to the
licensed recommendations (see above).
In order to avoid adverse effects and unnecessary costs it is recommended to switch to oral
paracetamol as soon as this administration route is possible.
Background
Intravenous (IV) paracetamol is licensed for the short-term treatment of moderate pain, especially
following surgery and for the short-term treatment of fever. Use of the IV route is clinically justified by
an urgent need to treat pain or hyperthermia and/or when other routes of administration are not
possible (1). There is however concern that the IV route may not always be chosen appropriately, due
to
 associated risks of infection or local pain and inflammation
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As



potential for overdose with concomitant orally administered medicines containing paracetamol
or in patients with hepatic impairment or severe renal impairment
failure to adjust the dose according to body weight or other patient-related factors
increased nursing time and costs.
Answer
For some years paracetamol for IV use was only available (not licensed in the UK) in the form of
propacetamol, a pro-drug of paracetamol. A dose of 2g of propacetamol is hydrolyzed to 1g of
paracetamol (2) within 7 minutes of administration. Bioequivalence (3) and therapeutic equivalence
(4) of 2g of IV propacetamol and 1g of IV paracetamol have been demonstrated. A large proportion of
the efficacy data on IV paracetamol is derived from studies of IV propacetamol.
Post-operative pain
 Pharmacokinetics
IV vs Oral
The manufacturer of IV paracetamol recommends the use of a suitable analgesic oral treatment as
soon as this administration route is possible (1). There may be situations where this is not appropriate
e.g. following abdominal or gastric surgery where normal stomach motility may not be restored for 15
hours or more, also after oral surgery, or if a rapid onset of action is required (5). Paracetamol is not
absorbed in the stomach, therefore delays in gastric emptying decrease the transfer of drug to the
small intestine, resulting in diminished peak plasma concentrations (6). A one-off dose of IV
paracetamol in the immediate post-operative period has been suggested to achieve baseline
analgesia in the sedated patient (5).
The onset of analgesia occurs rapidly within 5-10 minutes of IV paracetamol administration. The peak
analgesic effect is obtained in 1 hour and its duration is approximately 4-6 hours (1,4). Although oral
bioavailability is good (63-89%), early plasma concentrations following oral administration may vary,
and in some cases may remain subtherapeutic (7). The minimum plasma paracetamol level required
for analgesia and antipyresis is thought to be 10 mcg/mL (66 micromol/L) and although not clearly
defined, the therapeutic range is usually considered to be 10-20 mcg/mL (66-132 micromol/L) (8).
In a small study comparing early bioavailability of paracetamol after oral or IV administration, 35 adult
patients undergoing day surgery (5 groups of 7 patients) received either 1g or 2 g paracetamol
tablets, 1g or 2g bicarbonate paracetamol tablets or 2g IV propacetamol. After 40 minutes IV
propacetamol gave a median plasma concentration of 85 micromol/L (range 65-161). Eleven out of 28
(40%) of the patients given paracetamol orally showed undetectable plasma concentrations of
paracetamol after 40 minutes. At 80 minutes after oral paracetamol the median (range) plasma
concentrations were 36 (0-90) and 129 (21-306) micromol/L for the 1- and 2-g groups respectively.
Three of fourteen patients who received 1g had a plasma paracetamol concentration of <10
micromol/L (8). The study did not report clinical outcomes i.e. pain relief, although pain was assessed
by Visual Analogue Scale (VAS) and treated when VAS values were>4, but no details are given. In a
small randomised controlled trial (RCT) 30 patients undergoing day case arthroscopy of the knee
received 1g oral paracetamol 30 to 60 minutes pre-operatively(n=20) or 1g IV paracetamol intraoperatively (n=10).Plasma paracetamol levels were measured 30 minutes after arrival in the recovery
room. All patients in the IV group had plasma levels above the therapeutic level compared to less
than half (7/20) of the patients in the oral group. Mean plasma paracetamol levels were 88.6
micromol/l for the intravenous group and 53.2 micromol/l for the oral group (P=0.0005). There was a
trend towards better analgesia and reduced duration of stay in the recovery room for the IV group,
although not reaching statistical significance. There was no difference in pain scores between
groups(9). However larger numbers of patients would be needed to demonstrate this at an acceptable
level of significance.
In an open non-blinded study patients scheduled for elective ENT surgery or orthopaedic surgery
were randomised to receive 1g paracetamol either orally 30 minutes before scheduled surgery(n=52)
or IV (n=54) immediately before induction of anaesthesia. Blood samples were collected 30 minutes
after the first dose and then at 30 minute intervals for 240 minutes. Therapeutic plasma
concentrations (≥ 10 mg/L) were reached in 67% of the oral group compared with 96% in the IV
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
group. Maximum median plasma concentrations were 19 mg/L (interquartile range 15 to 23 mg/L) and
13 mg /L (interquartile range 0 to 18 mg/L) for the IV and oral group respectively(10).
A comparison of the analgesic efficacy of single doses of propacetamol 2g IV and paracetamol 1g
orally in 323 patients with moderate pain following hallux valgus plasty, showed a significantly greater
and longer analgesic effect with the parenteral form (11). Duration of follow-up was 6 hours.
The analgesic effect of paracetamol is usually attributed to the total area under the concentration
versus time curve, but studies suggest that the peak concentration may also be important for the
analgesic effect (10). Some centres use a higher preoperative loading oral dose of paracetamol than
the licensed dose, according to the patient’s weight, followed by a higher total daily oral dose for the
first postoperative 24 hours. Studies are required comparing plasma levels and analgesia achieved
using these loading doses versus IV dosing (10). Preliminary evidence suggests that in patients
undergoing wisdom tooth extraction under general anaesthesia, premedication with a loading dose of
oral paracetamol gives similar postoperative pain relief to IV paracetamol(12).
IV vs Rectal
Absorption of paracetamol following rectal administration is slower and more variable than with IV or
oral administration (5,7,13). High initial doses are needed to achieve therapeutic plasma
concentrations (7) and therefore the rectal route is not the preferred route of administration of
paracetamol for the immediate relief of post-operative pain (5). In the UK the acquisition cost of
paracetamol suppositories may be higher than that of the injection, depending on brand and strength
(14).
 Therapeutic efficacy and tolerability
Paracetamol is a well-tolerated analgesic when used at normal dosages for the acute management of
mild-to-moderate post-operative pain (5). Where alternative routes are unavailable, IV paracetamol is
mostly used in association with NSAIDs and opioids to allow a reduced dose of these analgesics, that
have a worse adverse effect profile, to be given (5), rather than as monotherapy (5,13). The Summary
of Product Characteristics (SPC) states that ‘frequent’ adverse reactions at the injection site have
been reported during clinical trials (pain and burning sensation) (1). However, the incidence of local
adverse events such as injection-site pain and contact dermatitis is significantly lower with IV
paracetamol compared with propacetamol (4,13) and comparable to placebo in two studies: 2% (4,15)
and 0%(16).
A number of systematic reviews have assessed the effectiveness of adding a non-opioid to (PCA)
morphine for pain relief and reduction of morphine-related side effects following surgery (17).These
are briefly summarised below:
Paracetamol plus morphine
Remy et al(18) showed that paracetamol (including propacetamol) combined with PCA morphine
results in a pooled mean reduction of 9mg in morphine consumption in the first 24 hours after surgery
[95% CI: -15 to -3] equivalent to a 20% reduction. Seven RCTs, mainly in orthopaedic and spinal
surgery, were included. Five studies used IV paracetamol, one used oral and one used IV plus rectal
paracetamol. There were 265 patients in the group with PCA morphine plus paracetamol and 226
patients in the group with PCA morphine alone. There was no statistically significant reduction in
morphine-related adverse effects including urinary retention, pruritus and sedation (OR 1.3 for
sedation; 95% CI 0.79 TO 2.16; P=0.3). Paracetamol administration resulted in a non-significant
reduction in PONV (OR = 0.99; 95% CI, 0.64 to 1.55; P=0.98). Patient satisfaction as assessed by
verbal rating scales did not differ between the groups.
Elia et al (19) showed that paracetamol (including propacetamol) reduced 24-hour morphine
consumption by 8.3mg [95% CI, -10.9 to -5.7]. However, there was no statistically significant
reduction in PONV or sedation (19). Fifty -two RCT (4,893 patients undergoing orthopaedic,
abdominal, gynaecological, spinal or thoracic surgery) were included. This review also assessed the
effect of NSAIDs and COX-2 inhibitors. These were associated with a statistically significant increase
in adverse effects: surgical bleeding complications and renal failure, respectively. No adverse effects
were noted for paracetamol (19).
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
A more recent systematic review compared the effectiveness of paracetamol, NSAIDs and COX-2
inhibitors in reducing cumulative morphine consumption for the first 24 hours after surgery, and
associated adverse effects, when used as part of multimodal analgesia following major surgery (17),
including thoracic, orthopaedic, gynaecological, obstetric and general surgery. Sixty studies were
identified, 40 of which were from the previous review (19) and 20 new trials. Only 5 studies were
identified that directly compared paracetamol and NSAIDs. Seven studies compared paracetamol vs.
placebo. Of the 12 paracetamol studies, 9 used IV paracetamol and 3 used oral and/or rectal
administration. Data was combined from 56 trials that randomised patients to four treatments
including placebo. The main analysis was mixed treatment comparison (MTC) evaluating the relative
effects of the four treatment classes: paracetamol, NSAIDs, COX-2 inhibitors and placebo. The mean
difference in 24h morphine consumption for paracetamol was -6.34mg; 95% CI -9.02 to -3.65.
NSAIDs and COX-2 inhibitors were more effective than paracetamol, but the differences were small
and probably of limited clinical significance. Paracetamol was well-tolerated, with no reports of
surgical bleeding, compared to 2.4% of participants receiving a NSAID, based on 6 trials (n = 695)
NSAIDs were only slightly more superior to paracetamol in reducing PONV (RR 0.78; 95% CI 0.51 to
1.20) and sedation (RR 0.35; 95% CI 0.04 to 3.00) in patients on PCA morphine.
The most recent systematic review assessed the efficacy and safety of IV formulations of paracetamol
(paracetamol or propacetamol) for treatment of acute postoperative pain in both adults and
children(2). Thirty-six (3896 participants) randomized, double-blind, placebo- or active- controlled
single or multiple-dose dose clinical trials of IV paracetamol or propacetamol were included.
Outcomes were assessed 4 to 6 hours after first administration of IV paracetamol or propacetamol.
The primary outcome was 50% or greater pain relief over 4 to 6 hours. Thirty-seven percent of
participants receiving IV paracetamol/propacetamol experienced at least 50% pain relief over 4 hours
compared with 16% of those receiving placebo (NNT to benefit= 4.0; 95% confidence interval (CI) 3.5
to 4.8).Participants receiving IV propacetamol/paracetamol needed 30% less opioid over 4 hours than
those receiving placebo. However this did not result in a reduction in opioid-induced adverse events.
Meta-analysis of efficacy comparisons between IV/propacetamol /paracetamol and active
comparators (opioids or NSAIDs), were either not statistically significant, not clinically significant, or
both. Meta-analysis demonstrated a statistically significant reduction in the rate of hypotension for IV
paracetamol compared with NSAIDs. Similarly a comparison of data for IV paracetamol with data for
opioids showed a reduction in the rate of gastrointestinal disorders in those receiving IV paracetamol.
There are other studies of IV paracetamol for post-operative pain which did not meet the inclusion
criteria for these systematic reviews (2,17,19), or have been published since. Some of these are
summarised below.
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
Table 1. Studies of IV paracetamol for pain relief after cardiac surgery
Ref
Trial design
Petterson
200520
RCT
Cattabriga
200721
Randomised,double
blind, placebocontrolled trial
Trial
population
80 patients after
CABG
Treatment
Primary outcome(s)
Results
Paracetamol 1g IV(n=39)
or PO(n=38)every 6h after
extubation for 15h or 14h
Mean dose of ketobemidone : IV paracetamol
17.4 ± 7.9mg vs PO paracetamol 22.1 ±
8.6mg (p=0.016).No difference in incidence of
PONV & in VAS scores
113 patients
after cardiac
surgery. All
patients
received
tramadol for
72h.
Paracetamol 1g IV (n=56)
or placebo (n=57) 15 min
before the end of surgery
and every 6h for 72h.
Mean cumulative
ketobemidone
administration during
the study period
VAS pain scores and
PONV
Pain as assessed by
VAS.
Cumulative dose of
rescue IV morphine
over 72h
At 12,18 and 24 h, pain scores significantly
lower in paracetamol group (p=0.0041, 0.0039,
0.0044 respectively)
48mg vs 97mg (p=0.274) paracetamol vs
placebo)
Table 2. Studies of IV paracetamol for pain relief in other types of surgery or trauma
Ref
Mitra
201222
Trial design
Double blind RCT
Trial population
204 women
undergoing
caesarean
section
Craig
201123
Randomised,
double blind pilot
study
55 patients aged
16-65 with
isolated limb
trauma and
moderate to
severe pain
Treatment
100mg diclofenac PR 8hourly for 24h plus IV
paracetamol 1g 6-hourly
or 100mg diclofenac PR
8-hourly for 24h plus IV
tramadol 75mg 6-hourly.
IV paracetamol 1g (n=27)
or IV morphine
10mg(n=28)
Primary outcome(s)
Sum of timeweighted pain
intensity scores over
24 h as an AUC
Results
Overall pain score for the observation period
significantly lower in the diclofenac-tramadol
group (31.82 vs 38.67 [P=0.039] but
associated with significantly more nausea 15%
vs 2%, P=0.001)
Pain score assessed
by VAS at 0, 5, 15,
30 and 60 min
No significant difference in analgesic effect
between paracetamol and morphine at any
time interval. Fewer adverse effects in
paracetamol group (8 vs. 2 patients)
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
Gehling
201024
Double-blind,
placebo-controlled
RCT
140 patients after
thyroid or
parathyroid
surgery
Memis
201025
Randomised,
placebo- controlled
trial
40 patients after
complex major
abdominal or
pelvic surgery
Kurcuoglu
201026
Non-randomised
comparative study
54 patients after
septoplasty
Yalcin
201227
Randomised,
placebo-controlled
trial
90 patients
undergoing total
abdominal
hysterectomy.
Anaesthesia
maintained with
remifentanil
infusion
IV parecoxib 80mg(n=35)
or IV paracetamol
5g(n=35)[given as a bolus
30 min before the end of
surgery , followed by an
infusion over 24h], or
parecoxib 80mg +
paracetamol 5g(n=35), in
24 h
IV paracetamol 1g + IV
pethidine (n=20) every 6h
[PP] or IV pethidine
(n=20) for 24 h [P].
Pethidine dose
determined by BPS and
VAS scores.
IV paracetamol 1g every
6h (n=27) or IM diclofenac
75mg 12-hourly
IV ketamine 0.5mg/kg
bolus followed by infusion
intra-operatively(n=26)or
IV paracetamol 1g
infusion before induction
of anaesthesia(n=26)
Total opioid
requirement over 24
h. (Rescue analgesia
provided by
piritramide delivered
by a PCA).
Total opioid consumption in 24h reduced
significantly in all three groups compared with
placebo. Eight hours and 24h after surgery,
parecoxib was superior to paracetamol,
compared with placebo.
Pethidine
consumption in 24 h
and opioid adverse
effects.
Total pethidine consumption reduced
significantly in the PP group compared with the
P group, (77mg vs. 198mg). Significantly less
nausea and vomiting [7 vs 1, (p<0.05)].
Significantly less sedation at extubation and at
24h in PP group
Post-operative pain
as assessed by VAS
Pain scores lower in diclofenac group but
difference not statistically significant (p >0.05).
Post-operative pain
as assessed by VAS
for 24h,pressure pain
thresholds at the
incision region and
morphine
consumption at 24h
and 48h
No significant difference between the
paracetamol and ketamine groups for VAS
scores and pain thresholds, but morphine
consumption was higher in the paracetamol
group
Glossary
AE
AUC
BPS
CABG
CI
IM
Adverse effects
Area under the curve
Behavioural Pain Scale
Coronary artery bypass graft
Confidence intervals
Intramuscular
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
NS
NSAID
OR
PR
PCA
PONV
RCT
RR
VAS
VRS
Not Significant
Non-steroidal anti-inflammatory drug
Odds Ratio
Rectal administration
Patient-controlled analgesia
Post-operative nausea and vomiting
Randomised controlled trial
Risk Ratio
Visual Analogue Scale
Verbal Rating Scale
From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
Renal colic
A RCT in 165 patients admitted with suspected renal colic compared single IV doses of paracetamol
1g, morphine 0.1mg/kg and placebo for pain relief. Patients were excluded if they needed rescue
analgesics within the first 30 minutes of the study, so 146 patients were included in the final analysis.
The mean reduction in VAS pain intensity scores at 30 minutes was 43 mm for paracetamol (95% CI
35 to 51mm), 40 (29 to 52 mm) for morphine, and 27 (19 to 34 mm) for placebo. There was no
difference in pain intensity reduction between paracetamol and morphine. At least one adverse event
was experienced by 11(24%) receiving paracetamol 16(33%) receiving morphine and 8(16%) in the
placebo group (28). In a further double-blind RCT 80 patients with renal colic received a single dose
of 1g paracetamol IV (n=40) or morphine 0.1mg/kg for pain relief. 73 patients were included in the
final analysis (paracetamol n=38). The difference between VAS pain reduction scores for the two
groups at 30 minutes was 7.1 mm (95% CI -18 to 4); this was not clinically or statistically significant.
Two adverse events were recorded in the paracetamol group and five in the morphine group
(difference 9%, 95% CI -7% to 26%)(29).
 Adverse effects/precautions/potential risks
Cases of accidental overdose have been reported during treatment with IV paracetamol 10mg/mL
solution for infusion. In most cases this occurred in infants and neonates (30). However there are
reports of clinical incidents involving paracetamol overdose in adult patients weighing less than 50kg,
where the dose was not adjusted according to the patient’s weight (31,32). Failure to reduce the dose
appropriately may result in paracetamol-induced liver toxicity. This could lead to hepatic failure and
death (31,32). ). The manufacturer has reinforced this warning in a joint communication with the
MHRA (33). The British National Formulary (BNF) advises that the maximum daily dose of infusions
should be also reduced to 3 g for patients with hepatocellular insufficiency, chronic alcoholism,
chronic malnutrition, or dehydration (14). In addition, since the infusion is presented in a rigid
container (glass bottle), careful assembly and close monitoring are needed throughout the
administration period and it must be stopped at the end of the infusion when the bottle is empty, in
order to avoid air embolism (1,34,35).
Limitations
This Q&A discusses the evidence from studies in adults. The use in infants and children is not
discussed. For full prescribing information please refer to the Summary of Product Characteristics
Disclaimer
 Medicines Q&As are intended for healthcare professionals and reflect UK practice.
 Each Q&A relates only to the clinical scenario described.
 Q&As are believed to accurately reflect the medical literature at the time of writing.
 The authors of Medicines Q&As are not responsible for the content of external websites and
links are made available solely to indicate their potential usefulness to users of NeLM. You
must use your judgement to determine the accuracy and relevance of the information they
contain.
 See NeLM for full disclaimer.
Acknowledgements
Dr Hannah Blanshard, Consultant Anaesthetist, Bristol Royal Infirmary
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postoperative pain ( Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007126.
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Medicines Q&As
DOI: 10.1002/14651858.CD007126.pub2. Accessed via
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drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic
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From the National Electronic Library for Medicines. www.nelm.nhs.uk
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Medicines Q&As
(24) Gehling M et al. Postoperative analgesia with parecoxib, acetaminophen and the combination of
both: a randomized, double-blind, placebo-controlled trial in patients undergoing thyroid surgery. Brit J
Anaesth 2010; 104: 761-7
(25) Memis D et al. Intravenous paracetamol reduced the use of opioids, extubation time, and opioidrelated adverse effects after major surgery in intensive care unit. J Crit Care 2010; 25: 458-62
(26) Kurkcuoglu SS et al. Pain reducing effect of parenteral paracetamol and diclofenac after
septoplasty. Duzce Med J 2010; 12: 42-7
(27) Yalcin N et al. A comparison of ketamine and paracetamol for preventing remifentanil induced
hyperalgesia in patients undergoing total abdominal hysterectomy. Int J Med Sci 2012; 9:327-33
(28) Bektas F et al. Intravenous paracetamol or morphine for the treatment of renal colic: a
randomized, placebo-controlled trial. Ann Emerg Med 2009; 54: 568-74
(29) Serinken M et al. Intravenous paracetamol versus morphine for renal colic in the emergency
department: a randomised double-blind controlled trial. Emerg Med J 2012; 29: 902-5
(30) MHRA Drug Safety Update July 2010;3 (12): 2-4 accessed via
http://www.mhra.gov.uk/Publications/Safetyguidance/DrugSafetyUpdate/CON087803
on 14.9.10
(31) Claridge LC et al. Lesson of the Week. Acute liver failure after administration of paracetamol at
the maximum recommended daily dose in adults. BMJ 341:doi:10.1136/bmj.c6764 (Published 2
December 2010) Accessed via www.bmj.com on 7.12.10
(32)Fatality due to inadvertent overdoses of intravenous paracetamol. Accessed via
http://www.nelm.nhs.uk/en/NeLM-Area/News/2011---March/18/Fatality-due-to-inadvertent-overdosesof-intravenous-paracetamol/ on 9.11.12
(33) Risk of accidental overdose with Perfalgan ▼ (intravenous paracetamol). Bristol-Myers Squibb
Pharmaceuticals. 26 March 2012. Accessed via
http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessag
esformedicines/Monthlylistsofinformationforhealthcareprofessionalsonthesafetyofmedicines/CON1469
14 on 22.8.12
(34) Pierson R, Coupe M. Reducing the risk of air embolism following administration of IV
paracetamol. Anaesthesia 2008; 63:96-107
(35) Davies I, Griffin JD. A novel risk of air embolism with intravenous paracetamol .BMJ Case
Reports 2012;10.1136/bcr01.2012.5488 accessed online on 28.11.12
Quality Assurance
Prepared by
Julia Kuczynska, South West Medicines Information and Training, University Hospitals Bristol NHS
Foundation Trust
Date Prepared
December 2012
Checked by
Trevor Beswick, South West Medicines Information and Training, University Hospitals Bristol NHS
Foundation Trust
Date of check
13 February 2013
Search strategy
 Medline: exp *ACETAMINOPHEN and [ exp *INFUSIONS, INTRAVENOUS or exp
*INJECTIONS, INTRAVENOUS] or "paracetamol infusion".ti,ab or "paracetamol
injection*".ti,ab] [Limit to: Humans] date of search 24.8.12
 Embase: (PARACETAMOL/iv,pa [Limit to: Human] and exp *PAIN/ [Limit to: (Clinical Trials
Clinical Trial) and Human]) PARACETAMOL/po and PARACETAMOL/iv,pa and exp *PAIN/
[Limit to: (Clinical Trials Clinical Trial) and Human]) on 24.8.12
 Micromedex: Acetaminophen Drug Evaluation Monograph
From the National Electronic Library for Medicines. www.nelm.nhs.uk
10
Medicines Q&As




In-house database/resources
Google : intravenous paracetamol site:nhs.uk
NELM: “Paracetamol infusions” OR “Intravenous paracetamol”
Dr Hannah Blanshard, Consultant Anaesthetist, Bristol Royal Infirmary
From the National Electronic Library for Medicines. www.nelm.nhs.uk
11