Panadol

Uses
Panadol (Paracetamol) - 500mg (24 Tablets) is a non-narcotic analgesic, which blocks Cyclooxygenase 1 and 2 predominantly in central nervous system, affecting pain and heat regulating centers. In the inflamed tissues, cell peroxydases neutralize the effect of Panadol (Paracetamol) over Cyclooxygenases, which explains the general lack of anti-inflammatory effect. As long as Panadol (Paracetamol) does not block Pg synthesis in peripheral tissues, it doesn't have adverse effect on water-salt metabolism (such as retention of Na+ and water) and gastro-intestinal tract mucous membranes.

Dosage and Administration
Panadol (Paracetamol) - 500mg (24 Tablets) is taken orally with plenty of water in 1-2 hours after the meal (administration right after the meal leads to the delayed onset of its action).

For adults and children above the age of 12 years (with the body weight over 40kg), standard single dose is 500mg; maximum single dose is 1g. Dosage frequency should not exceed 4 times a day. Maximum daily dose is 4g, with the maximum treatment duration of 5 to 7 days.

For patients with compromised liver or kidney function, with Gilbert's syndrome, and elderly patients, the daily dose needs to be reduced, while the intervals between doses need to be lengthened.

For children, the maximum daily dose under 6 months (up to 7kg) is 350mg, under 1 year (up to 10kg) - 500mg, under 3 years (up to 15kg) - 750mg, under 6 years (up to 22kg) - 1g, under 9 years (up to 30kg) - 1.5g, up to 12 years (up to 40kg) - 2g.

The dose for children at the age of 1 to 3 months is prescribed on an individual basis. Dosage frequency is 4 times a day, and the intervals between the doses should be at least 4 hours. Maximum duration of treatment without consulting a physician is 3 days (as an antipyretic medication) and 5 days (as an analgesic medication).

Side effects
Skin: itching; skin and mucous membranes rash (usually, erythematic rash or hives); angioedema; erythema multiforme (including Stevens-Johnson syndrome); toxic epidermal necrolysis (including Lyell's syndrome).

Central nervous system (usually develop in case of high doses administration): dizziness; psychomotor agitation; disorientation.

Digestive system: nausea; epigastric pain; increase in the activity of liver enzymes; normally, jaundice doesn't develop; hepatonecrosis (dose-dependent effect).

Endocrine system: hypoglycaemia (including hypoglycemic coma).

Hemopoietic system: anemia, sulfhaemoglobinaemia, and methemoglobinemia (cyanosis, shortness of breath, haertache); haemolytic anaemia (especially in patients with glucose-6-phosphate dehydrogenase deficiency).

Long-term administration of high doses may cause aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leucopenia, thrombocytopenia.

Urinary system (in case of high doses administration): nephrotoxicity (renal colic, interstitial nephritis, renal papillary necrosis).

Acute overdose develops within 6-14 hours after the administration, while chronic overdose develops within 2-4 days after the dose has been exceeded.

Acute overdose symptoms: Digestive system dysfunction (diarrhea, decreased appetite, nausea and vomiting, discomfort in the abdomen and / or stomach pain), excessive sweating.

Chronic overdose symptoms: Hepatotoxic action develops, accompanied by the general symptoms, such as pain, weakness, adynamia, and excessive sweating, and by specific symptoms, typical of liver damage. As a result, this may lead to hepatonecrosis. Hepatotoxic action may be complicated by hepatic encephalopathy (thinking disorder, central nervous system depression, and stupor), seizures, respiratory depression, coma, cerebral edema, hypocoagulation, disseminated intravascular coagulation (DIC), hypoglycaemia, metabolic acidosis, arrhythmia, collapse. In rare cases, peracute liver dysfunction may develop and may be complicated by liver failure (kidney tubular necrosis).

Overdose treatment: Administration of sulfhydryl group donors and the precursors of the glutathione and methionine synthesis in 8-9 hours after the overdose and N-acetylcysteine in 12 hours. Further need for any additional therapeutic interventions (such as continued administration of methionine, intravenous administration of N-acetylcysteine) is defined depending on the blood concentrations of the active ingredient, as well as on the time, elapsed after its administration.

Precautions
Counter indications: Hypersensitivity, newborn age (under 1 month).

With caution: Kidney and liver failure, benign hyperbilirubinemia (including Gilbert's syndrome), viral hepatitis, alcohol-induced liver damage, pregnancy, breast feeding, elderly age, early infant age (under 3 months), glucose-6-phosphate dehydrogenase deficiency.

In case of the ongoing fever syndrome when Panadol (Paracetamol) has been used for over 3 days and pain syndrome when Panadol (Paracetamol) has been used for over 5 days, it is required to consult your physician.

The risk of liver damage related to Panadol (Paracetamol) administration is higher in patients with alcohol induced liver disease.

Panadol (Paracetamol) distorts laboratory test counts of the glucose and uric acid plasma concentrations.

During the long-term treatment with Panadol (Paracetamol), it is required to monitor peripheral blood and liver function.