Therapeutic indications
Paraford is indicated for the short-term treatment of moderate pain, especially following surgery and for the short-term treatment of fever, when administration by intravenous route is clinically justified by an urgent need to treat pain or hyperthermia and/or when other routes of administration are not possible.
Posology and method of administration
Intravenous route. The 100 ml vial or 100 ml bag is restricted to adults, adolescents and children weighing more than 33 kg. The 50 ml vial is restricted to term newborn infants, infants, toddlers and children weighing less than 33 kg.
Posology
Adolescents and adults weighing more than 50 kg
AParacetamol 1 g per administration, i.e. one 100 ml vial or one 100 ml bag, up to four times a day.
The minimum interval between each administration must be 4 hours.
The maximum daily dose must not exceed 4 g.
Children weighing more than 33 kg (approximately 11 years old), adolescents and adults weighing less than 50 kg
Paracetamol 15 mg/kg per administration, i.e. 1.5 ml solution per kg up to four times a day.
The minimum interval between each administration must be 4 hours.
The maximum daily dose must not exceed 60 mg/kg (without exceeding 3 g)
Children weighing more than 10 kg (approximately 1 year old) and weighing less than 33 kg
Paracetamol 15 mg/kg per administration, i.e. 1.5 ml solution per kg up to four times a day.
The minimum interval between each administration must be 4 hours.
The maximum daily dose must not exceed 60 mg/kg (without exceeding 2 g)
Term newborns infants, infants, toddlers and children weighing less than 10 kg (up to approximately 1 year old)
Paracetamol 7.5 mg/kg per administration, i.e. 0.75 ml solution per kg up to four times a day.
The minimum interval between each administration must be 4 hours.
The maximum daily dose must not exceed 30 mg/kg.
No safety and efficacy data are available for premature neonates
Severe renal insufficiency
It is recommended, when giving paracetamol to patients with severe renal impairment (creatinine clearance 30 mL/min), to increase the minimum interval between each administration to 6 hours
In adults with hepatocellular insufficiency, chronic alcoholism, chronic malnutrition (low reserves of hepatic glutathione), dehydration: The maximum daily dose must not exceed 3 g
Method of administration
The paracetamol solution is administered as a 15-minute intravenous infusion.
Text for the 50ml and 100ml vials
Use a 0.8 mm needle and vertically perforate the stopper at the spot specifically indicated.
Text for the 50ml vials
Paraford of 50ml vial can also be diluted in a 0.9% sodium chloride solution or 5% glucose solution up to one tenth. In this case, use the diluted solution within the hour following its preparation (infusion time included).
Text for the 50ml and 100ml vials
As for all solutions for infusion presented in glass vials, it should be remembered that close monitoring is needed notably at the end of the infusion, regardless of administration route. This monitoring at the end of the perfusion applies particularly for central route infusion, in order to avoid air embolism.
Contraindications
PARAFORD is contraindicated
in patients with hypersensitivity to paracetamol or to propacetamol hydrochloride (prodrug of paracetamol) or to one of the excipients.
in cases of severe hepatocellular insufficiency.
Special warnings and precautions for use
Warnings
It is recommended to use a suitable analgesic oral treatment as soon as this administration route is possible.
In order to avoid the risk of overdose, check that other medicines administered do not contain either paracetamol or propacetamol.
Doses higher than the recommended entails risk for very serious liver damage. Clinical symptoms and signs of liver damage (including fulminant hepatitis, hepatic failure, cholestatic hepatitis, cytolytic hepatitis) are usually first seen after two days of drug administration with a peak seen usually after 4 - 6 days. Treatment with antidote should be given as soon as possible
This medicinal product contains less than 1 mmol sodium (23mg) per 100ml of Paraford, i.e. essentially "sodium free".
Text for the 50ml and 100ml vials
As for all solutions for infusion presented in glass vials, a close monitoring is needed notably at the end of the infusion
Precautions for use
Paracetamol should be used with caution in cases of
hepatocellular insufficiency,
severe renal insufficiency (creatinine clearance 30 mL/min)
chronic alcoholism,
chronic malnutrition (low reserves of hepatic gluthatione),
dehydration.
Overdose
There is a risk of liver injury (including fulminant hepatitis, hepatic failure,cholestatic hepatitis, cytolytic hepatitis), particularly in elderly subjects, in young children, in patients with liver disease, in cases of chronic alcoholism, in patients with chronic malnutrition and in patients receiving enzyme inducers. Overdosing may be fatal in these cases.
Symptoms generally appear within the first 24 hours and comprise: nausea, vomiting, anorexia, pallor, abdominal pain. Overdose, 7.5 g or more of paracetamol in a single administration in adults and 140 mg/kg of body weight in a single administration in children, causes hepatic cytolysis likely to induce complete and irreversible necrosis, resulting in hepatocellular insufficiency, metabolic acidosis and encephalopathy which may lead to coma and death. Simultaneously, increased levels of hepatic transaminases (AST, ALT), lactate dehydrogenase and bilirubin are observed together with decreased prothrombin levels that may appear 12 to 48 hours after administration.
Clinical symptoms of liver damage are usually evident initially after two days, and reach a maximum after 4 to 6 days.
Emergency measures
Immediate hospitalisation.
Before beginning treatment, take a tube of blood for plasma paracetamol assay, as soon as possible after the overdose.
The treatment includes administration of the antidote, N-acetylcysteine (NAC), by the i.v. or oral route, if possible before the 10th hour. NAC can, however, give some degree protection even after 10 hours, but in these cases prolonged treatment is given.
Symptomatic treatment.
Hepatic tests must be carried out at the beginning of treatment and repeated every 24 hours. In most cases hepatic transaminases return to normal in one to two weeks with full restitution of liver function. In very severe cases, however, liver transplantation may be necessary.