Farmacoriflessioni
Come si usa il paracetamolo
How to use paracetamol
Anna Di Sessa1, Federico Nappi2, Pierluigi Marzuillo1, Egidio Barbi3
1Dipartimento della Donna, del Bambino e di Chirurgia generale e specialistica, Seconda Università di Napoli
2IRCCS Materno-Infantile “Burlo Garofolo”, Università di Trieste
3IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Settembre 2014 - pagg. 451 -458
Abstract
Paracetamol (acetaminophen) is one of the most popular and widely used drug for the
treatment of pain and fever in children. Despite its frequent prescription, a full knowledge
of many aspects regarding the mechanism of action is lacking. There are different
paracetamol dosages not only for different route of administration, but also for different
indications (fever and pain treatment); for example the rectal route, even if efficacious as
antipyretic, should be avoided in pain management. This review takes into consideration
aspects dealing with pharmacology, toxicity and therapeutic prescription of paracetamol;
the latest paracetamol toxicity management indications and the guidelines for
fever and pain treatment are reported in order to help physicians to use this drug correctly.
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Bibliografia
Paracetamol:
a focus for the general pediatrician. Eur J
Pediatr 2014;173:415-25.
2. Squires RH Jr, Shneider BL, Bucuvalas J, et
al. Acute liver failure in children: the first 348
patients in the pediatric acute liver failure study
group. J Pediatr 2006;148:652-8.
3. Watkins PB, Kaplowitz N, Slattery JT, et al.
Aminotransferase elevations in healthy adults
receiving 4 grams of acetaminophen daily: a
randomized controlled trial. JAMA 2006;296:
87-93.
4. Anderson BJ. Paracetamol (acetaminophen):
mechanisms of action. Paediatr Anaesth 2008;
18:915-21.
5. Gibb IA, Anderson BJ. Paracetamol (acetaminophen)
pharmacodynamics: interpreting
the plasma concentration. Arch Dis Child 2008;
93:241-7.
6. Anderson BJ, Woollard GA, Holford NH.
Acetaminophen analgesia in children: placebo
effect and pain resolution after tonsillectomy.
Eur J Clin Pharmacol 2001;57:559-69.
7. Singla NK, Parulan C, Samson R, et al. Plasma
and cerebrospinal fluid pharmacokinetic
parameters after single-dose administration of
intravenous, oral, or rectal acetaminophen.
Pain Pract 2012;12:523-32.
8. Prescott LF. Kinetics and metabolism of paracetamol
and phenacetin. Br J Clin Pharmacol
1980;10:291S-298S.
9. Patel M, Tang BK, Kalow W. Variability of
acetaminophen metabolism in Caucasians and
Orientals. Pharmacogenetics 1992;2:38-45.
10. Manyike PT, Kharasch ED, Kalhorn TF,
Slattery JT. Contribution of CYP2E1 and
CYP3A to acetaminophen reactive metabolite
formation. Clin Pharmacol Ther 2000;67:275-
82.
11. van der Marel CD, Anderson BJ, van Lingen
RA, et al. Paracetamol and metabolite pharmacokinetics
in infants. Eur J Clin Pharmacol
2003;59:243-51.
12. Miller RP, Roberts RJ, Fischer LJ. Acetaminophen
elimination kinetics in neonates, children,
and adults. Clin Pharmacol Ther 1976;
19:284-94.
13. Lowe AJ, Carlin JB, Bennett CM, et al. Paracetamol
use in early life and asthma: prospective
birth cohort study. BMJ 2010;341:
c4616.
14. Schnabel E, Heinrich J. Respiratory tract infections
and not paracetamol medication during
infancy are associated with asthma development
in childhood. J Allergy Clin Immunol
2010;126:1071-3.
15. Tapiainen T, Dunder T, Möttönen M, Pokka
T, Uhari M. Adolescents with asthma or atopic
eczema have more febrile days in early
childhood: a possible explanation for the connection
between paracetamol and asthma? J Allergy
Clin Immunol 2010;125:751-2.
16. Linee Guida della Società Italiana di Pediatria.
Gestione del segno/sintomo febbre in pediatria.
17. Jaffe DM. Assessment of the child with fever.
In: Rudolph CD, Rudolph AM, Hostetter
MK, Lister GE, Siegel NJ (Eds). Rudolph’s Pediatrics,
21st ed. New York, NY: McGraw-Hill,
2002:302-9.
18. Adam HM. Fever and host responses. Pediatr
Rev 1996;17:330-1.
19. Tornese G, Bua J, Simeone G, Marchetti F.
Antipiretici e convulsioni febbrili: qualcosa di
nuovo? Medico e Bambino 2009;28:657-60.
20. Marchetti F, Bua J, Maschio M, Barbi E. Il
trattamento sintomatico della febbre e del dolore
nella pratica ambulatoriale. Medico e Bambino
2004;24:47-54.
21. Updated guidance to help assess children
with fever, NICE clinical guidelines, 2013.
22. Section on Clinical Pharmacology and Therapeutics;
Committee on Drugs, Sullivan JE,
Farrar HC. Fever and antipyretic use in children.
Pediatrics 2011;127:580-7.
23. Nabulsi M, Tamim H, Sabra R, et al. Equal
antipyretic effectiveness of oral and rectal acetaminophen:
a randomized controlled trial.
BMC Pediatr 2005;5:35-42.
24. Zuppa AF, Hammer GB, Barrett JS, et al. Safety
and population pharmacokinetic analysis
of intravenous acetaminophen in neonates, infants,
children, and adolescents with pain or fever.
J Pediatr Pharmacol Ther 2011;16:246-61.
25. Bryant RE, Hood AF, Hood CE, Koenig
MG. Factors affecting mortality of Gram-negative
rod bacteremia. Arch Intern Med 1971;
127:120-8.
26. Weinstein MP, Iannini PB, Stratton CW,
Eickhoff TC. Spontaneous bacterial peritonitis.
A review of 28 cases with emphasis on improved
survival and factors influencing prognosis.
Am J Med 1978;64:592-8.
27. Graham NM, Burrell CJ, Douglas RM, et al. ibuprofen on immune function, viral shedding,
and clinical status in rhinovirus-infected volunteers.
J Infect Dis 1990;162:1277-82.
28. Brandts CH, Ndjave M, Graninger W,
Kremsner PG. Effect of paracetamol on parasite
clearance time in Plasmodium falciparum
malaria. Lancet 1997;350:704-9.
29. Doran TF, De Angelis C, Baumgardner RA,
Mellits ED. Acetaminophen: more harm than
good for chickenpox? J Pediatr 1989;114:1045-8.
30. Lee BH, Inui D, Suh GY, et al. Association of
body temperature and antipyretic treatments
with mortality of critically ill patients with and
without sepsis: multi-centered prospective observational
study. Crit Care 2012;16:R33.
31. Young PJ, Saxena M, Beasley R, et al. Early
peak temperature and mortality in critically ill
patients with or without infection. Intensive Care
Med 2012;38:437-44.
32. Schortgen F, Clabault K, Katsahian S, et al.
Fever control using external cooling in septic
shock: a randomized controlled trial. Am J Respir
Crit Care Med 2012;185:1088-95.
33. Yang YL, Liu DW, Wang XT, Long Y, Zhou X,
Chai WZ. Body temperature control in patients
with refractory septic shock: too much may be
harmful. Chin Med J (Engl) 2013;126:1809-13.
34. Pelkonen T, Roine I, Cruzeiro ML, Pitkaranta
A, Kataja M, Peltola H. Slow initial !-lactam
infusion and oral paracetamol to treat
childhood bacterial meningitis: a randomised,
controlled trial. Lancet Infect Dis 2011;11:613-
21.
35. Kuikka A, Sivonen A, Emelianova A, Valtonen
VV. Prognostic factors associated with improved
outcome of Escherichia coli bacteremia
in a Finnish university hospital. Eur J Clin Microbiol
Infect Dis 1997;16:125-34.
36. Kuikka A, Valtonen VV. Factors associated
with improved outcome of Pseudomonas aeruginosa
bacteremia in a Finnish university hospital.
Eur J Clin Microbiol Infect Dis 1998;
17:701-8.
37. Facchina G, Minute M, Massaro M, et al. Il
dolore acuto del bambino: dalla misurazione al
trattamento, farmacologico e non. Medico e
Bambino 2013;32:237-42.
38. Dart RC, Rumack BH. Intravenous acetaminophen
in the United States: iatrogenic dosing
errors. Pediatrics 2012;129:349-53.
39. Korpela R, Korvenoja P, Meretoja OA.
Morphine-sparing effect of acetaminophen in
pediatric day-case surgery. Anesthesiology
1999;91:442-7.
40. Ceelie I, de Wildt SN, van Dijk M, et al. Effect
of intravenous paracetamol on postoperative
morphine requirements in neonates and infants
undergoing major noncardiac surgery: a
randomized controlled trial. JAMA 2013;309:
149-54.
41. Remy C, Marret E, Bonnet F. Effects of acetaminophen
on morphine side-effects and consumption
after major surgery: meta-analysis of
randomized controlled trials. Br J Anaesth
2005;94:505-13.
42. Maund E, McDaid C, Rice S, et al. Paracetamol
and selective and non-selective non-steroidal
anti-inflammatory drugs for the reduction
in morphine-related side-effects after
major surgery: a systematic review. Br J Anaesth
2011;106:292-7.
43. Apfel CC, Turan A, Souza K, Pergolizzi J,
Hornuss C. Intravenous acetaminophen reduces
postoperative nausea and vomiting: a systematic
review and meta-analysis. Pain 2013;
154:677-89.
44. Elfant AB, Levine SM, Cencora B, et al.
Bioavailability of medication after laparoscopic
cholecystectomy. J Laparoendosc Surg 1995;5:
237-40.
45. Elfant AB, Levine SM, Peikin SR, et al. Bioavailability
of medication delivered via nasogastric
tube is decreased in the immediate postoperative
period. Am J Surg 1995;169:430-2.
46. van der Westhuizen J, Kuo PY, Reed PW,
Holder K. Randomised controlled trial comparing
oral and intravenous paracetamol (acetaminophen)
plasma levels when given as preoperative
analgesia. Anaesth Intensive Care
2011;39:242-6.
47. American Academy of Pediatrics. Committee
on Drugs. Acetaminophen toxicity in children.
Pediatrics 2001;108:1020-4.
48. L’Erario I, Di Benedetto A, Bua J, Norbedo
S, Barbi E, Marchetti F. Farmaci e utilizzo
“wrong label” in pediatria. L’esempio del paracetamolo,
del salbutamolo e dell’amoxicillina.
Medico e Bambino 2007;26:580-5.
49. Burns MJ, Friedman SL, Larson AM. Acetaminophen
(paracetamol) poisoning in adults:
pathophysiology, presentation, and diagnosis.
UpToDate 2014.
50. James LP, Chiew A, Abdel-Rahman SM, et
al. Acetaminophen protein adduct formation
following low-dose acetaminophen exposure:
comparison of immediate-release vs extended
release formulations. Eur J Clin Pharmacol
2013;69:851-7.
51. Lauterburg BH, Mitchell JR. Therapeutic
doses of acetaminophen stimulate the turnover
of cysteine and glutathione in man. J Hepatol
1987;4:206-11.
52. Ceelie I, James LP, Gijsen V, et al. Acute liver
failure after recommended doses of acetaminophen
in patients with myopathies. Crit Care
Med 2011;39:678-82.
53. Flanagan RJ, Mant TG. Coma and metabolic
acidosis early in severe acute paracetamol poisoning.
Hum Toxicol 1986;5:179-82.
54. Heard K, Dart R. Acetaminophen (paracetamol)
poisoning in adults: treatment. UpTo-
Date 2014.
55. Hodgman MJ, Garrard AR. A review of acetaminophen
poisoning. Crit Care Clin 2012;28:
499-516.
Corrispondenza: nappifederico@gmail.com
