1. Name Of The Medicinal Product
Boots Pain Relief Paracetamol 120mg/5ml Suspension
2. Qualitative And Quantitative Composition
Active ingredients | Per 5 ml |
Paracetamol | 120 mg |
3. Pharmaceutical Form
Oral Suspension
4. Clinical Particulars
4.1 Therapeutic Indications
To relieve mild to moderate pain and to reduce fever in many conditions including headache, toothache, teething, feverishness, colds and influenza and following vaccination.
4.2 Posology And Method Of Administration
For oral administration.
Babies 3 months to 1 year: 2.5-5 ml (60-120 mg paracetamol)
Children 1-6 years: 5-10 ml (120-240 mg paracetamol)
Repeat every 4-6 hours as needed, up to a maximum of 4 doses in 24 hours.
Elderly: Dosage may need to be reduced because of the longer elimination half life and reduced plasma clearance of paracetamol.
Babies under 3 months: A 2.5 ml dose (60 mg paracetamol) is suitable for babies who develop pyrexia following vaccination at 2 months followed if necessary, by a second dose 4 to 6 hours later.
If fever continues after the second dose consult a doctor.
4.3 Contraindications
Hypersensitivity to paracetamol or any of the other ingredients.
4.4 Special Warnings And Precautions For Use
Caution in patients with severely impaired liver or kidney function.
The hazards of overdose are greater in those with non-cirrhotic alcoholic liver disease.
Do not give more than 4 doses in 24 hours.
Do not give more than 3 days without consulting your doctor.
Do not give to babies under two months except on the advice of your doctor.
Do not give with any other paracetamol-containing products.
Do not exceed the stated dose.
If symptoms persist consult your doctor.
Contains paracetamol.
Keep all medicines out of the sight and reach of children.
Label:
Immediate medical advice should be sought in the event of an overdose, even if the child seems well.
Leaflet or combined label/leaflet:
Immediate medical advice should be sought in the event of an overdose, even if the child seems well, because of the risk of delayed, serious liver damage.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone and absorption reduced by colestyramine.
The anticoagulant 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.
Patients who have taken barbiturates, tricyclic antidepressants and alcohol may show diminished ability to metabolise large doses of paracetamol, the plasma half-life of which can be prolonged.
Alcohol can increase the hepatotoxicity of paracetamol overdosage and may have contributed to the acute pancreatitis reported in one patient who had taken an overdose of paracetamol.
Chronic ingestion of anticonvulsants or oral steroid contraceptives induce liver enzymes and may prevent attainment of therapeutic paracetamol levels by increasing first pass metabolism or clearance.
4.6 Pregnancy And Lactation
Epidemiological studies in human pregnancy have shown no ill effects due to paracetamol used in the recommended dosage, but patients should follow the advice of their doctor regarding its use.
Paracetamol is excreted in breast milk but not in a clinically significant amount. Available published data do not contraindicate breast feeding.
4.7 Effects On Ability To Drive And Use Machines
No adverse effects known.
4.8 Undesirable Effects
Adverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. Very rarely there have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol.
4.9 Overdose
Liver damage is possible in adults who have taken 10 g or more of paracetamol. Ingestion of 5 g or more of paracetamol may lead to liver damage if the patient has risk factors (see below).
Risk Factors:
If the patient
a) Is on long term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes.
or
b) Regularly consumes ethanol in excess of recommended amounts.
or
c) Is likely to be glutathione deplete e.g eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.
Symptoms
Symptoms of paracetamol overdosage in 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 poisoning, 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.
Management
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-acetylcystine 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 declines 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.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Paracetamol is a peripherally acting analgesic with antipyretic activity.
5.2 Pharmacokinetic Properties
Paracetamol is readily absorbed from the gastrointestinal tract with peak plasma concentrations occurring about 30 minutes to 2 hours after ingestion. Paracetamol is metabolised in the liver and excreted in the urine mainly as the glucuronide and sulphate conjugates, with about 10% as glutathione conjugates. Less than 5% is excreted as unchanged paracetamol. Plasma protein binding is negligible at usual therapeutic concentrations, although this is dose dependent. The plasma elimination half life varies from about one to four hours.
5.3 Preclinical Safety Data
There are no preclinical data of relevance to the prescriber which are additional to that already included.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Sorbitol solution
Glycerol
Dispersible cellulose
(containing microcrystalline cellulose and sodium carboxymethylcellulose)
Hydroxyethylcellulose
Acesulfame potassium
Methyl hydroxybenzoate
Strawberry flavour (containing Benzyl alcohol, Ethyl benzoate, Propylene glycol)
Purified water
6.2 Incompatibilities
Not applicable
6.3 Shelf Life
24 months
6.4 Special Precautions For Storage
Do not store above 25°C.
6.5 Nature And Contents Of Container
120ml, 130ml, 140ml, 150ml, 200ml, 240ml, 250ml 300ml amber PET bottle with polypropylene child resistant closure with expanded polyethylene liner.
Not all pack sizes may be marketed.
6.6 Special Precautions For Disposal And Other Handling
Not applicable.
7. Marketing Authorisation Holder
The Boots Company PLC
1 Thane Road West
Nottingham NG2 3AA
8. Marketing Authorisation Number(S)
PL 0014/0617
9. Date Of First Authorisation/Renewal Of The Authorisation
27 November 2000
10. Date Of Revision Of The Text
September 2006
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