Paracetamol doses!

[pharma-man]

Hi, I'm a recently qualified pharmacist.

I have a question about paracetamol doses for children. The following is from bnf children:

Child 1–3 months

30–60 mg every 8 hours as necessary
Child 3–12 months

60–120 mg every 4–6 hours (max. 4 doses in 24 hours)
Child 1–6 years

120–250 mg every 4–6 hours (max. 4 doses in 24 hours)
Child 6–12 years

250–500 mg every 4–6 hours (max. 4 doses in 24 hours)
Child 12–18 years

500 mg every 4–6 hours

I had a prescription for a 1 month old for 120mg/5ml paracetamol 2.5ml tds

I changed dosing to 1.25ml tds

Also had prescription for 4yrs old child for 250mg/5ml paracetamol 5ml qds

My question is... is there a cut off point where you would give the upper end of the dose. e.g. I thought the 60mg tds was a bit high for a 1month old but then again I did not know the weight of the child.

Is it better not to change dose instructions as long as the dose is within range?

[Web Ferret]

Your 2011/2012 BNFc is out of date.

Here is a 36 page document issued last month which will answer all the above.

http://www.mhra.gov.uk/home/groups/c.../con134921.pdf

I assume that you spoke to the doctor before changing their dosage? Or did you assume the the DOB on the script and the BNFc was correct or perhaps you weighed the baby and did LFTs and then re-calculated the dose? Did either of these children have terminal cancer and so the clinician upped the dose to provide analgesia as any hepatic damage wasn't going to matter in the final weeks of their short life?

Paediatric dosages are better calculated on body weight than age. ALWAYS check with the prescriber there maybe a LOT that you don't know. There may also be a lot that the prescriber doesn't know too.

[Fleegle]

Pharma-man..technically Web Ferret is correct.

Web-Ferret..We were all newly-qualified once. is your answer the one you would have wanted to hear if you had asked this question?

[Web Ferret]

Pharma-man..technically Web Ferret is correct.

Web-Ferret..We were all newly-qualified once. is your answer the one you would have wanted to hear if you had asked this question?

Yes
Things you don't know you don't know.

[pharma-man]

Thanks web ferret for the info and for that document. It is better than current children's bnf on licensed doses. In hindsight, since under 2 months is unlicensed use, I should have checked with the prescriber first before making the change. Lesson learned. I did discuss paracetamol doses with my tutor during pre-reg, he said he did change doses without contacting the gp, but i think we were discussing licensed doses at the time. For example, I had a prescription for child 2 years 0months prescribed 250mg/5ml paracetamol. The dose on the script just said four times a day. I dispensed 2.5ml four times a day without checking with gp. Was I correct in doing this or do you think I should have checked with the gp in this case also?

[Web Ferret]

A VERY high percentage of prescriptions are entered onto the computer by untrained admin staff. Its routine at most surgeries for even new drugs to be entered by non-clinicians from the letters sent by secondary care. Drs don't always read scripts when they are signed. So yes check with the GP as this may alert them to a procedural issue at the surgery. 250mg QDS is quite an overdose for a 2 year old. I'd be minded to send in an anonymous NPSA report too.

I know of one surgery that was trying to implement the following:
When the admin staff repeat a CD or cytotoxic script the admin staff put a sticker on the script to alert the doctor to check it carefully when signing. No sticker = no through check.

[pharma-man]

Thanks for the words of wisdom