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Title: Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight.
Austin Authors: Reid, Olivia;Ngo, Janet;Lalic, Samanta;Su, Elizabeth;Elliott, Rohan A 
Affiliation: Victorian Poisons Information Centre
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
Pharmacy Department, Monash Health, Victoria, Australia
Issue Date: 10-May-2022
Date: 2022
Publication information: British Journal of Clinical Pharmacology 2022; 88(10): 4565-4572
Abstract: To describe paracetamol dosing and liver function test (LFT) monitoring in older hospital inpatients who are frail or have low body weight. Retrospective observational study, at a 790-bed metropolitan public health service in Australia. Patients aged ≥70 years, with body weight <50 kg or frailty index based on laboratory data (FI-Lab) score ≥0.3, who were administered paracetamol during an admission with length-of-stay >72 hours, were included. Data were extracted from electronic medical records. Paracetamol doses administered in hospital, and doses prescribed on discharge, were compared against consensus guidelines that recommended ≤60 mg/kg/d for older people weighing <50 kg, and ≤3000 mg/d for frail older people. In total, 240 admissions (n = 229 patients, mean age 84.7 years) were analysed. During 150 (62.5%) admissions, higher than recommended paracetamol doses were prescribed. On 138 (57.5%) occasions, patients were prescribed paracetamol on discharge, and 112/138 (81.2%) doses were higher than recommended. Most discharge prescriptions (97/138, 70.3%) were for regular administration. The median daily dose on discharge for patients <50 kg was 83.7 mg/kg (interquartile range 73.6-90.9 mg/kg). For frail patients ≥50 kg, the median daily discharge dose was 3990 mg (interquartile range 3000-4000 mg). LFTs were measured in hospital for 151/200 (75.5%) and 93/166 (56.0%) patients who received paracetamol for >48 hours and >5 days, respectively. Majority of paracetamol doses prescribed for frail or low-weight older patients in hospital and on discharge were higher than recommended in consensus guidelines. LFTs were not measured for 44% patients who received paracetamol regularly for >5 days. Further studies are needed to explore long-term outcomes of this practice.
DOI: 10.1111/bcp.15394
ORCID: 0000-0002-7750-9724
Journal: British Journal of Clinical Pharmacology
PubMed URL: 35535712
PubMed URL:
Type: Journal Article
Subjects: acetaminophen (paracetamol)
frail elderly
Appears in Collections:Journal articles

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