Analgesic

Intravenous Acetaminophen

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Intravenous Acetaminophen, IV Acetaminophen, Ofirmev

  • See Also
  1. Acetaminophen
  • Pharmacokinetics
  1. Onset: 5-10 min
    1. Contrast with onset of oral or rectal formulation at 10 to 60 min
  2. Peak Concentration Time: 15 min
  • Background
  1. Released for use in U.S. in 2011
  2. Cost of IV dose at $30, compared with $0.01 for an oral dose has dissuaded use
  3. Generic preparations expected in 2022 and may result in increased usage
  • Efficacy
  1. Decreases postoperative Morphine usage in studies
  2. When combined with NSAID, increases Analgesic effect over NSAID alone
  • Indications
  1. Patients unable to take oral or rectal Acetaminophen for fever, mild pain or adjunctive combined with NSAIDs and Opioids
  • Contraindications
  1. Severe liver Impairment or progressive liver disease
  2. Acetaminophen Hypersensitivity
  • Dosing
  1. Adults (weight >50 kg)
    1. Dose: 650 mg IV every 4 hours or 1000 mg IV every 6 hours
    2. Maximum single dose: 1000 mg
    3. Daily cummulative maximum: 4000 mg
  2. Children (age > 2 years, and weight <50 kg)
    1. Dose: 15 mg/kg IV every 6 hours OR 12.5 mg/kg IV every 4 hours
    2. Maximum single dose: 15 mg/kg
    3. Daily cummulative maximum: 4000 mg
  3. Reduced dosing indications
    1. Hepatic insufficiency
    2. Chronic Alcoholism
    3. Malnutrition
    4. Dehydration
  • Adverse Effects
  1. Side effects (e.g. Nausea, Vomiting, Headache, Insomnia) are similar to rates of Placebo adverse effects
  • References
  1. Rigdon and Lovecchio (2017) Crit Dec Emerg Med 31(1): 24