Intravenous Acetaminophen

Aka: Intravenous Acetaminophen, IV Acetaminophen, Ofirmev

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II. 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

III. 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

IV. Efficacy

  1. Decreases postoperative Morphine usage in studies
  2. When combined with NSAID, increases Analgesic effect over NSAID alone

V. Indications

  1. Patients unable to take oral or rectal Acetaminophen for fever, mild pain or adjunctive combined with NSAIDs and Opioids

VI. Contraindications

  1. Severe liver Impairment or progressive liver disease
  2. Acetaminophen Hypersensitivity

VII. 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

VIII. Adverse Effects

  1. Side effects (e.g. Nausea, Vomiting, Headache, Insomnia) are similar to rates of Placebo adverse effects

IX. References

  1. Rigdon and Lovecchio (2017) Crit Dec Emerg Med 31(1): 24

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