1Paracetamol Dosing in India (15 mg/kg)
The Indian Academy of Pediatrics (IAP) and global guidelines recommend an antipyretic and analgesic dose of 15 mg per kg body weight per administration. This may be administered every 4 to 6 hours as required for fever or pain.
• Standard Single Dose: 15 mg/kg (Range: 10–15 mg/kg)
• Minimum Dose Interval: Every 4 to 6 hours
• Absolute Maximum Doses: 4 administrations per 24-hour period
• Maximum Pediatric Daily Total: 75 mg/kg/day (or 4000 mg/day, whichever is lower)
• Maximum Adult Single Dose: 1000 mg (1 g); Adult Daily Cap: 4000 mg (4 g)
2Common Paracetamol Brands & Formulations in India
| Brand Name | Formulation Type | Strength & Concentration | Target Patient Group |
|---|---|---|---|
| Calpol / Dolo / Crocin Drops | Infant Oral Drops | 100 mg / 1 mL | Young infants <1 year (calibrated dropper) |
| Calpol 120 / Dolo 120 / Metacin | Pediatric Suspension | 125 mg / 5 mL (25 mg/mL) | Toddlers and young children (1–4 years) |
| Calpol 250 / Dolo 250 / P-250 | Forte Suspension | 250 mg / 5 mL (50 mg/mL) | Older children (5–12 years; avoids large liquid volumes) |
| Crocin 500 / Calpol 500 | Oral Tablet | 500 mg per tablet | Adolescents (>35–40 kg) and adults |
| Dolo 650 / Calpol 650 | Oral Tablet | 650 mg per tablet | Adults and older adolescents (>45–50 kg) only |
3Preventing Overdose & Hepatotoxicity
Paracetamol is metabolized in the liver via glucuronidation and sulfation. A small fraction is metabolized by cytochrome P450 (CYP2E1) into the hepatotoxic electrophile N-acetyl-p-benzoquinone imine (NAPQI), which is rapidly detoxified by glutathione. When excessive doses are ingested, glutathione stores become exhausted, allowing free NAPQI to bind hepatic centrilobular hepatocytes and trigger acute liver necrosis.
Critical Nursing & Parental Precautions:
• Always verify concentration: Accidentally giving Calpol 250mg/5ml using the volume calculated for Calpol 125mg/5ml doubles the dose, precipitating severe toxicity.
• Avoid combination cold remedies: Do not co-administer with cold syrups (e.g. Febrex Plus, Sinarest, Maxtra) which frequently contain paracetamol as a hidden ingredient.
• Do not alternate routinely: Alternating paracetamol and ibuprofen creates dosing confusion and increases parental medication error rates.
• Always verify concentration: Accidentally giving Calpol 250mg/5ml using the volume calculated for Calpol 125mg/5ml doubles the dose, precipitating severe toxicity.
• Avoid combination cold remedies: Do not co-administer with cold syrups (e.g. Febrex Plus, Sinarest, Maxtra) which frequently contain paracetamol as a hidden ingredient.
• Do not alternate routinely: Alternating paracetamol and ibuprofen creates dosing confusion and increases parental medication error rates.
4Frequently Asked Questions
Can paracetamol be given every 4 hours?+
Yes. Paracetamol may be administered every 4 to 6 hours for breakthrough fever. However, you must never exceed 4 doses in any 24-hour period. If doses are spaced 4 hours apart, a mandatory prolonged gap must follow before the next daily cycle begins.
Is Dolo 650 safe for children?+
No. Dolo 650mg tablets are formulated specifically for adults and older adolescents weighing at least 45 to 50 kg. Administering whole or crushed 650 mg tablets to a young child causes dangerous acute overdosing. Use pediatric suspensions with a measuring syringe.
What is the treatment for paracetamol overdose?+
The specific antidote is N-acetylcysteine (NAC), which restores hepatic glutathione stores and scavenges toxic NAPQI. If an overdose is suspected or a child ingests >150 mg/kg, seek immediate hospital emergency care. Treatment within 8 hours of ingestion offers complete protection against liver failure.
Clinical Summary: Standardize dosing at 15 mg/kg. Double-check syrup strength (125mg/5mL vs 250mg/5mL) before measuring volume. Never exceed 4 doses in 24 hours.
Medical Disclaimer: This dosing calculator provides clinical decision-support estimates. Always confirm dosages with a licensed physician or pharmacist. Keep all medicinal syrups and tablets securely stored out of reach of children.