7th January 2024

Paracetamol

This is a non-opioid analgesic available over the counter in the UK and traditionally used as step 1 of the analgesic ladder. The recommended dose is 1g four times a day, but this is reduced to 500mg in patients with a weight of <50kg, poor nutritional status, or hepatic impairment. It mainly acts within the CNS and has some weak impact on prostaglandin synthesis. Combining Paracetamol and NSAIDs has been shown to improve analgesia. This suggests differing modes of action; hence, Paracetamol is not considered an NSAID.

Paracetamol, in combination with opioids, has been shown to improve overall pain control and reduce opioid requirements (opioid-sparing). It is, therefore, appropriate to continue Paracetamol alongside strong opioids even at step 3 of the WHO analgesic ladder.