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Drug

Effect of interaction

Busulfan

Paracetamol possibly inhibits metabolism of intravenous busulfan

Colestyramine

Absorption of paracetamol reduced by colestyramine

Coumarins

Prolonged regular use of paracetamol possibly enhances anticoagulant effects of coumarins

Metoclopramide

Rate of absorption of paracetamol increased by metoclopramide

Monitoring – none needed

Dose

By mouth, 0.5–1 g every 4–6 hours to a max. of 4 g daily; child 2 months 60 mg for post-immunisation pyrexia; otherwise under 3 months (on doctor's advice only), 10 mg/kg (5 mg/kg if jaundiced); 3 months–1 year 60–120 mg, 1–5 years 120–250 mg, 6–12 years 250–500 mg; these doses may be repeated every 4–6 hours when necessary (max. of 4 doses in 24 hours)

By intravenous infusion over 15 minutes, adult and child over 50 kg, 1 g every 4–6 hours; max. 4 g daily; adult and child 10–50 kg, 15 mg/kg every 4–6 hours; max. 60 mg/kg daily

By rectum (see individual preparations)

Ibuprofen by Vicky Smith

Class: NSAID

Indications:

Pain and inflammation in rheumatic disease (including juvenile arthritis) and other musculoskeletal disorders

mild to moderate pain including:

o

dysmenorrhoea

o

postoperative analgesia

o

migraine

fever and pain in children, post-immunisation pyrexia

Mode of operation:

Ibuprofen is a non-steroidal anti-inflammatory drug, a propionic acide derivative.  It blocks synthesis of thromboxane A2 in platelets from arachidonic acid by binding to and inhibiting Cyclooxygenase enzymes (it is an unselective Cox inhibitor). Inhibiting Tx A2 means that it has a mild anti-inflammatory, anti-pyrexial and analgesic effects, but it’s properties are weaker than other NSAIDS. Unlike aspirin (which has irreversible action on the cox enzyme), it has competitive inhibition.

Side effects:

Gastrointestinal discomfort

Nausea

Diarrhoea

Bleeding

Ulceration

Hypersensitivity reactions

4

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