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2015 ; 7
(2
): 121-32
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Paracetamol: a review with specific focus on the haemodynamic effects of
intravenous administration
#MMPMID26157738
Chiam E
; Weinberg L
; Bellomo R
Heart Lung Vessel
2015[]; 7
(2
): 121-32
PMID26157738
show ga
Paracetamol is one of the most commonly used drugs worldwide with
non-prescription sales exceeding 25 thousand million doses per year in the United
States of America. The haemodynamic effects of the intravenous paracetamol
formulations are largely understudied. There is an emerging body of evidence
suggesting that intravenous paracetamol may cause iatrogenic hypotension. Little
is known as to the mechanisms of this phenomenon or if intravenous paracetamol
indeed does cause hypotension. As paracetamol has negligible solubility in
aqueous solutions, many of the commercially available intravenous formulations
contain mannitol (up to 3.91 g/100 mL paracetamol) as a stabilising ingredient.
It is unknown if mannitol is a contributing factor in the observed hypotension.
In this review, we outline the development of paracetamol's current intravenous
formulations, describe the composition of these formulations, and overview the
literature pertaining to the proposed phenomenon of paracetamol-induced altered
hypotension. Understanding the pharmacokinetic and pharmacodymanic properties of
intravenous paracetamol may have important clinical implications for vulnerable
patients in subgroups where haemodynamic stability is at risk such as those
undergoing elective and emergency surgery.